Gloucestershire NHS is unwell

That’s their diagnosis in the ‘Review’ this week with a half page advertisement describing their community healthcare roles, along with a statement   claiming that changes across the NHS mean that they ‘cannot provide these services in the future’.

As someone running a local self-sustaining social enterprise,   I joined the protesters of Forest Against the Cuts in Coleford’s Main Place and went inside to met with the leaders of the proposed healthcare social enterprise.  I asked whether they intended to outsource healthcare and the respone was an emphatic no.  Asked if they supported other social enterprise, I was told they’d look favourably on other CICs for procurement .  That kind of selectivity worried me.

As we’ve learned in recent news, their plans to transfer services to a Community Interest Company were thwarted by a legal challenge.  As David Lock QC explains in his recent article , the £80 million annual contract was placed without a tendering process, in violation of EU regulations.

I run a social enterprise myself. It has nothing to do with health services although some of our customers are NHS trusts.  I’m on record for making the point that there’s a role in the supply chain which adds social value rather than displacing primary services.

In the past, we’ve responded with an ‘expression of interest’ to IT services procurement.  An experience with a far from satisfactory outcome, when I’d asked for their reason for exclusion.  It’s not surprising to learn that issues of transparency and accountability arise now.

One of the points David Lock makes is the top-down imposition of a CIC by management, also fails to meet the government guidelines set out in 2003 for  ’employee led’ organisations to be exempt from procurement rules, which is contradicted by our own experience.

As we’ve already learned here in the Forest of Dean, from the example of a ‘Pathfinder’ Social Enterprise Trust (SET), the Community Interest Company status, does not preclude dishonesty.  Had it not been for the mistake of tapping into council tax funds, we’d probably never have know how much public money had been spent on consultancy.

Looking closer,  at the consultant who gained, we find a connection with Atos Healthcare . Atos had been involved some years earlier in plans to outsource diagnostics at Lydney Hospital.

We discover that Gloucestershire MPs have benefited financially from the investors in Circle Healthcare where it’s alleged there are links to companies in the tax haven of the British Virgin Islands.  For those unfamiliar, this is where Eastern Europe’s gangsters have been known to conceal their financial interests , within so called bearer instruments.

The problem may lie in the Community Interest Company itself, which as Cooperative Futures in Gloucester point out to me, is merely a set of guidelines with no governing rules and only the oversight of a regulator to scrutinise fair play.

Rob Williamson, drawing attention to the assumption that CIC status will improve grant funding opportunities, says:

“The recipient of investment into business expansion for social returns might equally be a charity as a CIC, a community group as much as a co-operative. It is the activity that counts, not the organisational form. In short, social enterprise is a verb, not a noun.”

When one looks into the background of the CIC and its introduction in 2005,  we begin to see the roots of dishonesty. More rigorous examples of community re-investment were already in existence, ours and the cooperative Community Benefit Society for instance, which we saw as good match in our earlier local economic development proposals. An  experience of  ‘not invented here’ which put back the creation of social investment funding for almost a decade.

As David Floyd and others have observed recently,  a business which actually invests surplus revenue into the community is a rare beast indeed.  Most social enterprise is supported substantially by government funding, as our local SET fiasco illustrates.

A key point made in 2004, with our business plan  was that government should support business for sucial benefit:

Traditional capitalism is an insufficient economic model allowing monetary outcomes as the bottom line with little regard to social needs. Bottom line must be taken one step further by at least some companies, past profit, to people. How profits are used is equally as important as creation of profits. Where profits can be brought to bear by willing individuals and companies to social benefit, so much the better. Moreover, this activity must be recognized and supported at government policy level as a badly needed, essential, and entirely legitimate enterprise activity.”

In 2007 we’d said:

“An inherent assumption about capitalism is that profit is defined only in terms of monetary gain. This assumption is virtually unquestioned in most of the world. However, it is not a valid assumption. Business enterprise, capitalism, must be measured in terms of monetary profit. That rule is not arguable. A business enterprise must make monetary profit, or it will merely cease to exist. That is an absolute requirement. But it does not follow that this must necessarily be the final bottom line and the sole aim of the enterprise. How this profit is used is another question. It is commonly assumed that profit will enrich enterprise owners and investors, which in turn gives them incentive to participate financially in the enterprise to start with. 

That, however, is not the only possible outcome for use of profits. Profits can be directly applied to help resolve a broad range of social problems: poverty relief, improving childcare, seeding scientific research for nationwide economic advancement, improving communications infrastructure and accessibility, for examples – the target objectives of this particular project plan. The same financial discipline required of any conventional for-profit business can be applied to projects with the primary aim of improving socioeconomic conditions. Profitability provides money needed to be self-sustaining for the purpose of achieving social and economic objectives such as benefit of a nation’s poorest, neediest people. In which case, the enterprise is a social enterprise.”

In 2008, asking ‘What is Social Enterprise, founder Terry Hallnan asked:

“Is an enterprise social if it produces some sort of social benefit? If so, in that sense, many or indeed most traditional businesses for profit can be considered social enterprises.”

Then going on to say:

“The term “social enterprise” in the various but similar forms in which it is being used today — 2008 — refers to enterprises created specifically to help those people that traditional capitalism and for profit enterprise don’t address for the simple reason that poor or insufficiently affluent people haven’t enough money to be of concern or interest. Put another way, social enterprise aims specifically to help and assist people who fall through the cracks. Allowing that some people do not matter, as things are turning out, allows that other people do not matter and those cracks are widening to swallow up more and more people. Social enterprise is the first concerted effort in the Information Age to at least attempt to rectify that problem, if only because letting it get worse and worse threatens more and more of us. Growing numbers of people are coming to understand that “them” might equal “me.” Call it compassion, or call it enlightened and increasingly impassioned self-interest. Either way, we are all in this together, and we will each have to decide for ourselves what it means to ignore someone to death, or not.”

Since my own diagnosis in 2010, I’m wholly dependent on Gloucestershire NHS for a drug from Novartis with a price tag way above my means.  The NHS buffers me against capitalism whereas our founder, one of 50 million Americans without health insurance wasn’t so fortunate. When I asked  his embassy for help in his last week, I was told there was nothing to suit his budget.

He was essentially ignored to death  as a victim  of capitalism and that might soon be the prognosis for many more of us.

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