cbo peer learning event: employment, housing & crime: launching a social impact bind in mental...

LAUNCHING A SOCIAL IMPACT BOND IN MENTAL

HEALTH AND EMPLOYMENT

DECEMBER 2015

© Health and Employment Partnerships 2015

INTRODUCING SOCIAL FINANCE AND HEALTH AND

EMPLOYMENT PARTNERSHIPS

Not-for-profit social enterprise,

founded in 2007

Designed / developed first Social

Impact Bond

Work across multiple issue areas,

including employment, health &

social care, children’s services

Mobilised ~£100M socially-

motivated investment; £33M

contracts under management

Social purpose company, set up by

Social Finance

Aims to help people with health

issues to improve wellbeing by

achieving sustained and fulfilling

employment

Works with commissioners to

integrate funding and services across

health and employment sectors

Able to mobilise social investment


INTRODUCING STAFFORDSHIRE COUNTY COUNCIL

Medium-sized County in “greater” West Midlands

• 1,010 square miles; 0.8m people

8 District / Borough Councils and 5 Clinical Commissioning Groups

Employment rate for people with severe mental illness 58 percentage points lower than overall employment rate

• Slightly better than England average (65 points lower)

Existing IPS service currently the only non-NHS “Centre of Excellence”

• Provided by Making Space

Stoke on Trent with separate IPS service (also a Centre of Excellence)

• Provided by North Staffordshire Combined Healthcare NHS Trust

3


OBJECTIVES FOR THIS SESSION

Share background to the mental health and employment SIB

Describe the key steps taken to develop the SIB

Share lessons learnt from our experience

Answer your questions!

4


5

“Between 10 and 16 per cent of people

with a mental health condition, excluding

depression, are in employment. However,

between 86 and 90 per cent of this group

want to work.

Meaningful work is integral to recovery.”

- Indicator Quality Statement: NHS Outcomes Framework 2.5


THE CASE FOR CHANGE 6

Getting a job improves individual health and wellbeing, and delivers savings to

government

People with health conditions have a higher rate of unemployment. Existing

interventions have struggled to make a significant difference

Building closer links between health and employment services has the potential

for transformative impact on health, wellbeing, and employment

• Improve engagement with services, building on trusted relationship between

clinicians and patients

• Enable health and employment needs to be considered and addressed together

COMBINATION OF SOCIAL AND FINANCIAL BENEFITS

SUGGESTED SIB MODEL COULD BE APPROPRIATE


KEY STEPS TO DEVELOP THE SIB 7

Understand social

issue

Define intervention

and outcomes

Build business case

for commissioners

Design programme,

incl. outcome tariffs

Engage investors

Procure services

1

2

3

4

5

6


FIRST PROJECT: SCALE UP IPS WITH SOCIAL INVESTMENT 8

IPS is a standardised supported employment

intervention with consistently strong job and

health outcomes

• Extensively studied

• UK providers emerging

average percentage point

increase in job outcomes+34

hours worked

earnings per hour

job sustainmentMore

hospital admissions

days in hospitalFewer

…Yet not available for

most who need itIPS has delivered strong outcomes…

Only ~4,000 people have

access to high-fidelity IPS

services in the UK

• Out of estimated 240,000

who could benefit from it

14 “Centres of Excellence”

accredited, but most

services still small-scale

• Other provision of IPS not

always compliant with

evidence-based principles /

practice

2


BUILDING THE BUSINESS CASE… 9

Evidence shows strongly

positive cost/benefit of IPS…

Supporting an individual into work

generates savings on out-of-work /

means-tested benefits, tax credits, and

tax receipts

Additional savings likely to accrue

to health service

• Significant saving if someone with

severe mental illness does not

relapse

Intervention cost per incremental

job outcome (vs. counterfactual)

implies net saving overall to HMG

…But launching a SIB requires

more than a positive cost/benefit

1. Contribution to commissioner

strategy

2. Ability to establish an appropriate

referral and operational model

3. Investability

4. Compatibility with future PbR

contracts

• E.g., needed to benchmark against

current WP / Work Choice tariffs and

existing IPS tariffs in the market

3


10

Payments for

user

engagement /

job outcomes

IPS Provider

PROGRAMME DESIGN TO EXPAND IPS

4

Payments per user

(30% of contract

value)

Payments

per job

outcome

Up-front

finance

Example: Programme

design in Staffordshire


FIVE KEY OUTCOMES, WITH TARIFFS SPLIT BETWEEN BLF

/ CABINET OFFICE AND LOCAL COMMISSIONERS

11

User engagement

Job entry (<16

hours/week)

Job entry (>16

hours/week)

Job sustainment

(<16 hours/week)

Job sustainment

(>16 hours/week)

4


NEED STRUCTURED APPROACH TO ENGAGE INVESTORS 12

5

Many potential social

investors…

…Need clear set of criteria in

mind when engaging them

Cost of finance

Type of finance needed (is it more

equity-like or debt-like? What repayment

conditions do we need?)

Alignment with social mission

Expertise

Experience in the social issue area

and/or geography

Investment “style”

cbo peer learning event: employment, housing & crime: launching a social impact bind in mental...

Government & Nonprofit