the voice of NHS leadershipan uneasy consensus:patients, citizens and the NHSJune 2012 Paper 5                            ...
Building social value in the NHSSocial value – the theory              they are often one of the largest      integrated s...
Building social value in the NHSHow can the NHS generate social value?NHS organisations that become well embedded within t...
Building social value in the NHSNorth West Social                      Professor Henry Mintzberg’s8             Difficulti...
Building social value in the NHS                                                                                         C...
Building social value in the NHSencouraging local membership and         and dependence on health and           Conclusion...
Building social value in the NHS•	convening like-minded  organisations and partnerships                                   ...
Building social value in the NHSAcknowledgementsThe authors of this paper are Mike Farrar, chief executive, and Louise Gro...
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Building social-value

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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.

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Building social-value

  1. 1. the voice of NHS leadershipan uneasy consensus:patients, citizens and the NHSJune 2012 Paper 5 Paper 5 Building social value in the NHSKey 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. 2. Building social value in the NHSSocial 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-enterprisesSocial value means recognising employees live in the communities and building community assets,5that social outcomes, such they serve, and they frequently do looks at how small communityas stronger communities and business with local suppliers. All organisations can developimproved 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 ofsociety 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 realisedclaim policy success based on of health services at a time of at individual level but supportoutcomes achieved rather than need rather than being strong individuals to form groups andthose intended. But without a community partners. draw on community contributions.clear view of what outcomes arebeing 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 involvedconsistent way of knowing how to its challenges or conflicts with and trying to change and improveapportion funds2. The NHS, with existing policies and aspirations. services for yourself and yourall its economic muscle and social The first paper published in this family6. Commentators on socialstanding, must aim to create more series, Personal experiences, public value ask how user innovation cansocial value in the communities in value: changing relationships in be encouraged in health serviceswhich it sits. the NHS3, explores how people’s and what increased ‘voice’ mightIn these austere times, those on relationships with the NHS have mean for NHS policy, practice andall 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 activepublic services providing value attachment to the idea of the NHS communities may change thefor money, leading to a growing as a public service. Other papers dynamics between the NHS and theinterest in concepts such as ‘social in the series ask questions about citizens and patients it serves. Thisvalue’, ‘public value’ or ‘value community empowerment and the may be welcome but might alsoadded’. By defining this additional NHS, moving beyond ‘voice’ to a be uncomfortable for the vestedneed 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 andfor wider value creation, beyond Community empowerment professional behaviourssimply healthcare delivery, that Behavioural psychologists tell It is clear that embedding sharedare available to us as the largest us the optimal size for human decision-making, collectiveorganisation in the country today. group behaviour is very small involvement and generating moreIn short, we are having to think compared to the size of most social value out of NHS servicesdifferently about ourselves and NHS organisations. So how might means significant changes towhat 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. ItThe philosophy of social that establishing shared ‘mutual’ draws attention to the required models may create the kind of skills, capabilities and expertisevalue creation through overly bureaucratic structures the of clinicians and commissionersthe NHS aim of engaging communities is to effectively engage with theseFor the NHS, social value designed to remove? In future, if ways of working. Behaviourmeans developing the idea social value creation is designed change is required from boththat NHS organisations exist to place a greater emphasis on professionals and individuals withinwithin communities rather than stimulating more local suppliers, communities to shift towardsapart from them. Healthcare away from large monolithic more patient and public-centredorganisations need to be well monopoly providers, will this health services and thereforeembedded 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. 3. Building social value in the NHSHow can the NHS generate social value?NHS organisations that become well embedded within their communities have the opportunity to capitalise onthe 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 BetterImagine two identical health programmes serving deprived areas. Both are hitting their outcome targets, but oneis doing a whole lot more. Somehow, its service users are not just in better health, they are also happier and moreconfident. Some who were unemployed have found jobs, in some cases taking whole families off benefits, andthese families are eating better and taking more exercise. Their children’s attendance at school is better and theirresults are improving.It is obvious which approach is more satisfying for healthcare professionals and more attractive to cash-strappedfunders; Altogether Better’s community health champion approach is delivering this social value across Yorkshireand Humber. Its volunteer health champions work alongside the health and social care system to improve healthand wellbeing and transform the lives of people experiencing the poorest health. Altogether Better supportspeople to take responsibility and act for themselves to improve theirs and their friends’ and families’ health andwellbeing.The NHS Confederation is working with Altogether Better to support development of its work. For moreinformation, visit www.altogetherbetter.org.uk/home.aspxCase study: Bite Veg BagsBite is a partnership between Manchester Mental Health and Social Care NHS Trust and Manchester Mind thatsupports 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 bagcollection scheme. Organic vegetables are bought from New Smithfield Wholesale Market in Manchester andservice users pack them at North Manchester General Hospital, supported by staff and volunteers from the trustand Manchester Mind. Local people choose the size of bag they’d like and collect it from one of several locationsaround Manchester.www.harp-project.org/projects/project_bite_about.phpNHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012 03
  4. 4. Building social value in the NHSNorth West Social Professor Henry Mintzberg’s8 DifficultiesValue Foundation theory that most health and social Big organisations like the NHS tend care would be better delivered to find it difficult to add socialNorth West Social Value by third sector organisations or value because:Foundation, of which the NHS organisations that adopt a thirdConfederation’s Mike Farrar was sector ethos which fall somewhere • they are too large, anda founding member, launched in between what we usually consider insufficiently flexible to remain2010 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 ofIts board is made up of local NHS, The important difference, he diverse partnerships with othercivic and charity leaders, but argues, is that the public and organisations can most NHSthe foundation is separate from private sectors seek to serve bodies maximise their social valueactual NHS and local government constituencies – through citizens contribution.hierarchies. and voters, and consumers and investors respectively – while the Social value andThrough grants, loans and ‘help third sector seeks to engage with thein kind’, the foundation provides sustainability communities it serves.resources to encourage, support Social value and sustainabilityand sustain social innovation and Aspirations are inextricably linked and alocal social value initiatives. Its March 2012 King’s Fund paper, From this work, the Socialaccreditation award programme Sustainable health and social Value Foundation concludedrecognises excellence and progress care: Connecting environmental that large organisations likeon 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 atawareness among staff of their roles for example buying goods and the core of sustainable healthon social value, and a knowledge services locally and social care. The paper is clearmanagement service to provide that public expectations can playspecific intelligence across the • creating social value through a significant role in driving highlygeography of the NHS in the north creating an organisational resource-intensive and potentiallywest. Its partnership exchange culture that highlights the unsustainable practices, makingforum engages charity, voluntary importance and benefits for the it vital that sustainable care is notand other potential partners to community of adding social value equated with sub-standard careenhance existing relationships and in the public mind. And publicfoster other possible collaborative • realising social value that’s support will be important inarrangements. already there in community the context of increased patient resources, for example local choice, the growth of any qualifiedA social sector? professional sports teams provider, and movement towardsIn 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 building04 NHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012
  5. 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, supportivesupport for more sustainable to new providers, increasing social communities and supportiveapproaches 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 longthat communities with higher Community ownership has the and worthwhile journey in creatinglevels of social cohesion and value for our patients that has potential to develop while thestronger social capital may be social purpose.” social enterprise movement,more able to withstand the effects if supported and incubatedof natural disasters and extreme The creation of health and properly, could gather pace.weather. The role of organisations wellbeing boards (HWBs) willwith respect to the sustainability be able to make social value Social value is now enshrined inof communities is also worth part of the fabric of improving legislation through the Publicconsidering. The paper asks if health and wellbeing within their Services (Social Value) Actthere is a role for professionals localities across local authority, (see box on page 6). NHS, voluntary and private sectorin building community-levelresilience to the health effects of services. New opportunities NHS reforms are provided by strengtheningenvironmental change. Does the Putting patients and local decision- community engagement andNHS 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 interventionsfrom the combined effects of NHS reform programme. The new through joint health and wellbeingclimate change and rising prices forfuel, 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 consideringThe political environment increase social value to improve how they can improve the socialand NHS reforms health and wellbeing. value of their work.While many concerns havebeen expressed4 about the Dr Amit Bhargava, clinical Foundation trusts will have theGovernment’s Big Society policy, accountable officer, Crawley clinical added opportunity and freedomincluding its accountability, the commissioning group (CCG) and to engage with their localaim of opening up public services national co-lead, NHS Alliance communities by increasinglyNHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012 05
  6. 6. Building social value in the NHSencouraging local membership and and dependence on health and Conclusionhaving representative governors. social care and reduce socialBut this is by no means yet the isolation. The programme process Every year, the NHS benefits fromnorm and trusts can do much involves the trust working with a massive amount of tax payermore to exploit the community’s local social enterprises and social money and, as a nation, we arepotential and harness their assets. entrepreneurs. proud of our NHS and its coreThis may lead directly to more values, now enshrined in the NHSlocal health benefits but also to It is also true that in those Constitution. This places a moralgreater community regeneration organisations such as aspirant and economic obligation on us toand wealth over time. community foundation trusts create value. We have traditionally and the emergent community- defined health outcomes as theSalford Royal Foundation NHS based social enterprises, we have main value of the NHS, but mustTrust is working with the North organisations naturally given to now focus additionally on creatingWest Social Value Foundation understand and operate with and social value in the communities into develop solutions to address within their communities. There which we sit.how to enable people to care for is potential here for pioneeringthemselves to reduce demand approaches to social value creation. Added social value, created deliberately by the NHS, has the potential to enhance the wealthWhat 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 2012Social value is enshrined in legislation through the Public Services (Social If you have any queries orValue) Act 2012. The Act aims to strengthen the social enterprise business comments on this paper, contactsector and make the concept of social value more relevant and important nicola.rosenberg@nhsconfed.orgin 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. 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 programmeAny one of our existing members to ensure it meets their needs.can participate in this forumincluding attending events or The Ministry of Justice commissioned an evaluation10 as a first stepreceiving/debating papers online. towards developing a more robust evidence base for this potential newFor further information, please funding mechanism. The evaluation was published in May 2011.email socialvalue@nhsconfed.org.References1. National Association for Voluntary and Community Action (NAVCA). Introduction to social value3. NHS Confederation An uneasy consensus series. Personal experiences, public value: changing relationships in the NHS4. King’s Fund. Big Society, political philosophy and implications for health policy5. NHS Confederation An uneasy consensus series. Working locally: microenterprises and building community assets6. NHS Confederation An uneasy consensus series. Alive and clicking: information that benefits all7. King’s Fund. Sustainable health and social care: Connecting environmental and financial performance8. Henry Mintzberg www.mintzberg.org9. Social Finance. Peterborough Social Impact Bond overview10. Ministry of Justice Social Impact Bond evaluation www.justice.gov.uk/publications/research-and-analysis/moj/2011/social-impact-hmp-peterboroughUseful web linksAltogether Better www.altogetherbetter.org.uk/home.aspxBite www.harp-project.org/projects/project_bite_about.phpNorth West Social Value Foundation www.nwsocialvaluefoundation.orgTurning Point Connected Care modelwww.turning-point.co.uk/community-commissioning/connected-care.aspxAmbulance Service Network An involving service: ambulance response in urban and rural areaswww.nhsconfed.org/Publications/briefings/Pages/An-involving-service.aspxNHS Confederation annual conference and exhibition, 20–22 June 2012, Manchester www.nhsconfed.org/2012 07
  8. 8. Building social value in the NHSAcknowledgementsThe authors of this paper are Mike Farrar, chief executive, and Louise Grocott, senior editorial officer, NHSConfederation. We would like to thank all those who contributed towards this paper, which has been developed inpartnership with the Department of Health.Come and meet Mike Farrar and the other authors of the An uneasy consensus series at the 2012 NHSConfederation 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. @nhsc_conferenceFurther copies or alternative formats can be requested from:Tel 0870 444 5841 Email publications@nhsconfed.orgor visit www.nhsconfed.org/publications The NHS Confederation© The NHS Confederation 2012. 29 Bressenden Place London SW1E 5DD Tel 020 7074 3200 Fax 0844 774 4319You may copy or distribute this work, but you must give the author credit, you may not useit for commercial purposes, and you may not alter, transform or build upon this work. Email enquiries@nhsconfed.org www.nhsconfed.orgRegistered Charity no: 1090329Stock code: INF30201

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