Step 4: Measuring impact, reviewing policy and embedding into practice

Summary

The fourth step in the model framing needs to be focused on the difference made, rather than simply progress made. Now we are looking at measuring and reviewing programmes of work in the chosen areas, which will invariably differ in scale, leadership, extent, resourcing and timeframe.

Systems might have the overriding purpose, and the constituent parts a formal duty to collaborate, but the nuance, structure and focus of local economies are not straightforward. Across many systems ‘place’ will be the hub of local activity, the meeting point for a variety of sectors and a recognised economic footprint and social identity. Consistent and concerted working across the tiers is therefore vital to achieving impact.

Approach

Measuring the health sector’s impact on social and economic development has never been straightforward. Several parts of the country have made a start on seeking to understand how to do this through their local anchor strategies and through social value frameworks and approaches, though this is still at an early stage. Looking across the NHS, the mental health sector is often considered leaders at understanding return on investment, such as with interventions into children’s mental health.

The nature of social and economic development is diverse. It may be that economic impact is mainly derived at a macro, or system, level, while social impact is found in hyper-local situations, such as on the high street. Both matter and both should be pursued where relevant change and impact can be sought. Interventions that target the above list, for example, are all clearly within scope but all differ in their approach, modelling and measurement.

In terms of measurement specifically, the Health Anchors Learning Network (HALN) has promoted work that can be extended widely and support this, and a range of economic and social consultants are actively supporting local organisations to understand their own impact. At a regional level NHS London has, through the NHS London Procurement Partnership, procured a social value reporting and monitoring tool for all NHS organisations within the capital to determine and measure their added value and is engaging the five London ICSs on the shared economic and social outcomes they wish to individually focus on.

Universities are also exploring how they can measure their own impact. Nationally, funding for the National Civic Impact Accelerator (NCIA) was announced in September 2022, a threeyear programme to gather evidence and intelligence of what works, share civic innovations, and provide universities with the framework and tools to deliver meaningful, measurable civic strategies and activities. More localised examples include the Civic Index developed by WM-Redi and which is an interactive dashboard tool in which universities can assess their civic impact on their local place.

Recommendations

• ICPs develop a living map across their footprint to help understand the variety and focus of where an ICB is adding economic and social value. This interactive map can also highlight the multiple aspects of the interventions and the local anchor institutions most relevant to this work.
• ICPs approach local or combined authority and university colleagues about new approaches to measuring piloted placebased work programmes. Measurement outside a single sector will always be a complex process and in discussing local priorities ICPs may need to experiment with a range of measures that stretch across traditional NHS boundaries and timescales. The Technical Annex to the levelling up white paper, published in February 2022, is helpful when reviewing metrics on the 12 levelling up missions set out by government. These metrics relate to a variety of issues such as wellbeing, employment rates, research investment, educational attainment, skills training, healthy life expectancy, life satisfaction, and first-time home ownership – all vital for population health yet not traditionally something an NHS organisation would consider. An amalgamation of some of these metrics, perhaps using local academic expertise (such as business schools) and leadership to prioritise and structure, would increase the broader knowledge of an ICS significantly.
• ICPs keep under review areas where further devolution or decentralisation of powers or resources could stimulate greater impact. Given the breadth of issues which this ICS purpose can help local leaders focus on, some of the new initiatives and programmes supported will highlight where a system can scale up and deliver significant change in ways that is difficult to achieve nationally. In these areas an ICP should be ambitious about seeking further support from national leaders, whether from the Department of Health and Social Care or NHS England or indeed from other governmental departments. Such a process would be analogous to the wider devolution agenda, where Mayoral Combined Authorities discuss with government on a regular basis where further local empowerment can unlock broader challenges and support the UK economy.

Reviewing and monitoring the outcomes of the programmes of work supported by an ICP under this purpose is critical in understanding which policies make the biggest difference – whether as a short-term or episodic change in process or practice, or as a longer-term way of revisiting strategic objectives. This process will also have increased the awareness of the broad social and economic impact the NHS can have, further strengthening the will, reach and ambition of ICP leaders, the role and purpose of the ICB in delivery, and influencing the future social and economic landscape in which they will themselves operate.