The passing of the Health and Social Care Act - the largest upheaval to our health system in recent history - leaves an uncertain future for the way in which the UK's health services will be delivered.
One thing is certain; the increase in outsourcing to external contractors is leading to fears that the reforms are simply privatisation through the back door.
It would not be entirely wrong to think this way. Barely has the legislation got off the ground and we are already seeing private sector giants picking up million pound contracts. Serco has just secured a deal worth £140m to deliver services, including community nursing and specialist children's services, across Suffolk.
But as the private sector rapidly swoops in to capitalise on the reforms, another sector has been quietly making headway in the delivery of quality health services - but crucially, without putting profits at the heart of its agenda.
The social enterprise sector is delivering more and more public services and is proving to be an effective guardian of our health services.
Central Surrey Health's Track Record
In the past 15 years we have seen an increase in the number of social enterprise spin-outs, where teams of staff move out of the public sector and set up independent organisations, which then sell back their services.
More recently, under the government's right to request policy, nearly 40 social enterprises have been established to deliver primary and community services.
One of the pioneers was Your Healthcare, previously Kingston PCT in Surrey. Although it has only been operating as a social enterprise for less than two years, it is already seeing considerable results.
For example, by reinvesting 89% of its resources into frontline services, it has extended its rapid response service, which now responds within two hours, helping to prevent unnecessary hospital admissions.
Despite social enterprises delivering excellent patient care and reinvesting their resources, they remain poorly understood and are regarded with suspicion by some in the NHS. It is now more important than ever for the social enterprise sector to set the record straight and rid itself of any misperceived association with the privatisation of our health services.
Although social enterprises are businesses, they differ fundamentally from private sector providers. Their focus is on their social impact, which defines and guides the services they provide.
Simply put, they are organisations that exist to benefit society, and are accountable to local communities and to their staff.
The benefits of using a social enterprise are hard to argue against - a service provider whose profit goes back into their services and the communities they serve makes obvious sense.
It steers the NHS towards a locally accountable, staff controlled service model. But most importantly, health services exist to benefit patients and communities, not to line shareholders' pockets.
With the passing of the Public Services (Social Value) Act in February, which will require public bodies, including clinical commissioning groups (CCGs), to consider the social value created when services are commissioned, we should hopefully begin to see more social enterprises delivering services.
But there are challenges for social enterprises wanting to maximise the opportunity presented by this legislation. Faced with competition from heavily capitalised private firms such as Serco and Virgin Care, social enterprises must do all they can to prove their effectiveness, so CCGs take them seriously.
One social enterprise with a strong track record is Central Surrey Health, the first to spin out from the NHS in 2006. It provides therapy and community nursing services in central Surrey.
Its productivity has increased annually. In 2009 alone, it identified and removed £1m worth of inefficient systems and processes that were taking up clinical time, which could be better spent on direct care.
By setting up as a social enterprise, Central Surrey Health has not only been able to maintain and improve existing services and care, but also to reinvest surplus profit in new services that benefit local communities.
Social enterprises, unlike private sector providers, ensure services stay in the hands of staff who are focused on delivering quality health services, not financial return. It is essential that CCGs consider this when awarding contracts. It is now time for social enterprises to step in and prevent profiteering becoming the driving force behind our healthcare system.
- Ceri Jones is head of policy at Social Enterprise UK, the national body for social enterprise, and will be speaking at Fit for the Future on 17 May – an event for healthcare professionals.