This introduction to the application of Social Return on Investment to health and wellbeing was originally developed to assist the Royal Borough of Greenwich and their partners in the NHS and Community Organisations to develop their approach to this issue at workshops. I have now updated this to share some ideas at the Sodexo Institute Brussels Dialogue on Quality of Life and the Workshop on Implementing and Leading Positive Deviance at Oxford. I set out some of the ideas that have guided my work for the UK Department of Health in developing tools for evaluating health and wellbeing programmes such as the Health Trainer Service, Smoking Cessation services, Obesity, diet and activity programmes, Alcohol harm reduction, Bowel Cancer survey response and Breast Feeding continuation and my work for an EU Integration Fund programme to develop Social Capital amongst new migrant women and a project to provide “through the gate” mentoring for ex‐ offenders. This is an emerging field in which our understanding – or at least mine – is limited so it is important to stress that I know there is much that I don’t know and hope to learn from colleagues. The context for the Greenwich workshops was: the Health and Social Care Act of 2012 which gave Local Authorities responsibility for local population health improvement and introduced Health and Wellbeing boards and the Public Services Act of 2012, which requires Local Authorities to consider the impact of services in terms of their social value to wellbeing. In addition a number of measures, including the Care Act of 2014, have underlined the importance of Local Authority Social Care services working in closer harmony with NHS and local Community Organizations. At a time of public sector austerity, such initiatives must demonstrate that they represent good value for money. The relevance of applying techniques for measuring health and wellbeing programmes in terms of the Social Return on Investment (SROI) achieved has been underlined by Cabinet Office support for the publication of the New Economic Foundation guidelines in 2009 and the 2013 guide to the application of SROI to Wellbeing. See http://www.neweconomics.org/publications/entry/a‐guide‐to‐ social‐return‐on‐investment and http://www.neweconomics.org/publications/by/well‐being The dimensions of autonomy and positive deviance brought by the Brussels and Oxford dialogues offer exciting opportunities to address wellbeing improvement in fresh and exciting ways.
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This introduction to the application of Social Return on Investment to health and wellbeing was
originally developed to assist the Royal Borough of Greenwich and their partners in the NHS and
Community Organisations to develop their approach to this issue at workshops. I have now updated
this to share some ideas at the Sodexo Institute Brussels Dialogue on Quality of Life and the
Workshop on Implementing and Leading Positive Deviance at Oxford. I set out some of the ideas
that have guided my work for the UK Department of Health in developing tools for evaluating health
and wellbeing programmes such as the Health Trainer Service, Smoking Cessation services, Obesity,
diet and activity programmes, Alcohol harm reduction, Bowel Cancer survey response and Breast
Feeding continuation and my work for an EU Integration Fund programme to develop Social Capital
amongst new migrant women and a project to provide “through the gate” mentoring for ex‐
offenders. This is an emerging field in which our understanding – or at least mine – is limited so it is
important to stress that I know there is much that I don’t know and hope to learn from colleagues.
The context for the Greenwich workshops was: the Health and Social Care Act of 2012 which gave
Local Authorities responsibility for local population health improvement and introduced Health and
Wellbeing boards and the Public Services Act of 2012, which requires Local Authorities to consider
the impact of services in terms of their social value to wellbeing. In addition a number of measures,
including the Care Act of 2014, have underlined the importance of Local Authority Social Care
services working in closer harmony with NHS and local Community Organizations. At a time of public
sector austerity, such initiatives must demonstrate that they represent good value for money.
The relevance of applying techniques for measuring health and wellbeing programmes in terms of
the Social Return on Investment (SROI) achieved has been underlined by Cabinet Office support for
the publication of the New Economic Foundation guidelines in 2009 and the 2013 guide to the
application of SROI to Wellbeing. See http://www.neweconomics.org/publications/entry/a‐guide‐to‐
social‐return‐on‐investment and http://www.neweconomics.org/publications/by/well‐being
The dimensions of autonomy and positive deviance brought by the Brussels and Oxford dialogues
offer exciting opportunities to address wellbeing improvement in fresh and exciting ways.
When considering the cost and benefits of any project it is obvious that if high benefits can be
achieved at low cost it will be a worthwhile investment, while if costs are high and benefits low, it is
likely to be a poor investment. But in most cases both costs and benefits are intermediate – so the
question is how much is it worth spending to achieve each incremental unit of benefit? This is the
cost/benefit ratio which is the criteria for deciding whether a project should be funded or not.
Cost benefit ratios are developed by considering the level of return available from alternative
programmes to achieve similar outcomes and /or the value that members of the public or employers
attribute to comparable outcomes. In the case of investment to improve health, the National
Institute for Health and Care Excellence, expenditure of £20,000 or up to £30,000 is considered
reasonable for each Quality Adjusted Life Year (QALY) achieved, based on studies of willingness to
pay to reduce health risks and an estimate that it costs the NHS about £25,000 for each additional
QALY it generates (though this figure has recently been challenged). For employers a cost benefit
ratio for improving employee wellbeing may be derived from the unit cost of alternative measures,
the reduction in costs of recruitment and/or improvement in productivity.
Value for money is always important. Both the public and private sector seek to achieve the best use
of resources. To ensure this cost/benefit analysis can be applied at different levels:
a) Cost Offset – is used to examine actions which have a direct effect on reducing other costs,
e.g. systems to inform people of their appointments may reduce the cost non‐attendance.
b) Cost effectiveness –compares different ways of achieving the same outcomes, e.g. different
smoking cessation services can be compared in terms of cost per quitter.
c) Cost consequences – is used to evaluate initiatives that have multiple outcomes, e.g. a
project may describe and measure: health, mental wellbeing and social outcomes.
d) Cost‐utility – compares actions with different, but comparable outcomes using a common
scale, e.g. QALYs are used to compare different health outcomes in comparable terms.
e) Cost‐benefit – can be applied when outcomes can be translated into economic values, e.g.
by applying assumptions about the value of different outcomes such as lifetime earnings.
f) Social Return on Investment – is a form of cost benefit analysis comparing total social costs
and benefits, e.g. examining cost/benefit to society, employers and individuals.
Cost benefit analysis is based on how much the funder is prepared to pay for each unit of benefit.
While there are many references to wellbeing, ranging from the World Health Organization
Constitution to UK Legislation, there is no simple answer to the question: “What is wellbeing?” see
the discussion provided by the National Wellbeing Institute Australia