With healthcare facing an unprecedented number of challenges, from inequalities and an ageing population, to the global climate crisis, are old models for change still fit for purpose when planning new facilities? Social, economic and environmental (SEE) value looks beyond the old cost, time, quality considerations and outlines a new approach, allowing leaders to take a more holistic view of infrastructure improvements. This page offers an introduction to SEE, and how it applies in healthcare, as well as a deeper dive into some of the ideas, research and methodologies behind it.

Updated 6 January 2025

In the context of healthcare infrastructure, Social, Economic and Environmental (SEE) Value is about maximising the total value (or social welfare, wellbeing) we create for society. It recognises that investment in new hospitals and other healthcare facilities, can drive improvements in health outcomes in two ways:

• Directly through the provision of modern and digitally-enabled healthcare facilities, that enable the NHS workforce to provide high-quality healthcare services where and when required, transforming patient care and driving improvements in clinical health outcomes;
• Indirectly, by affecting the wider economic, social and environmental determinants of health (e.g. income levels, quality of our jobs, education & skills, quality of the natural environment).

It also recognises that the relationship works both ways and as well as being determined by a wider range of socio-economic and environmental factors, health is also a key driver of sustainable and inclusive economic growth. By recognising the inextricable links between the environment, our health and our economies, we can design and deliver infrastructure to deliver transformative outcomes for society as encapsulated by the United Nations Sustainable Development Goals, thus greatly scaling the short and long benefits that can be generated by healthcare infrastructure.

Who are we?

We are the social value team, an NHS team who lead the Social, Environmental, and Economic (SEE) value creation work on key NHS projects. The team is responsible for developing and implementing the SEE Value strategy. The strategy outlines how the NHS can reduce health inequalities and enhance health and well-being through its activities, ultimately building the capacity to make value-based decisions. With a vast array of experience across healthcare, infrastructure, social value, skills & employment, environmental, social, and economic sustainability, the team is well-equipped to drive impactful change that works towards broader goals of creating lasting, positive outcomes for communities.

Want to learn more about SEE and how you can get involved? Contact us at england.nhpinnovation@nhs.net 

Our work represents a move away from a siloed mentality focused solely on delivering a set of high-quality healthcare facilities on time and to budget, to also consider the role of healthcare infrastructure within the wider ‘system’ and opportunity to take a more holistic approach to improving health by designing and delivering health infrastructure in a way that also tackles the wider economic, social and environmental determinants of health.

• SEE value talks to the outcomes that we can create through building SEE value priorities into all of our products and processes within the NHS.
• This can directly reduce health inequalities by taking the burden of an already stretched NHS and putting care and wellbeing back into the community.
• There are several levers in which to do this. For example, procurement, where we can encourage and incentivise contractors to provide health and well-being facilities and services within their provision of contracts. This could include having a nurse on construction sites, to monitor, take questions and be the first line of care.
• Other examples include:
  • designing in well-being or green spaces within a hospital
  • increasing lighting for public spaces in or around our healthcare facilities
  • increasing education and skills within community, not only to plug vital skills gaps within the NHS needed to run our health care facilities, but also to decrease health issues that may stem from economic inequality.

What is the aim of the work?

To bring all three strands of social value and sustainability (i.e. economic, social and environmental) together in a single approach, to provide a joined-up, Programme/project -wide and focused approach to value creation

To deliver transformational societal outcomes (economic, social and environmental) in partnership with the community, contractors and trusts.

Healthcare infrastructure, like all major infrastructure programmes and projects, can deliver economic outcomes such as job creation and economic growth. However, if these economic outcomes are actively enabled and combined with long-term considerations of sustainability, inclusivity and resilience, they can also deliver transformative outcomes and benefits, including:

• access to critical health care services for all income groups
• sustained job creation and economic growth
• reduced inequalities in income and health
• disruptive innovation
• equitable access to labour market opportunities
• improved skills
• reduced regional disparities
• digitalisation
• low-carbon transition
• disaster and climate adaption
• pollution reduction and environmental restoration
• circularity
• social cohesion
• social equity and stability

These wider societal outcomes and benefits are fundamental to delivering the government’s Five Missions for the nation (including sustained economic growth and reducing inequality in opportunity, income and health) and core to the objectives of the NHS Long Term Plan (including tackling health inequalities and supporting wider social outcomes). They also reflect the obligations the UK is required to fulfil under the UN 2030 Agenda for Sustainable Development and related international agreements on climate change and biodiversity.

Our aims are:

• To focus all key stakeholders on a core set of priority societal outcomes that healthcare infrastructure, has strong levers to influence, and which, if delivered, will have a measurable and meaningful positive impact on people, communities, businesses and nature in the local areas impacted by the new healthcare facilities
• To set direction for a programme or project to work collaboratively with key stakeholders to progress the priority outcomes in each of the local/regional area impacted by the work
• To signal the level of ambition and reflect the full scale of the aspirations to deliver modern, digitally-enabled and resilient healthcare facilities in a way that that delivers more inclusive and sustainable public health and wider social, economic and environmental outcomes
• To provide a framework for developing delivery plans for each priority outcome, identifying the existing, planned and new strategic initiatives to drive delivery of the priority outcomes in the most effective and efficient manner, at each stage of the life-cycle of NHP schemes
• To present the measurement framework that needs to be developed to monitor, measure and evaluate the programme/project’s contribution to the priority outcomes and targets, using consistent, comparable and verifiable metrics. This is necessary to demonstrate the contribution the schemes are making to priority outcomes in the local/regional areas affected and measure the long-term value created over time
• Utilise the breadth and depth of investment into the NHS to create a co-ordinated approach which delivers real value
• To address issues in social value. Current approaches concentrate efforts on bid responses and competition. This work focuses more on the delivery of real positive impacts

Why is it necessary?

Infrastructure investment is a key tool for addressing the challenges that we face. Infrastructure is linked to all 17 of the UN Sustainable Development Goals (SDGs), either directly or indirectly and influences the attainment of 92% of the 169 individual targets that underpin the goals.

However, infrastructure will only deliver these goals if the wider benefits and value that can be created by inclusive and sustainable infrastructure, are reflected in decision-making. Under business-as-usual approaches to infrastructure, many of the social and environmental costs generated by the infrastructure programmes/projects are not taken into account as these costs are borne externally and only show up financially much further downstream. This means that the opportunity to identify solutions that minimise, avoid and convert these costs into benefits, are missed. The scale of these downstream costs (i.e. inequality, climate change, biodiversity loss) are such that business-as-usual approaches to infrastructure are no longer deemed to be acceptable.  

The current approach to infrastructure is therefore producing a ‘value gap’ where the investments that are being made do not generate the best outcomes available, meaning that opportunities to create value across the programme/project lifecycle are being lost and key local, national and global challenges are not being adequately addressed. This leads to sub-optimal decisions and sub-optimal solutions being commissioned because opportunities to identify and realise wider value are not being taking into account .

There is worldwide consensus that major infrastructure projects, including social infrastructure such as health facilities have a critical role to play in achieving the SDGs by 2030. This, however, requires radical changes to the way we plan, appraise, design, construct. operate and measure the impact of health infrastructure.

It requires moving away from traditional approaches that have failed over and over to deliver real social value and have created a significant ‘value gap’ .

In some areas we are still making decisions about healthcare and infrastructure based on outdated models that focus on cost and time. While minimising cost and delivery time are essential goals of any programme/project, no project which fails to deliver its intended outcomes can be considered a success, no matter how cheap or fast.

A radically new approach is required  to address the unprecedented challenges facing the nation – inequality, low growth/productivity, climate change and the accelerating nature loss.

Inequalities

The UK is one of the most unequal countries in the developed world, irrespective of whether the focus is on income, health or regional inequalities. Over the last decade, for example, life expectancy in England has stalled, years spent in poor health have increased and health inequalities have widened. Those living in the most deprived areas die up to a decade earlier and spend an average of 19 extra years in poor health, compared to those living in the least deprived areas. Health and income inequalities also constrain growth due to:

• the loss of productive capacity from those that are excluded; and
• because much public spending in the UK is dealing with the consequences of failing to tackle inequality.

It is estimated that: “health inequalities in England cost the NHS an extra £4.8 billion a year, cost the UK between £31-33 billion a year in lost productivity and between £20-£32 billion a year in lost tax revenue and higher benefit payments.”

These figures demonstrate the scale of the opportunity that exists to turn current vicious cycles into virtuous cycles of economic activity. If this can be achieved, it will take the pressure off public finances which are currently constrained due to low productivity and economic growth and the high debt burden. The latter is at its highest level since the 1960s due to the global financial crisis of 2008 and COVID-19 pandemic. Many countries, including the UK and the US, are also experiencing a rise in populist sentiment which reflects public dissatisfaction with the way overall economic growth currently benefits society. The moral, economic and political case for tackling inequality, therefore, could not be stronger.

Climate change

The links between human health and climate change are well recognised:

“Climate change presents an imminent and pervasive threat to human health around the world. It is already causing more climate-related deaths and worsening medical conditions including infectious diseases, chronic illnesses and mental health disorders. It is also increasing the strain on global health systems and on socio-economic factors that indirectly affect health outcomes.” Shyam Bishen, Head of Centre for Health, World Economic Forum

“Climate change is a health emergency, as well as an environmental emergency.” Amanda Pritchard, NHS England Chief Executive

The fundamental connection between nature, economic prosperity and human health/wellbeing became evident during the current Covid-19 pandemic, which itself had its origins in nature’s over-exploitation and degradation, making the spread of deadly pathogens to humans more likely. Embracing a ‘One-Health’ approach in decision-making reinforces the links between the health of our planet and all aspects of human health and wellbeing.

Nature loss

Biodiversity and well-functioning ecosystems are critical for human existence, economic prosperity, and a good quality of life. They provide food, energy, shelter and medicines, sustain water and soil quality, regulate the Earth’s climate; and provide opportunities for recreation, recuperation and inspiration.

The quality of the built and natural environment is also a major determinant of health. Evidence shows that access to nature is linked to significant improvements in both physical and mental health and reduces health inequality. Everyone should be able to take advantage of these benefits, but more than one third of the population – nearly 9.5 million households in England – are unable to access green places near their home. Children who live in deprived areas are currently nine times less likely to have access to green spaces than those in the least deprived areas.

In recognition of the health benefits, the NHS is beginning to prescribe contact with nature as part of the solution to health problems, through ‘social prescribing’. It is essential that there is sufficient natural green space within 15 minutes’ walk to provide people with this opportunity. The resulting health benefits would mean significant savings for the NHS. In 2009 Natural England estimated that if everyone in England had access to green space, the resulting health benefits would mean that the NHS could save £2.1 billion per year.

Creating better quality or new green spaces and preventing the loss of existing greenspace and making them more accessible, can therefore support:

• improved population health outcomes
• reduced health disparities
• environmental sustainability
• green jobs for local communities
• reduced NHS costs

The NHS is extending pilots to incorporate “nature for wellbeing” and the use of green and blue spaces into the healthcare system. They are also using green social prescribing programmes to prevent and tackle mental health. Emerging findings from existing programmes are showing significant improvements in mental health and options are being explored to embed green social prescribing across multiple pathways.

By taking measures to rehabilitate and restore natural habit on NHS land and in the communities impacted, new healthcare infrastructure can therefore not only improve the environment, but simultaneously deliver co-benefits for local human health and wellbeing.  Preventing natural ecosystem damage is much less costly that restoring them and so protection needs to be prioritised early-on in the planning phase of schemes.

Nature is also the backbone of the world economy. All businesses depend on nature either directly or indirectly. Industries that are highly or moderately dependent on nature generate over half of global GDP^. Despite this, we are using double the resources that the Earth can regenerate each year.

The UK is one of the most nature-depleted nations on Earth and is also within the lowest 10% of countries globally on the Biodiversity Intactness Index. The State of Nature Report identified an average 32% decline in species’ abundance in England between 1970 and 2021 The abundance of the species of greatest conservation concern; the UK’s priority species, have declined by 60 per cent.

Infrastructure is one of the main drivers of biodiversity loss globally. The impact of infrastructure on nature and biodiversity can take many forms, including the:

• extraction of raw materials and production of construction materials
• loss of natural ecosystems from land conversion
• loss of habitat or habitat fragmentation
• disturbance and pollution during construction, operation and maintenance

While a focus on building net zero buildings is critical in reducing the impacts on nature, it is at least equally important for major healthcare infrastructure programmes and projects to reduce consumption of natural resources, stop the further degradation/ destruction of natural ecosystems and takes steps to actively restore and rehabilitate nature.

A recent report directed by an advisory committee that included representatives from DEFRA, HM Treasury and the Task Force on Nature-related Financial Disclosures (TNFD), has found that nature degradation could cause a 12% loss to UK GDP, demonstrating that “nature-related risks are as, or more detrimental to the economy, as those from climate risks”.

To put this in context, the scale of the potential economic costs associated with nature-related risks are predicted to be greater than those experienced during the COVID-19 pandemic.

This evidence challenges us think differently about how we plan, design and construct major infrastructure programmes, including healtcare infrastructure Nature is not an expenditure item to be minimised but rather an investment in what matters most for the health of the economy, people and nature.

We must therefore start making decisions based on long-term value and consider the impact of each decision on the priority outcomes infrastructure projects are ideally placed to influence, alongside cost and programme.

The construction industry is missing millions of skilled workers, the NHS has clear plans to build multiple hospitals how can we expect to do this when the industry has no resource and the efforts to create new talent isn’t being followed through?

Health inequalities have never been so severe, we can support the governments initiatives to put healthcare back into the community taking the strain off an already stretched resources.

How do we build and implement a social, economic and environmental value strategy?

• We focus our approach on the key societal challenges being faced at the global, national and local level where healthcare infrastructure has powerful levers to affect change.
• We build strategies based on place-based analysis to understand the key characteristics and key challenges facing the local people, economy and environment in these local areas i.e. we diagnose and understand the problems first providing the local evidence and insights that will inform programme, trusts and contractors. This ensures we build an approach that works with communities rather than doing things too them.
• We identify a subset of local challenges/problems that healthcare infrastructure has strong levers to influence and undertake the analysis required to enable credible baselines to be set against which future improvements can be measured and verified.
• Our work shows directly how the planned investment in healthcare will contribute to new government priorities .
• We also draw on the robust evidence and insights gained from vast programmes of work being led by global and UK infrastructure initiatives on how to deliver sustainable and inclusive infrastructure.

This enables us to build strategies based on best practice evidence of what works and just as importantly  what doesn’t and why, thereby accelerating learning and building knowledge, capability and expertise on the most effective and efficient initiatives to capture wider benefits.  In this way, healthcare infrastructure can provide real examples and practical advice and recommendations for other major projects in the UK and globally on how to resolve the issues that arise in the process of developing and delivering transformative social infrastructure.

We provide a framework for developing delivery plans for each priority outcome, identifying the existing, planned and new strategic initiatives to drive delivery of the priority outcomes in the most effective and efficient manner.

To implement the strategy it needs to be embedded throughout all programme workstreams (at all levels), processes, controls, risk management and reporting mechanisms.

Using all programme levers, we aim to ensure SEE value is built into all processes and products. This includes building SEE value into business case templates, wellness considerations, into design requirements and contractor/client best practice sharing groups.

We utilise current provision of Voluntary, Community, and Social Enterprises (VCSEs) that have strong community links and builds on resource and provision by adding contractor budgets and involvement.

Who should be involved?

Delivering the strategy will require whole-system collaboration and whole-system action at both the programme and local level, leveraging the investment and advantages offered by the programmatic approach to further enable and support action at the regional and local level, to simultaneously drive health, productivity, growth, equality, net zero and restoration of the natural environment.

It will involve the programme/project team working with other national departments, major programmes operating in the portfolio regions and a wide range of place-based organisations (including local and combined authorities, local enterprise partnerships, integrated care systems, schools and colleges, the voluntary and community sector organisations and local businesses). This is necessary to identify and capture the wider co-benefits that can be generated from investing in new healthcare infrastructure and to pool resources and budgets in order to achieve shared outcomes that create on-going value at scale, both for this generation and future generations to come.

So whose can make this happen?

• Everyone! The key to delivering SEE value is promoting a culture where it is prioritised and built into everything we do
• Particularly leadership roles where key decisions are made with SEE value in mind. This means it can remain a priority even with competing agendas.
• Those on the ground, there are always opportunities to include SEE priorities in the products and processes of NHS work, including sponsoring students in work placements, volunteering or offering your skills and expertise to help teach a teacher from a local school.
• SEE champions. We are building a network of people to champion the priorities to promote and communicate across the organisation

What resources are available?

• Our team – to get started with SEE, simply contact us and let’s talk about how we can help you
• We are embarking on a series of pilots to sandpit new and progressive ideas which we would love you to be involved in
• We can offer 1-on-1 sessions with NHS England SEE value experts, to answer your questions explore how you can get involved etc

Our team

The team has an incredibly collaborative approach with a commitment to continuous learning and a culture of open communication and shared knowledge. We look forward to sharing the results of our work and continuing to make a positive difference through healthcare infrastructure.

Mark Johnson, Head of Social Value, leads efforts in developing social value strategy for the programme and embedding in procurement, contracts and delivery. With 20 years of experience in public sector and sustainable procurement, he brings strategic vision and a deep understanding of the right levers to embed to enable the sustainable outcomes we want.

Tally Jones, Social Value Manager, brings expertise in building social value into procurement, delivering projects, initiatives in the community and wider programmes. She excels in communication, organisation and delivery. With over 5 years in the voluntary and public sector she plays a key role in social value delivery, supporting our team’s overall objectives and fostering collaboration.

Jennifer Anderson, SEE value economist & strategic advisor, leads on the SEE value creation strategy. A world leading economist with immense experience across Environmental, Social and Economic Sustainability, she is instrumental in creating the teams forward thinking vision. Her skills in economics and research ensures our work is aligned with the latest industry standards and best practices.

Faye Jenkins, Social Value Lead, develops tangible solutions through procurement, planning, and delivery in partnership with key stakeholders. With 20 years experience leading social value in tier 1 construction and engineering organisations, Faye brings unrivalled knowledge of how to make social value ‘work’ through enterprise models that drive better outcomes for customers, communities, and supply chain.

What happens next?

• Get in contact, help support the approach by giving us your opinions on what more the NHS can do in these areas and how we can achieve for SEE value creation  Email us at england.nhpinnovation@nhs.net 
• We will suggest areas to build SEE value into any ideas you may have
• We continue to develop the strategy and implement it across more projects
• Watch out for a new collaboration group coming soon on the FutureNHS platform.