Policy Update – What’s happening in Westminster and what it means for social enterprise

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.

Impact Hub Yorkshire celebrated a milestone five years of empowering individuals, communities, and businesses across the region with a special gala dinner at Bradford Live on 12th June. Nearly 300 guests and dignitaries gathered for the occasion, which also marked a significant moment for the city — the first event to be held in the newly restored Bradford Live ballroom since 2000.  The milestone comes shortly after His Majesty The King visited the organisation’s headquarters in Bradford’s Little Germany, where he met with social entrepreneurs and community leaders supported by the Impact Hub. The visit also marked the formal transition from Impact Hub Bradford to Impact Hub Yorkshire, reflecting the organisation’s ambition to scale and support communities and projects across the region.  Founded in 2020 at the height of the pandemic, Impact Hub Yorkshire emerged as a catalyst for driving innovation and positive change. Since then, it has supported over 1,000 individuals and businesses. From developing accessible funding models to leading regeneration projects, empowering young people, and championing inclusive economic growth in underserved communities, its work continues to create meaningful impact across the region.  The gala dinner at Bradford Live brought together community members, project partners, and supporters from across Yorkshire. It is also the first formal evening event to be held in the newly restored ballroom, making it a symbolic location for an organisation rooted in the regeneration of Bradford and committed to shaping the region’s future.  Kamran Rashid, CEO and founder of Impact Hub Yorkshire, said: Five years ago, we made the bold decision to launch Impact Hub in the middle of a pandemic, during a period of global uncertainty and personal change. What began as Impact Hub Bradford has grown into something far bigger – because we believed, and still believe, that meaningful change begins with community.   “Expanding to a Yorkshire-wide remit marks an important shift. It speaks to our belief that every community across this region deserves access to opportunity, investment, and space to lead. We’ve been privileged to work alongside some incredible partners over the years, and I’m deeply grateful to our sponsors and to Bradford Live for helping us mark this milestone in such a special way.”  Throughout the evening, guests enjoyed a three-course meal, networking, and talks and panel discussions from Kamran Rashid, Imran Hussain MP, Cllr Susan Hinchcliffe, and Kersten England CBE – Chair of Bradford City of Culture 2025. Sponsors included Bradford Live, Bradford UK City of Culture, the Broadway Shopping centre, Mylahore British Asian Kitchen, Biscayne Maintenance Services, Faum Architecture, Schofield Sweeney, and Jinnah Restaurants. With their support, the Impact Hub was able to host the evening for over 270 guests.   Impact Hub Yorkshire continues to support a wide range of projects, including partnerships with organisations such as Green Street, Pandora’s Box Desserts, the African Caribbean Achievement Project, and the Tasif Khan Community Boxing Academy.  Kamran concluded: “As we step into this next chapter, our commitment remains the same: to build a movement grounded in equity, shaped by collaboration, and driven by the people and places we serve.”

“Stop Fixing, Start Listening!” Meet the people training healthcare workers to hand power over to patients - and transforming lives in the process. It all began with curiosity. Twenty-five years ago, a physiotherapist asked a simple question: why do some stroke patients manage to find their way to a fulfilling life more speedily and completely than others? Obviously, the severity of the stroke plays a big part but even those with similar neurological and physiological impacts had very different experiences. Determined to find the answer, Fiona Jones decided to speak to stroke patients in depth. What she found was surprising: the key was the nature of their relationships. And the relationships that mattered were not just those between the patient and family and friends but, crucially, that between the patient and the healthcare workers trying to help them. Too often stroke patients felt disempowered by the way professionals interacted with them. Out of the very best of intentions, those professionals wanted to ‘fix’ their patients by taking control of their recovery, failing to fully acknowledge the complexity and diversity of their lives. The stroke patients that did better were those that helped to play a bigger role in their own care by managing their medication, rehabilitation regimes and pace of recovery independently of their clinicians – what is often termed ‘self-management’ A Bigger Story But extensive further research revealed something deeper. The secret to a truly fulfilling change in a stroke patient’s life was self-efficacy. Those who felt more in control of every aspect of their recovery also began to feel more in control of the lives that had been so disrupted by a severe medical condition. That meant moving beyond self-management’s focus on medicines, exercise and training and instead allowing the patient to shape the underlying methods, goals and style of recovery. This was radical stuff. As Fiona puts it: while self-management requires the patient to change their behaviours, an approach based on self-efficacy and empowerment requires the healthcare professional to change theirs. It means shifting mindset and practices away from any sense that the health worker knows best with ready-made solutions at hand. Instead, they need to act as expert collaborators led by the expectations, hopes and challenges identified by the patient themselves. It’s an ethos that originates with the heartfelt recognition that when it comes to their own lives, the person in front of you is the world-leading expert. Fast forward to 2013 and, after further research, Fiona founded Bridges Self-Management (with the support of City St. Georges and Kingston Universities) - a social enterprise designed to help health workers play that empowering role. This is far from easy. Health workers sometimes feel they are abdicating their responsibility by not coming up with quick solutions, not being in the lead. And when they do recognise the need for self-efficacy, the skills, strategies and language to enable that are often undeveloped. In addition, what they see around them is countless colleagues - often very highly regarded ones - doing things to rather than with their patients. Breaking down these personal and cultural norms requires lots of self-reflection, self-questioning and gradual, careful introduction of new approaches. But the impacts speak for themselves. Bridges’s work training staff who support people with Long-Covid was recently the subject of a randomised control trial. Called, appropriately enough, ‘Listen’, the project was found to have improved patients’ ability and confidence in managing their symptoms and doing everyday tasks. It also improved their sense of self-efficacy and emotional well-being. Most significantly, that greater sense of self-efficacy was directly related to the improvements in patients’ recovery. It is research that endorsed the findings of Fiona’s own initial enquiries all those years ago and the knowledge the Bridges team has accumulated through research and experience since it started work. Workers’ Liberation The impact of this way of working extends beyond the patients. Call it ironic, call it counter-intuitive, but it seems that by stepping back, listening and empowering the patient, the health worker actually ends up feeling more empowered themselves. Liberated from the strictures of routinised interventions and the pressure of taking sole responsibility for fixing their patients, health workers report being able to build much more fulfilling human relationships focused on helping people build a self-defined, decent life for themselves rather than achieve a set of externally set, medicalised milestones. It gives them more time. And most importantly, of course, they can see that working in this “Bridgey” way is better for the patients and their recovery. Again, the data speaks for itself. Of over 250 NHS staff trained by Bridges in the last 6 months alone, 84% said they are now listening more and ‘fixing less’. 94% said that Bridges was having a positive impact on their day-to-day work and 60% said working in the Bridges way had already increased their job satisfaction. Ultimately, the ethos of Bridges is a challenge not just to the professionals they work with but to a whole healthcare and public service system that is still built around doing to rather than doing with. Of course, there are many occasions when the enormous expertise of health workers must operate unhindered with little immediate regard for co-designing a solution - no-one undergoing cardiac arrest or a major trauma wants anything other than to be fixed by experts as rapidly as possible. But too much of this acute mentality has leached into every other aspect of healthcare - often reinforced by time pressures and lack of empowering skill sets. So, the question now is how we can make the training Bridges provides utterly normal across healthcare rather than something so out-of-the-ordinary that it can almost feel like a process of deprogramming for those seeking a better way of working. Given the theme, the final word should go to Jeremy - a patient with Long Covid. His testimony shows what happens when a health worker takes the time to really listen and co-design ways forward. His words speak with far greater eloquence of the power of patient empowerment than anything written here. Do find the time to listen! By Adam Lent This case study forms part of a series we are producing together with the healthcare consultancy Baxendale and think tank King’s Fund, to demonstrate the innovation shown by social enterprises delivering health and social care.