Social Enterprise and Health Case Studies

Social Enterprise and Health Case Studies





The challenge for social enterprises is to demonstrate clearly the value they can bring in delivering effective and efficient public health services. This report seeks to showcase the activity of a range of social enterprises through 14 examples from Scotland and 5 from England. This work stems from recommendations that emanated from the ‘Fit for Purpose – Social Enterprise and Health’ Conference held in Glasgow in September 2007.


The intention is to help demonstrate the case for social enterprise to be acknowledged as an accepted vehicle for delivering good quality services to the health and social care sector in Scotland.  The social enterprises in question were selected on the strength of their perceived success after carrying out desk-based research, together with tacit knowledge gained via the Local Social Enterprise Networks. They represent a broad mix in terms of turnover, staff size, lifespan and development capacity. From this research, a number of common threads emerged:


a) Almost all the social enterprises involved have been dependent on the drive and commitment of a key individual or individuals. This element has proved vital in setting up and establishing the respective enterprises. The role of the ‘keyman’ is well documented in business circles. It also appears to be the case in social business circles.


b) Their motivation has often stemmed from a sense of injustice arising from seeing services delivered poorly for a particular client group, and feeling that they could do things better. There has been a strong sense that alternative methods will produce better outcomes for people using the services. This is backed up by a conviction that a personal investment in such a style or method or client group brings about tangible benefits. Also evident is a political rationale that ‘not for profit’ enterprises are able to encourage better employee retention and, therefore, quality and consistency of service.


c) A perception that local authorities are often unwilling to commission social enterprises, and ‘play safe’ by invoking the ‘best value = cheapest option’ approach.


d) Social enterprises are concerned that commissioners of services do not always take into account the merits of the wider social impact of their business. One example is the perception that by employing clients or service users, a service is often deemed less ‘professional’.


e) Approximately 30% of the case studies are actively involved in the contract and tendering processes with Public Sector commissioning bodies. Another 30% are significant ‘sellers of services/products’. The remaining percentage continue to rely on Service Level Agreements, frustrated that they cannot move beyond this to elicit contracts or are still needing to ‘prove their worth/value’.


It is clear that social enterprises are impacting amongst vulnerable, hard to reach, disenfranchised and under-served groups. Whether their worth and value is being fully recognised is difficult to gauge. There still appears to be a lack of understanding on both sides – in terms of what social enterprises can deliver, and what commissioners are looking for.


The contrast between the social enterprises in England and Scotland was evident in the level of contracts secured and the scale of the operations and, most importantly, in terms of measuring and articulating the benefits they bring. While all found it difficult to explicitly detail outcomes, often relying instead on ‘woollier’ language of self worth, confidence, combating loneliness, widening circle of friends, the English examples were, in the main, clearly more attuned to the notion of demonstrating their ‘added value’.  This is, perhaps, not surprising in light of the investment and support available through the NHS in England.


Regardless of their location, all the enterprises were able to demonstrate the positive impact that they had on the communities they serve, be that of interest or place. They are vital to the people who are using the service; there is no doubt that without them there would be a greater ‘draw’ on the public purse and on local communities. The challenge will be to help social enterprises to demonstrate their worth and value within the policy context of NHS Scotland’s health outcomes. Commissioners of services do not appear to be ‘in tune’ with social enterprises and vice versa. This is the barrier that has to be overcome.


Within the last couple of months, two reports – one in England and the other in Scotland – have reinforced the fact that the gap (between commissioners and social enterprises) still exists, but it is also clear that benefits can be derived and evidenced from a new approach.


The Cabinet Office and the Improvement and Development Agency (IDeA) published a report last month (February 2008) that suggested that while commissioners are beginning to recognise that social enterprises can offer added value in terms of innovation, local knowledge and engagement with service users – particularly in hard to reach communities – commissioning policies are still not reflecting this.


Their evidence found that 83% of commissioners acknowledged that the sector brings something unique to public sector delivery but, crucially, there was still a lack of trust about its ability to deliver. Their belief was that the sector still lacked the capacity and resources to manage service contracts.


Social enterprises themselves felt that they continued to be stereotyped as ‘amateurish’, and that the procurement process was cumbersome, over-bureaucratic and stacked against them.


In Scotland, however, the ‘Community Benefits in Procurement’ Report (Scottish Government, January 2008) highlighted the fact that social inclusion clauses in the letting of regeneration and housing contracts had delivered clear and measurable social benefits.


If it is accepted that social enterprises are good value in terms of innovation, local knowledge and engagement with service users, particularly in hard to reach communities, social benefit clauses – as referred to in the ‘Community Benefits’ Report – can put social enterprises at a distinct advantage not only in providing social benefits for commissioners of public sector contracts, but also in providing a credible local partner for other contractors.



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February 2008