Commissioners can think about more than money

Most healthcare commissioners are neglecting to use a key tool for getting the best value and the most community benefit from their spending, according to a new report called Healthy Commissioning from National Voices and Social Enterprise UK.

That tool is the Public Services (Social Value) Act 2012, which requires public sector commissioners to consider how their procurement can best deliver social, economic and environmental benefits to the local area.

Put simply, the act means that in competitive tendering, value for money (and therefore the lowest cost bid) does not have to be the only consideration. Commissioners can also weight the qualification so that, for example, benefits to local communities, such as from engaging voluntary, community and social enterprise organisations, are also valued.

A review of the act in 2015 found that many local authorities, which overtly see themselves as shaping local markets for the supply of services and support, had made effective and imaginative use of these provisions. It seemed that the NHS was doing less.

Better relationships

National Voices and Social Enterprise UK put this to the test through a Freedom of Information request to the then 209 Clinical Commissioning Groups that are responsible for using two thirds of the NHS budget (£72bn in 2016-17).

We found that just 13 per cent (25 CCGs) could demonstrate they were highly active and committed to using the act: that is, they had a formal policy, actively considered these benefits in their commissioning, and gave significant weight to them in procurement.

Many others had social value policies in place without appearing actively to pursue them, while 43 per cent appeared ‘passive’, in not having a policy or being able to demonstrate that they did so.

This matters to local health and wellbeing because the directions set by current reforms of health and care – through the Five Year Forward View and related models of care – suggest that public service leaders should be working together towards place-based and population-focused systems of care, that use better relationships with their people and communities to prevent ill-health, create community resilience, and support people to manage their own health rather than responding only to episodes of ill-health.

Greater wellbeing

The Social Value Act is a key enabler to these approaches because its avowed aim is to create opportunities for local, smaller, and often non-profit groups and organisations to be commissioned.

The assessment of commissioners’ readiness and ability to use the act’s principles and provisions is therefore a good test of the NHS’s capacity to deliver its own stated goals.

During 2016 there was a raft of in-depth reports, such as those from the Realising the Value programme, exploring the roles that communities and the voluntary sector can play in supporting greater wellbeing, and the actions that system leading bodies could take to back them.

Every one of these suggested that greater use of the Social Value Act in healthcare commissioning was essential, and that NHS England in particular, as leader of the commissioning system, should take action to promote it.

While our report makes some modest recommendations to strengthen the act, its guidance, and the sharing of best practice, a rapidly changing context makes it somewhat unclear by whom social value principles should be taken forward in healthcare.

‘For the first time in its history the NHS has a vision and goals for bringing the contributions of community groups and organisations into the mainstream of care’

NHS England is now talking of moves to ‘end the purchaser-provider split’, particularly by developing the 44 fledgling regional sustainability and transformation plan areas into all-encompassing ‘accountable care systems’. This and other developments are likely to blur the lines between commissioners and providers.

On the procurement front, as the UK moves towards exit from the EU, future rules and guidance remain uncertain.

But commissioning – including a more active, place-based and market shaping approach – will continue to have some importance, and the use of the Social Value Act, and more broadly of its principles, will continue to offer a route to the best local value for people and the system. And the act remains a legal requirement for them.

For the first time in its history the NHS has a vision and goals for bringing the contributions of community groups and organisations into the mainstream of care, as an essential component of sustainable healthcare. A deep review of how social value principles can best be used to secure those goals is urgently required.

Don Redding is director of policy at National Voices, the coalition of charities that stands for people being in control of their health and care.