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The social enterprise network meeting in London on Monday raised critical questions about the medium and long term development of social enterprise and third sector organisations in health and social care.

There are issues about the competitive disadvantages that small, start-up organisations face in competing for bigger, established providers. There are issues too about regulation and management of health markets. But as NHS Networks national lead and chair of Monday's meeting Edna Robinson was keen to emphasise, social enterprise can't be boiled down to a set of technical problems to be solved or procedural obstacles to be dismantled.

There are softer factors at work too. Everyone agrees that while no particular organisational form or structure confers virtue on the social enterprise model per se, that the aims and values of these organisations remain distinct from more conventional private and public sector models. In the newer emerging forms of social enterprise, such as the community interest company (CIC) the social mission is enshrined in regulation and is subject to the governance arrangements of the organisations concerned, which have boards of directors and non-executive members whose job it is to keep things on track.

That doesn't guarantee that all social enterprises will necessarily be of high quality or that the people running them will have a genuine commitment to their company's stated mission. Delegates at the event acknowledged that there are those that don't get it and never will and who are simply riding the wave.

The event provided some strong positives too. Among them, a whistle-stop tour of the policy aims of the Department of Health by director of system management and new enterprise Bob Ricketts, who left it in no doubt that the political will is there to encourage social enterprise and help overcome the remaining problems. He said that a level playing field was not enough to give social enterprises the chance to compete on equal terms for NHS contracts and that his aim was to create a fairer playing field tilted in favour of social enterprise where necessary.

Coming in the same week as the announcement that NHS budgets are to be trimmed by £2.3bn by 2011, the event was a reminder - if we need one - of the continuing economic gloom. Bob Ricketts struck a note of optimism here too, pointing out that small, lean-running, agile organisations are likely to flourish in an environment where bigger slower moving institutions may struggle.

The event demonstrated a clear requirement not just for continued support for social enterprises but for a parallel process to educate and inform PCT commissioners about the potential of social enterprise to begin to find solutions for intractable problems such as long-term conditions and end-of-life care. It is clear though that if that if PCTs are unwilling to use the support provided, there is a small army of new regulators, including the NHS Cooperation and Competition Panel, ready to intervene.

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