Pushing enterprise and entrepreneurship in the delivery of rural public services: the case of education and health services

Purpose
As entrepreneurship and market mechanisms are increasingly seen as a central part of public sector reforms to health and education, this chapter examines the entrepreneurial behaviour of public service providers in rural areas of the United Kingdom. Specific questions to be addressed include: How do rural providers (GPs, hospitals, schools) respond to the ‘market’ for provision of public services in rural areas? What are the constraints in acting entrepreneurially in these rural ‘markets’?
Methodology/approach
This chapter draws on a review of the literature and an empirical study of health care providers and schools with an emphasis on provision in rural areas and non-metropolitan urban areas. The results are based on 130 interviews with public, private and not-for-profit sector providers, and commissioners in health and education. Providers interviewed include schools, primary health care providers (General practitioners) and hospitals.
Findings
The challenges facing rural provision are examined. In terms of income generation providers reported the difficulties in having the critical mass required to keep services viable. There was particular attention to finding ways of diversifying income sources to increase turnover. Providers for rural areas are also having to find ways of coping with increased costs compared to urban providers, with limited account taken by the commissioners/buyers of services. The constraints related to introducing entrepreneurial behaviour to individuals who are resistant to risk taking and innovation based on market forces are also examined.
Research limitations
The work is based on a qualitative survey of a number of sectors. Further larger sample work is required to explore the propositions identified in more detail. The policy context has also been changing, with a need to identify how changes in government have affected the nature of entrepreneurship in public services.
Practical implications
The chapter provides policy implications and insights for providers of rural public services. There is a need to encourage diversity of income sources and to encourage collaboration between providers. There is also a need to identify where entrepreneurs in the public, private and social enterprise sectors are unwilling to deliver.
Originality/value
The chapter identifies key theoretical issues related to the role of enterprise in delivering public services. Further insights are provided regarding the role of rurality on both enterprise behaviour and public service delivery.