Thought Leadership

Not having access to a dentist can be life threatening. The growth of one Bedfordshire-based organisation is a result of offering real care to the community. Here at Social Enterprise UK, growth, which the government has focused on since inception, means everyone rises together, that everyone’s life is improved. For that to happen, we need to ensure we look after the most vulnerable members of our society.   Access to dental care is challenging for people. The government admitted as much in a 2024 policy paper. An aging population, more complex health needs and an increase in children with high levels of tooth decay are all creating a significant rise in demand for services. If you’re homeless, have learning disabilities, mental health issues or severe anxiety, finding a dentist can feel like a mountain to climb.   The growth of Community Dental Services CIC (CDS), which specialises in caring for vulnerable patients and operates 58 clinics across much of the East of England and the Midlands, is therefore no surprise. Patients with complex needs who require specialist treatment are referred to CDS by a general high street dentist or health or social care professional. Dental health is a key indicator of overall health and wellbeing but is often overlooked. Poor oral health contributes to chronic conditions such as diabetes, cardiovascular disease, and respiratory infections. And then there’s mental health; poor oral health can erode confidence, limit social interaction and damage mental wellbeing.    A business for the community CDS was formerly part of the public sector. After what one former Clinical Director described as “a never ending cycle of constant reorganisations and frequent cuts to our dental budgets to fund other parts of the health service,” senior leaders took up a ‘Right to Request’ option made possible by 2010 health service reforms, asking the Regional Health Authority to leave the public sector and set up independently. The founders wanted to control the destiny of the organisation and make changes to the service in the best interests of patients and employees. One of those founders is the current CEO Helen Paisley. It was the beginning of Community Dental Services Community Interest Company (CIC). CDS is a business which operates as a social enterprise. It is wholly owned by employees, who have representatives on the Board and can influence how it is run, especially concerning the care provided to patients. It is now commissioned by the NHS and local authorities to provide community dental services, oral health improvement, and epidemiology surveys in seven counties. CDS provide more than 63,000 patient appointments annually and 5,275 children have participated in supervised toothbrushing programmes.   Those concerned about NHS privatisation by stealth should know that, as a community interest company, any surplus is reinvested straight back into patient care, oral health improvement or into community oral health projects. Beginning with a single contract in Bedfordshire in 2011, CDS now provides special care and paediatric dental services in seven counties. Turnover has grown to £34m and a lot of jobs have been created: the workforce has grown to 500.    Growth through innovation  As an independent business, CDS has been able to innovate free of the bureaucracy of the public sector. It has invested in a mobile dental fleet to reach underserved communities, including partnering with local charities to support homeless people, a group that is notoriously hard to reach and who face many barriers to accessing healthcare.    Growth has also come from ‘flexible’ commissioning, where CDS has responded quickly in developing new micro services that address local commissioner priorities, enabling the business to test new service models that are potentially scalable.   A good example is a recent ‘pop-up’ clinic in Luton where CDS provided examinations, oral health advice and preventative treatment to 100 local children in a sports centre. Commissioned by Luton Borough Council to address the high levels of child oral health improvements needed locally, it supported a ‘Covid generation’ of children who have never seen a dentist, received preventative advice or had simple interventions such as small fillings.   Labour won the 2024 election promising growth, describing it as 'good jobs and productivity in every part of the country making everyone better off.' As a business, Community Dental Services are certainly productive and creating jobs. And if ‘health is wealth’ as the old saying goes, plenty of people are better off because of the work of this growing social enterprise. communitydentalservices.co.uk

Social Enterprise, Chocolate Films has been awarded a Royal Warrant by King Charles III for Video Production Services. Chocolate Films is currently the only video production company of its kind to hold a Royal Warrant. The warrant is in recognition of over a decade of service to the Royal Household and Royal Collection Trust. Video production company and social enterprise Chocolate Films, is proud to announce that it has been granted a Royal Warrant of Appointment by His Majesty King Charles III. This highly prestigious endorsement recognises Chocolate Films for its service to the Royal Household and Royal Collection Trust. Since its first commission in 2013, Chocolate Films has produced a diverse range of content for the Royal Household and Royal Collection Trust, working from its London and Glasgow offices. The Royal Warrant is granted to companies that have supplied goods or services to the Royal Household for at least five years and continue to uphold the highest standards of sustainability, quality and reliability. This appointment is not only a significant achievement for Chocolate Films as a creative agency, but also as a social enterprise. The company reinvests its profits into community filmmaking programmes across the UK, working with young people, underrepresented voices, and those with limited access to the creative industries. “This is a landmark moment for us. As a small business and a social enterprise we are beyond proud to be honoured in this way.” said Mark Currie, Director and Co-Founder of Chocolate Films. “It’s a testament to the creativity and commitment of our team, and to our unique approach to film production — combining storytelling, craftsmanship and a strong social mission.” Chocolate Films joins a distinguished group of Royal Warrant holders, including heritage British brands such as Fortnum & Mason, Barbour, and Twinings. It also shares the honour with luxury chocolate companies such as Prestat and Bendicks — a sweet alignment for a company named ‘Chocolate Films’. As a new member of the Royal Warrant Holders Association, Chocolate Films also looks forward to actively supporting the association’s charitable initiatives and promoting excellence and community service across its industry. About Chocolate Films Chocolate Films was founded in 2001 by creative partners Rachel Wang and Mark Currie, Chocolate Films was built on a belief that access to media careers should not be limited to the few. Its mission is to transform lives through film. Starting as a two-person team, the company has grown to a full-time staff of 22. It now delivers a wide range of content including documentaries, campaign films, animations and branded content across sectors such as heritage, education, and charity. Chocolate Films has two bases: the London HQ at the purpose-built Nine Elms Studio, and the Scottish office in Central Glasgow. As a social enterprise, Chocolate Films goes beyond production. Every year, it runs filmmaking workshops with over 3,000 young people from disadvantaged or underrepresented backgrounds, opening doors to creative careers and helping shape the next generation of storytellers. In 2025 Chocolate Films relaunches its flagship project 1000Londoners, creating a portrait of a city through a collection of 1000 short documentaries about the people that live and work in the city. It is also a certified Living Wage Employer, committed to equality, inclusion, and environmental sustainability. Chocolate Films operates a net zero model, using electric vehicles, low-carbon equipment, and sustainable energy sources. It maintains a no air travel policy unless absolutely necessary, and works with local crews for international projects. chocolatefilms.com

Artificial intelligence is no longer a distant concept. It is already being used by many social enterprises in the UK to save time, improve services, and stay resilient. But how prepared is the sector for AI? And what kind of help is needed to ensure that adoption supports, rather than threatens, mission-led work?  Over the past few months, we surveyed 92 UK social enterprises. Some were already using AI, others were beginning to explore the possibilities, and a few were not planning to adopt it at all. Our goal was to understand these different positions and help shape better support across the sector.  A snapshot of AI adoption  60% of respondents said they already use AI. The tools in use include content generation software, automation systems, and chatbots. The main goals behind adoption were to improve operational efficiency and reduce costs. Another 16% were preparing to adopt AI soon, while 24% said they had no current plans to use it.  Most AI adopters were micro or small enterprises, often working in education, healthcare, or business support. These organisations used AI for day-to-day operations that required speed, consistency, and scale.  The organisations preparing to adopt AI expressed strong interest in improving customer service and automating administrative tasks. However, they also raised concerns about unclear return on investment, ethical considerations, and a lack of implementation guidance. These barriers were not about values. They were about capacity and clarity.  Non-adopters reported few challenges directly related to AI. But this may reflect limited exposure rather than lower risk. Some said they were watching how others manage adoption before making their own decisions.  What challenges are emerging?  As organisations gain more experience with AI, they become more aware of practical and ethical barriers.  Among current users, 83% raised concerns about data privacy. Nearly 75% reported challenges integrating AI into existing systems. A large number also identified skills gaps within their teams. These are not hypothetical problems. They affect how effectively organisations can use new technology over time.  Future adopters, by contrast, were more likely to question whether the effort and cost of AI would deliver meaningful value. Their interest is real, but their concerns are about making the right choice, and not rushing into something unproven.  Non-adopters reported the fewest concerns. However, this should not be taken as a sign of readiness or resilience. It may simply reflect a lack of exposure to the realities of AI use. Many are still deciding whether this is something they need to prioritise.  Support must match need  Our findings revealed a strong link between where organisations are on their AI journey and what kind of support they require.  Nearly 80% of current users asked for more training. They are looking for help with strategy, technical skills, and data handling. Those planning to adopt AI wanted early-stage guidance, including case studies, onboarding materials, and ethical frameworks.  Non-adopters were least likely to request support. But this may be due to uncertainty rather than opposition.  The conclusion is clear. One-size-fits-all support will not work. A staged, modular approach is needed. Organisations at different stages need different forms of help.  What we plan to do next  We are using these pilot findings to inform a national research programme. The next stage will include case studies and interviews with social enterprises across the UK. We want to explore how organisations think about AI, how values shape their choices, and what helps build confidence.  We will then co-create resources with sector partners. These may include onboarding guides, training tools, or decision-making frameworks. We will test them through online experiments to find out what is effective, useful, and scalable.  This is not about promoting AI. It is about ensuring that if social enterprises want to use it, they have access to trustworthy and well-designed support.  Get involved  If you are working in a social enterprise and thinking about AI, whether you are already using it or just starting to consider it, we would love to hear from you.   We are currently looking for interviewees, workshop participants, and collaborators. Your insights will help shape a practical and inclusive approach to AI for the entire sector.  Please get in touch if you would like to be involved: gordon.liu@open.ac.uk This piece was co-authored by Alessio Antonini (Open University), Ali Ataullah (Open University), Francesca Calò (Open University), Joyce Ko (Brunel University), Gordon Liu (Open University), Micaela Mazzei (Glasgow Caledonian University), Fidele Mutwarasibo (Open University), Artur Steiner (Glasgow Caledonian University), and Simon Teasdale (Queen's University Belfast) This article is part of SEUK’s Social Enterprise Knowledge Centre University Network – to find out more please contact research@socialenterprise.org.uk

The north Liverpool-based cooperative social enterprise is continuing its laundry adventure, delivering more positive social impact with new sustainable growth plans. Kitty’s Launderette plans to grow the scale and impact of its work across the Liverpool city region. It plans to purchase an electric delivery van and charge point, as well as install a solar panel array on the roof. This will enable them to reach more customers and increase the long term environmental sustainability of the community business. To do so, they have launched a fundraising campaign on Crowdfunder UK, with a plan to raise £20,000 by 30th July. The launderette, based in Anfield/Everton offers good quality, affordable and environmental laundry services, as well as an accessible social space. Alongside becoming a thriving community hub, its work tackles social isolation and hygiene poverty with a programme that includes film nights, knitting groups, social history projects and subsidised laundry services for people struggling with the cost-of-living crisis. Supporters can choose from a range of rewards made by local artists and craftspeople, including recycled textile tote bags, natural soaps, postcards and enamel pin badges. There are also opportunities to hire the launderette for an event, or name a solar panel on its roof. Kitty’s Launderette was established in 2019 by a group of local residents to support their communityand invests everything it makes back into local jobs paying the Real Living Wage, quality services andfree social and educational events. It has survived the pandemic within their first year, and growninto a thriving community hub. In 2023 Kitty’s won the Community-Based Social Enterprise Awardfrom Social Enterprise UK, at the national sector body awards, which recognise impact andinnovation in purpose-led business. An independent Social Impact Report conducted in 2024, found that for every £1 spent or investedinto Kitty’s Launderette, they turn this into £43 of Social Value for their community. Grace Harrison, Organisational Development Lead at Kitty’s, says: “Kitty's Launderette has only gotthis far through the amazing support of people near and far who have believed in us and our vision.“ When Kitty’s Launderette launched its first crowdfunder back in 2018, it received massive interest and support – from Anfield to Canada, and was featured on the BBC, The Independent, The Guardian and Elle Magazine. Its 366 backers on the platform Kickstarter, included eight people who chose to name washing machines after loved ones. The plaques, proudly named after Granny Trixie, Dominic Magurie and Phyllis, can still be seen on the machines in Kitty’s today. Grace says “We were bowled over by the excitement and trust people put in us to deliver on our commitment to building a community launderette! We are so proud to say we achieved our dream with the support of our community. We really wanted to invite everyone to be part of this next stage of our development and so when people see our amazing new lecky van driving around town they can know they played a role in making that happen!“ It is the launderette’s experience of community need, shaped over the last six years, that has driven this new investment in environmentally-sustainable growth. Anthony Scott, Community Lead at Kitty’s said: “We have been working towards plans for a delivery service for some time. We established a temporary delivery service during the Covid-19 pandemic to support residents who were shielding at home in partnership with another local social enterprise, Peloton, using their cargo bikes. Recently, we have been running a commercial delivery service pilot with a local cab driver. We Know there is lots of interest in us establishing a permanent service with lots of capacity for responding to the changing needs of our community." Kitty’s has been committed to being an environmentally conscious business from the start. All of its machines are electric, powered by 100% renewable electricity. The plans for an electric van, powered by solar panels, enables Kitty’s to continue to grow, while minimising the impact on the environment and reducing localised emissions. In 2023, Kitty’s won the Community-Based Social Enterprise Award at the Social Enterprise UK Awards, receiving national recognition for the role it plays in its community. The awards recognise impact and innovation in purpose-led business. The campaign features a beautiful animated film from local artists Laura Spark and Jack Whiteley. To find out more about the campaign and take part, head to https://www.crowdfunder.co.uk/p/kittys-laundry-deliveries. https://vimeo.com/1094783968?fl=pl&fe=sh kittyslaundrette.org.uk

If we want workers to be productive and boost the economy, someone is going to have to look after the kids. London Early Years Foundation is helping to make childcare affordable for everyone. You wouldn’t think the late, great Whitney Houston and PM Keir Starmer have much in common. But just as Whitney believed children are the future and that we need to teach them well, Keir Starmer wrote an election-winning manifesto that promised ‘A new Britain … where our children are equipped with the skills to thrive in the future’. His government has had a relentless focus on growth since gaining power, but growth requires productivity and if the workers are going to be productive, someone is going to have to look after the kids. And for that to happen, childcare needs to be affordable for everyone. Providing access to high quality, affordable early years education and care is the purpose of London Early Years Foundation (LEYF), which looks after 4,000 children across 43 nurseries in 13 London boroughs. Only 14% of nurseries nationally are rated ‘outstanding’ by children's services regulator Ofsted but 46% of LEYF’s nurseries are rated as such. One mother, whose child attends LEYF New Cross Nursery & Pre-School, describes it as “Excellent. Staff are well trained, clearly love their job and are very caring. Children are entertained with many activities promoting language, musical awareness, physical agility etc. We're glad our child attends New Cross and wouldn't hesitate to recommend it." Three quarters of LEYF’s nurseries are situated in areas identified as having high levels of deprivation, but all children are welcome, irrespective of social background or ability. Equal access to childcare is made possible by LEYF’s unique cross-subsidiary model, with profits from nurseries in wealthier areas helping to subsidise places for children in less affluent communities. Financially, better performing nurseries in Crystal Palace, Camberwell and Maida Value subsidise nursery places in poorer neighbourhoods. “Since our son started attending LEYF Nursery Barking Riverside, we've seen remarkable growth in him. He has become more confident, independent, and sociable. What we appreciate most is the strong support and communication we receive from the staff. It truly feels like a partnership, with everyone working together to ensure the best development for our son,” commented another parent. Growing up together The organisation started in 1903 as Westminster Health Society during a time of poverty and shockingly high mortality when founders embarked on an ambitious plan to promote child welfare and family health at the heart of a community in need. More than a century later, that focus on making a positive social impact has blossomed into all areas of the business. Many of LEYF’s senior staff started out as apprentices in the organisation, helped by a Career Pathways programme which supports growth into leadership. Of the 1,000 staff, 120 are apprentices, an approach which reduces recruitment costs, strengthens retention, and supports social mobility. Bobbi Jo describes how, when she first started as a LEYF apprentice, she just wanted to find a job she enjoyed where she could keep learning. “I did and I’ve never stopped learning. LEYF supported me through my degree and gave me the confidence to keep progressing. I always hoped I’d become a manager by the time I was 30… but I made it at 25! It’s been such a journey.” An Early Years Degree graduate, Bobbi Jo in now a Nursery Manager at LEYF’s Bessborough Nursery and Pre-School. All staff (including the chefs and cleaners) can access tailored training, covering subjects such as child development, sustainability, SEND, and nutrition – ensuring children benefit from confident, knowledgeable educators. LEYF also offers a bespoke Early Years degree with the University of Wolverhampton. Keir Starmer's manifesto focused on growth that promised ‘A new Britain … where our children are equipped with the skills to thrive in the future’. He would no doubt be happy to know that LEYF’s work has led to business growth, with revenue increasing by 11% and 75 jobs being created last year. LEYF has grown steadily and (importantly for a social business) sustainably over the past decade, expanding from 23 social enterprise nurseries in 2014 to 43 nurseries by 2025. This contrasts with the picture generally, with research by UCL finding that the number of nurseries in England declined between 2018 and 2024. They found a 19% decline in the not-for-profit group.  If LEYF’s trajectory continues, it will help to meet the increasing demand for quality childcare. A 2024 report by the London Assembly found a shortage of available childcare and staff shortages, noting the knock-on effect this can have on women, who statistically are more likely to have to choose between career progression and childcare costs. Instead of being surrendered to shareholders, as a social enterprise, LEYF’s profits are reinvested to provide more childcare services to more communities. A growing business that nurtures the development of children and staff, making for healthier, happier communities. That’s the kind of growth both the Prime Minister and the electorate can get behind. leyf.org.uk

Based in Oxford, Tap Social Movement are on a mission to reduce reoffending through employment in brewing, baking and running hospitality venues. To date across its five sites, they have created more than 100,000 hours of paid meaningful employment for prison-leavers, with 30% of their hospitality and production teams having lived experience of the UK criminal justice system. To achieve more of this great impact, last week Tap Social launched a Crowdcube investment campaign. This is the first time they've opened the company up to investment from the public; as well as shares, there are rewards offered for investments. They are in the midst of an exciting growth stage that includes wider distribution of their beers across the UK through national retail, the launch of an ambitious, purpose-built new venue (with plans for more in the coming years), extensive expansion of their bakery Proof Social Bakehouse, and much more. The campaign runs until 30 July. Please visit the campaign page if you think you can find a space to share this, or might be interested in investing. VISIT THE CAMPAIGN PAGE

To reduce the severe pressure facing children’s services, the government must find alternatives to private equity profiteering, reform procurement for public benefit, and support partnerships between local authorities and social enterprises and cooperatives, MPs were told last week. Speaking at the first roundtable of the Social, Cooperative and Community Economy All-Party Parliamentary Group (APPG) on public service provision, parliamentarians, local authority commissioners, and social enterprise providers explored the systemic barriers hampering effective care for society’s most vulnerable children and heard how mission-led providers could be better supported to deliver it. Challenges facing children’s residential services Provision for children needing an alternative to remaining within their immediate family is stretched across local authorities due to rising demand, funding cuts, procurement and commissioning limitations. Not enough children stay with extended family, foster care supply is limited – in part due to issues around access to appropriate properties. And residential care provision is too often in the hands of expensive, out-of-area, profiteering providers who don’t provide holistic and joined-up care.   Local authorities are struggling. The roundtable heard that 46% of councils are overspending their budgets by 20% or more, with many citing children’s services as the primary cause. The dominance of private equity was repeatedly identified as a structural issue. In Greater Manchester alone, 50% of children’s care providers are controlled by private equity firms, many of which are offshoring profits. “Private equity extracting profit and offshoring needs to stop” said one attendee. Barriers to positive children’s social care provision Social enterprise, co-op and charity provision offers cost-effective solutions – cost-effective not only because they aren’t off-shoring high profits, but because provision is child-centred, trauma-informed, locally-based and – increasingly – co-designed with local authorities around need and capacity. What is stopping this being the norm everywhere? Funding and finance Accessing suitable finance remains one of the greatest barriers to expanding mission-driven businesses’ children’s residential care provision. The upfront cost of setting up residential care - from property to compliance - was highlighted by attendees as prohibitive. One provider described “£100,000 runway costs” before a home can begin accepting children. Sourcing the right type of finance takes time, finance can be expensive, and grant funding is often too short-term or restrictive. A social investor told the roundtable: “We need more patient, impact-aligned capital and government funding can act as a catalyst for social investment.” Commissioning and regulatory constraints The procurement framework within local authorities, designed originally for large-scale goods provision, isn’t fit for the purpose of securing quality services at a local level – and as such often biases towards provision by profiteering firms.   Variations in planning regulations between local authorities mean mission-led providers face very different commissioning and regulatory issues depending on geography. Differences in commissioning culture, for example, mean that some councils are seen as risk-averse and less likely to facilitate mission-led provision. Similarly, in some areas, residential homes can be set up with minimal bureaucracy but elsewhere regulatory loopholes around approval of buildings and scale of provision can be prohibitive. Workforce challenges and high churn The absence of a professionalised workforce, including a lack of recognised qualifications or progression pathways, was cited as a major issue for provision. Low pay, lack of professional development, and poor status in the sector all contribute to workforce churn. One attendee described this as “entirely inappropriate,” given the responsibility care workers hold. Turnover of managers is particularly disruptive, as care homes must be reinspected by Ofsted even if managers move between sites within the same organisation. The lack of a “passport” system for staff was flagged as a fixable bottleneck. Social enterprise solutions: building local, trauma-informed care Despite these barriers, social enterprises, cooperatives, and other diverse mission-led businesses identified how they can provide more stable, child-focused, and community-rooted models of care. Finance and investment The UK’s social investment market now stands at £10 billion, creating new opportunities for blended finance. Social AdVentures, a Salford-based social enterprise, was held up as an example of how social investment and combined authority support can enable new models though convening multiple actors remains a complex task. Mission-led alternatives to private equity Social enterprises reinvest surpluses into services, enabling them to focus on long-term, trauma-informed care. They are well placed to support children with complex needs and prioritise relationships and wellbeing over short-term profit. Mandating open-book accounting and capping profits - currently up to 40% for some private equity firms - were floated as policy options to level the playing field. Localised, values-led commissioning Reserving contracts for public benefit organisations is already happening in parts of the UK, and speakers suggested this approach could inform wider policy. Ministers were urged to embed social value more directly into commissioning decisions. Roundtable attendees highlighted examples of small-scale provisions to address the acute needs of children with complex care requirements, as well as the value of long-term partnerships between providers and local authorities to ensure sustainable care solutions. Regional Care Cooperatives (RCCs), being developed through the Department for Education with the intention they will allow local authorities to partner with providers in a more integrated way, were discussed as a promising structure, potentially offering a single point of contact and shared vision for care. Professionalising and empowering the workforce Several solutions focused on improving staff conditions and morale. Social enterprises were praised for involving staff in business planning, providing training, and minimising reliance on agency staff – which can be a runaway cost in children’s services provision. Attendees called for structured training programmes and better career pathways, noting that 22% of children’s homes currently have no registered manager. Professionalising care roles and offering qualifications would improve retention, stability, and ultimately, outcomes for children. Asks and ambitions for reform As the government launches consultations into procurement reform, parliamentarians present, including Georgia Gould MP (the Cabinet Office Minister responsible for public sector reform) and Josh MacAlister MP, heard clear evidence that social enterprises are already delivering, but need the right support to sustain and scale. The current system is not built with social enterprises in mind; new legislation and guidance must explicitly create space for mission-led providers to flourish, providing cost-effective solutions with quality service outcomes. Attendees stressed that this will require bravery among commissioners, and for local authorities to be supported in taking creative, child-centred risks. Speakers also called for a fundamental shake-up of the care model, moving away from crisis-driven residential placements toward more flexible and therapeutic alternatives. Attendees called for the NHS to take a more direct role, one noting that “health sits on a lot of money and they are responsible for these children.” Greater alignment between social care and Children and Adolescent Mental Health Services (CAHMS) was seen as essential to building joined-up, trauma-informed support. Ultimately, the ambition of roundtable participants was clear: to build a children’s care system that starts with the child, not the contract. That will require longer-term funding, shared purpose, and a willingness to put public value above private gain.

The 10 Year Plan feels like it's taken a lot of lessons from social enterprise models. But the Plan still seems blind to the significant contribution social enterprises make in delivering services, writes Social Enterprise UK Associate Director, Dan Gregory. Today (3 July) saw the much-heralded launch of the Government’s 10 Year Health Plan for England. It tells us three important things about the thinking in Wes Streeting’s department. First, this is a 10-year plan. Yet this Government has been elected for a 5-year term. So, this is ambitious, it’s aspirational. And perhaps a little detached from reality. Second, they see the launch of a document as significant. From all the recent invitations Social Enterprise UK has received from the Department of Health and Social Care (DHSC), they are very keen that we read the output of what they’ve been doing for nearly a year. Even if they remain less keen to listen to what we have to say. Third, this is the Plan that will lead to delivery. To change. To the future of the NHS. What's in the Plan? But how? What is in the Plan? What does it say? The plan is long (166 pages) as we might expect. But is remarkably short on how. It helps to have ambitions before you set off, of course. But this isn’t really a complete plan. More of a direction. Perhaps this is wise, and Streeting understands that dictating everything from the top down or centre out is not the answer. The department is directing whilst not directing – the Plan is “tight on what, loose on how”. It’s less of a plan and more a series of bets, trials, pilots and avenues to explore. Change will be slow. New Foundation Trusts (FTs) and Neighbourhood Health Centres will be gradually rolled out through programmes. Various other whizzes – a Choice Charter and Patient Power Payments - will be trialled and “rolled out progressively". On the money side, "in the next 3 years we will make a start on the journey to establishing a new financial foundation." New tariff models will be slowly phased in. New "year of care" payments will be trialled in pioneering areas. Later this year they will "publish a 10-Year Workforce Plan". Of course, this may be quite sensible. But it’s clear that much of the plan is still to be designed and delivered. The new operating model will be "devolved and diverse". This means more messiness in the medium term for sure. But what’s the direction then? Well, the ambition is great. And it’s very much aligned with the ethos and experience of our social enterprise members working in health and care. The ambitions are around prevention and community. Empowered staff, with agile and autonomous models embedded in the local community. Financial incentives to break even and reinvest. Some of this is even quite explicit: "more money towards areas with disproportionate economic and health challenges". Great. No more bailing out FTs in deficit. Good. Hospitals will be expected to “do more as anchor institutions to support wider societal and economic goals. Through their procurement, supply chains and role as an employer, they have significant influence over social and economic development in their communities.” Also good. FTs will have more freedoms to retain surpluses, reinvest them and borrow for capital investment”. Indeed, they will be more like social enterprises. Then of course, there is a lot on the NHS app, on AI and other innovations which I won’t attempt to summarise here, even if I understood them. But some of the detail is rather more troubling. The big new idea is the Neighbourhood Health Centres which will “co-locate NHS, local authority and voluntary sector services, to help create an offer that meets population need holistically” a good idea, for sure. But who is going to tell local charities and social enterprises they are going to have to relocate - is that what this means!? Meanwhile, the financing of new Neighbourhood Health Centres looks a lot like a new wave of Private Finance Initiatives. Then the Plan also seems to effectively nationalise Healthwatch, which was a social enterprise experiment that will now be forgotten and airbrushed away. What about social enterprises? What does it say about social enterprise? There are (phew!) a few mentions. So, we have the recognition we wanted as a baseline – the flag in the sand. Indeed, there are also two case studies - Primary Care Sheffield and Live Well Manchester, which are built around social enterprise. But unhelpfully, the Plan refers to social enterprise at one point as "outside the NHS", which is infuriating. Perhaps, this is partly our fault for reinforcing this idea? I am often annoying our members by asking them to say, “We span out of the public sector” rather than “out of the NHS”. We are part of the NHS! This is indicative of the wider problem here. Large parts of the Plan don’t recognise at all that significant chunks of NHS services are not delivered by the public sector. Where it says - "every NHS provider should be an FT" - it clearly means every public sector provider, not every social enterprise, hospice or GP practice. This blind spot is maddening and doesn't seem to want to go away. Social enterprises deliver several billion of pounds’ worth of NHS services but still we are forgotten and fall between the cracks when it comes to the backlog bonus, access to digital and capital investment, CPD resources, international nurse recruitment, and the list goes on. At Social Enterprise UK, we keep fighting to be included and not forgotten and pull all the advocacy levers we can lean on. Sometimes we win! Some parts of DHSC and NHSE listen. But others don’t. We are currently working with some very engaged NHSE officials on equal access to digital investment, which will be even more critical as these pots of money grow. We are talking to NHSE about how their new structures within DHSC might replicate the old Social Enterprise Unit. But the next day we meet a senior strategist who doesn’t even know that in West Yorks, Plymouth, Bristol, Nottingham. Grimsby, Medway and beyond, we are the NHS outside of hospital. We provide urgent out of hours care to 2/3 of the population. Yet we are nearly invisible to some system leaders. Maybe they don’t like us. Maybe we are too awkward. Maybe we don’t fit and they know it, and hope we go away. Or maybe they know we aren’t where the problems are, and they are mainly focused on the problems. Maybe NHSE and DHSC are just a mess and half the staff are facing redundancy. Or maybe the NHS is simply a massive, complex system equivalent in size to the Hungarian or Moroccan economies. Influencing a system of that scale is a Sisyphean task. We keep on regardless! The Plan ends with a Wes Streeting afterword entitled "Be the Change", which many will know is the well-established motto of the social entrepreneur. While the system largely ignores us, and even puts barriers in our path, it also seems to be moving our way, and trying to build an NHS more like us. While we aren't winning (though also maybe not losing) the battle of ideas and policy, across the country we are winning in practice, through the daily work of our members and their staff, leading the way. Health and care social enterprises will carry on delivering the future, whatever the plan. To see a few examples of how social enterprises are already transforming the delivery of health and social care across the country, read our series of case studies produced in partnership with King's Fund and Baxendale.