Branch Secretary's speech to North Somerset Council's Health Overview and Scrutiny Panel against Proposal for NHS North Somerset Community Services to become a Social Enterprise

Below is my speech to North Somerset Council regarding a report on NHS North Somerset Community Services becoming a Social Enterprise. Councillors were asked to consider whether it constitutes a substantial change to healthcare provision. Councillors requested more information on monitoring and as a result the minutes should read along the lines of that as the report stood at the moment it did not constitute a substantial change. Anyway here's my speech:

Thanks for letting me speak. You might be surprised that I asked to address you today, but North Somerset UNISON not only represents council workers but also has members in the PCT and Weston Area Health Trust.

The government is pushing the health service toward a market-style system where a range of health providers will compete with each other for business. UNISON has serious concerns that the increase in social enterprises will lead to increased fragmentation of the NHS and to a situation where smaller organisations are taken over by profit-driven private companies, leading to a poorer service for patients.

Department of Health guidance states that:

“In developing the vision, values and mission for a social enterprise, it is important to involve staff, service users and other stakeholders. This should also involve the unions that represent staff and the Local Involvement Networks. Their buy in to this process and support will be key to success. Proposals for Social Enterprises will therefore need to test the extent to which staff involved in the social enterprise are supportive of the proposals going forward.”

It is interesting that the document you will be considering talks about a “staff led” social enterprise. It is my understanding that this is management led, and that staff themselves would prefer to remain working for the NHS. Although management were initially resistant to UNISON requests for all staff to be balloted on creating a Social Enterprise, a survey has now or is about to be sent out and it will be interesting to see the results.

You are being asked to consider whether the proposal constitutes a substantial variation or development, that is - does it constitute a proposed major change in healthcare provision? We think the question should actually be does this constitute an improvement in healthcare provision for North Somerset? Particularly given the fact that North Somerset has the widest social inequalities gap in the South West, and the 10^th widest in England – gaps in health inequalities and life expectancy being linked to this.

We would argue that the neutral impacts listed for patients, carers, health inequalities and the local health community are not a good enough reason for it to become a Social Enterprise. In fact, in our view, in order for there to be good case for the move to Social Enterprise there should be a clear demonstration of the improvements that will be achieved.

The report argues there will be no services changes as a result of the move to Social Enterprise, but provides you with no evidence for this. The report goes on to set out the benefits of moving to a Social Enterprise – we would question whether (with one exception) these benefits are any different from the current service or from Community Services staying within the NHS.

The one benefit that seems to be different is the ability to bid for external funding to enable them to develop in other areas such as Home Care, services historically provided by Social Care, services currently provided by the Acute Trust, Out of hours services, and Services in other Geographical areas. But will a local social enterprise be strong enough to compete with other private sector organisations bidding for these contracts?

It is being argued in the report that the creation of a Social Enterprise does not constitute a major change, but in our opinion it begins the dismantling of the National Health Service, opening the health service up to the market, where after the initial 4 year contract award to the Social Enterprise, massive global healthcare providers will be bidding for contracts in North Somerset – a local Social Enterprise simply won’t be able to compete with them.

There remain unanswered questions about what happens when a social enterprise fails financially in mid-contract or fails to have its contract renewed. In terms of the bigger picture, there is no guaranteed sustainability for new types of organisations, particularly during the recession. Indeed, a 2008 report by Global Entrepreneurship Monitor found that social enterprise companies are twice as likely to fail as conventional ones. This then also raises the lurking threat of takeover by other companies with no social ethos. I am therefore urging you to consider this proposal over the long term.

We also question the rationale for creating a Social Enterprise. It is unclear to us why the preferred option to merge with Weston Area Health Trust cannot be completed before 1^st April, and yet what is being described as a shadow organisation will be created on 1^st April, because there won’t be time for a Social Enterprise to be created by then either.

Finally, Councillors should ask to see the Integrated Business Plan, along with the risks and how these will be managed. Councillors should also ask if an equality impact assessment been completed on these proposals and if so what was the result. If not, when will this be completed? As councillors are aware from my correspondence with them, as a local authority they have a legal duty to consider the impact on the 6 different equalities groups.

Thank you