Comment / How social investment can support NHS recovery

Social investment is not new to the NHS, but its expanded use could offer a way for NHS bodies to invest in prevention and support NHS recovery following the Covid-19 pandemic. Resources are scarce, but by linking repayment to outcomes, social impact bonds (SIBs) can reduce the risk of investments for the health service and provide an opportunity to test out programmes that could deliver real social impact.

SIBs bring together NHS organisations with funders in a partnership focused on delivering improvements for patients. Repayment of the funding is linked to the achievement of pre-agreed outcomes, for example, a reduction in acute activity.

The approach could tackle some of the biggest challenges to NHS recovery by providing targeted funding while supporting key system priorities such as reducing health inequalities and designing services that pivot round the person.

The challenge

The NHS faces a monumental climb to recover from the pandemic. In Wales, it is estimated it could take five years to clear the waiting list backlog. In Scotland, a recent survey found a doubling of the number of patients reporting severe pain, while waiting for joint replacement operations. Thousands of adults and children missed vital scans in Northern Ireland as non-urgent elective treatment was put on hold. And cancer waiting times have grown.

Calls are increasing to make sure that the health inequalities so starkly exposed by the pandemic are addressed quickly. This all underlines how the road to recovery will be long and difficult.

Although the chancellor allocated an additional £3bn to the NHS for Covid recovery, the BMA and others have suggested this will be insufficient to tackle the pressing issues, from workforce shortages to the elective care backlog.

With funding for recovery in short supply, there are limited opportunities to invest in new services.  Social investment, however, can play a key part in enabling service development with a strong focus on the outcomes that matter to people.

Social investment has already proved successful in the NHS. The End-of-Life Care (EoLC) Integrator was established in 2016 by Social Finance, a not-for-for profit organisation, in partnership with the Department of Health, NHS England Macmillan Cancer Support and Big Society Capital. Since then, it has channelled more than £3m into six EoLC projects in England using the SIB model.

Outcomes that matter

The integrator team works with partners to implement effective models of community-based EoLC. It focuses on three things:

1. Providing capital as a catalyst to change the way that EoLC is commissioned and delivered, bringing the system together.
2. Developing outcomes-based contracts for personalised EoLC, focused on the outcomes that matter to people such as spending less time in hospital at end of life.
3. Driving the use of applied analytics to empower decision makers and ensure agile service management, quickly addressing unmet need; wedded to the outcomes, not the service model.

Addressing system stressors such as acute bed deficits or lack of coordination of patient care helps all partners identify ‘system-wins’. Jointly agreeing the value for a specific measurable outcome means no partner loses out to support investment elsewhere in the health system.

The impact of this approach can be felt by patients and systems. For example, one operational delivery group member commented that ‘the growth of the palliative care register is a strong indicator for better identification of people who are dying, by general staff. This in turn is leading to a reduction in admissions for people in the last 90 days of life.’ Elsewhere a partnership board member reported that subtle changes to ways of working had been transformational. ‘We [the system] are all now on the same page and have the same understanding,’ they said. ‘There is now system maturity and true multi-disciplinary team working.

Rising to meet the challenges of the next half-decade, the SIB model in EoLC will promote investment in services alongside robust proof they are delivering outcomes that matter to people.

The EoLC Integrator team is running a webinar on social investment in end-of-life care in partnership with the HFMA on 18 May 2021.

Register for webinar.

Or find more details on social investment and the funding application form.