Research and analysis

Replication and Scaling of mutuals within Health and Social Care

Research commissioned by DCMS into the replication and scaling of the mutual model in health and social care.



Government has supported the growth of public service mutuals (mutuals) as part of a broader push to create a more diverse marketplace for public services. In this context, it is important to understand ways to reduce the time and resources required to spin out a mutual and to replicate successful mutual models at scale. 48% of public service mutuals operate in health and social care. Most of them are high performing organisations and score higher than average in their Care Quality Commission ratings. Early evidence suggests mutuals are well suited to being successful in health and social care, and government continues to build and assess the evidence base on mutuals.

This independent report has been commissioned by the Department for Digital, Culture, Media and Sport and was jointly produced by Baxendale and Mutual Ventures. It draws from relevant literature and the experience of existing mutuals and sector experts to:

  • identify the most successful mutual models in specific service areas
  • assess the viability of replicating these models at a scale
  • establish the most promising channels to drive widespread take-up

The recommendations presented in this report were informed by a literature review supplemented by over 20 in-depth interviews with subject matter experts and practitioners, and further validated by an expert advisory panel.

The report is designed to equip policy-makers with an understanding of the role mutuals can play as one model of service delivery within health and social care, and to provide practical guidance on how to support the creation of new mutuals.

While this report highlights the key risks and benefits of mutualisation, we recommend that individual services should develop a full business case to understand the implications of pursuing mutualisation or any other alternative delivery model. Mutualisation will not fit every context and each organisation needs to choose the model most appropriate for them and their service area.

Published 4 November 2019