A flagship Big Society programme to set up a new wave of NHS mutuals has yielded just 19 proposals, less than half the figure set up under the transforming community services programme in 2010 and 2011.

The new companies are also likely to be far smaller on average than the TCS social enterprises, around half of which accounted for a full primary care trust provider arm, each with hundreds of staff.

The low level of enthusiasm is in spite of a government aspiration to move one in six public sector jobs into new staff-owned companies.

Launching the right to provide in March 2011, then health secretary Andrew Lansley said he had heard from “many NHS staff over the years” that they could run their services better themselves, and said he wanted “as many of them as possible” to set up new mutuals.

Cabinet Office minister Francis Maude, whose mutuals taskforce is leading the programme, has previously said he wanted one in six public sector workers in mutuals by 2015. He has said spinning out public services into staff-owned social enterprises was a “Big Society approach”.

But the Cabinet Office has only named four new NHS mutuals currently in progress. They are:

  • A primary mental health care service run by Barts Health Trust;
  • A research and innovation unit working to improve maternity services for families in Birmingham and Solihull, employing 20 staff;
  • Community equipment and wheelchair services at Northern Lincolnshire and Goole Hospitals Foundation Trust, although the plan is “in its infancy”;
  • A smoking prevention service currently provided by NHS Sefton.

The Cabinet Office said another 15 potential mutuals were “looking at options” and doing early development work. Because many of the plans were not finalised, it is not possible to say how many people will work in them or how much income they will get from NHS commissioning.

A further two proposed mutuals previously listed by the Cabinet Office in June have since been abandoned. These were Norfolk Community Health and Care physiotherapy outpatient musculoskeletal services, and the Royal National Throat, Nose and Ear Hospital’s adult audiology provision.

Ceri Jones, Social Enterprise UK head of policy and research, said setting up new social enterprises “was always going to be incredibly difficult” when no contracts of more than a year were on offer, and it was unclear how clinical commissioning groups would use any qualified provider.

She also told HSJ that many NHS staff would want to wait and see how successful the transforming community services social enterprises were over the long term in retaining their contracts before committing to spinning out.

A Cabinet Office spokesman said: “Mutuals are led by employees who want freedom to do their jobs in the way they know is best  – it’s their decision so we do not have a target. However, to date small and medium services are pioneering the model – if it is adopted by some of the larger organisations numbers could increase rapidly.

“We have a range of support in place including a £10million fund and the Mutuals Information Service website and hotline. On top of this, we’re actively lobbying the European Union to reform procurement directives, which can act as a barrier to mutuals.”