There is a prevailing policy imperative to produce evidence about the social impact of public spending interventions. Whilst on the face of it this may appear to be a sensible development, the ubiquity of notions like social value, social enterprise, and social return on investment raises questions about the impact of these principles on broader notions of welfare. Rather than the claim that social value brings considerations of the social into the economics of welfare spending decisions (i.e. socialising the economic), these practices inveigle economic logics into all aspects of the welfare state provision (in effect, economising the social). Often this economising logic functions to demonstrate that some interventions are more ‘socially valuable’ than others. Whilst much of the associated rhetoric refers to demonstrating the social impact of economic investment, the effect of these processes is to transform issues of social inequality into simple spending decisions that maximise a social return on investment – however that return might be construed – usually it takes the form that for every £1 spent on service X, e.g. a frailty service, this will save £5 by reducing the number of hospital admissions. This imperative ignores the alternative view that the welfare state providing health and welfare services are not ‘investment opportunities’ but rather are about economic redistribution, not capital accumulation.
Social value refers to processes that identify non-financial impacts of programmes, organisations and interventions, by measuring the impact of an intervention upon individual or community wellbeing, coupled to levels of social capital or environmental impact. Much of the emphasis is placed on how these models are socially progressive, going beyond conventional cost-benefit analyses, with their narrowly defined notions of value and benefit. Rather these new models offer analytical tools for measuring and accounting for much broader conceptions of value, across economic, social and environmental contexts.
However, the ubiquitous rise of social value occurs at the same time as more and more aspects of health and social care are marketised, across voluntary and for-profit providers, in turn creating new modes of service delivery. In this context we see NHS providers re-branding themselves as ‘Social Enterprises’, intent on demonstrating their ‘social value’ in order to be re-commissioned by the relevant local authority or Clinical Commissioning Group (CCG). These social enterprises now operate outside the NHS, with lifelong NHS staff now TUPE’d onto employment contracts that bear scant relation to their previous terms of employment.
A more critical perspective than the progressive view of social value offered above argues that these models represent a state withdrawal from processes of social reproduction. For example, historically the NHS can be regarded as a triumph in addressing enduring health inequalities in the UK, with the state playing a central role, such that, year upon year, the UK state reproduced lower levels of health inequality, due to the success of the NHS as a free universal service based on need, not ability to pay. The rise of social value pushes the role of social reproduction onto carers and the wider community.
Again, this is not necessarily in itself a bad thing. But the push towards social enterprises, for-profit corporations and voluntary organisations (rather than the state) providing this care signals the opening up of new health and social care markets, where pursuit of profit can comfortably sit alongside provision of care. In this context, social value begins to take on the appearance of a ‘stalking horse’ for profiteering, whereby health and social care decisions are inescapably ‘caught up in a cost-benefit logic’.
When considered on their own merits none of these processes appears particularly problematic. However it is when they are considered together, as a suite of changes that the problems become apparent. Dowling and Harvie detail how
“Money advanced by social investors (in expectation of a profit) is supposed to allow social enterprise (responding to social need) to take place, while the competitive environment in which social investment and social enterprise occurs is supposed to ensure innovation and efficiency in public service delivery” (p.870)
It is in this context that it becomes apparent how these processes function to prioritise the economic and push notions of profit and loss further and further into the decision making processes that underpin statutory welfare provision.
In effect, these processes function to fundamentally re-categorise the form and function of the welfare state. It transforms the job of welfare, from one that was about redistributing existing resources to people in need, to one that is about generating profit from existing services in order to fund future services (thus facilitating the withdrawal of the state as the single payer for these services). The fact that these resources are largely contributory (accrued from national insurance and taxation) does not feature in the austerity crisis. A focus on social value facilitates this shift without any crisis of legitimacy due to its coupling to a prevailing austerity culture that underpins the consistent imperative to make ‘social investment’ more effective and efficient. It is in this context that the true value of social value becomes apparent.