This document discusses launching a social impact bond to expand supported employment programs for people with mental health issues in Staffordshire County, UK. It describes the key steps taken to develop the social impact bond, including understanding the social issue, defining the intervention and outcomes, building the business case, designing the program and outcome tariffs, and engaging investors. The social impact bond is intended to scale up Individual Placement and Support (IPS) services, an evidence-based supported employment program, to help more people with mental health conditions obtain and maintain meaningful employment.

1. LAUNCHING A SOCIAL IMPACT BOND IN MENTAL
HEALTH AND EMPLOYMENT
DECEMBER 2015

2. © Health and Employment Partnerships 2015
INTRODUCING SOCIAL FINANCE AND HEALTH AND
EMPLOYMENT PARTNERSHIPS
Not-for-profit social enterprise,
founded in 2007
Designed / developed first Social
Impact Bond
Work across multiple issue areas,
including employment, health &
social care, children’s services
Mobilised ~£100M socially-
motivated investment; £33M
contracts under management
Social purpose company, set up by
Social Finance
Aims to help people with health
issues to improve wellbeing by
achieving sustained and fulfilling
employment
Works with commissioners to
integrate funding and services across
health and employment sectors
Able to mobilise social investment

3. © Health and Employment Partnerships 2015
INTRODUCING STAFFORDSHIRE COUNTY COUNCIL
Medium-sized County in “greater” West Midlands
• 1,010 square miles; 0.8m people
8 District / Borough Councils and 5 Clinical Commissioning Groups
Employment rate for people with severe mental illness 58 percentage points
lower than overall employment rate
• Slightly better than England average (65 points lower)
Existing IPS service currently the only non-NHS “Centre of Excellence”
• Provided by Making Space
Stoke on Trent with separate IPS service (also a Centre of Excellence)
• Provided by North Staffordshire Combined Healthcare NHS Trust
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4. © Health and Employment Partnerships 2015
OBJECTIVES FOR THIS SESSION
Share background to the mental health and employment SIB
Describe the key steps taken to develop the SIB
Share lessons learnt from our experience
Answer your questions!
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5. © Health and Employment Partnerships 2015
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“Between 10 and 16 per cent of people
with a mental health condition, excluding
depression, are in employment. However,
between 86 and 90 per cent of this group
want to work.
Meaningful work is integral to recovery.”
- Indicator Quality Statement: NHS Outcomes Framework 2.5

6. © Health and Employment Partnerships 2015
THE CASE FOR CHANGE 6
Getting a job improves individual health and wellbeing, and delivers savings to
government
People with health conditions have a higher rate of unemployment. Existing
interventions have struggled to make a significant difference
Building closer links between health and employment services has the potential
for transformative impact on health, wellbeing, and employment
• Improve engagement with services, building on trusted relationship between
clinicians and patients
• Enable health and employment needs to be considered and addressed together
COMBINATION OF SOCIAL AND FINANCIAL BENEFITS
SUGGESTED SIB MODEL COULD BE APPROPRIATE

7. © Health and Employment Partnerships 2015
KEY STEPS TO DEVELOP THE SIB 7
Understand social
issue
Define intervention
and outcomes
Build business case
for commissioners
Design programme,
incl. outcome tariffs
Engage investors
Procure services
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8. © Health and Employment Partnerships 2015
FIRST PROJECT: SCALE UP IPS WITH SOCIAL INVESTMENT 8
IPS is a standardised supported employment
intervention with consistently strong job and
health outcomes
• Extensively studied
• UK providers emerging
average percentage point
increase in job outcomes+34
hours worked
earnings per hour
job sustainment
More
hospital admissions
days in hospitalFewer
…Yet not available for
most who need itIPS has delivered strong outcomes…
Only ~4,000 people have
access to high-fidelity IPS
services in the UK
• Out of estimated 240,000
who could benefit from it
14 “Centres of Excellence”
accredited, but most
services still small-scale
• Other provision of IPS not
always compliant with
evidence-based principles /
practice
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9. © Health and Employment Partnerships 2015
BUILDING THE BUSINESS CASE… 9
Evidence shows strongly
positive cost/benefit of IPS…
Supporting an individual into work
generates savings on out-of-work /
means-tested benefits, tax credits, and
tax receipts
Additional savings likely to accrue
to health service
• Significant saving if someone with
severe mental illness does not
relapse
Intervention cost per incremental
job outcome (vs. counterfactual)
implies net saving overall to HMG
…But launching a SIB requires
more than a positive cost/benefit
1. Contribution to commissioner
strategy
2. Ability to establish an appropriate
referral and operational model
3. Investability
4. Compatibility with future PbR
contracts
• E.g., needed to benchmark against
current WP / Work Choice tariffs and
existing IPS tariffs in the market
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10. © Health and Employment Partnerships 2015
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Payments for
user
engagement /
job outcomes
IPS Provider
PROGRAMME DESIGN TO EXPAND IPS
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Payments per user
(30% of contract
value)
Payments
per job
outcome
Up-front
finance
Example: Programme
design in Staffordshire

11. © Health and Employment Partnerships 2015
FIVE KEY OUTCOMES, WITH TARIFFS SPLIT BETWEEN BLF
/ CABINET OFFICE AND LOCAL COMMISSIONERS
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User engagement
Job entry (<16
hours/week)
Job entry (>16
hours/week)
Job sustainment
(<16 hours/week)
Job sustainment
(>16 hours/week)
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12. © Health and Employment Partnerships 2015
NEED STRUCTURED APPROACH TO ENGAGE INVESTORS 12
5
Many potential social
investors…
…Need clear set of criteria in
mind when engaging them
Cost of finance
Type of finance needed (is it more
equity-like or debt-like? What repayment
conditions do we need?)
Alignment with social mission
Expertise
Experience in the social issue area
and/or geography
Investment “style”