David Maher and David Pencheon: Adding wider social value when commissioning

Increasingly, we are being asked to do more with less. The Public Services (Social Value) Act 2012, a private member’s bill, became law in January 2012. It requires all commissioners of public services to consider 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; it reflects a more balanced approach in assessing outcomes, taking into account the wider benefits to the patient and their community.

For clinical commissioning groups (CCGs), who are faced with increasing pressure to deliver more and better services under tighter budget constraints, social value is not just about squeezing suppliers or applying cost reduction schemes. It is about thinking creatively on how things could be done differently to ensure that the local community, as a whole, gets additional benefit through commissioning activity.

Take, for example, the decision of City and Hackney CCG to reduce medicines wastage.

The Department of Health estimates that unused medicines cost the NHS around £300 million every year; of this unused resource an estimated £110 million of wasted medicine is returned, annually, to pharmacies for safe disposal. In line with the CCGs commitment to minimising waste, the Prescribing Programme Board of City and Hackney CCG was successful in bidding for funds to undertake a medicines waste campaign in the borough.

The campaign was made up broadly of two parts. Firstly, a three month patient campaign that was delivered through posters and leaflets displayed in GP practices and community pharmacists. And, secondly, advertisements on London buses, which highlighted the scale of medicines waste. These encouraged patients, and their representatives, to only order what medicines they required, and persuaded them to return unused medicines to their community pharmacists.

In addition, the medicines management team coordinated a community pharmacy audit, which assessed the scope of medicines waste by using medicines returned to City and Hackney pharmacies as a proxy. Fifty three of the 65 City and Hackney pharmacies submitted reports for the audit. Extrapolating the value of returns over a year suggested that at least £250 000 worth of unused medicines are returned to pharmacies annually. From knowing that nationally around one third of unwanted medicines are returned to pharmacies, and, allowing for the relatively quiet period of time that the campaign was undertaken, these figures suggest that each year at least £1 million of medicines issued in City and Hackney are not being taken as intended.

By focusing on the environmental consequences of wasted medicine, we have been able to also add social value to our work by:

• Improving patients’ understanding of waste and how taxpayers’ funds can be better used.
• Freeing up resources that can be diverted to other medicines initiatives which improve patient care.
• Engaging patients in an ongoing dialogue about how they can control some of the impacts of their care pathways.

Incorporating social value into healthcare systems is now less of a supplementary option, and more a part of the core business. Social value describes the multiple benefits for health, welfare, and justice that can be achieved by considering broader models and systems of care, rather than focusing narrowly on financial value or immediate, short term outcomes. Appreciating social value allows us to act broadly, and to help maximise the benefits of public investment so that we get the best possible outcomes.

Demand for public services is rising, and in a time of reduced funding. So it is particularly important that we get maximum value for every pound spent on public services, and that commissioners are able to identify better targeted and more innovative service delivery models. That is what the Social Value Act is designed to enable and encourage commissioners to do.

How to do it meaningfully and in a way which is measureable?

The Sustainable Development Unit for the health and social care care system is currently drafting a module on social value as part of its wider sustainability strategy. We will be asking for input into the approaches across England, which will, hopefully, lead to a measurable and scalable implementation of social value. A holding page for the module is based here, and we are asking for contributions and case studies to inform the final module due for publication in January 2015. The rest of the strategy’s modules are available here

david_maherDavid Maher is a commissioning and social value adviser for the Sustainable Development Unit and a programme director for City and Hackney CCG. He has a wide breadth of experience in commissioning and supporting primary care based health innovation.



david_pencheon_3David Pencheon is a UK trained doctor and is currently director of the Sustainable Development Unit [SDU] for NHS England and Public Health England.



Competing interests: Both David Maher and David Pencheon have no competing interests to declare.

This blog is part of a series on ethical procurement in the NHS, with other blogs listed below.

Read more at www.bma.org.uk/fairmedtrade