The Public Services Bill 2010 could help healthcare commissioning and procurement deliver wider social benefits to the community than population health, as David Maher and colleagues explain.
The Public Services (Social Enterprise and Social Value) Bill 2010, a private member’s bill, is making its way through Parliament and is currently at the House of Lords. If it becomes law it will require all commissioners of public services to consider taking into account economic, social and environmental value, not just price, when buying goods and services.
“Social value” is about how well scarce resources are allocated and used and how their collective use delivers measureable outcomes. It reflects a more balanced approach in assessing outcomes, taking into account the wider benefits to the patient, their wider community and the general public.
Social value may be thought of as the collective gain to the community from commissioning/procurement over and above the direct purchase of goods and services. It is primarily concerned with ensuring “impacts”, both positive and negative, are measured and accounted for.
In these pressured economic climes it is more important than ever that both commissioners and providers account for social and environmental impacts and value, reflecting a better shift of resources to the right people, in the right place, at the right time.
Clinical commissioning groups are faced with increasing pressure to do more with less as they seek to deliver more and better services under tighter budget constraints. Social value is not just about squeezing suppliers or applying QIPP; it is about thinking creatively about how things could be done differently to ensure that the local community as a whole gets additional benefit through commissioning activity.
Clinical commissioning groups will be required to apply the same, if not more intensive, public and community engagement policies as PCTs have previously. Their public assurance duty will also require them to ensure their procurement of public services are entirely weighted towards public interest and not in the interest of a narrower shareholder group. This presents challenges for how the market post the Health Bill responds and begins to shape itself.
The Royal College of General Practitioners has published its framework for commissioning with an emphasis on: improving outcomes, patient empowerment, evidence-based practice, community mobilisation and sustainability. These five pillars of commissioning are reinforced by the work of the Social Value Foundation. This foundation, established in 2009, works to support commissioning organisations align their work to a set of principles which maximize the value of the investments made on behalf of local communities.
It will be the responsibility of CCGs and their commissioning support service partners to align commissioning intentions in a way that optimizes the opportunities for measurable social value. It might be through the development of user-led design and delivery similar to the work of Thurrock Lifestyle Solutions – a disability service provider owned and run by disabled people – true localism in action, or staff-led mutuals delivering innovative care such as Central Surrey Health – a previous NHS owned service, now owned and run by 700+ nurses and therapists as a social business.
In this context of changing policy, budget constraints and new systems of accountability, how should we use the social value private member’s bill to guide our thinking from a commissioning and a commissioning support perspective? In the future, we will explore social value approaches across the commissioning cycle, in particular the role social value plays in meeting best value and value for money as outlined by the Treasury Green Book.
Future articles will explore the role of social value commissioning in community engagement and the principles of Total Place, Localism and the current emphasis on the benefits of a Big Society. We will outline a framework of support for CCGs and local health and wellbeing boards to ensure CCGs exceed their statutory obligations, and emerging commissioning support service organisations embody social value principles. The CSOs can become facilitators of choice for ensuring best value in commissioning is achieved across all domains outlined by the RCGPs, the Social Value Foundation, the Sustainability Development Unit and national guidance such as the Treasury Green Book.