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30 March 2011: speech to the Voice 11 social enterprise conference

  • Last modified date:
    1 April 2011

Together, with social enterprises inside the NHS, and working with the NHS, we can do something extraordinary in the years ahead.

We can create, for the people in this country, the assurance that – whatever their means, whatever their needs – they will have access to one of the finest healthcare systems anywhere in the world.

And the assurance that we can deliver for our country some of the best health, anywhere in the world.

But if we’re going to do that, we need to empower people, we need to empower patients, we need to empower care users, we need to empower those who care for them.

In doing this, I want social enterprise and employee ownership models to be a leading feature in health and social care provision.

Principles of reform

Healthcare, when all’s said and done, is about people.

It’s about caring for people. And it’s caring about them.

As David Cameron put it, the NHS isn’t a machine, it’s a living and breathing organisation.

It draws its strength from the strong human relationships and interactions that exist within it and across it.

People depend on the NHS, just as the NHS depends upon people.

And so when we talk about the Big Society …

When we talk about pluralism, or patient-centred care, or any of the language that goes with this debate …

We’re actually talking about something very straightforward: strengthening human bonds, the relationships, and the vital connections which individuals and the service rely upon.

And for the health system, I think that means doing three things in particular – three things that are central to our plans.

First, to give people more choice over how and where they’re treated; give them more information to inform that choice.

Let me be clear: a process of shared decision-making, between patients and care users, and those who care for them.

What Tuckett described as ‘the meeting of experts’.

In the health service we have experts who understand diagnosis and treatment, and patients are experts about themselves.

So let’s bring those experts together.

Let’s make sure that for everybody looked after by the NHS, the principle of ‘no decision about me, without me’ is a reality.

Second, we have to empower communities so that local people have a greater say in how their health services operate for them.

We’re doing this through the new HealthWatch organisations, the shift in commissioning to General Practice-led consortia and the increased role of local authorities.

And third, we need to return power to the frontline professionals on a grand scale.

Giving people control.

Giving them permission to innovate and improve on behalf of the patients they serve.

Focusing on outcomes, focusing on quality.

And this is where social enterprise and employee ownership models come into their own.

Because as good as the NHS is, I think it can be better.

We have improved; we know we can improve further.

To do that, we should look critically and openly at what we can do better, and at who can bring new ideas and new ways of working to the NHS and to healthcare.

We have to compare results.

We have to reduce the variation – variation that exposes poor performance and lack of productivity. 

And we have to foster the enterprise and innovation which is the hallmark of all successful organisations.

Frankly, I don’t think it’s about public sector versus private sector vs voluntary sector.

It’s about the characteristics of successful organisations.

And I’ve seen some those characteristics in social enterprises.

Take for example when I was in Tower Hamlets with WhizzKids, a voluntary sector organisation applying themselves in order to give great services, focussing on the people you’re serving.

They designed what they did around the needs of young wheelchair users.

And it wasn’t just that the wheelchair users got the service they need, when they needed it, but it cost 60% less than it had done under the previous arrangements.

And for every pound spent on Whizzkidz services, you get up to £65 back in social value – because of the social, environmental and economic benefits of good wheelchair access for young people.

There is very clear evidence of how the business model, the social enterprise model that you represent, really does deliver.

Before the election, I helped to launch a study into the economic and business impacts of a social enterprise model, on behalf of the Employee Ownership Association together with John Lewis Partnership and Circle Health Partners.

It demonstrated very clearly that where you have employee ownership and strong employee participation together, you get better results. More initiative and innovation. Better retention and morale. Higher standards and a strong commitment to excellence.

And it’s that commitment to excellence which I believe must be at the heart of our NHS. Over those several years, I visited hundreds of hospitals and clinics over the last seven years.

I talked to thousands of NHS staff.

One message above all others came home to me.

It was people saying:

“Look, we could do our jobs much better if you gave us room to breathe …

If there was less bureaucracy and political micro management…

If we felt our voice was heard …

If we didn’t have to jump through so many hoops to make good ideas happen…

If only they would listen to us, we would do it much better.”

Well, of course, the ‘they’ is now me. And I do intend to listen.

And the first message I’ve heard is that people want to take greater ownership of the service they deliver, because they really feel they can deliver better for the patients and the care users they look after.

So I want to give doctors, nurses and other health professionals the autonomy and discretion that their expertise and training deserves.

I want to end the arrogance that suggests that the men and women from Whitehall – and still less we politicians – know better than professionals living and breathing the realities of healthcare day-to-day.

The value of social enterprise

So if micromanagement has been a malady in the NHS, then social enterprise models can be a cure.


Well, as someone put it me, being part of a social enterprise means you respond with “how I can” rather than “why I can’t”.

Social enterprise is liberating. It’s inspiring. It projects a ‘can-do’ ethos which we need in a modern health service, and in modern public services.

But, above all, it really delivers for people.

It delivers because those most in tune, most directly in contact with a person’s needs, are put directly in charge of the services that meet them.

It gives them the capacity to do things the traditional NHS simply couldn’t comprehend.

And that is a change we’re seeing around the country.

If you drive up the M1 to Leicester, you can visit Inclusion Healthcare service in the city.

Not only does it operate as a successful GP-led drop-in centre for homeless people.

It also works with other local agencies to run numeracy and literacy skills and computer training sessions for its clients.

It’s doing more than returning people to health, it’s helping them return to employment too.

Or head up the M6 and visit the brilliantly named Social AdVentures in Salford.

Go and see its ‘Change4Life on Prescription’ programme, which works with community gardening centres to help people with depression and anxiety to spend time in the fresh air, honing their gardening skills.

Or for a social enterprise on a grander scale, go across the Pennines to the City Health Care Partnership in Hull.

There, more than a thousand front line health professionals have worked at arms length from the PCT since 2008.

As well as giving staff a greater sense of belonging and control, it’s allowing the organisation to offer a small grants scheme for local voluntary and community groups.

And so the health improvement work it supports isn’t formulaic, isn’t straight-off-the-shelf.

It’s targeted and personalised at a neighbourhood level.

It’s support for local people, designed and delivered by local people.

And that makes all the difference.

Right to request

There are many more out there, doing similar things.

All of them flourishing through the Right to Request programme, which has accelerated over recent months.

As I’ve been able to announce since the election, more than 50 organisations inside the NHS are breaking away from PCT control and reinventing themselves as social enterprises.

To give you a sense of scale, it means a tenth of the entire NHS budget for community services will be delivered by social enterprise in the years ahead. That’s nearly 25,000 staff.

Right to provide

However, the original Right To Request programme had a narrow base.

It only covered community services, which is only one side of the coin as far as health services are concerned.

We now want to broaden this out. To offer the same opportunities for the rest of the health and social care sector.

Today, I’m publishing a new guide on the “Right to Provide” programme, the sister scheme for Right to Request.

It formalises our commitment to allow any group of people within the NHS to set up as independent, employee-led organisations, and it opens up potential on a much greater scale.

We want to attract the people who know things can be done better, and who have the skills and expertise to make it happen.

One example would be a group of professionals involved in diabetes care, who might want to come together to deliver a multidisciplinary service within one organisation.

It's the opportunity to break down the professional silos, and the organisational silos, and redesign organisation and delivery around the needs of patients.

Financial support

So we do want to sow the seeds of social enterprise more widely.

But as any gardener will say, the best blooms only come when you nurture and nourish the seedlings.

We need make sure any new organisations get the best possible start, and that the environment is conducive to future growth.

That’s why I’m pleased to say we will be putting at least £10m this year into the Social Enterprise Investment Fund.

The Fund has helped more than 400 organisations to date, giving them the springboard to self-sufficiency.

We’re making the funding available to help many more get themselves up and running over the next 12 months.

Any qualified provider

We’re also going further in allowing social enterprises to gain a strong foothold in the NHS.

In recent years, there’s been a tendency for the NHS to be a secret garden, where ideas don’t come out and new providers don’t come in.

We need to make sure that we use all of the enterprise, innovation and expertise that we can, to deliver the best possible care for patients. I don’t want to see social enterprise and voluntary groups left out in the cold.

We will not give preference to incumbent NHS providers.

Where competition has existed in the past, it’s been lost in a kafka-esque world of bureaucracy that people have to journey through.

So I want to change this – to simplify, to streamline, to throw open the doors to any organisation that can improve quality and effectiveness in the health service.

Now, in the past we’ve talked about “any willing provider”. What we’re saying now is “any qualified provider” can do so.

It’s a subtle change, but it’s more than just semantics.

The terminology reflects our commitment to put quality at the heart of choice.

“Any qualified provider” means an end to the complicated and costly tendering processes that blocked many from providing services.

In their place, most organisations will undergo a simple, once-only qualification process for providing health services.

Once you’re qualified, once you’re on the list, the power is where it should be.

Not with administrators or managers running tendering process or trying to allocate patients to organisations.

But with patients and their GPs, or their referring physician, choosing the best service for them – and doing so always on the basis of quality, and never on the basis of price. Price will have been established through national and local tariff arrangements. So at the point of referral, the issue is only one of quality.

It’s a simpler, fairer, more open way of working.

I expect people won’t understand change.

They always scaremonger and mutter darkly about backdoor privatisation, or the break-up of the NHS as we know it.

It is not that.

The NHS will continue to be absolutely based on its founding principles, of a comprehensive service available to all based on their needs.

It will be not more fragmented than in the past, but less fragmented.

Less fragmented because it will be designed increasingly around the needs of patients, bringing more opportunities for integrating services.

And in that context, NHS providers have the chance to succeed, because we will give them the opportunity to be more enterprising and more innovating.

I think that inside the NHS we have an immense number of people and organisations potentially that themselves can embrace the social enterprise model.

And I don’t think we’ll see radical changes in the shape of provision, but I do hope we will see really positive change in the relationship between people and the service that is provided to them.

Public services should constantly be open to the test: are they delivering the best quality care.

What we want is quite simple. A fair playing field for all providers to compete – always on quality, not on price – to make the NHS the very best it can be.

And if you want my personal hunch, it’s not private businesses that stand to benefit most from this. It’s actually the voluntary sector and social enterprises with pre-existing relationships with patients and communities.

They’re the ones who will have the greatest potential in these arrangements– and ultimately the greatest potential for patients.


So let me conclude with a final thought.

People love to pour scorn on the Big Society, to be cynical about it and say it’s a sound bite. They say it lacks definition.

We’ve always known – David has always known – that we didn’t invent the big society in May last year, we’ve embraced the Big Society. It has existed. It does exist.

The point is to give people greater opportunity in the future.

What we’re doing in the health service really demonstrates that. We’re showing tangible commitment by this Government to improve public services by embracing new providers.

We see social enterprise and employee led models from outside the NHS and from within the NHS, alongside charities and voluntary groups as the key players.

Vital for shaping the future.

Vital for securing better outcomes.

Vital for strengthening NHS values, never to undermine them.

We know these organisations can work. Social enterprise is an obvious business model for a social market.

We know they can deliver – for patients and staff alike.

With your help, I think we can make social enterprises a mainstay of health and social care in the years ahead.

Tremendous possibilities lie ahead. Exciting times. And challenges, many challenges.

But I believe that together we can overcome those challenges and realise those ambitions.

The best possible health service, the best possible care, for the people whom we all look after.

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