Social investment funding: a lifeline for the NHS

This article was first published in The HSJ. 

NHS clinicians and managers have many great ideas to improve patient care and create efficiencies. But it is disincentivising when improvements are only valued if they’re cash-saving and only reduce the deficit by a tiny margin. Poor population health and lack of preventive care drive an overwhelming focus on treatment. There is no spare bandwidth for experimentation or prevention: everything is triage.

National health charities are struggling to meet the increasing demands for their support and to ensure their funding is used in a sustainable way. Grant-making increasingly creates a ​“cliff edge” when funding comes to an end.

Against this backdrop, there is an exciting opportunity for a new type of repayable grant, paid for via social investment from charities with no expectation of return, to provide much-needed sustainable transformation funding and expert capacity to improve our nation’s health.

The Hewitt review called for 1 per cent of the NHS budget to focus on prevention, while acknowledging there is no new money to support this shift. NHS leadership knows this is the right thing to do, but there is little opportunity to invest, test, and learn.

NHS Confederation chief, Matthew Taylor, in his recent Royal Society of Medicine’s Stevens lecture, said:

“We need to explore other avenues. At the Confed, we are working with partners to explore the scope for models of social investment in which upfront money generates a return through reducing demand. Ultimately, every ICS should aim to have a portfolio of social investment projects.”

But what is a social investment, and how could it be used to support a shift to prevention and be a lifeline for innovation and transformation when there is no spare cash in the system?

Social investment is a form of repayable finance used to achieve a social purpose. The social investment sector in the UK is a £8bn market. Big Society Capital put more than £700m into seed specialist social investment funds. In partnership with Macmillan Cancer Support, this included nearly £4m for end-of-life care. The Care and Wellbeing Fund launched in 2015 and since then has supported more than 14,000 people to have improved outcomes during their last year of life.

Macmillan launched its groundbreaking social investment fund for end-of-life care in 2021. In Scotland, the fund underpins a £1.4m palliative care helpline and response service across the Highlands with the Highland Hospice.

Boosted by the inclusion of social investment as a funding option in the NHS England commissioning and funding guidance for end-of-life care, the Macmillan fund also supports a £9m social investment in Oxfordshire, in partnership with Oxford University Hospitals Foundation Trust and the Sobell House Hospice.

In conjunction with existing services in Oxfordshire, they provide enhanced palliative care for around 1,500 people with advanced progressive life-limiting illnesses. The service has reduced the pressure on local hospitals from unplanned admissions. People cared for have spent on average 16 fewer precious days of their last year of life in hospital.

In Bradford, social investment is funding the £2.4m Marie Curie Reactive Emergency Assessment Community Team service. This reduces inequality, improves patient care and choice, and maximises capacity in the emergency department. One patient in his last days of life was seen by the team and within 90 minutes could be discharged from the hospital with ongoing support set up so that he could be cared for at home.

The potential for social investment has been clearly demonstrated on an individual service level. Now is the time for it to power integrated care system-wide innovation funding.

National health charities can be anchor organisations supporting smaller place-based charities and community groups to improve population health, providing more flexible, affordable and effective care. An example is the HIV Social Impact Bond that invested money from the Elton John Aids Foundation into local charities to undertake health improvement work, with the NHS taking on the role of facilitator rather than funder or provider.

By developing new outcomes-based social investment Health Improvement Community Funds, ICSs’ and health charities’ investment and the value created would be ring-fenced. Outcome payments would be recycled across a portfolio of projects and ultimately re-invested back into the NHS. This would create long-term health improvement funding that demonstrates outcomes and impact that isn’t lost in the struggle to improve the bottom line.

The Care and Wellbeing Fund and the Macmillan End-of-Life Care Fund show the possibility that outcome payments can be recycled to leverage investment: the current Macmillan end-of-life care fund aims to support more than £30m of service costs with £16m of social investment.

Most importantly, social investment can re-energise clinical teams to improve care for patients. It can transform the relationship between major health charities and the NHS by creating ring-fenced funding to help shift resources where they can be used most effectively.

Now is the time for the NHS to grab this lifeline.