Managing Enterprise

In
Health and social care
By lovely Vargas Valera

Table of content
Title page 1
Table of content ..2
Introduction 3
1.1 systematically analyse the concept of entrepreneurialism3
1.2 critically evaluate entrepreneurialism as an agent of change in both public
and private health and social care sectors..3
2.1 investigate the key concept of demographic and epidemiology 4
2.2 critically assess the impact of key demographic trends and changes in the
Epidemiological environment on health and social care 4
2.3 identify the key sources of demographic and epidemiological data....5
2.4 investigate the key aspect of the social environment.......6
3.1 systematically analyse the culture of enterprise...7
3.2 investigate the nature and sources of power 7
3.3 differentiate between positive and negative aspect of politics.8
3.4 conflicts in collaborative working ...8
4.1 critically evaluate the effectiveness of change management style models
By applying them to a given organisation in health and social care9
4.2 investigate appropriate strategies for managing on-going change 10
4.3 critically evaluate these recommendations in the context of constraints
Of an health or social care organisation 11
Recommendation .11
Conclusion ..11
Bibliography 12=15

Introduction
Demographic and epidemiological trends have put more pressure in the UK healthcare
service. An increase of aging population and migration will cost the NHS more to treat extra
people. Life expectancy and mobility has increase in England and there has been fall in
mortality. People are living longer with long term conditions such as, cardio vascular cancers
and mental illness. The increase of South Asian migration in UK has brought more complex
diseases in England such as diabetes. The NHS is no longer sustainable the way they are
delivering the service, a need for change is compulsory. Various change models are used to
drive change in an organisation, the most widely used in the health care system is the Lewin`s
change model. The government has encourage social enterprise to drive change in the NHS
An enterprise culture can save the NHS for further deficit and thus keep on successful ongoing change by reducing financial constraints.

1.1Systematically analyse the concept of entrepreneurialism.

Entrepreneurship is well known for to develop in uncertain environments and right now, the
NHS is at most uncertain. With the reduce of resources and new unfamiliar market it was
essential to think a better way to deliver care.( O'Brien, C,2012,Entrepreneurship and the
NHS's untapped). Entrepreneurship exists because different people have differing ideas when
resources are turn from inputs to outputs. (Alvarez and Busenitz, 2001). It is recently claimed
that if managers adopt the entrepreneurial behaviour, while making strategies, the
organisation will face a brighter future (Lee and Peterson, 2000). The concept of
entrepreneurialism is essential for economic progress, as it show sit fundamental importance
in different ways. The NHS is now open to for business and prepares to export its national
treasures to foreigners to get more profit from abroad. (bmj.com, will expansion of NHS
abroad benefits UK patients). The Nottingham University Business School is running a two
day course Institute for Enterprise and Innovation (UNIEI) for nurses, HR staff, consultant,
team coordinators to become more innovative in other word to benefit the organisation.
(nottinghamshirehealthcare.uk, Invest to lead 2 yearbook) .The Social Enterprise Unit in the
Department of health encourages innovations and entrepreneurialism in health and social
care, that make progress in to meet patient and service user`s needs while achieving greater
value for money.(institute.nhs.uk,Social Enterprise) In Peter Druker`s view (1985),
entrepreneurship is neither a science nor an art. It is a practice. It is not about just making
money. It is all about imagination, flexibility, creativity, willingness to think conceptually,
readiness to take risk.

1.2 critically evaluates entrepreneurialism as an agent of change in both

public and private health and social care sectors.
In 2008, The Labour Government introduces the Right to Request a process through which
managers and clinician working in England could seek to develop a social enterprise to
deliver health service. (birmimgham.ac.uk, Social enterprise, spin out from English health
service ). The High Quality for ALL report (DH 2008), continued to connect to the idea of
Health entrepreneurs and social enterprise to enable staff to manage the organisation in
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which they work. The social enterprise investment fund was introduce to support existing
social to enterprise into extend delivery of health care. There are around 62,000 social
enterprise in UK which contribute 24 bn to the economy of the health and social care
( hsj.co.uk, 2014 , Running community hospital as social enterprise, ). The NHS chief
executive Simon Stevens, talk about changing Community Hospitals and he said what if
staff in your community hospital were not employ by the NHS but by the social enterprise .
The managing Director of Spiral Health, Tracey Bush, argues , give social enterprise a
greater role in the provision of health care and support staffs to save the NHS money and
bypass the law that hold back innovation. The Spiral health has a good relationship with the
GP and community team which benefit the patient from merging of health and social care. By
getting patient home quicker than acute ward, the organisation saves the NHS up to 2.7 m
per year and any money save are reinvested for better delivery service. Large private firm like
Hirmoni and Serco are preparing to bid to get contract and a coalition of 10 Gp out of hours
social enterprise in the North West, have join forces with the NHS. Dr Jenner ( member from
the NHS Alliance) stated partnering with a private firm make sense and long term contract
must be provided to help mitigate huge risks social enterprises face when they started.
Commissioners are more keen to see providers have more money available to redesign the
service and provide a high quality of care.

2.1 investigate the key concepts in demography and epidemiology.

Demography is the study of the size of human population, birth and mortality rate as well as
the structure of migration. (Caldwell JC 1960). The studies in demographic population create
the idea concerning requirements and resources developing good health. The Nuffield Trust
wrote a series of paper for the Policy Future in UK by examining the external environment.
They estimate the population in UK will be 61 million by 2015 and the government
projection of mortality rate is to fall and life expectancy will rise. The next to demographic
trend is epidemiological trend which shows countries health status. In UK most diseases is
related to life style and with an increase of mass immigration, UK is in a threat of allowing
all sorts of diseases and infection. (Nuffield.dh, 2014) The outbreak of Ebola virus has killed
over 4000 people in the West Africa. Since October 14th 2014 The UK government has
started screening passengers who come from infected countries in Heathrow to prevent the
virus to spread in the country. (bbc 2014, Heathrow start screening for Ebola). The concept
of Epidemiology is to monitor the physical condition of people in the development of medical
emergencies by geographical locations (Boeima JT, Holt E, Black Re, 2001). Since UK is the
the oldest region in the world. This will posed a great economic and political challenge in
UK (Squire 2002).

2.2 critically assess the key impact of demographic trends and the changes
in the epidemiological environment on the health and social care.
The two demographic changes which will affect the health in UK are the ageing population
and greater mobility of people. Globalisation will continue have complex effects on UK and
4

health on its population. (Nuffield.dh.,2014). The UK population is estimated to be 61 million

by 2015 and the mortality rate is falling with life expectancy is rising; this will be a threat to
inequalities to health and also financial pressure to the Government. Such growth will require
more staffs, hospitals, doctors, equipment and fund. The World Health Organisation (WHO)
carried out and assessment and suggested that the world`s major health problem will be
diseases such as cancer, infectious and parasites disease , circulation system , mental health
and visual impairment and external causes such as violence will increase the demand in the
health care system . with the growth of population , the environment will eventually get
over crowed thus resulting to poor hygiene and cause higher risk of spreading infectious
disease among the population.(WHO , 2014). Migration of South Indian continent countries
like Pakistan, Bangladesh and India is estimated over two million in UK. They are six time
more likely to have diabetes than white people. Researches have predicated an increase of 47
% by 2025 people will suffer from diabetes across England.(diabetes.org.uk, Diabetes Uk
and South Asian health Foundation).Up to 200 000 Bulgarians and Romanians has come to
UK since January 2014 . The migrants have cost up to 8000 each in the NHS care.
(telegraph.co.uk, 2014, End of free NHS care for migrants under the new bill ). The impact
of obesity or overweight has increase the risk of developing range of disease and have a
significant impact in the NHS cost.(noo.org.uk, The economic burden of Obesity, 2010). It
has been estimated by the National Obesity Observatory a cost of 991 million to 1,124
million to treat people who are overweight in 2009.

2.3 identify key sources of demographic and epidemiological data.

Since 1801 in England data of the general population is collected every ten years except in
1941. The demographic data includes age , gender , country of birth, educational level,
marital status ,migration patterns, ethnicity occupational status etc. are gathered in a census
which are collected on individuals and on households, in addition to census data , there are
other data which are collected to understand population health. The National Strategic
Tracing service data base contains information on, NHS numbers, name, address, poste code,
sex, date of birth, place of birth, GP and GP practice patient is registered with .
(healthknowdlege ,2010). The Office for National Statistic (ONS) carries out the census for
England and Wales, The General Register Office for Scotland (GROS) and the census for
Northern Island is conducted by the Northern Island statistics and research Agency (NISRA).
Epidemiological data come from various sources of routine data collected on a national or
regional basis such as, cancer registration, infectious diseases notifications, fertility and
death. The ONS annually published death certificates for Wales and England which underlay
the cause of death. The Morbidity Data may be utilized for epidemiological studies which
include the, Hospital Episode data, data from health surveys, cancer registration, laboratory
report of microbiological data, statutory notifications of infectious disease and morbidity
survey from general practice. The ONS plays a big role to collect and publish both
demographic and epidemiological data in UK which helps to understand population health.(
ons.gov.uk, Office for national statistic ).

2.4 investigate the key aspects of social environment.

The National children`s bureau summarise the key impact of social environment on children
and young`s people health. The Marmot Review (p78-81) stated, the more deprived is the
neighbourhood; it is more likely to have social environment which are risk to health. This
includes higher rate of crime, poor housing, and poorer air quality, lack of green spaces, nonhealthy eating and higher carbon emission. Some large evidence of social gradient to
behaviour relating diet, drugs, tobacco and alcohol. Furthermore 5% of the population who
are in low income report skipping meal whole day and lack of availability of healthy food is
associated to obesity. The Health Survey in England carried out a survey in 2012 and the
key fact was, there have been a decrease in psychical activity among the population and an
increase in gambling and drinking habits. Studies show that child obesity has increase across
all social class. (Bbc , 2013, Rise in child obesity related hospital admissions ) .
Doctors said UK has the highest rate of obesity in Western Europe. Professor Mitch Blair
considered of banning fast food near schools. The Wirral Primary care trust carried out a
survey on Child poverty. Children who are born with parents living in poverty are at risk of
health and nutrition. Children growing in poverty suffer from asthma, diabetes, cancers,
infections, lead poisoning, oral health example dental care, anaemia, mental health and
increase in mortality rate. Increase of illicit drug use among young people in UK is highest in
European Union (Hibbell et al, 2004). The WHO shows Britain`s drinking levels are among
the highest in the world. Internal research has found 44% British 15 years old girls are likely
get drunk on at least two occasions. (hscic.gov.uk, Statistic on Alcohol, England 2014 )
.

3.1 systematically analyse the culture of enterprise

Enterprise culture has been defined as a belief and assumption and behaviour of enterprises
mainly internal stakeholders.( Belak Janko , 2010).The Circle Group , a co-owned healthcare
company was awarded to run Hichingbroke Hospital , as an NHS hospital. Circle has an aim
of providing an Enterprise culture as well as implementing efficient operating process in
order to make their hospital more productive. The Care Quality Commission (CQC)
inspection report was satisfied in December 2012 as waiting list in A&E department was
reported among the best in England, with low mortality rate. The National Audit Office
(NAO) in November 2013 report the group made an early improvement in clinical are.
(nao.org.uk, The Franchising of Hichingbrooke health care NHS Trust ). The Chief
Executive of Circle Group, Ali Parsa said, he believes the NHS Midlands and East`s courage
and an enterprise culture will drive success in the organisation. With the new idea ,
innovation and belief it will be success for the NHS to have an enterprise culture as the
mission of re-engineer the delivery to make it better , simpler and smarter value to patient. An
organisation with enterprise culture is where people are creative, imaginative and not
reluctant to take risk. (Local Enterprise office). The Hichingbroke Hospital won coveted
prize for good quality, only two other hospital in the country has been awarded a prestigious
prize for food excellence. The hospital was named best trust in England for quality care in
May 15 2014 by the CHKS. The managing director of the trust said, a share commitment is
6

to drive an engineering culture throughout the organisation.( (hinchingbroke.nhs.uk,

hichingbroke Hospital News). Hofshed (2000) states enterprise culture is combined with the
organisation culture.

3.2 identify the nature and sources of power.

Power and leadership and closely link. But leaders have power for different reason as people
tend to follow those who have power. On more positive side leaders who have power can
influence others effectively because their source of power comes from their skills, knowledge
and experience. John French and Bertram Raven (1959) identify five bases of power.
(mindtool.com, 2014, French and Raven`s five forms of power)
1. Legitimate, it comes from the belief that an individual has the formal right to make
demands and expect obedience and compliance from others.
2. Reward , a person who has the ability to compensate other for their compliance
3. Expert, comes from a person`s superior , qualities, knowledge and skills
4. Referent, a person who is recognize by his attractiveness, worthiness and has right to
respect from others.
5. Coercive, it comes from the belief that a person can punish others for non-compliance.
Leaders in NHS must have exert power, as they are given the greater priority to patient and
engagement of staff. The need to use their skills and knowledge to operate within the team (
kingfund.org.uk , leadership and engagement for improvement in the NHS ). Tom Moriarty
(2011) explained the difference between position power and personal power. Position power
is given by the organisation where as personal power is given by people to a leader.
Source
Coercive power
Reward power
Legitimate power
Expert power
Referent power
Information power
Connection power

Type
Position
position
Position
Personal
Personal
Position and personal
Position and personal

A leader should consider these sources of power and integrate them appropriately and use the
best source of power to achieve success and effectiveness. Without a source of power there
would be no leadership. (plaintsevices.com, 2011, Human Capital, & sources of leadership).

3.3 Examine the value of conflicts arise in joint and collaborative working
and how they may be overcome.
To make joint and collaborative work effectively is one of the toughest challenges facing the
public sectors managers. (Audit commission 1998 p .5). Because joint working involved
distinct permitted services, each constrained by their own policies, code of practice and
financial limitation. Despite lots of beneficial support of joint working, there have been
conflicts across all clients group. (communitycare.co.uk, 2013, Join working). Some
examples are delayed in discharges mainly of older people where there is unavailability of
health and social care services in the community, or administrative problems in the hospital.
Continuous cut in the NHS the healthcare has led dispute between NHS and social care
professionals and reduce cost to the councils. Tom Gentry, the charity policy adviser said the
cut is going to affect individuals in many ways. Some areas in England councils have
remove social care staff from mental health team, which are run by mental health trusts
because of cost pressure. A five million healths and social care partnership collapsed in
Glasgow in May 2010, following a dispute between the local NHS board and the council over
their future direction. The Greater Glasgow and Clyde decided to stop the community health
and care partnership (CHCPs) and replacing them with arrangement covering healthcare
alone. The council came with a series of incremental measures to devolve responsibilities to
CHCPs; however the NHS said they would not offer a viable way forward. Other conflicts
in good partnership working include, health and social care agencies facing different
performances regime and using different IT systems. Health and social care staff being in
different conditions and terms in integrated teams. Under section 75 of the NHS Act 2006,
local authorities and NHS bodies in England can pool budgets, join together staff and
management structures and delegate commissioning responsibilities to each other. The NHS
must provide more fund to make availability of communities services for elderly people and
fund the councils as well give them power to control their own budget. (NHS ACT 2006 ,
s75).

3.4 differentiate between positive and negative aspects of politics.

The Department of health (DH) and the Cabinet Office have committed to fund and assist
more nurses and doctors and other public workers run community-tailored services. In June
2012 the DH, announced a further 19m over the years coming for Social Enterprise, on top
of the 100m which has been already invested over the last five years. (gov.uk, 19m for
social enterprise, 2012) The Health Secretary Jeremy Hunt said, Now is the time for
entrepreneurial public servant to take the initiative and push to ownership. The Minister of
Cabinet office , Francis Maude said many health services have benefits from becoming Social
enterprise for example Inclusion healthcare , a multiagency one stop shop for homeless team
people in Leicester , has reported better motivated staff who feel ownership of the business. A
10 million Mutual support program has been placed by the cabinet office to develop the
public sector worker run the service. The Government introduce the Right to Provide in 2011,
which give frontline line professionals more freedom to personalise and improve service
delivery in the public.(gov.uk, Equity and Excellence: liberating the NHS , 2010). During a
8

survey among 3, 628 health staff, only 5% thinks the reform has a positive impact. David
Bowers, senior research manager said the Health and social care act 2012 shows a clear
tension with the health service surrounding the need to make more efficiency. He added
money will remain tight for the future. Allowing social enterprise working in the NHS has
been also a disadvantage by public mistrust of private companies. (theguardian.com,2011,
NHS social enterprise, face a stiff challenge ). Companies who focus only on profit have
made it harder for Social Enterprise). Chief executive of Social Enterprise in London
,Allison Ogden-Newton said we dont want to be associate ourselves from stack high , sell
it cheap and if you ask most people if they wanted their hospital to be manage by Serco ,
they would say NO . (issu.com, ISSU- Financial time, 2014).

4.1 critically evaluate the effectiveness of change management models by

applying them to a given organisation in health and social care
Managing change in health care setting is always a big challenge although there are different
types of change management models and theories. The best used change management
models are Kurt Lewin`s model, Kotter`s model, Mckinsey model and recently the NHS
change management model has been created to lead change and transformation in the
organisation. The Brighton and Sussex University hospital use the Lewin`s model
(bsuh.nhs.uk, to view the report, Brighton and Sussex Hospital, Quality account 2012-2013)
to implement of Bar coded medication administration. Also referred as Lewin`s force field
analysis. The model consists of three stages, unfreeze, moving and freezing. In the unfreezing
stage the hospital identified the driving and restraining forces such staff resistance, lack of
computer experience and lack of organisation trust. Driving forces could be more investment
to provide training and diminish restraining forces.
In the moving stage, the Bar coding was implemented across the facility require sustained
effort from various team. It is recommended to actively involve nursing staff to create feeling
of ownership for the success of the change (Bozak 2003).it is also important at this stage
leader to monitor the change and any challenge will be resolved.
The freezing stage of lewin`s theory is the change practice has occur and its time for stability
( Bozak , 2003, p.84). An on-going support is continued by the hospital until it deemed
complete and all users are comfortable with the technology. By using the Lewins model of
change has effectively reduce stakeholders resistance and fear for change and the have
actively participate in the change process. The change has reduced medications errors in the
hospital and has put patient safety at their top priorities.

4.2 investigate appropriate strategies for managing on-going change in

organisation.
The NHS Improving Quality published a document on Our Strategic Intent in March 2013.
The change management process contains the three following phases.( england.nhs.uk, Our
strategic Intent, 2013).
1. Preparing for change( preparation , assessment and strategy development)
2. Managing change ( detail planning and change management implementation )
3. Reinforcing the change ( date gathering , corrective action and recognition)
Assessment tools are used by leaders to find out what is driving change in the organisation.
Leaders use Pestle (Political, Economic, social, technological, legal environment)and
SWOT( strength, weakness opportunity threat ) analysis to identify changes. These changes
are clearly informed to the employees through a communication plan to build awareness
around the need of change. Leaders must create a desire among the staff and explain them the
vision of the organisation why the change is necessary. The NHS must providing training and
coaching to develop requirement based knowledge, skills and a culture which is vital to
implement the change. Leaders must manage resistance throughout the on-going change
process in the organisation. By spotting the resistant early, understand the impact of change
on the employee, leaders must negotiate and allow the staffs to ask questions and involved in
decision making. Staff will learn about the need of change once the leaders will successfully
overcome the resistance. The employees will be more creative and take more responsibilities,
fully participate and engaged in dialogue in the change process. Measuring performance is
very important in the process of on-going change. Key Performance indicators are place to
monitor performance of employees on the process of change. Leaders should give more time
if necessary to staff to adopt the change and any success during the process should be
celebrate as well reward those employees who have perform well. Helen Bevan stated,
leaders must themselves be as a role model and motivates the staffs to change.

10

4.3 critically evaluate these recommendations in context of the constraints

of a health of social care organisation.
No strategy however can be successful without a good leader. The Health Secretary, Jeremy
Hunt said the difference between good and bad often lies on leadership skills. The Health
Education Yorkshire and the Humber published a document on Innov8 Fund to develop more
talent on leadership. The lack of budget or funding can stop good ideas before they start. Due
to lack of funding, they are unable to provide education, training and workforce development
which drive the highest quality of patient outcomes. The centre was unable to hire venue,
recruit more good leaders and do more research to develop staff because of lack of funding.
The NHS is facing the longest period of financial constraint in his history
(thetelegraph.co.uk. 2012, Waiting time rises as NHS facing crisis).It claims organisations
changes and loss of experience managers could leave the NHS due to financial pressure.
Leaders at all levels are facing a big challenge to manage on-going change and improvement
in the NHS. As the NHS has to save 20 bn by 2015, their pay is constrained Staffs are facing
a difficult period as they are at risk to lose their job or pensions. (bbc.co.uk, 2014, worrying
shortage of senior staf).Forthcoming report shows that there will be a shortage of workforce
between 22 % to 29% by 2022.(theguardian.com, 2012 , Motivate staff are the NHS`s best
medicine ) .studies has shown in 76 hospitals that , nurses has to rationed care because of
time constraints to properl look after patients.( the guardian July 2013 ). Given resources
constraints, the NHS Commissioning Board (CB) cannot meet the health need for every
patient. (england.nhs.uk, Ethical framework for priority, setting and resource allocation). All
the constraints mentioned above are barriers in the process of on-going changes in the NHS.

Recommendation
Due to financial constraints and changes in the demographic and epidemiological trends, it is
important for the government to continue to support social enterprise and invest more fund
and places for staff can deliver care with an enterprise culture which will benefit both the
NHS and the population. Leaders should themselves be as model and motivate them first and
drives change throughout the organisation.

Conclusion
Growth of population and change in the epidemiological trends in UK has put huge pressure
in the NHS. The government announced the right to request in 2011 to give staff rights to
directly manage the service through social enterprise. With the knowledge, skills and new
innovation by staff they will apply an enterprise culture which will drive change in the
service. Leaders must use appropriate change models and have a clear vision how to

11

successfully drive change in the organisation despite the constraints which the healthcare
service if facing.

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