With the coalition government intent on prising open up the NHS to competition, the growing number of co-ops delivering healthcare services are now proving that there is a viable alternative to the private shareholder-led providers.
The latest figures from Co-ops UK, the trade body representing the co-operative economy, show that there are currently just under one thousand healthcare co-ops operating within the NHS with a combined turnover of over £600m.
One of the leading healthcare co-ops is Salford-based Unlimited Potential which, according to the national Social Enterprise 100 Index, is the second fastest-growing social enterprise in health and social care in the UK.
"We provide social innovation for happiness," states Chris Dabbs, chief executive of Unlimited Potential which operates in one of the most deprived parts of the UK and which now employs 30 people full-time with an annual turnover of more than £1m.
The business which is run as an industrial provident society comes up with innovative solutions for people with seemingly very difficult long-term mental or physical problems with a focus on getting earlier diagnosis of cancer and heart disease for its target client group.
One of the most successful schemes has been the promotion of smoke-free spaces which in turn has led to a dramatic reduction in the number of people smoking.
"With just a short ten minute intervention we link local people with the impact of their smoking on something that they love such as their kids and sign them up to have a smoke-free home or car," describes Dabbs.
Of the three thousand households who joined the scheme, one in six had quit smoking six months later, a success rate which outstrips that of more conventional anti-smoking programmes.
Dabbs believes that being a IPS offers a key benefit. "Our ethics and social mission is absolutely at the core of everything we do," he says. "When we approach our funders I can give a cast-iron guarantee that everything we do benefits the local community."
Dr Guy Turnbull, business development director at the Sunderland-based Care And Share Associates says that their employee-owned business structure makes sound business sense:
"Because our employees have a share in the business our staff turnover is much lower than the private sector and overall our business model yields significant benefits on performance," says Turnbull.
"This is crucial in health care as you aim to have continuity of support as you want to have the same person toileting you every day. Plus as we have no external shareholders we can reinvest our surpluses in staff development and training."
CASA, which provides domiciliary care for the elderly as well as adults with varying disabilities, operates one of the UK's most successful social franchises with six businesses across the north of England and now employs almost 600 people.
The group received a major boost last year with a £200,000 investment from London-based investor Bridges Ventures through its Social Entrepreneurs Fund.
"The funding was incredibly important," says Turnbull who has ambitions to make CASA the John Lewis of the social care sector.
"We'd reached a size where we needed access to investment which would take us up to the next level and we wanted somebody else to share the risks across the business."
One of the healthcare sectors where co-ops have a dominant presence is that of out-of-hours emergency healthcare.
Formed from the merger of seven existing GP out-of-hours co-operatives in 2004, Local Care Direct is now one of the most successful social enterprises commissioned by the NHS providing a range of Urgent and Primary Care services to 2.5milion people across West and North Yorkshire.
The group which operates as a community mutual, employs almost 800 people and has a turnover of just under £20million.
"Our central belief is that patients should come first unlike the private health care provider companies who have a duty to their shareholders and we felt that we didn't want patients not being put first," says director Andrew Nutter explaining the background to the formation of the company.
"Plus health care professionals wanted the local community and that included themselves as local GPs, to retain an important influence on the service and the way it's provided."
But so long as they are being well looked after, does it really matter to a patient if a healthcare provider is a private company or a co-op?
"It's absolutely crucial," answers Turnbull.
"Our strap-line is people before profit. Care is about people and not about stripping out profit. The recent debacle involving private health care providers such as Southern Cross was underpinned by the desire to maximise profit and if this is your main motivation then you're not going to deliver a long-term resource for the community."
And what about the future, is the co-operative sector likely to bloom under a new-look competitive NHS?
"Politicians like to portray the image that they're supportive of social enterprises operating within the NHS," says John Harrison chief executive of Northern Doctors which delivers out-of-hours care to 1.5million people across the north east and which employs over 600 staff.
"However if the government really wanted social enterprises to be a significant deliverer of services within the NHS, then they would open up the NHS to social enterprises in the same way that they've opened up the NHS to the private sector. One thing they should be doing is setting targets for the level of service of social enterprises within NHS."
Harrison says that many people are uncomfortable with commercial organisations delivering clinical services in the NHS and that social enterprises are able to offer NHS commissioners with an alternative.
"There's a fantastic opportunity for the NHS to help grow the social enterprise sector," says Harrison.
"The NHS is big enough for everybody, we just need to ensure that we have the opportunity to make a contribution."
Dr John Horrocks, chief executive of Urgent Health UK, which represents 15 urgent out-of-hours co-ops agrees, with John Harrison, saying that the nature of NHS commissioning favours the bigger, better funded private health care companies.
"Until there's a better alignment with the government's stated intentions on social enterprises within the NHS and the actual process of awarding contracts, then the sector faces a difficult future."
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