The global aging demographic is putting pressure on state-delivered health and social care services. As the austerity agenda in the UK cuts state-funded service provision for older people despite increasing demand, social enterprise has become a politically and economically attractive model for the sustainable delivery of some public services. Yet little is known about the impact of social enterprise on the health and wellbeing of older people. In this paper we address this gap in understanding and consider social enterprise activities as complex public health-promoting interventions. Our study aimed to understand what impact social enterprise activities had on the health and wellbeing of participants aged over 50, and also how that impact was created. To achieve this, we conducted qualitative semi-structured interviews with a sample (n = 43) of staff, volunteers, clients and carers aged over 50 who were involved in activities delivered by three social enterprises. Using a thematic analysis to explore manifest and latent themes, two antecedents of subjective younger age emerged explaining how benefit was created, namely downward social comparison and identity. The social enterprise activities we studied benefited participants' health and wellbeing, impacting positively on participants' sense of purpose, social support, connectedness and inclusion. These health and wellbeing benefits can be considered as outcomes of complex public health interventions for older people, and we relate these outcomes to beneficial conditions within the intermediary social determinants of health. We conclude by discussing the future impact of social enterprise activities and current UK policy on the structural determinants of health.
Purpose In Scotland, the self-directed support (SDS) legislation is a catch-all payment system which brings challenges to local authorities, service delivery organisations and the service users it is intended to empower. Set against a backdrop of cuts to local authorities and third-sector funding, this policy presents third-sector organisations with both the opportunities and challenges of commercialising their activities to become more sustainable. The purpose of this paper is to provide evidence of the challenges faced by one charity as it engages in a process of hybridity to accommodate changes in its funding due to the introduction of SDS. Design/methodology/approach The paper utilises a case study approach. The paper captures the experiences and views of managers, staff and parents advocating for their children through interviews with a purposive sample from each group. The challenges of gathering data and giving a voice to caregivers advocating for children with complex needs are discussed, particularly the difficulties in accessing a hard to reach group. Findings The findings identifies issues which have arisen because of the proposed changed in strategic direction of the organisation due to the introduction of SDS and are all related to hybridity. The findings are arranged in four sub-sections based on the themes that emerged from the qualitative data generated from the interviews: the practical delivery of care; tensions between care and quality, the care workforce, and the parent perspective. Research limitations/implications SDS policy has had unexpected impacts and reactions whilst rolling out across regions in Scotland, but policymakers and those involved in the care sector, including consumers, face significant challenges in gathering evidence not only from the vulnerable populations this policy affects but also from organisations already under pressure from austerity-led cuts. This paper presents the challenges to organisations involved in caring for children with complex needs, who are a particularly neglected group of stakeholders. Practical implications Organically arising barriers to organisational transition from charity to social enterprise are presented, as staff and caregivers react to the prospect of SDS uptake affecting their organisation. Proactive attempts to embrace a hybrid approach by the organisation are analysed. Social implications Understanding how social care organisations and clients are reacting to the implementation of individual payments as opposed to the previous system of block contracts is crucial as the sector faces very real prospects of organisations closing when individuals are able to pick and choose care. A policy based on choice and control for the consumer risks removing choice through a loss of services in the marketplace, leaving vulnerable populations at risk. Originality/value This study is unique. No research has been done exploring the transition of charities servicing children with complex needs in anticipation of self-directed payments creating an open market. The paper further contributes to the existing knowledge regarding hybrid organisations within the third sector.
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