Opinion  

Unions are demonstrating a poor grasp of the facts by pledging to fight social enterprises (IN, 28 May). Though the case for increasing the role of social enterprise in the delivery of health and social care is about providing better value for money, what the unions need to realise is that social enterprise is first and foremost about people.

Key to the social enterprise ethos is a belief that front line staff must be treated well to perform well, and that they know what needs fixing and how to fix it. Whether through official channels or an 'open door' working environment, social enterprises listen to staff and can therefore identify the real problems. By combining staff input with a low level of bureaucracy and an acceptance of change, social enterprises are often in a better position than the NHS to come up with solutions.

Social enterprises put staff welfare first
Social enterprises also tend to focus on staff training and development more than their NHS or local authority equivalents. This is not to say there aren't some staff issues when it comes to moving people from the NHS; transferring pensions is one example (which, though complicated, is far from impossible). However, unlike many private businesses, social enterprises will always put the welfare of their staff first.

So, how long will this situation last before private business takes over and starts putting profit above people? If things are done properly, the answer is never. The argument that social enterprises are a Trojan horse for the invasion of private business is misinformed. First, they are independent community businesses, not government-controlled so they do not follow any political agenda but reflect what staff, management and patients want. Second, there are many ways to safeguard against a buyout by a private company.

The reinvestment of profit is also safeguarded and, unlike the NHS, profit made in a social enterprise is reinvested locally, allowing staff to enjoy the fruits of their labour, instead of seeing savings sucked back into the wider NHS system.

Unions overlook the role of the third sector
Unions also complain about the business model's tendency to fail, with frightening (but unsubstantiated) statistics bandied around. The evidence base for the sector is still in its early stages, but everything we have learned so far indicates that social enterprises have a better success rate than small- and medium-sized start-ups in the private sector. Any instability can be addressed by ensuring contracts are an appropriate size and length, and risk is shared appropriately with the NHS.

The reaction to social enterprise by some unions at a national level shows they have not grasped what this debate is about. It is not the NHS on one side and uncaring businesses on the other. This overlooks the 'third sector' (encompassing social enterprises and charities), which offers a viable third choice.

Government policy means that more health and social care will be commissioned externally - what is still to be decided is from whom. Unions can support a system that promotes community ownership, cooperation, fixed staff terms and conditions and an ethic of people over profit, or fight us at every turn and allow private business an even bigger slice of the pie.

If we work together we can use the social enterprise model to ensure fair, efficient, high-quality services, where profit is reinvested locally and front line staff are always put first.

Emma Wilson is chief executive of Local Care Direct, one of the UK's largest social enterprise healthcare providers, and director of the Social Enterprise Coalition's Health and Care Forum. She works closely with government, fellow businesses and commissioners as an ambassador and advocate for community benefit businesses.

What do you think? Email your views to independentnurse@haymarket.com