In Research


Year: 2019
Published in: Social Science & Medicine
Cited as: Caló, F., M. J. Roy, C. Donaldson, S. Teasdale and S. Baglioni (2019). “Exploring the contribution of social enterprise to health and social care: A realist evaluation.” Social Science & Medicine 222: 154-161.


Since the late 1990s social enterprises have been increasingly utilised as a means of delivering of health and social care services. However, there is little evidence on if, and how, provision by social enterprise might achieve positive health outcomes, particularly in comparison to other modes of delivery. In this paper, we draw upon the multiple perspectives offered by stakeholders involved in a rural social enterprise initiative based in Scotland, UK, and in a nearby comparator public sector organisation. Both types of organisation aim to increase the physical activity levels of people with chronic health conditions. In order to gain perspectives on the range of mechanisms and outcomes involved in different types of organisation providing similar interventions, realist evaluation of data gathered from in-depth semi-structured interviews (n = 68) was undertaken. Interviews were carried out with beneficiaries, service providers and external stakeholders and Context-Mechanism-Outcome (CMO) configurations developed to support our explanations for how, and in what ways, social enterprise might impact differently on health. Our findings highlight that the social enterprise is differentiated from the publicly-run service in two distinct ways: firstly, the social enterprise was better able to flexibly deliver a bespoke programme designed around the needs of service users; and secondly, their role as a community ‘boundary spanner’ helped facilitate strong ties and feelings of connectedness between beneficiaries, organisational staff and community stakeholders. However, these advantages were significantly compromised when funding was constrained. Our findings serve as an important basis for future research to better understand the means by which social enterprises might deliver health outcomes, particularly in comparison with public sector providers.

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Recommendations from this resource

Future Research

1) More studies should testing the results in different organisations with different characteristics in different settings with different forms of intervention. This will enable exploration of whether the impacts are related specifically to the social enterprise organisational form, or whether they are more related to the specific context in which the social enterprise operates.

Policy Makers

The advantages that come from the economies of scale inherent in state provision of healthcare can also prove to be a disadvantage at a community level.Flexible, bespoke services that are more closer and more connected to the community are more likely to be trusted and they could be more effective at performing certain roles. Investments should be made where the greatest health gains ca potentially be achieved. Social enterprises is worthy of attention as an alternative provider of health and social care provision due to their ability to work flexibility and act as a “boundary spanner” on behalf of beneficiaries