Rebel alliance: the ever greater need for social enterprises to tackle issues in health and care

Close your eyes. You’re in an airport departure lounge. Polished hallways stretch off to either side. What do you hear? Announcements. General bustle. And within all that, the clickety clack of dozens of wheelie suitcases rolling towards their gate.

True now. But not in 1970, when Bernard Sadow was going store to store in New York trying to sell the concept of wheels glued to the bottom of luggage. He was laughed at. Seen as crazy. Eventually Macy’s decided to take a closer look, and the soundscape of airports changed forever.

What’s all this to do with healthcare in 2023?

And particularly on Social Enterprise Day? Tucked away in the first session of this week’s NHS Providers conference was a question so perfect that it could have legitimately resulted in every other session being cleared just to focus on it. “Why do people not do stuff we know works?” Dominique Allwood asked.

So we come to the whole process of new ideas, of innovation, of how change really happens. As my Kaleidoscope colleague Shane Carmichael beautifully writes, in healthcare change is a constant, but whether we manage this process well is optional.

Healthcare, as with suitcase manufacturers, struggles with new ideas, particularly when they come from an unusual source. One of the early proponents of anaesthesia, the great Henry Hickman, received the same rejection as Sadow’s suitcases (the Lancet called it ‘surgical humbug’).

The NHS needs radical innovation in a way it never has before: quality is teetering, the money is broken, staff are striking.

In England we have chosen to have a national health service. It’s what makes us more proud to be British than anything else. But it also means that we have deliberately chosen a model with a very strong orthodox ‘way we should be doing things’ and central control. If Victoria Atkins wanted to mark her first week as Secretary of State by calling a random selection of NHS chief executives and asking them to resign, they would feel obliged to comply. This is not a system that incentivises outsider, rebellious thinking.

This is a very major problem. The NHS needs radical innovation in a way it never has before: quality is teetering, the money is broken, staff are striking. The inability to innovate its way out could be one of the reasons why the NHS fails to see its 100th birthday.

Social enterprises – companies with social purpose at their core – offer an alternative. There’s more than 100,000 across the country, contributing £60bn to the economy, and reinvesting £1bn every year to help people and the planet.

While they remain a relatively small proportion of how we plan and provide healthcare in the UK, social enterprises have a disproportionately large impact. That’s why social enterprise dominates all parts of my professional life: being part of the incredible team at Kaleidoscope Health and Care, chairing the wonderful Here in Brighton, and deputy chair of the revolutionary House of St Barnabas in Soho.

At Kaleidoscope we’re proud to deliver services as packed full of creativity and new ideas as you will find anywhere, while at the same time showing a different way organisations can be.

At Here, working with our Sussex partners, our radical approach to personalised musculoskeletal care has transformed outcomes (at a lower cost) for many years. Our latest innovation – ‘Community Appointment Days’ – has been highlighted by BBC Radio 4’s Today programme, Amanda Pritchard, and hundreds more across the country seeking to explore how its principles could be applied to other long-term conditions.

A world without wheelie suitcases is a poorer world. An NHS without social enterprises likewise. With healthcare facing a sea of challenges, it’s never been more important to find new ways to encounter surprising ideas.