Creating healthier, more resilient communities and reducing our environmental impact are essential elements in delivering a more sustainable NHS. These ambitions are reflected in the four core aims assigned to integrated care systems (ICSs), which are to improve outcomes in population health and healthcare, tackle inequalities, enhance productivity and value for money, and support broader social and economic development.
The NHS has set an ambitious target to become net zero by 2040, while public bodies have had legal responsibility to commit to the social, environmental and economic sustainability of their communities for many years. As a result, social value and environmental commitments are increasingly embedded in procurement and other legislative requirements. But how we translate these often fragmented commitments into quantifiable achievements is less clear. Social value could have a major role to play in tackling our most pressing health and social care challenges but this will require ICSs to adopt a more cohesive and proactive approach.
Seizing opportunities
Social value advocates for looking much more broadly at the wider determinants of health and considering how system partners can work together to achieve more for their communities. This holistic approach encompasses social, economic and environmental areas such as education, housing, work, crime and community services, and how these connect and contribute to the overall wellbeing of an area and its population.
Using population health data to inform priorities, system-wide collaboration gives health, public and voluntary sector organisations an important opportunity to develop a coordinated, strategic approach to delivering social value. This requires bringing the right mix of skills and disciplines together to identify programmes that will have the greatest impact, and mapping out the connections that need to be made for this to work. We know, for example, that poor quality housing can affect health. The health service could invest resources in treating a patient’s pneumonia only to discharge them back to their draughty or damp home, which is likely to cause a return to ill health. Similarly, if a voluntary organisation runs activities to help tackle social isolation but people cannot afford the transport to get there, the initiative won’t achieve its aims, despite appearing on paper to meet population needs. Sharing information and planning interventions across system partners creates opportunities to break these vicious cycles and move towards disease prevention and wellness.
Agreeing priorities
Organisations will typically have specific activity, savings or outcome targets to meet, or be used to working in certain ways. This is where data can help identify common challenges and demonstrate the value of becoming more aligned. What are your staff surveys telling you about workforce priorities? What recruitment and retention pressures does your system face? Where are the gaps in your health provision? Which patients are driving demand and which communities are you not reaching? Engaging effectively across your ICS, and with your patients and communities, will help determine priorities at system, place and organisational levels.
Some initiatives may be unique to individual organisations or communities but aligning them to a broader set of strategic priorities will make it easier to evaluate overall impact and share learning. In Coventry and Warwickshire ICS, for example, the ICB is taking a system-wide approach to tackling health inequalities, drawing on partners’ roles as anchor institutions to deliver social value across the region. They are establishing a charter that aims to act as a framework, enabling each partner organisation to do what it needs to do meet its own requirements, albeit contributing to a wider strategy to deliver a more proactive and sustainable health and care service. The charter aligns to their long term planning process while giving a specific approach to delivering social value through an overarching framework.
In Cheshire and Merseyside, the ICS developed a Social Value Charter which defines what social value means to them, using a coproduction approach that enabled system partners, voluntary organisations, the private sector and citizens to contribute. The Charter sets out the principles and approach signatories sign up to, including how social value will be measured using a Social Value Outcomes Framework.
Making suppliers part of the solution
Setting social value priorities helps organisations seek meaningful contributions from suppliers. To fulfil procurement requirements, bidders are commonly required to come up with social value initiatives and carbon reduction plans which tend to be silo projects that are difficult to monitor and manage. By inviting them to show how they would contribute to your existing social value priorities, your system can start to harness a collective contribution towards priority programmes which can be measured and evaluated against agreed criteria. This means working with procurement colleagues much earlier in the commissioning process and challenging established ways of working that prioritise savings and lower cost contracts. If your system has prioritised paying a real living wage, for example, contracts need to be assessed not just for efficiency but for the long-term, wider benefits that may come with using suppliers that pay their staff well.
Measuring impact
Social value is not about quick wins but long term sustainability. It requires taking a step back from continuous day-to-day pressures to consider initiatives that it may take us years to fully benefit from. This makes measurement even more important – we need to be able to see steps towards achieving sustainability goals, which in turn will lead to better, broader outcomes. NHS Arden & GEM has been working with the Social Value Portal to adapt their social value themes, outcomes and measures system (TOM system) for healthcare which incorporates five key themes:
- Jobs – opportunity for all
- Growth – inclusive growth
- Social – empowering communities
- Environment – safeguarding and restoring our world
- Innovation – new ideas to deliver social value.
The TOM system is endorsed by the Local Government Association and maps to both major external frameworks and the Government Social Value Model. Using robust data, proxy values are applied to each objective and outcome which helps organisations convert their progress into a quantifiable value. Using consistent standards across systems enables more reliable assessment and benchmarking, which in turn will strengthen best practice and accelerate learning across regions.
Where to start
ICSs and their individual partner organisations will be at different stages of maturity and will have varying support needs. In recognition of this, NHS Arden & GEM has established a Social Value Network to encourage information-sharing and innovation across England, and a Future NHS social value workspace where organisations can access free resources. More recently, we have partnered with the Social Value Quality Mark CIC and the Social Value Portal to create the Social Value in Health Excellence Programme, providing independent assessment, support and monitoring to help organisations move successfully through their social value journey. This is not about adding to the to do list, but about developing best practice in social value to help ICSs deliver the four core aims they are already tasked with.
Understanding and adopting a system-wide approach to social value has the potential to deliver significant strides towards preventative care but it’s not an overnight solution. Although today’s pressures must be tackled, it is equally important to build the knowledge and confidence needed to make long-term investments in social value that will improve community health and resilience in the long term.
You can read the original version of this article on the Integrated Care Journal website.
Read more about our social value support here.
