Chapter 1: Introduction

It is increasingly accepted that good health is shaped by the conditions in which people live, learn, work and age, with access to clinical care playing an important but more minor role.,,,,,,, In addition to its core purpose of delivering health care services, the NHS has the potential to influence these conditions: it is the largest employer in the UK, spends billions on goods and services each year and controls significant land and physical assets – all of which give it enormous economic clout in local communities. Through its scale, size and relationship with local populations, the NHS represents a powerful ‘anchor institution’ that can positively influence the social, economic and environmental factors that help create good health in the first place.

The idea of anchor institutions is not new. Until now, though, it has mainly been local government and universities that have more consciously recognised their role as anchors., There are signs that this is changing. The NHS Long Term Plan promised to explore the potential of the NHS as an anchor institution and identify examples of NHS initiatives that have benefited their surrounding communities. But how the health service chooses to operate and leverage its resources will determine the extent of that impact. Questions remain as to how the NHS can best be supported and challenged to think differently about the social and economic value it brings to local populations.

This report explores how NHS organisations act as anchor institutions in five areas:

  • employment
  • procurement and commissioning for social value
  • use of capital and estates
  • environmental sustainability
  • as a partner across a place.

It showcases where NHS organisations are already implementing anchor practices, and discusses opportunities for how practice and policy can evolve to maximise the NHS’s contribution to local communities.

What are anchor institutions?

The term anchor institution gets used in different ways, but for the purposes of this report we are referring to large, public sector organisations that are unlikely to relocate and have a significant stake in a geographical area. Anchors have sizeable assets that can be used to support local community wealth building and development, through procurement and spending power, workforce and training, and assets such as buildings and land. Anchors have a mission to advance the welfare of the populations they serve. They tend to receive (or are significant stewards of) public resources, and often have a responsibility to meet certain standards on impact or value. These characteristics mean that the NHS, like other anchors, is well placed to have a powerful voice in where and how resources are spent. The NHS can also lead by example and help spread and champion the principles of anchor institutions in local economies.

Our approach

This report draws on a number of workstreams, including the following.

  1. Research commissioned by the Health Foundation and produced by the Centre for Local Economic Strategies (CLES) and The Democracy Collaborative (TDC), which included a review of evidence on the role and impact of anchor institutions, as well as three case studies: University Hospitals Birmingham NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust and East Lancashire Hospitals NHS Trust.
  2. Interviews about existing practice from a range of perspectives, including the acute sector, community and mental health trusts, primary care, clinical commissioning groups (CCGs), research, policy and local government. Interviewees included leads for transformation, sustainability, purchasing, public health, partnerships, estates and workforce.
  3. Workshops with an expert advisory group to identify the greatest opportunities for progress. Participants included representatives from acute trusts, local government, national bodies, academia, primary care, commissioners and the voluntary sector.

For each of the five areas (employment, procurement, capital and estates, environmental sustainability and partnerships), we explain why it matters, provide examples of what anchor practices look like in the NHS and briefly explore the policy context. We conclude with a summary of implications for practice and policy moving forward.

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