Building Research Infrastructure in Social Enterprises Nat Wright Clinical Research Director Transform Research Alliance and Co-clinical lead Yorkshire and Humber NIHR Clinical Research Network Phil McEvoy Managing Director Six Degrees Social Enterprise CIC
What is a Social Enterprise? Business trading for social, environmental and economic purposes Rather than maximising private profit for shareholders, asset lock guarantees surpluses are reinvested into social and environmental goals Recent estimates indicate there are approximately 70,000 SEs operating in the UK, with 8-9% of the total providing NHS-funded care to the public Approximately 10% of community health services provided through SEs, and 14% of all community nursing care providers are SEs
Why social enterprises? Social enterprises generate more pound for pound social value Increase market competition, innovation and entrepreneurship Improve quality and efficiency of health and social care service provision
What organisational form do social enterprises adopt? At one end of the spectrum are mutuals, akin to the philanthropic activity and cooperative movement from the late nineteenth and early twentieth centuries At the other end of the spectrum are hybrid models of for-profit. UK Government has supported such a model through the creation of the Community Interest Company (CIC) The CIC reconciles the inherent tensions between having a business focus and providing social benefit Therefore, social enterprises can be seen as businesses that tackle social and environmental challenges, creating jobs while prioritising impact over profit Where financial profits are generated, they can be shared with co-owners, staff or other social ventures
Social Enterprises and NHS Research Frameworks Lack of clarity regarding whether SEs are eligible to access funding streams for applied health research Guidance from NIHR states that programme grants and the RfPB (Research for Patient Benefit) Programme are open to NHS bodies and other providers of NHS services in England, which might include local authorities or social enterprises; other organisations can join applications for Programme Grants and RfPB as collaborators However, a need to nominate a lead NHS trust which precludes SEs from being the host organisation.
Social Enterprises and NHS Research Frameworks (2) SEs not specifically mentioned in the AcoRD guidance for chief executives of NHS organisations which provides a framework to identify, attribute and recover the various costs associated with research in the NHS The framework documents the responsibilities of both the sponsor organisation and the chief investigator of the research study. These responsibilities equally apply to SEs conducting research amongst its patient populations. SEs not NIHR partner organisations and fall outside of the remit of the Health Research Authority centralised governance process which from April 2016 became the route for granting approvals for all project-based research in the NHS in England
Research Governance Models for SEs Internationally no documented models of research governance in health-based social enterprises In the absence of such an evidence base, a variety of models are worthy of implementation and evaluation A social enterprise could work in partnership with an NHS trust which would assume research governance functions for the enterprise Alternatively, smaller social enterprises could form research alliances to share governance expertise Or, larger enterprises could stand-alone in providing research governance functions to a standard outlined in the new UK Health Research Authority frameworks for research governance
Transform Research Alliance: Who we are Twelve spin-out social enterprises from across the country working in the field of health and social care Incorporated Charitable Status September 2015 Spectrum is the host organisation on account of having an in-house research team (clinical research director, 2 research assistants with administrative support)
Key Aim To work in partnership to support the implementation and governance of high quality research in the member organisations
What does this mean in practice? How can we meaningfully respond to unsolicited requests to access patient data for research purposes? How can we build the reputation of social enterprises to undertake high quality research? How can we harness research activity to better understand and respond to the inherent threat of the commissioning process?
References Social Enterprise Coalition. State of social enterprise survey 2009. London: Social Enterprise Coalition; 2009. Department of Trade and Industry. Social enterprise: a strategy for success. London: Department for Trade and Industry; 2002. BMG Research. Social enterprise: market trends. London: Cabinet Office; 2013. Social Enterprise UK. The people s business: state of social enterprise survey 2013. London: Social Enterprise UK; 2013. Miller R and Millar R. Social enterprise spin-outs from the English health service: a Right to Request but was anyone listening? Working paper 52. Birmingham: Third Sector Research Centre; 2011. Spilsbury K and Pender S. A changing landscape: mapping provider organisations for community nursing services in England. Journal of Nursing Management 2013; 23(1):128-38 National Institute for Health Research. Funding opportunities for research and career development. London: National Institute for Health Research; 2014. Central Commissioning Facility Research Management System https://ccfrms.nihr.ac.uk/login.aspx?returnurl=%2f (accessed 23 August 2015). Department of Health. Attributing the costs of health and social care research & development (AcoRD). London: Department of Health; 2012. Department of Health. Research Governance Framework for Health and Social Care Second edition. London: Crown Copyright, 2005 Health Research Authority. http://www.hra.nhs.uk/about-the-hra/our-plans-and-projects/assessment-approval/ (accessed 01 September 2016) National Institute for Health Research. Clinical Research Network: our performance. https://www.crn.nihr.ac.uk/about-crn/our-performance/ (accessed 01 September 2016).
Any questions? nat.wright@spectrum-cic.nhs.uk phil.mcevoy@nhs.net
Case Study At a recent meeting of NHS trust partners for the regional Clinical Research Network, one of the senior research managers highlighted a concern that since the provision of their local community services had been taken on by a social enterprise, a cohort study of patient outcomes had stopped and all emails to the social enterprises were not replied to. What issues are raised by this scenario and if the partnership group tasked you with obtaining a resolution to the problem, what actions would you take?