Considering Social Value in Health and Social Care Procurement

Attain’s Commercial team have considerable experience in shaping, managing and supporting commissioners undertake procurements across the health and care sectors.

Samuel Naxton a Senior Manager within the Commercial team at Attain provides some insights into the Social Value Act and how it relates to Procurement and Commissioning.

When contracting for public services, commissioners are looking for positive social outcomes, which have a lasting impact with benefits for service users / patients that can be clearly demonstrated.

The NHS Five Year Forward View argues for ‘a more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health’[1]. The Forward View builds on the publication of the Wanless[2] report, whose proposal that a scenario in which people and communities are ‘fully engaged’ in health is key to the sustainability of health care and the Marmot Review[3], which recommends that to improve health for all of us and to reduce unfair and unjust inequalities in Health, action is needed across the Social gradient.

The ‘New Care Models’ as described within the Five Year Forward View builds on both these reports and provides further opportunity for contracting authorities to look closer at Social Value, implement new ways of working and engaging with communities to ultimately improve the health and wellbeing of individuals whilst reducing inequality.

So, what is Social Value?

The Public Services (Social Value) Act 2012 came into force on 31 January 2013 and is an important lever for addressing and reducing health inequalities. Since its introduction, it requires organisations who commission public services to think about how commissioned and procured services can secure wider social, economic and environmental benefits. There is no defined list of benefits as social value is best approached by considering each local context and needs which will likely involve undertaking extensive engagement with stakeholders.

[1] NHS England – 5 Year Forward View

[2] Wanless Report – Securing good health for the population,

[3] Marmot Review – Fair Society, Healthy Lives’

So how does this impact on commercial procurement and commissioning?

Getting serious about prevention is a key message within the NHS Five Year Forward View and implementing new models of care require extensive planning, strategy design/redesign well before a procurement process can commence. During this pre-procurement phase, it is important that commissioners begin to think about whether the services they are going to buy, or the way they are going to buy them, could secure benefits to enhance the well-being for their area, stakeholders, service users and/or patients.

Complex or novel contracts will likely necessitate the need for more collaborative procurements being undertaken with increasingly higher numbers of stakeholders working together, bodies such as Local Authorities, NHS Trusts, NHS Clinical Commissioning Groups (CCGs), Primary Care, Social Enterprises, Voluntary & Community Sector organisations and even the Private Sector.

As we engage with stakeholders and providers, developing new or transforming services, greater opportunities may present themselves to ensure Social Value is embedded securing social benefits within and across the Community.

NHS Trusts, CCGs and other health and care organisations make decisions on social benefit every single day. Decisions about commissioning a service, or funding a project in an area focusing on a need or requirement in their locality/regional area can all create and deliver an additional social benefit. These additional benefits can take almost any form, ranging from the very tangible, such as:

  • jobs for the long-term unemployed e.g. building requirements for organisations to consider apprenticeships when bidding for large scale procurements such as Community Services, or
  • sub-contracting opportunities for small businesses e.g. delivering Health and Wellbeing services with partner organisations under a single branding but promoting ‘one service’.

to softer, but equally important, benefits such as

  • engagement with communities or groups of individuals who might otherwise feel entirely disengaged e.g. holding Networking Events to provide opportunities to help shape the delivery of programs/services and service specifications such as “Care Closer to Home”. This will help improve access to services, improve patient choice, and break down silos within the health and care community.

Doing so also supports the organisation’s public-sector equality and diversity duties.

Working together in place-based systems of care begins to focus commissioner attention on how we utilise resources effectively, break down barriers between services to provide integrated care solutions for patients and service users. This in turn may lead to the development of innovative solutions to difficult problems whilst ensuring we gain more value for money out of procurement. Considering social value’ should shift the focus from the bottom-line (cheapest) price or cost of a service towards the overall value of the outcomes delivered, ultimately improving care provision of service users/patients and the overarching health and care economy.

So why is Social Value important and what does it look like in practice?

The public sector spends more than £200bn p.a. on procuring goods and services. Consequently, there is often pressure to buy services or goods at the lowest possible cost, but such an approach can often result in missed opportunities to create real value in the community.

The Act is flexible and gives commissioners and procurement professionals the freedom to determine the types of additional social or environmental value that would best serve the needs of the local community.

To effectively influence population health, Contracting Authorities should take responsibility and ensure that health considerations are also integrated into the broader range of related policy areas such as employment, education and social policy to support health equity.

Contracting Authorities adopting a ‘Health in All Policies’ (HiAP) approach recognises that health is influenced by a range of social, environmental and economic factors which are beyond the remit of the health sector. This help ensures that health and health equity considerations become part of the decision-making process and provide a means to identify and avoid those unintended impacts of public policy. Ultimately reducing health inequalities whilst improving care outcomes.

Inclusion of social value in a HiAP approach is important as it can deliver considerable benefits such as improving the feeling of wellbeing within the Community (especially for people living in disadvantaged communities), promote social inclusion, help reduce crime, drive efficiencies to deliver cost savings, while promoting economic growth and social wellbeing, and minimising environmental damage.

However, there’s no one size fits all approach for what social value should look like in health and social care commissioning. The non-prescriptive nature of the Social Value Act, means that each area/commissioning body can develop their own priorities as to what social value means for them and their community. There are several case studies available through the http://socialvaluehub.org.uk/ that highlights areas of good practice.

The procurement steps to achieve good quality social benefits

Social value benefits should be considered at all stages throughout the commissioning cycle. Attain’s Commercial Assurance toolkit highlights each stage of the cycle that should be followed to maximise benefit opportunity:

For benefits to be realised you should:

  • Identify opportunities for creating/realising social value through the assessment of needs, resources and assets, stakeholder engagement and consultation, and market analysis/development;
  • Embed social value in strategies, business cases and commissioning plans;
  • Incorporate social value into the procurement process i.e. when developing service specifications, tender documents/questions and key performance criteria.
  • Manage contracts – ensuring that they are performance monitored to ensure delivery of desired outcomes.

In summary

When you are considering new care models you really need to first consider what you want to achieve and how you are going to go about it whilst also considering:

  • The total value of the contract;
  • The outcomes that your population wants to achieve (established through meaningful engagement);
  • How social benefit is articulated, and measured as a core part of the contract;
  • The nature and complexity of the contract (i.e. what’s it for?);
  • Whether it is a regulated or unregulated contract; and
  • What types of provider organisations and/or stakeholders might be interested in it?

The new models of care highlighted by NHS England provide the perfect platform for Social Value to be considered and deeply embedded in system transformation. At Attain we have built a strong reputation as a market leader in the provision of end to end services to transform care, working across care systems in partnership with organisations. We are at the forefront of supporting the design and implementation of new models of care across the country, developing services that are: joined up, integrated and sustainable. To this end we are well placed to provide you with the necessary support to ensure Social Value is embedded in your business strategies, commissioning & service transformation plans and ultimately after following a robust procurement process (if required) delivering benefits to your population – improving the health & wellbeing of individuals and communities.