Exploring strategies for generating social value

The concept of social value has gained significant traction within the healthcare sector over the past decade, not least in the management of healthcare estates. Social value refers to the broader social, economic, and environmental benefits that organisations can deliver for the communities they serve. For NHS hospital Trusts, embedding social value in estate development and management practices is not only a legal requirement, but also a strategic necessity. This article explores the various strategies that NHS hospital Trusts can employ to generate social value from their estate management practices, with a particular focus on the journey we have started — but by no means completed — at Royal Cornwall Hospitals NHS Trust (RCHT). We round off with a brief guide to key pieces of legislation, and some simple steps that you can put in place to embed social value within your health estate management teams and processes.

Community engagement

As with most conversations that lead to something good, the most fundamental starting point is a desire to engage. Active community engagement isn’t easy. It requires us to accept that we must learn more about the local communities around us, their needs, and the problems they face, and how we involve them in the planning, development, and operation of healthcare facilities to improve what we deliver. We must facilitate, listen, and then lead with confidence.

At RCHT we have worked closely with our Communications team to actively involve a wide range of local stakeholders in the planning process for our new Women and Children’s Hospital (to be constructed under Wave 1 of the NHP), ensuring that the facility will address the unique needs of women and children in Cornwall and the Isles of Scilly. It is a start that will not only enhance the relevance and effectiveness of the healthcare services provided, but also fosters a sense of ownership and pride amongst our local community.

Sustainability is a critical component of social value. NHS hospital Trusts can significantly enhance social value by implementing ‘green’ building practices and aiming for Net Zero carbon emissions. This includes using renewable energy sources, improving energy efficiency, and reducing waste. There is no shortage of guidance for Trusts and staff working at all levels, including:

• Delivering a ‘Net Zero’ National Health Service1 outlines the NHS commitment to achieving Net Zero emissions; detailing the targets, strategies, and actions required. It includes extensive analysis and modelling to support the NHS Net Zero ambition.
• NHS England’s Carbon reduction plan and net zero commitment requirements for the procurement of NHS goods, services and works2 provide details on the implementation of carbon reduction plans and Net Zero commitments for the procurement of NHS goods, services, and works. The document outlines the steps that suppliers must take to align with the NHS Net Zero ambition through to 2030.
• Greening the business case3 sets out how estates and facilities staff can support the business case for investing in carbon reduction measures, and why this is critical for all NHS organisations.

Some Trusts ‘further down the road’

There are Trusts further down this road than us who have been able to prioritise significant investment in reducing carbon emissions, but we are doing our best to make every kWh count. RCHT has implemented various sustainability initiatives across its estate, including installing solar panels and the use of energy-efficient lighting. Recent bids to the NHS Energy Efficiency Fund secured a further £1.4 m investment in the roll-out of solar panels and LED lighting, which both reduce carbon emissions, and save significant sums of money that can be reinvested elsewhere.

It’s not just on and in our buildings that we aim to contribute to sustainability. Active participation in NHS Forest4 initiatives has helped engage staff outdoors in planting trees for the future, and biodiversity mapping across our estate has given us a better understanding of where we can best improve combined small parcels of land to achieve Biodiversity Net Gain (BNG) targets attached to new developments. Not only is this a much cheaper option than outsourcing BNG, but it also contributes to staff and patient wellbeing, which is covered further on in this article.

Another key strategy for embedding social value in health estate management is to prioritise support for local economic development. Many Trusts already do this by using local suppliers to deliver smaller contracts, recognising that this is often more convenient, supports local businesses to increase employment, and develops skills that may find their way into NHS estates and maintenance teams in the future.

At RCHT, we are working to further enhance this as part of initiatives to develop local Tier 2 contractors for larger construction and maintenance projects, often by doing something as simple as sharing greater detail around procurement requirements, or ‘demystifying’ social value at supplier engagement events.

NHS Trusts can, and do, create direct job opportunities and apprenticeships for local residents within their Estates teams with support from initiatives such as the former Estates and Facilities Workforce: Apprenticeship Challenge.5 There is also more creative use of the sometimes overlooked Apprenticeship Levy, which can be transferred to support a wider range of communities and staff in the supply chain.6

In designing facilities that are physically accessible, culturally sensitive, and user-friendly, Estates management teams have significant influence over the extent to which healthcare facilities are accessible and welcoming to all members of the community — recognising those with disabilities and impairments, the elderly, and other vulnerable groups.

RCHT has embraced inclusive design principles in its estate management practices, and the Major Capital Projects Team has operated an Accessibility Advisory Group at RCHT for the past three years alongside the Cornwall Disability Alliance.6 This Group ensures that the voice of lived experience is heard, and creates real change across new developments. Examples to date include ensuring accessible audio/visual intercoms; the introduction of Makaton signage; improved colour contrast and colour definition (including dementia-friendly colours); audio-described information and stoma-friendly shelves in accessible toilets; raised ‘sweeps’ on faucets to denote hot and cold water; improved ‘turning circles’ for wheelchairs in waiting areas, and improvements to the provision of accessible parking.

Health and wellbeing

Promoting health and wellbeing is a core objective
of NHS hospital Trusts, and by designing estates 
that encourage health and wellbeing, such organisations can enhance the overall environment for patients, staff, and visitors. While sterile spaces are important in a hospital setting, that doesn’t mean they can’t include colour, fresh air, views of nature, and peace and quiet. A quick internet search of new hospital developments, and many retrofits, will reveal use of biophilic design7 principles rapidly becoming the norm, with widely reported benefits to patient recovery, wellbeing, and staff productivity.

In 2023, RCHT won the Construction News Patient Experience Network National Award for its Critical Care Healing Garden. Fully funded by charitable donations, this is one of the first therapeutic gardens in the country to have medical gases directly piped into a dedicated biophilic outdoor space — enabling patients to spend as much time as they are able to experiencing the healing powers of the natural environment.

Partnerships and collaboration

Collaboration with other public sector organisations, charities, and social enterprises, can help NHS hospital Trusts maximise the social value of their estate management practices. By working together, we can pool resources to engage with wider stakeholders, share expertise, and deliver more comprehensive and effective services. NHS Property Services’8 social prescribing hubs have shown that for every £1 invested, there is a return of between £2.14 and £8.56 in social and economic value. It makes sense to share space.

At the core of our emerging social 
value strategy is partnership with organisations who invest in construction skills to support the local economy, and those who help reduce demand for acute health services. For example, RCHT collaborates with Cornwall Council, Falmouth and Plymouth Universities, local colleges, and a wide range of local charities and community organisations, to develop construction skills, offer opportunities for young people, and provide additional support services for patients and their families. These partnerships have enabled RCHT to offer a more holistic and integrated approach to preventative healthcare. Recently, our focus has turned towards our contractors and suppliers, and how they can help extend these opportunities and deliverables through further social value collaborations as part of the procurement cycle.

How embedding social value in estates management saves the NHS money

If you’re hooked on the potential of social value, but you’re still struggling to convince others, here’s a good example. Social value activities, when targeted carefully and backed by data-informed decision-making, can lead to reductions in hospital admissions and improvements in patient recovery. For example, clinical guidance published by NICE in 20139 highlights falls as a common and serious problem for older people. Falls often lead to admission to the Emergency Department in a hospital; around one in three adults aged over 65, and half of people over 80, will have at least one fall a year. Unaddressed fall hazards in the home are estimated to cost the NHS in England £435 m annually.10 Asking a contractor for a social value contribution that helps an older persons’ charity run a falls prevention session in a local village hall could directly reduce hospital admissions. Imagine it was your elderly relative receiving that social value benefit.

The Public Services (Social Value) Act 201311 requires people who commission public services to think about how they can also secure wider social, economic, and environmental benefits. Before healthcare estates staff start the procurement process, they should think about whether the services to be purchased, or the procurement route, could secure benefits for the service or stakeholders in a project. The Act is a tool to help get more value for money out of procurement. It also encourages discussion with the local provider market or community, to design better services, often finding new and innovative solutions to difficult problems.

The Procurement Act 202312 gives greater prominence to social value and sustainability in the new procurement landscape. The Act encourages authorities to consider broader community benefits, such as local job creation and reduced carbon emissions, when making procurement decisions. The ‘most advantageous tender’ (MAT) criterion replaces the previous ‘most economically advantageous tender’ (MEAT) approach, allowing for a broader consideration of factors beyond price — including quality, innovation, and environmental impact. Transparency is also boosted under the new Act, with expanded requirements for publishing notices throughout the procurement lifecycle.

NHS Trusts’ Standing Financial Instructions (SFIs) are designed to encourage transparency, equitability, and value for the public purse. RCHT has social value written into its SFIs, taking account of Procurement Policy Note 06/20,13 and requiring Net Zero Carbon and social value to form at least 10% of tender evaluations. Specific carbon reduction plans are required from suppliers with contract values over £5 m. Remember, 10% is the minimum, but you can go higher.

Embedding social value workstream priorities — some top tips

• Social value needs to be one of the key priorities at the beginning of any new project planning.
• Identify the needs of the community in which the contract will be delivered. What are the key pressures and priorities for the NHS originating from that community?
• Share and use these priorities with project teams, stakeholders, and potential bidders, as part of the procurement cycle.
• Set out clear expectations at the contract stage, requiring contractors to provide an agreed Social Value Action Plan with Key Performance Indicators and a reporting schedule.
• Collate and communicate the social value benefits that accrue across a range of contracts.
• Make social value a standing agenda item at team meetings, project working groups, and project board meetings.
• Arrange structured learning sessions to support team members with understanding social value. We all struggle with things we don’t understand, or haven’t had the opportunity to discuss in a safe environment.
• Engage with voluntary and community sector organisations and public sector support initiatives to improve collaborative working with contractors.

Conclusion

Embedding social value in health estates management is both legally required and beneficial for NHS hospital Trusts. By adopting strategies such as community engagement, sustainability initiatives, local economic development, inclusive design, a focus on health and wellbeing, and partnerships and collaboration, Trusts can create estates that deliver significant social, economic, and environmental benefits for the communities they serve, and belong to.

Royal Cornwall Hospitals NHS Trust has experienced the positive impact that can be achieved through a commitment to social value, and continues to build its understanding and approach to delivering more, and more impactful, social value.

References/further reading

1 Delivering a ‘Net Zero’ National Health Service. NHS England, October 2020. https://tinyurl.com/2kz63sc8

2 NHS England. Carbon reduction plan and net zero commitment requirements for the procurement of NHS goods, services and works. NHS England. 31 October 2023. https://tinyurl.com/3ch5k9dj

3 Greening the business case. NHS England. 25 May 2023. https://tinyurl.com/p62a72w7

4 NHS Forest. https://nhsforest.org/

5 NHS Estates and Facilities Workforce: Apprenticeship Challenge 2022/23. NHS England. 28 April 2022.

6 Apprenticeship levy transfer. NHS Employers. https://tinyurl.com/5cwbt5wn

7 The Cornwall Disability Alliance — ‘Nothing About Us Without Us’. https://tinyurl.com/378sb7f2

8 What is biophilic architecture? 15 real-world examples in the built environment — University College of Estate Management, online, 10 January 2025. https://tinyurl.com/ycxj35y4

9 Using NHS buildings for social prescribing. NHS Property Services. https://tinyurl.com/mwth5k2b

10 Falls in older people: assessing risk and prevention. Clinical guideline [CG161]. NICE, 12 June 2013. https://www.nice.org.uk/guidance/cg161

11 Falls: applying All Our Health. Updated Office for Health Improvement and Disparities, 25 February 2022. https://tinyurl.com/2u4nprs5

12 Social Value Act: information and resources. Updated 29 March 2021. The Cabinet Office.

13 Procurement Act 2023. https://tinyurl.com/3t7kx6c9

14 Procurement Policy Note 06/20 — taking account of social value in the award of central government contracts. Cabinet Office, Department for Culture, Media and Sport, Department for Digital, Culture, Media & Sport. 24 September 2020. https://tinyurl.com/5fj6bk89