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New approaches to value in health and care

Why do we need new approaches to value in health and care?

The NHS has set new directions for itself. Its ‘new care models’, with new purposes (population health), new ways of working with communities and new cultures of care (engagement and empowerment) need new frameworks and measures for the value they are seeking to achieve.

This means starting now to develop better measures that will be capable, in three to five years’ time, of capturing whether integrated local systems are maximising the value created by people and communities, and securing the outcomes that matter most to them.

When people are actively involved in their own health and wellbeing, or support others to stay well, it creates value for them and the health and care system in a number of ways.

On an individual level: People make decisions every day that can impact on their longer-term health and wellbeing – for example in relation to exercise, managing stress, taking part in social activities or developing skills to successfully look after a health condition. The Wanless Review suggested that ‘for every £100 spent on encouraging self-care, around £150 worth of benefits can be delivered in return’. Caring for others: Over six million people are involved in informal caring, a quarter of them full time, with the total value estimated at £132bn a year – greater than the NHS budget. They are the biggest ‘workforce’ and deliver the bulk of care.

Volunteering: Around a quarter of all adults are involved in regular volunteering, with the Office for National Statistics (ONS) estimating formal volunteering to be worth almost £24bn per year.

Only a portion of this activity is directly related to health or care, but much of it supports individual and community wellbeing.

The majority of this value, however, goes unrecognised by formal systems. The Realising the Value programme therefore set out to explore what ‘value’ means for people and communities, and how this can be understood most appropriately by the NHS.

This paper builds on a discussion paper published in 2015 and subsequent engagament undertaken as part of the Realising the Value programme. It makes a series of calls to action to ensure that the approach to understanding, capturing, measuring and assessing value in health and care takes full account of value, as it is experienced and created by people and communities. The calls to action include:

• building a consensus on replacing the National Outcomes Frameworks with a simplified crosssystem framework
• basing core national outcomes on the health and wellbeing outcomes that are most important to people and communities
• prioritising support for commissioners to build skills, knowledge and confidence to commission for the outcomes that people and communities value
• ensuring widespread use of the Public Services (Social Value) Act 20125 in health commissioning.

These calls to action will enable a shift to a future articulation of value that is aligned across health and social care and community organisations.

The report also proposes a set of value statements and accompanying pledges. These could be adopted immediately by local areas or New Care Model programme vanguard sites, seeking to add value to people’s lives and mobilise the value that people and communities themselves can create for health and wellbeing.