The first SIB (Social Impact Bond) in health announced, TCS (transforming community services) refresh on the gradual increase, an explosion of interest in the use of COBIC style contracts and an overriding need for the integration of health and social care. Significant initiatives that are coming together to produce opportunities for the radical challenges facing commissioners.
Legislation has made integration of health and social care a statutory demand for commissioners. The £3.8bn now available for Health and Social Well Being boards for integration projects has made the demand realistic. The emphasis is now on ideas for innovation and routes to delivery.
The more radical solutions are including use of COBIC (Capitated Outcome Based Incentivised Contracts) as an 'integration through provider' approach. There are now 17 COBICs in or near procurement that we aware of – click here to view.
This creates a challenge for providers – who will pay for the activity pending the outcomes being met (and take the risk of not being paid if the outcomes are not met)? For many providers in the health and social care market this is not viable. A developing social investment market is growing in response to this, offering to fund third sector providers delivering under PbR contracts with the funders receiving a return upon the outcomes being met. This approach (often structured as a 'Social Impact Bond' or 'SIB') is now in use across the public sector, funding projects from homelessness to reoffending to child social care, and is growing all the time.
End of life care in the West Midlands provides a good example of the new type of opportunity. We are supporting Marie Curie Cancer Care who are proactively working with Sandwell and West Birmingham CCG on an innovative social investment pilot to explore transforming end of life care through greater integration of services resulting in reduced demand on hospital beds. Click here for further details, if successful the pilot will establish proof of concept for new finance and contracting opportunity for NHS commissioners.
There is unprecedented scope for innovative health and social care integration solutions and real opportunities for commissioners to be central to the delivery of the agenda. With large scale government funding available the emphasis is on providers and commissioners to propose viable solutions.