Social enterprises and public health improvement in England: a qualitative case study.

OBJECTIVES: To explore the contribution of social enterprises to publicly commissioned public health improvement and assess the risks and benefits of their role.

STUDY DESIGN: Qualitative case study of four south London boroughs.

METHODS: Documentary research; in-depth interviews with 19 key informants.

RESULTS: This study identified 24 social enterprises that were currently commissioned to contribute to public health improvement. These organisations ranged in size, longevity, and structure. They were widely reported as flexible and able to rapidly develop services responsive to local community needs. Their work often addressed upstream health determinants. However, to capitalise on securing contracts, they had to bureaucratise and establish provider alliances, which risked losing the very characteristics that make them unique. Social enterprises bore the financial risk of innovative service developments. Emerging mixed economies of public health were fragmented, limiting commissioners' abilities to plan strategically and evaluate the impact.

CONCLUSIONS: Social enterprises have an increasing role in providing potential solutions to intractable health improvement challenges, contributing to a broader vision around upstream action for health. However, the fragmentation and growing outsourcing of public health has risks for coherent and equitable service planning.