Right to request gives NHS staff the chance to establish social enterprises
By September there will 50 new health care social enterprises on the block. This is the number "spinning out" from primary care trusts under the Department of Health's right to request programme. The enterprises range from the small, six-person businesses to enterprises employing more than 1,000 people with a turnover of £100m or more. In total, they will deliver £900m of health care services a year. By any measure, we are witnessing a significant change in the way healthcare services are delivered.
A report published today by the National Audit Office provides the first major evaluation of the right to request programme . We recognise that, as most of the enterprises only got started from April this year, it is too early to make a full judgment about what the programme will deliver. But the report points to some places where, already, increased staff engagement in social enterprises is delivering cost or service improvements. Sandwell Community Trust , for example has made substantial savings by reducing average staff sickness absences from 22 days a year to less than half a day a year.
The report also recognises the part played by the Department of Health in helping social enterprises get off the ground. The department set up a central team that could provide guidance to both trusts and staff wishing to form an enterprise. Financial support of some £8m was provided by the department through the Social Enterprise Investment Fund to enable staff to develop their plans and as start up funding.
There are, however, a number of risks that will need to be managed if value for money is to be achieved. We found that trusts expected social enterprises to deliver more benefits than other providers but did not generally contract for them to deliver additional savings or benefits. Our view is that not enshrining these benefits in contracts reduces the likelihood that they will be delivered.
The report also notes that the social enterprises are currently almost entirely dependent on the business and cash flow provided by the primary care trusts. When their uncontested contracts end in two or three years' time, they will be operating in an environment that is still developing. In that competitive environment, there is a risk that some enterprises will run into financial difficulties or fail. Primary care trusts, or their successors, will need to have a clear idea of how they will react if this happens. At the moment there does not seem to be a clear contingency plan in place.
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By September there will 50 new health care social enterprises on the block. This is the number "spinning out" from primary care trusts under the Department of Health's right to request programme. The enterprises range from the small,
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Changes to Primary Care Trusts: 
New legislation: NHS Foundation Trusts and Primary Care Trusts (Transfer of Trust Property) Order 2011-SI 2011/1552 
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