It’s probably an understatement to say that the Health and Social Care Act 2012 (the Act), finally passed in March this year, left a great many of the details about how state-funded health and social care in the UK will be scrutinized and delivered open to local interpretation.
An interesting early example of a local interpretation that some may find perplexing is the decision of Lancashire County Council to award the contract to run HealthWatch – the new body which will be responsible for representing and communicating the views of patients and other local people about health and social care services – in their area to a private company, Parkwood Healthcare.
Local HealthWatch organisations are the Act’s replacement for Local Involvement Networks (LINks). It’s perhaps not surprising that Though Cowards Flinch, a left-wing blog, is concerned that the service in Lancashire is being taken on by a private company but they rightly point out that this raises an interesting question about the government’s understanding of ‘social enterprise’.
They note that, according the Act, HealthWatch services should be contracted out to a corporate body that:
“(a) is a social enterprise, and
(b) satisfies such criteria as may be prescribed by regulations made by the Secretary of State“
And that, based on a late amendment passed in the House of Lords, the definition of a social enterprises is as follows:
“For the purposes of this section, a body is a social enterprise if—
(a) a person might reasonably consider that it acts for the benefit of the community in England, and
(b) it satisfies such criteria as may be prescribed by regulations made by the Secretary of State.”
There’s never any shortage of awards being dished out in the world of social enterprise but, as far as I know, there’s not yet one ‘woolliest definition of social enterprise by a public body’. If and when it’s launched, this definition should be enough to ensure that the Department of Health has an annual addition to its trophy cabinet for many years to come.
Unusually for anything connected to the Act, this is not a cock-up. Neither is it a conspiracy. In the absence of any evidence to the contrary, it’s health secretary, Andrew Lansley’s policy on social enterprise. When he pledged, in July 2010, at the beginning of his battle to reform the NHS, that he was going to create ‘the largest social enterprise sector in the world’, he wanted to create an open market in NHS funded services which would be likely to lead to the NHS contracting out lots more services to companies that delivered health care.
HealthWatch is considerably less prominent in the public and political consciousness than actual NHS-funded service delivery so – although there was lots of discussion of its role as the Act made it’s way through parliament – the question of who delivers it didn’t get subjected to the same level of scrutiny.
In the case of the Lancashire contract there’s several important points.
One is that the company that won the contract, Parkwood Healthcare, is not a social enterprise in any sense that the term is currently used in the UK. In terms of what ‘a person might reasonably consider’, I as a person consider that Parkwood, as a PLC, acts primarily for the benefit of its shareholders because it’s legally obliged to do so. The only thing it’s obliged to do for ‘the community’ is obey the law. On the other hand, another person might consider that the organisation – by virtue of the fact that it delivers public contracts – acts for the benefit of the community. If so, Parkwood is a social enterprise but then so is BAE Systems.
The second important point, though, is that Parkwood Healthcare clearly does have relevant experience in delivering the kind of work it’s been contracted to deliver. It already manages LINks – the predecessor to HealthWatch – in four local areas. Is there any reason why the fact that it’s a PLC means that it won’t do a good job of supporting the people of Lancashire to scrutinise health and social care services?
The LINks contracts were awarded under previous legislation and, as As Though Cowards Flinch suggests, there is a potentially interesting legal question about the actions of Lancashire Council in awarding this contract under the Act. Whether it’s a question that gets examined will depend on whether any local people or social enterprises are concerned enough to take it up.
Either way, this suggests that the social enterprise movement is entering a phase where the eternal debate about what a social enterprise is, is going to move from the theoretically fascinating (to some more than others) to the practical relevant. There are a range of possible responses:
(a) We demand that the government defines clearly and unambiguously – across all departments – what it believes a social enterprise is and isn’t.
(b) The social enterprise movement joins with trading charities and community groups to agreed a broad and widely recognised social trading charter that tens of thousands of socially enteprising organisations could and would sign up to.
(c) We forget about definition entirely and attempt to win contracts like the Lancashire HealthWatch contract against all comers purely on the basis of the goods or services we can provide – and the price we can provide them for.
I think (b) might be worth considering. We could try all of them at the same time.