If you are being commissioned to provide it then social value can be an elusive thing to demonstrate in your work. If you are commissioning it then social value can be equally difficult to translate into contract management. The Public Services (Social Value) Act 2012 put an extra responsibility on those buying services to “have regard” for social value in designing contracts, but how successful has that been?
Given that the application of outcome based commissioning, which is readily measurable, has been a bit variable, it’s not surprising that, as yet, social value isn’t a recognised element of most commissioning plans. There is a belief that whilst some areas of the public sector are making progress, in incorporating social value into their contractual frameworks, this is not the case in health. This belief is reflected in some of the work done by Birmingham & Solihull Social Economy Consortium.
I think one of the main barriers to the health sector fully embracing social value, as a contractual driver, is the entirely reasonable question “Isn’t social value implicit in all that we do?”. This is not helped by the vague guidance on what social value really means within the Act itself. Although a reasonable question social value cannot just be defined as providing a public service. That doesn’t mean that social value is difficult to demonstrate.
There are three domains where a commissioning process can get the most traction in demonstrating social value. The operational structure of the service provider being the most obvious. Does the provider employ local people, do they provide employment opportunities to communities that don’t usually get employment opportunities? Does the structure of the service provider benefit the community it sits within, e.g. some forms of social enterprise?
I find this one problematic as it requires the commissioner to make a value judgement based on social benefits. Ostensibly any employment of local people is providing social value to that community. Equally you can stretch the interpretation of social value to say that the increased share value of large corporate providers provides social value to pension funds who hold shares. Obviously that is an absurd example but without a commissioner defining the relative weighting of different social values comparisons become tricky.
The second domain directly relates to the challenge that social value is implicit. In terms of providing preventative services in health and social care there is likely to be an added social value to the services you provide. Work around obesity and increased take up of exercise might have a direct correlation in reducing long term conditions but it also could also relate to increased confidence, possibly increased economic productivity. What some providers call unintended consequences and others might call added value, at the end of the day is social value.
This added value is possibly the biggest cultural challenge to most commissioning processes. How do you build into your process the extra benefit that commissioners in other sectors achieve through your work? If you are commissioning lifestyle services are you interested whether or not your work has an added benefit to the Department of Works and Pensions? If you commission lifestyle services are you interested whether getting more people active in a community has implications for improved community safety? Would you be more interested if you recognised that this was social value?
The third domain and, I believe, the most important in relation to health and wellbeing services, does the method of service delivery increase social coherence and integrity? Does it exist within a functioning system that works around all of the needs of the people that it supports?
The guidance, in relation to social value in health, makes frequent reference to Michael Marmot’s work on the social determinants of health and how these can be used as a framework for measuring social value in health. We wholly agree with this as it is the basis for how our Risk Tracker system recognises the interaction of socio-economic, behavioural and status/clinical outcomes. The true social value in providing services in health is recognising the interdependence of reasons that people access services. True social value is about reinforcing the links that bind society.
In a clinical setting it is the recognition of the value of improving a patients housing situation, in a lifestyles setting it is recognising the importance of a stable financial situation in motivating change. In an advice setting it is a recognition of how lifestyle risks, such as smoking and alcohol consumption can impact on how someone manages their day to day life.
Understanding how these issues connect together, and supporting people to resolve them is social value.
One of the main challenges in commissioning for social value is the fact that it is a vague concept. This can be a reason to see it as a problem that is too hard to solve or it’s an opportunity to reflect the wider society that we support in our own terms. We know the communities we live in and we know how the the services that exist within them can work better together. That’s social value.