Social Value – Reducing inequalities and improving health 11 February 2015

Jessica Allen UCL Institute of Health Equity

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Health inequalities and the Social Determinants of Health

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IHE work on social value with PHE

Health inequalities

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Social justice – the greatest inequality of all.

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the conditions in which we are born, grow, live, work and age

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Creating the conditions for people to have control of their lives

The Marmot Review : 6 Policy Objectives A. Give every child the best start in life B. Enable all children, young people and adults to maximise their capabilities and have control over their lives C. Create fair employment and good work for all D. Ensure a healthy standard of living for all E. Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill-health prevention

Social Value – What is it?

The Social Value Act states that during procurement public bodies in England and Wales must consider:

“How what is being proposed to be procured might improve the economic, social and environmental well-being of the relevant area, and… How, in conducting the process of procurement, it might act with a view to securing that improvement.”

Health and wellbeing Boards one year on – what priorities have been agreed?

Source: The King’s Fund, 2013

‘Opportunities for using social value provisions to tackle health inequalities in England’

How can ‘Social Value’ be used to tackle inequalities and improve health?

1.

Defining ‘social value’ as a reduction in local inequalities and an improvement in health.

2. Using methods for delivering social value locally which are also likely to improve health 3. The importance of recognising inequalities

• • •

How widely is ‘Social Value’ currently used?

Government enquiry found that 65% of LAs had changed their processes as a result of the Act.

SEUK survey of LAs and Housing Associations: – 71% ‘better service delivery’ – 70% ‘opportunities for innovation’ – 52% ‘cost savings’ – 82% ‘improved image of their organisation’ – 32% written a social value policy National organisations – very limited.

• NHS organisations? Less data, but seems to be less widely used .

Social Value

Economic Reducing local unemployment Social Increasing community engagement Environmental Reducing local crime Increasing wages – e.g. living wage Increasing standard of living – e.g. benefits Increasing educational outcomes Reducing social isolation and loneliness Tackling abuse and domestic violence Increasing use of local green spaces Improving housing quality Environmental sustainability – e.g. pollution, emissions

Social Determinants of Health

National Implementation

• Social Value Act applies to national government departments – their procurement and commissioning • National Govt not responded as positively as local govt • DH has run a programme to support action • Also role supporting local areas and holding them accountable

Halton Case Study

• Core group includes CCG, Council, CAB, VCA, a social enterprise.

• Social value ‘vision’:

“everyone in Halton recognising their contribution to social value and the changes it can bring about to reduce inequalities and improve wellbeing”

• Social value definition:

“a commitment to improve individual, environmental and economic well-being to reduce inequalities of all forms in Halton”

Source: Social Value Hub (SEUK)

Success Factors:

• Local leadership • Building on local narrative and existing priorities • Community engagement and communication • Define the vision, integrate across the business, deliver through partnership, measure the difference

Challenges:

• Lack of clarity and clout in the Act and definitions • Lack of accountability and national leadership • Difficulties around measurement • Making the case • Local barriers to implementation – Procurement approaches – Large scale reorganisation and changes to service provision – Cuts and austerity – Restrictions on the Act and conflicting legal demands

Success Factors:

• Local leadership • Building on local narrative and existing priorities • Community engagement and communication • Define the vision, integrate across the business, deliver through partnership, • measure the difference

System alignment and other relevant levers

• HI duties in HSCA • Integration duties • Localism Act • Sustainable Development

Summary, Social Value is…

• An opportunity to improve health and reduce inequalities in social determinants –

Locally AND nationally

• An opportunity to ‘work’ the economic power of public procurement. In 2012 13 over £230 billion spent on public sector procurement of goods and services.

• An opportunity to align with other priorities and obligations – win wins • A legal obligation!

A Case Study of Social Value in Salford

Anne Lythgoe Salford City Council

Social value aims in Salford:

• To support the achievement of Social, Environmental and Economic wellbeing for Salford’s citizens • To support the City Plan and embed aspects of it into partners’ commissioning plans and all public sector procurement • To support the delivery of the Joint Health and Wellbeing Strategy • To maximise the benefit from investment of the ‘Salford Pound’ • To do more than just meet the requirements of the Social Value Act

• • • • •

Approach:

Multi agency working group - City Council (representatives from all Directorates), NHS (CCG and Foundation Trusts), voluntary, community sector and social enterprise, Salford Community Leisure, University and housing providers, amongst those involved Role for Health and Wellbeing Board Recognition that there are 3 parallel areas for the work: • Strategic requirements • Commissioning and procurement - the whole commissioning cycle • Provider capacity and understanding Work should be concurrent and linked – interdependent Facilitation of behaviour change…

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Social Value Charter:

EMBED SOCIAL VALUE

: Adapt policies and governance arrangements to emphasise the role social value will play in services

DELIVER SOCIAL VALUE

: Implement social value through their commissioning and procurement processes from assessment of need through to advertisement and pre qualification questionnaires, specification, evaluation and contract compliance.

DEMONSTRATE SOCIAL VALUE:

Evidence how and when they have introduced social value into service delivery and the impact that this has made.

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Other work: Testing Toolkit Awareness-raising and training Evaluation

Why is Social Value so Important?:

Life expectancy gap between most deprived and least deprived areas is

11.5

years for

men

and

8.5

years for

women

Child Poverty The 2010 Salford average for children living in poverty was 28.6%, there had been a slight drop when comparing the 2009 average of 29.2%.

The 2010 average for England was 20.6%, again showing a slight drop from the 2009 average of 21.3% In 2008 this was equivalent to income levels before housing costs of: • £225 per week for a single adult with two dependent children under 14.

• £294 per week for a couple with two dependent children under 14.

This means that families living in poverty may have less than £11 per day per person to buy everything they need.

Children in Poverty 2010 Ward % Ward %

Irwell Riverside Langworthy Ordsall Little Hulton Broughton Winton Walkden North Weaste & Seedley Barton Pendlebury 51.3% 48.1% 44.9% 44.4% 40.5% 38.2% 32.4% 30.7% 30.3% 28.2% Swinton North Irlam Swinton South Kersal Cadishead Eccles Walkden South Claremont Boothstown & Ellenbrook Worsley 27.2% 26.9% 22.1% 20.0% 19.5% 19.2% 15.0% 8.6% 5.9% 2.8% CADISHEAD LITTLE HULTON WALKDEN NORTH WALKDEN SOUTH BOOTHSTOWN & ELLENBROOK WORSLEY WINTON PENDLEBURY SWINTON NORTH KERSAL BARTON SWINTON SOUTH CLAREMONT ECCLES IRWELL RIVERSIDE BROUGHTON WEASTE & SEEDLEY LANGWORTHY ORDSALL IRLAM Children and families are officially considered to be living in poverty if the household is either out of work and in receipt of benefits, or in receipt of tax credits where the reported income is less than 60% median income.

Data Source: HMRC September 2012

Legal compliance Social Value Act Joint working Better value for money / return from investment

Why SOCIAL VALUE?

Community resilience Public Health and wellbeing benefits 01/05/2020 Improved place Increased local employment and growth

Successes:

Challenges:

• Leadership • Language • Capacity / time / understanding • Buy-in • The Social Value Act (also an opportunity…)

What we have learned so far:

• ‘Social’ can measured in financial (or economic) terms, but the environment often gets overlooked • Variable understanding of social value across all sectors and sizes of organisation • Providers that are good at demonstrating social value are good providers • Social value is not just about ‘buying’ - and should be embedded throughout the commissioning process • Being able to ‘prove’ and evidence your social value is key