Five years ago in Vauxhall, one of the most run-down parts of Liverpool, John Whelan, an energetic local entrepreneur, spotted a market niche: the apparent failure of the NHS and social services to meet the mental health home care needs of local people.
It has spawned a thriving business. Liverpool Community Care, set up in late 1995, now has 40 staff and provides more than 600 care hours a week to the local community as part of a contract with Liverpool social services. It has a turnover of 250,000 a year.
Its staff are local, formerly long-term unemployed people with NVQ qualifications. They provide practical support and personal care to people with mental health problems, such as washing and dressing, assisting with medication, shopping, gardening and decorating.
Mr Whelan is not about to cash in on his success. He does not wear pin- striped suits or own a Rolls Royce. He says the profits are ploughed back into his 'community business' to develop better services and improve staff terms and conditions.
He is, in short, a social entrepreneur.
'We do it to create employment and fill gaps - providing services that the public sector would not provide even if it had the resources to do so. We make a surplus but we are not doing it for profit in the same way as commercial entrepreneurs.'
Social entrepreneurs would seem to be flavour of the month. Prince Charles is a fan. So is prime minister Tony Blair, who sees them as 'people who bring to social problems the same enterprise and imagination that business entrepreneurs bring to wealth creation'.
The left-of-centre think-tank Demos has published a pamphlet, Civic Spirit, which attempts to articulate the benefits of this hybrid approach. It argues that the welfare state - including the NHS - is clumsy, bureaucratic and inflexible, and 'finds it hard to learn and change'.
It calls for a 'mutual' approach to revitalise public institutions which would combine the social and entrepreneurial; make them democratic and accountable while 'capable of taking action and adapting to change'. It says partnerships between mutual institutions and the state should be promoted.
In the NHS, this means 'a combination of preventative local services, health education and self-provisioning as well as hospital care. The best opportunity to create mutual health services is in local, collective self- help.'
It cites a well-known example: the Bromley-by-Bow health
centre in east London, which is community-owned and purpose-built, and run by a trust, whose members are local residents. GPs rent space from the trust, which decides how profits are invested to develop services.
In Liverpool, Mr Whelan is in the process of setting up another health- related community business which has at its core the ideal of self-help. Called Eldonian New Care, it will train local people in a range of therapies - a 'tool kit' of skills they can learn 'to become a new type of health professional'.
These include touch, pressure and movement techniques, such as reflexology, massage, aromatherapy, tai-chi, shiatsu stress-management and listening. A community therapeutic care worker treats people by giving them an alternative to medication, and shows them how they can treat themselves.
Mr Whelan sees the initiative as a way of breaking the 'vicious circles of poor health, poor quality of life, dependency and the medicalisation of personal and social problems', where the conventional response to chronic illness - the prescription pad - has failed.
It also hopes to break down the gap between care professionals, who have little or nothing in common with the people they help, and patients. This involves emphasising self-help and
The key, says Mr Whelan, is not about developing top-down 'joint working' between public sector agencies or 'outreach' programmes. It is about breaking the dependency cycle by motivating people and communities to learn to help themselves.
The therapeutic care worker initiative gets under way as a pilot scheme in October. It will be a free service, but in the long term will need contracts with the NHS and other agencies. Proving its cost-effectiveness to the NHS, admits Mr Whelan, is a 'big issue'.
Civic Spirit by Charles Leadbeater. Demos, Bridewell Place, London EC4V 6AP (4.95 plus 60p p&p);
Practical People, Noble Causes: how to support community-based social entrepreneurs by Stephen Thake and Simon Zadek. NEF, First floor, Vine Court, 112-116 Whitechapel Road London E1 1JE.(9/15 institutions).