Social enterprise in health care: Promoting organisational autonomy and staff engagement

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In the White Paper, Equity and Excellence: liberating the NHS, the government announced its ambition to establish the 'largest and most vibrant social enterprise sector in the world'.

Social enterprise in health care explores the organisational and leadership changes that will be needed to support the development of social enterprises and makes recommendations that will be of particular interest to policy-makers and health care providers.

Based on the responses of a small group of directors of social enterprises and chief executives of acute and mental health foundation trusts, Social enterprise in health care explores the motivations for becoming a social enterprise and whether their ambitions have been realised in practice.

In particular, Social enterprise in health care looks at the impact of social enterprises on the financial framework and on employees' attitudes. One of the aims of the health reforms was to give greater autonomy to providers, but there is considerable uncertainty about how such organisations would develop and function.

Interviews with the chief executives of foundation trusts showed they were receptive to the social enterprise model in principle but had concerns about the scale of change needed and about whether it would detract from the underlying intention – increasing staff engagement in decision-making.

A number of key conclusions are reached.

  • Most providers in our study were motivated by the desire to become more autonomous; however, others saw a move to social enterprise as an opportunity to protect themselves from seemingly less favourable re-structuring. NHS organisations with realistic and positive motives are more likely to prosper in this context.
  • Staff engagement is essential to the successful development of a social enterprise but new organisational structures on their own do not automatically generate greater staff engagement
  • Significant business expertise will be necessary in an increasingly competitive environment, and leaders of social enterprises will need support and training
  • The benefits of social enterprise will need to be seen as long term.
  • Social enterprises may be vulnerable to changes in the policy and commissioning environment; to further promote social enterprise, there will need to be political commitment to a support programme and a commissioning strategy to nurture the development of the model.

Social enterprises could play a significant role as providers of health care. The question is whether these new organisations and their leaders have the necessary competencies to manage the risks and establish themselves as viable organisations in this increasingly competitive context.

Find out more with Rachael Addicott's blog on social enterprise and health care