What’s driving the new marketplace in health & social care?

The presentations from ISE’s recent — and excellent — Healthy Social Enterprise Conference are now available to download on the ISE website.

The conference was technically a project dissemination event but the speakers and presentations went significantly beyond that and anyone looking to get an overview of how current policy in health and social care (such as ‘personalisation‘, the ‘right to request’ legislation for DoH employees wanting to explore the SE potential of specific services, and the DoH Social Enterprise Investment Fund — worth £100m and open to existing as well as new-start health & social care operating on a not-for-personal-profit basis) is shaping a new ‘social marketplace’ in the provision of these services will find the presentations extremely helpful.

Cllr Len Clarke (Birmingham City Council) gave a fascinating opening address to the conference that set out, with just a handful of key statistics, the factors that are making a re-examination of health and social care delivery models inevitable.

For example:

  • Fifty years ago there were 8 people working to every retired person. Now, there are only 4. In fifty years time there will be only 2.
  • Birmingham found that its thirty elderly homes cost 2.5 times more each to operate than independent sector homes.
  • In home care, Birmingham was spending 70% of its budget on 35% of its services — this inevitably led to a need for services to be rationed.
  • An ‘industrial model’ of 9-to-5 delivery is inflexible and has disproportionately high unit costs. Birmingham’s health and social care costs are increasing by almost 80% a year — and yet the DoH budget control figure offers an increase of only 0.7% a year…

Given this scenario, an examination of the potential for third sector, social enterprise and independent sector delivery was pretty inevitable.

But for those in the sector seeking (or advocating) innovation, new delivery models and greater social and community benefit, it is also salutary to understand the extent to which third sector commissioning is actually driven by the need for cost savings. This can only become more the case as the anticipated public spending cuts deepen.

In this climate, says Cllr Clarke, Birmingham City Council cannot just wait for providers to emerge — there must be a degree of ‘market shaping’.

BSSEC absolutely agrees with this view. For several years now we have been arguing that third sector commissioning must, if it is to be meaningful, go hand-in-hand with a planned and systematic expansion of the marketplace of providers.

This requires systems, structures and processes that enable joint planning — i.e. that bring together social enterprises, voluntary & community sector providers, and service commissioners in the context of a suitable operating framework.

To fail to do this will turn the clock back to the kind of unplanned laissez-faire provision that preceded the NHS.

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