OUTSOURCING
Boosting the number of social enterprises delivering public services is a key Coalition aim that will impact on health as much as any other sector – but the National Audit Offi ce’s David Clarke says the DH and PCTs must think more carefully about the risks involved.
U
nder the Right to Request pro- gramme, since 2008 NHS staff have
been able to apply to their PCT to deliver services through a social enterprise they set up themselves. Although sometimes mis- used, the term ‘social enterprise’ is gener- ally defi ned as a business with social goals, whose profi ts are reinvested back into its services, and which relies on business in- come rather than donations.
It has been a slow process, with only a handful having been launched fully under that programme (which itself is now evolv- ing), although the process does now seem to be accelerating. 47 bodies are set to be in existence by the end of September 2011, delivering £0.9bn of health services a year, ranging in size from a few individuals to big concerns with more than 1,000 employees. The National Audit Offi ce investigated the
52 | national health executive Jul/Aug 11
process and the results so far, in order to inform and make recommendations on the future direction of such service transfor- mation.
Realising the risks
The NAO report did not make particularly happy reading for the scheme’s develop- ers, emphasising the amount of risk that remains with the PCT and NHS when ‘out- sourcing’ in this way, the high dependence of the social enterprises themselves on a single source of income, and the muddled objectives of the programme for which the NAO says not enough evidence is given be- yond hopeful lists of potential benefi ts.
David Clarke, director of Civil Society and Commissioning Value for Money studies at the NAO, spoke to NHE about the re-
port, which drew a number of comparisons with the ways that local authorities have handled the process of spinning out social enterprises, especially in the leisure and culture sectors – a process that the NAO believes had clearer objectives than the NHS approach.
We asked whether the differing ways in which councils and PCTs have handled this issue are more a refl ection of those organi- sations’ own priorities, than the national policy framework in which they are forced to operate.
Clarke told us: “It’s a very interesting ques- tion. It’s clear that when local authorities were spinning out – and most of those spin-outs have been in the leisure sector – the imperative for them to spin out was quite often that, if they did not do so, there
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