Big Society: little guys vs big guns

Not only does nobody know what the big society means, the government has now even given it the acronym of BS to confuse people more. It doesn’t help that government ministers try to explain in the tone of an angry aunt and with language that combines exhortation to better behaviour with an undertow of high moral threat.

The big society cannot just mean more of the old- style charity. It is time to combine civil society and the NHS

Irrespective of what BS actually does mean, for the government the role that civil society plays with the NHS will be an important part of the future of the health service.

Without going on too much about how the government has taken a good idea and messed it around, let’s analyse how the NHS might progress its relationship with the big society.

First, there can be no relationship that does not involve state resources. The NHS is free at the point of need because the state raises taxes from us all to pay for it.

The NHS has a long history of working with traditional aspects of civil society, from the hospital league of friends to the general public raising billions of pounds in donations for health. Look at the runners in the marathon and see how many health services they are funding. The big society can’t simply mean more of this charity of old, it has to involve a closer partnership between civil society and the resources that run the NHS. It is time to combine civil society and the NHS, not keep on running them side by side.

Second, the big society’s relationship with the NHS will not be transformative if it only works through the big society’s “small platoons”. Small platoons is a lovely phrase but the NHS is one of the biggest armies in the world. A big army doesn’t notice when it rolls over small platoons every morning before breakfast. And it is being rolled over that characterises the voluntary sector’s experience of the NHS.

I have met hundreds of charities that have tried and failed to obtain contracts for services that primary care trusts want. Often the PCT really wants to create that relationship with the small voluntary sector platoon, but the tendering process that the PCT runs precludes anything but a multinational from succeeding.

Getting organised

Small platoons rarely win the skirmish that the public sector tendering process represents. Big armies with tanks full of lawyers win those tenders.

For the big society to work, these small platoons need to organise into an army. And that is what they are doing. The modern army needs to combine the local control and power of the small platoon with the logistics and fire power of a large army.

This vision has led to the creation of the Third Sector Consortium (3SC). Set up by the Social Investment Business, the consortium has been formed of 10 of the larger voluntary organisations that provide services that help people on welfare get into work.

On their own they have found it very difficult to get the Department of Work and Pensions to take them seriously. Together they can buy the skills and defray the incurred costs needed to win contracts in competition with large public and private sector organisations. 

This sizing up does not lose the unique selling point of third sector organisation - its local relationship and the specific passion that drives it - but it organises that passion and allows it to compete and win.

The third sector is now developing a consortium for health (3SC4H) that will bid for work from the NHS. This will not compete directly with most NHS services, but important synergies are developing.

The Red Cross sells an important health service to a number of PCTs. It trains volunteers to stay overnight with patients who would otherwise be in hospital emergency beds. No one is pretending that those volunteers can replace emergency doctors; they don’t need to. They need to provide safe and secure care in the home, where the patient wants to be, and preserve the emergency beds for the people that really need them. The QIPP analysis of this service is that every pound spent with the Red Cross saves multiple pounds for the NHS.

The problem, as with most innovations in the NHS, is how to spread it quickly. It is important that they, and all services that ensure greater self management of long-term conditions, do not remain good ideas at the edge of the NHS.

To change the terms of trade for the NHS, to secure considerably better outcomes for the same resource, these innovations need to become mainstream. To help make that happen, 3SC for health will combine the small platoons into something approaching a big society. And they will be coming to an NHS near you.