Delivering social value is just one of many items on the 'to do' list for Integrated Care Boards (ICBs) and could easily fall prey to the more immediate challenges of day-to-day care. But embedding social value in system-wide planning is not optional.
Net zero carbon targets are already baked into NHS plans, with procurement contracts assigning at least a 10% weighting to social value and all NHS suppliers needing to demonstrate carbon reduction plans by April 2024.
This is just the start. The long-term intention behind social value is to build stronger, more resilient communities to reduce the burden on public services and minimise our collective impact on the environment. Reducing our carbon footprint doesn't just help the planet – it will reduce the number of pollution-related illnesses and deaths, in turn releasing some of the pressure on NHS services. This goes right to the heart of the role of ICBs as anchor institutions. When you consider the number of people employed and services provided by the public and voluntary sectors, and the resources and expertise required to deliver sustainable services, ICBs are uniquely placed to tackle urgent environmental, social and economic pressures.
Knowing where to begin
The challenge for ICBs is knowing where and how to start, particularly amidst so many competing priorities. Delivering social value is complex, not least because the potential remit is so broad. In our experience, a good place to begin is in developing a system-wide 'charter' which sets the vision and priorities for achieving social value. What are the values and behaviours you want to set for your system? How will that change how you commission services and what metrics will you use to determine your progress? Once these foundations are in place, it's easier to define, implement and measure initiatives across all partners.
Social value isn’t a new concept - some systems have been working on and developing this agenda for some time. Cheshire and Merseyside, for example, has been a social value accelerator site since 2018 and has already developed a social value charter, anchor framework and social value award. Recently, as a part of our work in the ICB, we built upon this foundation, by engaging with colleagues and local communities and working with the Social Value Portal, to become the first system in the country to develop a system-wide set of themes, outcomes and measures (TOMs). The wide-ranging TOMs have been signed up to by all parts of the Cheshire and Merseyside system as a way tracking and evidencing social value progress. They are aligned with the social value charter and anchor framework to ensure they are continually moving forward and raising the bar.
Fostering collaborative approaches
ICBs across the country are looking at developing their own themes, outcomes and measures to support social value, and some are more advanced than others. The NHS has a strong track record of sharing expertise to fast-track improvements, and there is value to be gained from applying a similar approach here. System-wide working is still relatively new and, while each system has its own unique characteristics, by sharing information and ideas, ICBs can support each other to achieve ambitious climate targets and start making serious inroads into the causes of health inequalities. Arden & GEM is supporting Integrated Care Systems to do this through a not-for-profit collaborative network designed to accelerate progress, with expert input from those further along on their social value journey.
How social value is delivered on a practical level will vary based on population needs and priorities. An initiative to curb car use, for example, may be achievable in urban areas but much harder in rural communities. And paying all staff a real living wage may be more accessible for organisations with set pay bandings but more challenging in social care or the voluntary sector. This is where the combined input from different individuals, communities and organisations is crucial to finding workable solutions that may deliver multiple benefits, both in improving patient outcomes and delivering wider societal advantages.
Engaging with our communities
Importantly, we also need to strengthen how we engage with our communities to identify creative and holistic solutions which not only solve a specific need but also bring wider long-term benefits. Social prescribing is just one example of this. Prescribing someone a bike or other exercise equipment, rather than anti-depressants, to help tackle mental health or social isolation reduces reliance on medication, while delivering greater health and wellbeing benefits through improved fitness and socialising. This in turn can help to grow social networks and support that person to become more self-reliant and less dependent upon public services. This could lead to a reduction in the high number of GP appointments that are linked to loneliness.
Alongside identifying new initiatives, we also need to consider measures or priorities which may be working against social value principles. A target to increase income from NHS car parks, for example, may be important to support a Trust's income but does not sit comfortably alongside policies to reduce reliance on cars.
Aligning these different priorities won't happen overnight. But when faced with mounting evidence of the harmful impacts of climate change, rising levels of respiratory and heart disease, and increasing pressure on public services, it's clear that social value deserves its place at the top end of the ICB 'to do' list – progress has to be made.
This blog was originally published by Healthcare Leader and is available here.
Arden & GEM is holding a free lunchtime webinar on 16 March about social value, including speakers from NHS England and Cheshire and Merseyside ICS. Book your place here.