
THE new Coalition Government’s plans for a radical shake-up of the NHS pose real challenges for social enterprises, such as Sound Communication.
Health Secretary Andrew Lansley claims the Con/Dem changes are aimed at giving GPs more power and control over the funding of patient care.
His clear intention is to dismantle the health authorities and Primary Care Trusts which largely administer the £80 billion which the NHS spends.
In their place?
Lansley argues that GPs will fulfill the role of the thousands of managers and administrators who currently decide how money is spent.
GPs will get together in large consortia and decide for themselves what is in the public’s best interest.
So who will fill the gap in providing the services of professional managers and admin staff to make the changes work?
The thousands of newly redundant ‘bureaucrats’ who will be expected to suddenly develop entrepreneurial flair? Or a new wave of US-style management companies who see the chance to make a killing?
Lansley says: “”Our ambition is to create the largest and most vibrant social enterprise sector in the world.”
If we take Lansley at his word, the commissioning function will therefore be taken over by organisations for whom making fat profits for faceless shareholders is not the predominant motive.
But it’s not that simple.
The Guardian today glibly describes social enterprises as ‘private companies’ and examines their varying nature and structures.
It is true that most social enterprises seek to make a profit. It’s what they do with the profits that distinguishes them from run-of-the-mill firms.
Some social enterprises are independently-regulated Community Interest Companies, like Sound Communication, whose profits go back into the business or the community they serve.
Others have a less formal structure. With some of these, who may well have strong social or environmental purposes, its not at all clear what they do with any profits they make.
If Andrew Lansley gets his way, the bottom line seems to be that, one way or another, profit will be introduced into our National Health Service.
Of course, profit is already involved in the NHS – look at the drug companies, the outsourced services, the providers of equipment, the management consultants.
But Lansley is going one step further and embedding profit’ into the fundamental fabric of our health service.
And there’s the rub.
How all this eventually shakes down remains to be seen. Perhaps we can trust GPs to have the time and expertise to run an ethical rule over organisations bidding to help them manage health and care services?
Perhaps not.
For the moment, what is vital is that there is open-ness and transparency at every level about how the Coalition Government’s reforms are implemented.
And there must be full and genuine democratic control and accountability.
The NHS does not belong to Andrew Lansley, or the Con/Dem coalition, or GPs, or management consultants, or social enterprises.
It belongs to the public – the patients who depend on the NHS and pay for the service with their taxes and National Insurance.
And whatever new structures are imposed on an NHS already suffering from systemic change-fatigue, it is the quality of the services it provides to patients – and what happens to the public’s money – that really counts
