Considering social enterprise involvement in the commissioning of health services in Shetland

Social enterprises are increasingly becoming involved in the commissioning of health services as the National Health Service in Scotland seeks more efficient and effective ways to care for an ageing population in a period of austerity. This development is of particular importance in rural areas where health services are being disproportionately affected due to funding cuts and health outcomes are suffering as a result. A geographic area of interest in terms of the inclusion of social enterprise in health strategies is Shetland. As a remote island group, different solutions to the provision of health services are required due to often inaccessible, ill-equipped and expensive statutory services. A history of available funding and ample volunteers has created a strong third sector that is able and willing to provide health services and which is increasingly adopting trading practices to ensure sustainability as non-traded income becomes scarcer. This research investigated the role currently played by social enterprises in the co-governance and co-management of health services in Shetland, what factors influence that involvement and how successful the commissioning process is seen to be. The findings shed light on the current role that social enterprises play in designing, delivering and managing health services in Shetland with implications for other rural and remote communities in Scotland.