Great overview of Social Value- and how organisations and services add social value to what they do. NHS biased- But then it is from the NHS. Great stuff nonetheless.

1. the voice of NHS leadership
an uneasy consensus:
patients, citizens and the NHS
June 2012 Paper 5
Paper 5
Building social value in the NHS
Key points Social value describes the social benefits achieved from public services,
and considers more than just the financial transaction. It includes
• Organisations can help create
wellbeing, health, inclusion and employment1. This paper develops what
social value when they engage
we understand by social value and what it means for the NHS.
with and involve their local
communities. Adopting an approach based on generating social value requires us
• For the NHS, it is about to change the traditional mindset of the NHS from one which sees
developing the idea that NHS communities and people as having needs, to one which understands and
organisations exist within empowers them as having assets. It also requires us to see that investing
communities rather than apart in health, like in education, is an investment rather than a cost, to the
from them. country and its inhabitants.
• The NHS reforms provide Healthcare organisations can help create social value when they engage
opportunities to increase social with and involve their local communities, rather than focusing on
value through enhancing the protecting their own organisational interests. Those that run with a more
opportunities of providers and social value focus engage people in running services and connect them
commissioners in the new with services provided within the resources available. This paper explores
system. what social value means for NHS organisations and asks if the NHS itself
• Social value is now enshrined in should operate more deliberately as a third, or social, sector organisation.
legislation through the Public
Services (Social Value) Act 2012. Intended to stimulate discussion ahead of and during the 2012 NHS
Confederation annual conference and exhibition, this paper is the last
in our series looking at interactions between the NHS, individuals and
communities. The first four papers explored: changing relationships in the
NHS; putting people first through shared decision-making; information
that benefits all; and micro-enterprises.
www.nhsconfed.org/2012

2. Building social value in the NHS
Social value – the theory they are often one of the largest integrated services?4 Our paper,
employers in an area, most of their Working locally: micro-enterprises
Social value means recognising employees live in the communities and building community assets,5
that social outcomes, such they serve, and they frequently do looks at how small community
as stronger communities and business with local suppliers. All organisations can develop
improved health and healthier this puts them in a strong position very personalised and cost-
environments, have a value to to engage with their communities, effective services. The gains of
society as a whole. In the past, but, in reality, many regard personalisation through micro-
policy-makers have tended to themselves simply as suppliers enterprise are not only realised
claim policy success based on of health services at a time of at individual level but support
outcomes achieved rather than need rather than being strong individuals to form groups and
those intended. But without a community partners. draw on community contributions.
clear view of what outcomes are
being aimed for, and how much
But aiming to create a more social Moving beyond ‘voice’
we value them, there can be no
value orientated NHS is not without ‘Voice’ means getting involved
consistent way of knowing how to
its challenges or conflicts with and trying to change and improve
apportion funds2. The NHS, with
existing policies and aspirations. services for yourself and your
all its economic muscle and social
The first paper published in this family6. Commentators on social
standing, must aim to create more
series, Personal experiences, public value ask how user innovation can
social value in the communities in
value: changing relationships in be encouraged in health services
which it sits.
the NHS3, explores how people’s and what increased ‘voice’ might
In these austere times, those on relationships with the NHS have mean for NHS policy, practice and
all sides of the political spectrum changed over the years, with priorities. Creating more engaged,
are understandably focused on increasing public expectation but more assertive, socially active
public services providing value attachment to the idea of the NHS communities may change the
for money, leading to a growing as a public service. Other papers dynamics between the NHS and the
interest in concepts such as ‘social in the series ask questions about citizens and patients it serves. This
value’, ‘public value’ or ‘value community empowerment and the may be welcome but might also
added’. By defining this additional NHS, moving beyond ‘voice’ to a be uncomfortable for the vested
need to generate social value, the more dynamic view of citizen and power bases within the service.
NHS is forced to think wider and patient engagement.
deeper about the opportunities Changing patient and
for wider value creation, beyond Community empowerment professional behaviours
simply healthcare delivery, that Behavioural psychologists tell It is clear that embedding shared
are available to us as the largest us the optimal size for human decision-making, collective
organisation in the country today. group behaviour is very small involvement and generating more
In short, we are having to think compared to the size of most social value out of NHS services
differently about ourselves and NHS organisations. So how might means significant changes to
what we can offer. this be overcome if the NHS is to the patient-clinician relationship
engage effectively? Is there a risk and the way care is organised. It
The philosophy of social that establishing shared ‘mutual’ draws attention to the required
models may create the kind of skills, capabilities and expertise
value creation through overly bureaucratic structures the of clinicians and commissioners
the NHS aim of engaging communities is to effectively engage with these
For the NHS, social value designed to remove? In future, if ways of working. Behaviour
means developing the idea social value creation is designed change is required from both
that NHS organisations exist to place a greater emphasis on professionals and individuals within
within communities rather than stimulating more local suppliers, communities to shift towards
apart from them. Healthcare away from large monolithic more patient and public-centred
organisations need to be well monopoly providers, will this health services and therefore
embedded in their communities; conflict with a desire for better improved health and wellbeing.
02 NHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012

3. Building social value in the NHS
How can the NHS generate social value?
NHS organisations that become well embedded within their communities have the opportunity to capitalise on
the social value and public assets that already exist. Below are some suggestions:
• allow employees to train and develop their engagement skills
• provide time and space for all relevant community groups (that use services) and sectors to come together
• provide civic leadership so that community groups can work together to include all sections of the community
• source food and other supplies from local suppliers. Manchester Mental Health and Social Care NHS Trust
works with Manchester Mind to produce Bite Veg Bags – see the case study below
• ensure the organisation adheres to corporate social responsibility principles, for example through responsible
investments
• take responsibility for environmental sustainability, for example through car share and cycle to work schemes,
and energy efficient building designs and solutions
• involve and make use of local volunteers such as first responder schemes in ambulance trusts
• make good use of foundation trust members and fully engage them in acute and community, ambulance and
mental health services.
Case study: Altogether Better
Imagine two identical health programmes serving deprived areas. Both are hitting their outcome targets, but one
is doing a whole lot more. Somehow, its service users are not just in better health, they are also happier and more
confident. Some who were unemployed have found jobs, in some cases taking whole families off benefits, and
these families are eating better and taking more exercise. Their children’s attendance at school is better and their
results are improving.
It is obvious which approach is more satisfying for healthcare professionals and more attractive to cash-strapped
funders; Altogether Better’s community health champion approach is delivering this social value across Yorkshire
and Humber. Its volunteer health champions work alongside the health and social care system to improve health
and wellbeing and transform the lives of people experiencing the poorest health. Altogether Better supports
people to take responsibility and act for themselves to improve theirs and their friends’ and families’ health and
wellbeing.
The NHS Confederation is working with Altogether Better to support development of its work. For more
information, visit www.altogetherbetter.org.uk/home.aspx
Case study: Bite Veg Bags
Bite is a partnership between Manchester Mental Health and Social Care NHS Trust and Manchester Mind that
supports people with mental health needs to participate in growing, cooking and marketing local food.
With mentoring support from Hackney’s Growing Communities project, Bite established a vegetable bag
collection scheme. Organic vegetables are bought from New Smithfield Wholesale Market in Manchester and
service users pack them at North Manchester General Hospital, supported by staff and volunteers from the trust
and Manchester Mind. Local people choose the size of bag they’d like and collect it from one of several locations
around Manchester.
www.harp-project.org/projects/project_bite_about.php
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4. Building social value in the NHS
North West Social Professor Henry Mintzberg’s8 Difficulties
Value Foundation theory that most health and social Big organisations like the NHS tend
care would be better delivered to find it difficult to add social
North West Social Value by third sector organisations or value because:
Foundation, of which the NHS organisations that adopt a third
Confederation’s Mike Farrar was sector ethos which fall somewhere • they are too large, and
a founding member, launched in between what we usually consider insufficiently flexible to remain
2010 to: to be the public and private sectors. in touch with their communities
Figure 1 on page 5 presents a and their issues and groups
• promote social value
model in which you can discuss the • they are subject to centralised
• support organisations that wish different sectors. For example, the
directives and non-negotiable
to learn more and implement it introduction of foundation trust
priorities that make it difficult to
membership and emerging new
• celebrate good practice across prioritise social value issues
approaches to commissioning that
the north west
involve commissioning of services • they tend towards a risk averse
• facilitate change by encouraging from both private and third sector culture with a reluctance to trying
funding for joint ventures between suppliers mean, he believes, that the new and novel ways of working.
community groups and the NHS. NHS is itself rapidly evolving into a
third, or social, sector organisation. Only by forging a range of
Its board is made up of local NHS, The important difference, he diverse partnerships with other
civic and charity leaders, but argues, is that the public and organisations can most NHS
the foundation is separate from private sectors seek to serve bodies maximise their social value
actual NHS and local government constituencies – through citizens contribution.
hierarchies. and voters, and consumers and
investors respectively – while the Social value and
Through grants, loans and ‘help third sector seeks to engage with the
in kind’, the foundation provides sustainability
communities it serves.
resources to encourage, support Social value and sustainability
and sustain social innovation and Aspirations are inextricably linked and a
local social value initiatives. Its March 2012 King’s Fund paper,
From this work, the Social
accreditation award programme Sustainable health and social
Value Foundation concluded
recognises excellence and progress care: Connecting environmental
that large organisations like
on adding social value locally. and financial performance7,
the NHS could aspire to add
sets out a range of research
social value in three ways:
The foundation also provides findings in this area.
an audit service to highlight • delivering social value as a by-
social value ‘readiness’ and raise product of mainstream business, Prevention, it says, must be at
awareness among staff of their roles for example buying goods and the core of sustainable health
on social value, and a knowledge services locally and social care. The paper is clear
management service to provide that public expectations can play
specific intelligence across the • creating social value through a significant role in driving highly
geography of the NHS in the north creating an organisational resource-intensive and potentially
west. Its partnership exchange culture that highlights the unsustainable practices, making
forum engages charity, voluntary importance and benefits for the it vital that sustainable care is not
and other potential partners to community of adding social value equated with sub-standard care
enhance existing relationships and in the public mind. And public
foster other possible collaborative • realising social value that’s support will be important in
arrangements. already there in community the context of increased patient
resources, for example local choice, the growth of any qualified
A social sector? professional sports teams provider, and movement towards
In the north west, engagement helping to get healthy living personalisation. It is key, therefore,
in this agenda was built around messages across. to engage patients in building
04 NHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012

5. Building social value in the NHS
Clinical Commissioning Federation,
Figure 1: The third sector option shared with us his CCG’s plans for
Two sector dichotomy strengthening social value within
G M their work. “The core business of
Government Market health and social care is to improve
(Public) (Private)
Sector
social value through technical
Social (Third)
Sector Engagement excellence, not only because it
(Social Value – is what our patients came to us
S
Community for, but also it is a way to reduce
Benefit) overall system risk by reducing
dependence and promoting
independence,” he said. “This is
the discussion that we have started
in Crawley CCG and, with our
Protection G M Consumption partners, we are in the beginning of
(Regulation/ Government Market (profit/loss) work on social value and diabetes,
Standards) (Public) (Private) and creating a dementia friendly
Sector town with local government and
the NHS. The intention is to create
supportive networks, supportive
support for more sustainable to new providers, increasing social communities and supportive
approaches to care. action and devolving power to environments for our patients,
local communities sits at the their carers and providers of care.
The King’s Fund points to evidence heart of the Government’s agenda. This is the beginning of our long
that communities with higher Community ownership has the and worthwhile journey in creating
levels of social cohesion and value for our patients that has
potential to develop while the
stronger social capital may be social purpose.”
social enterprise movement,
more able to withstand the effects if supported and incubated
of natural disasters and extreme The creation of health and
properly, could gather pace.
weather. The role of organisations wellbeing boards (HWBs) will
with respect to the sustainability be able to make social value
Social value is now enshrined in
of communities is also worth part of the fabric of improving
legislation through the Public
considering. The paper asks if health and wellbeing within their
Services (Social Value) Act
there is a role for professionals localities across local authority,
(see box on page 6). NHS, voluntary and private sector
in building community-level
resilience to the health effects of services. New opportunities
NHS reforms are provided by strengthening
environmental change. Does the
Putting patients and local decision- community engagement and
NHS have a role in ensuring that
making at the centre of the NHS is involvement through Healthwatch,
vulnerable groups are protected
key to the Government’s current and prioritising interventions
from the combined effects of
NHS reform programme. The new through joint health and wellbeing
climate change and rising prices for
fuel, food and water? bodies set up through the Health strategies. Many shadow health
and Social Care Act 2012 can and wellbeing boards, including
take on this new mindset to help Hackney, are already considering
The political environment increase social value to improve how they can improve the social
and NHS reforms health and wellbeing. value of their work.
While many concerns have
been expressed4 about the Dr Amit Bhargava, clinical Foundation trusts will have the
Government’s Big Society policy, accountable officer, Crawley clinical added opportunity and freedom
including its accountability, the commissioning group (CCG) and to engage with their local
aim of opening up public services national co-lead, NHS Alliance communities by increasingly
NHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012 05

6. Building social value in the NHS
encouraging local membership and and dependence on health and Conclusion
having representative governors. social care and reduce social
But this is by no means yet the isolation. The programme process Every year, the NHS benefits from
norm and trusts can do much involves the trust working with a massive amount of tax payer
more to exploit the community’s local social enterprises and social money and, as a nation, we are
potential and harness their assets. entrepreneurs. proud of our NHS and its core
This may lead directly to more values, now enshrined in the NHS
local health benefits but also to It is also true that in those Constitution. This places a moral
greater community regeneration organisations such as aspirant and economic obligation on us to
and wealth over time. community foundation trusts create value. We have traditionally
and the emergent community- defined health outcomes as the
Salford Royal Foundation NHS based social enterprises, we have main value of the NHS, but must
Trust is working with the North organisations naturally given to now focus additionally on creating
West Social Value Foundation understand and operate with and social value in the communities in
to develop solutions to address within their communities. There which we sit.
how to enable people to care for is potential here for pioneering
themselves to reduce demand approaches to social value creation. Added social value, created
deliberately by the NHS, has the
potential to enhance the wealth
What does this mean for your organisation? and wellbeing of our communities
and the people within them.
• Can you see the benefits of increasing social value? This creates a virtuous cycle of
• What are the drawbacks? added health benefit and wealth
creation, and the opportunity to
• What is your organisation doing to increase social value? enhance further the social value
we create. Up to now, the NHS
• Would you like to participate in the social value forum?
has underestimated its role in
• Do you have a proposal for consideration for a social impact bond? this regard but now we have the
opportunity and the obligation to
lead; an opportunity that must not
be missed.
Public Services (Social Value) Act 2012
Social value is enshrined in legislation through the Public Services (Social If you have any queries or
Value) Act 2012. The Act aims to strengthen the social enterprise business comments on this paper, contact
sector and make the concept of social value more relevant and important nicola.rosenberg@nhsconfed.org
in the placement and provision of public services. It:
• places a duty on the Secretary of State to publish a ‘national social
What is the NHS
enterprise strategy’ to encourage engagement in social enterprise Confederation doing on
social value creation?
• requires public services procurement, including the NHS, to consider
how what is proposed to be procured might improve the economic, We plan to establish a national
social and environmental wellbeing of the area to be covered by the social value forum with the explicit
contract. objectives of:
• amends Section 4 of the Local Government Act 2000 so that local • advocating and promoting the
authorities are required to include in their sustainable community role of the NHS in social value
strategy proposals for promoting engagement with social enterprise creation
in their area. They must also include a statement of the measures • promoting best practice among
suggested to enable social enterprise to participate in implementing members
these proposals.
06 NHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012

7. Building social value in the NHS
• convening like-minded
organisations and partnerships
Social impact bonds
between and within the NHS to A social impact bond9 is a contract with the public sector whereby it
take forward the agenda commits to paying for improved social outcomes. Investment is raised
from socially-motivated investors who receive payments from the
• highlighting and accrediting
Government if social outcomes improve.
achievements
• matching socially-minded A social impact bond programme at HMP Peterborough was launched
organisations with potential new in September 2010 with the aim of reducing short-term prisoner
funding sources reoffending. Sixty per cent of Peterborough’s short-sentence prisoners
• providing a service to convert reoffend within a year of their release, many into the local area, but they
good local ideas into investable receive little statutory support to address the causes. The social impact
ready propositions such as social bond programme is available to all short-sentence male prisoners leaving
impact bonds (see the box) and HMP Peterborough. It is not compulsory, but participation is high and
socially motivated investment. results are measured on all those released, whether or not they’ve taken
part. Prisoners were involved in developing the model for the programme
Any one of our existing members to ensure it meets their needs.
can participate in this forum
including attending events or The Ministry of Justice commissioned an evaluation10 as a first step
receiving/debating papers online. towards developing a more robust evidence base for this potential new
For further information, please
funding mechanism. The evaluation was published in May 2011.
email socialvalue@nhsconfed.org.
References
1. National Association for Voluntary and Community Action (NAVCA). Introduction to social value
3. NHS Confederation An uneasy consensus series. Personal experiences, public value: changing relationships
in the NHS
4. King’s Fund. Big Society, political philosophy and implications for health policy
5. NHS Confederation An uneasy consensus series. Working locally: microenterprises and building
community assets
6. NHS Confederation An uneasy consensus series. Alive and clicking: information that benefits all
7. King’s Fund. Sustainable health and social care: Connecting environmental and financial performance
8. Henry Mintzberg www.mintzberg.org
9. Social Finance. Peterborough Social Impact Bond overview
10. Ministry of Justice Social Impact Bond evaluation
www.justice.gov.uk/publications/research-and-analysis/moj/2011/social-impact-hmp-peterborough
Useful web links
Altogether Better www.altogetherbetter.org.uk/home.aspx
Bite www.harp-project.org/projects/project_bite_about.php
North West Social Value Foundation www.nwsocialvaluefoundation.org
Turning Point Connected Care model
www.turning-point.co.uk/community-commissioning/connected-care.aspx
Ambulance Service Network An involving service: ambulance response in urban and rural areas
www.nhsconfed.org/Publications/briefings/Pages/An-involving-service.aspx
NHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012 07

8. Building social value in the NHS
Acknowledgements
The authors of this paper are Mike Farrar, chief executive, and Louise Grocott, senior editorial officer, NHS
Confederation. We would like to thank all those who contributed towards this paper, which has been developed in
partnership with the Department of Health.
Come and meet Mike Farrar and the other authors of the An uneasy consensus series at the 2012 NHS
Confederation annual conference and exhibition.
Annual Conference &
Exhibition 2012 Manchester Central 20–22 June 2012
Join us as we bring together leaders from across
the health service to discuss and debate the latest
topics affecting the NHS, including:
• delivering high-quality care www.nhsconfed.org/2012
• rising to the financial challenge
• integration and working with partners NHS Confederation annual
• how the system is shaping – looking to the future conference & exhibition 2012
• leading and supporting your workforce.
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