Chapter 7: The NHS as a partner across a place

Why this matters

Across each dimension of anchor activity, the NHS can accelerate progress by working with others across a place – both within the NHS and with anchors from other sectors – to scale impact and develop shared approaches. The combined assets of anchor institutions (in terms of local jobs, spending and land) can be significant; working collaboratively can give anchors more reach into the community than they would have individually, and allows sharing of best practice. And by working together locally, anchors can use their collective influence to encourage other organisations in their local economies to adopt similar practices.

Establishing anchor partnerships and collaboratives can be key to developing greater intentionality and shared purpose around an anchor mission. There are, however, some contextual and wider issues around place-based anchor collaboration that must be carefully considered.

What do anchor partnerships look like in practice?

Partnering with other anchor institutions across a place

  1. Developing anchor collaboratives and networks to support shared approaches locally

Partnering with other NHS anchors

  1. Developing networks to support shared learning and spread good practice

Policy context

The growing focus on place-based approaches to improve health and economic outcomes, both within and across local areas, has changed the dynamics of how anchor institutions may function and work together across a place.

In some areas, devolution has brought sectors together to think collectively about how to channel assets to improve the wellbeing of local populations. For example, the Greater Manchester devolution deal, which gave the combined authority control over £6bn spend on health and social care in the 10 boroughs, has supported anchors to develop a joint strategy for improving population health and economic prosperity across the city region. But even when health and social care have been incorporated into plans, the NHS has not always actively contributed to broader economic strategy development and discussions.

Likewise, the delivery of the government’s Industrial Strategy relies on place-based approaches and calls on combined authorities and LEPs to come together to develop ways to spur growth across local communities. The extent to which NHS organisations have engaged with LEPs has been mostly limited: very few LEPs have NHS representation on their boards, though there are some exceptions – like in Dorset, where the chief system integration officer for the local CCG is a member., Stakeholders have noted that there is an opportunity for the NHS to take a more active role in supporting the delivery of these place-based strategies, given the significant economic assets they bring, and their powers to improve skills development, innovation, employment and infrastructure to support productivity. Moreover, working in partnership on these strategies can open up opportunities to access new funding streams.

‘We are very much trying to take an approach looking at how the local NHS organisations begin to play their part in shifting conversation. I don’t think what we’ve ever done particularly well in the NHS is to say, “What is the role of our organisation in contributing to the economic success of that area?” I don’t think we’ve made that connection powerfully enough, yet.’

Strategy lead

Combined authority

Within health and care, we have identified a number of opportunities for STPs and ICSs to develop anchor approaches around common aims. These are relatively new forums for partnership working and it is too early to tell whether they will realise their promise of supporting more collaboration around prevention. None of the 2016 STP plans referred explicitly to an anchor mission, and few described initiatives to work on anchor-like strategies to intervene in the wider determinants of health. However, as ICSs are a key part of the delivery mechanism for the NHS Long Term Plan, they may create the incentive for NHS organisations to develop their anchor role and collaborate with local partners for the benefit of local communities.

The emphasis on place, both within the NHS and in broader government policy, creates fertile ground for NHS organisations to think differently about their role in a place. If harnessed effectively, it could provide the conditions needed to support greater collaboration to develop communities and take collective action to tackle inequalities and improve the socioeconomic environments needed for good health.

Learning from practice

Partnering with other anchor institutions across a place

  1. Developing anchor collaboratives and networks to support shared approaches locally

Anchor institutions in several UK cities have started to work more closely to combine their influence and scale impact in local communities. This has often taken a range of forms including collaboratives, networks and economic coalitions, with shared objectives around a common anchor mission.

For example, in Sheffield the NHS has joined with local universities, housing associations, colleges, the city council, chamber of commerce and voluntary sector organisations to drive a collective commitment to building a more inclusive local economy. Led by the city council, the Sheffield City Partnership has developed a framework with a vision, commitments and shared objectives for implementing a city-wide approach to: education, skills and work; environmental sustainability and inequality; procurement; and homelessness and violent crime. The framework provides focus for working together around an anchor mission. It is also being underpinned by extensive engagement with local people to help identify what an inclusive economy would mean for them, and help define common standards and indicators to help track progress and ensure that resources are invested in the areas that could bring the greatest community benefit.

While the potential benefits of greater collaboration between anchors are clear, a range of structural and contextual factors conspire to make partnering around an anchor mission difficult. For one, each anchor has different accountability and governance mechanisms that affect their ability to develop and implement anchor strategies. Across each category of anchor activity, organisations will be accountable to different stakeholders, require different administrative processes and have different financial constraints, affecting their ability to work together across a place.

Having a clearly defined geographical area can help focus efforts, but the geographical footprint and population that each anchor works to, even when in the same locality, can vary.

‘We are all trying to get the best spend of our local pound, really, but there are challenges with that. We have different footprints – at the trust we are part of the ICS footprint, which is a different footprint from the city region. So, we have this constant footprint debate, which plays out when you’re trying to articulate the governance framework, the accountability, the permissions, and who has the authority to make decisions.’

Deputy chief executive

Acute provider trust

This is why stakeholders have emphasised that when developing collaborative approaches, it can be helpful to be flexible, by establishing common objectives and minimum standards for advancing anchor goals but allowing each organisation to determine the most appropriate path to implementation.

Without pre-existing relationships, collaboration at any level is even harder, and so a first step for anchor institutions is to find the time and space to foster working relationships. The exact method will vary, but it is often less about setting up new forums or mechanisms for collaboration and more about identifying those places where different anchor institutions already come together and using those as building blocks to build alignment around an anchor mission. In the current context, this may include health and wellbeing boards, local partnership boards, LEPs, or STP and ICS boards. Regardless of the forum, stakeholders emphasised the need to have the space and time to co-develop a shared vision to drive successful collaboration.

‘There are a lot of potential benefits to STPs and ICSs for developing anchor partnerships and approaches, but I don’t think we’ve realised them yet… But we probably just haven’t had enough space and time to think all that through well.’

Non-executive director

Acute trust

Building these relationships undoubtedly takes significant time, and it can be difficult to establish trust, respect and mutual understanding in the short term. Evaluations of the Greater Manchester devolution deal found that Manchester’s strong sense of place and 30-year history of partners working together was pivotal to delivering the plan and linking up policies to improve population health and wellbeing.

Given the different structures and focus of anchor organisations, it can also be difficult to know the best level at which to engage within each organisation around place-based strategies. Interviewees from outside the NHS said it is not immediately clear who holds responsibility or the most relevant expertise. Having a designated anchor or sustainability lead within NHS organisations can help, as it makes it obvious who to start conversations with, in cases where the NHS has not always taken part (for example, as part of LEPs).

Relationships have also been helped by working with third-party organisations who can act as a convener and facilitator and provide much-needed additional capacity to support partnership working. For example, the Joseph Rowntree Foundation has worked with Leeds (see case study 7) and CLES with places like Birmingham and Preston to bring different anchors together to provide forums for discussion and develop a common approach.

Local government has also frequently been an important driver of cross-sector collaboration, as in Sheffield, where councils have linked anchor partnerships to broader strategies around supporting more inclusive community development. NHS stakeholders we interviewed noted that when working in partnership, it is essential to recognise the value and expertise that other sectors bring, and be willing to work as equal partners alongside other sectors:

‘You know, (NHS organisations) should be partners, and we are partners with our local community. We shouldn’t be putting ourselves up on a pedestal, and then there’s a risk of that sometimes … we have a lot to contribute to the local growth agenda and the sustainability agenda, but we should do that in partnership.’

Deputy chief executive

Acute trust

Collaborative anchor approaches have been developed in procurement, where NHS organisations are working with other anchors to maximise the social value of public spend. Adopting joint progressive procurement strategies can help retain more money locally while also sending a collective market signal that social objectives are a priority, which can influence supplier behaviour. For example, in Birmingham, partners across the STP have agreed to apply a 10% social value weighting in their contracts and use procurement to meet shared social aims, including increasing the number of apprenticeships, recruiting more people from vulnerable populations and lowering carbon emissions.

By working collaboratively, anchor organisations can help build a common language for social value and reduce variation in how the concept is understood and applied in practice across a health economy. Interviews with stakeholders revealed that commissioners and providers often use a mix of approaches that contribute to a lack of clarity in how to interpret social value while also unnecessarily duplicating efforts. For instance, in one local area, a trust had to respond to two local authorities with different requirements for social value to deliver the same sexual health service:

‘The service specification looked exactly the same, but we had to report different types of evidence to show how we would meet standards for social value. This required a degree of expertise in how to respond to contracts, that thankfully we had, but not all providers do. It also created inefficiencies without changing anything fundamental about our approach to social value or increasing the community benefit we would bring in the way we delivered the service.’

Head of sustainability

Acute trust

STP and ICS leadership can help establish common standards while reducing duplication by coming up with contracting templates that can be adapted by anchors across the partnership.

Case study 7: Leeds City Region anchor framework

In Leeds, anchor organisations from across the city have formed an anchors collaborative and agreed common goals for supporting inclusive development. Working with the Joseph Rowntree Foundation, the collaborative developed a tool for partners to self-assess how they perform on five anchor dimensions (employment, procurement, capital, service delivery and corporate responsibility), visualise where they want to be and identify what actions they can take to get there. The framework has also helped anchors establish common goals and have a broader impact by sending a powerful collective signal to the local economy that narrowing inequalities and supporting inclusive economic development are priorities. To support this effort, Leeds City Council has also created a data dashboard so that areas with the greatest needs and inequalities can be targeted.

Though the framework establishes clear goals and specific actions for all partners, flexibility in how the tool is adapted and applied within each organisation is key.

Case study 8: Birmingham anchor network

A new network has formed in Birmingham to explore how six anchors can work together, including Queen Elizabeth Hospital, Birmingham City Council, the police, University of Birmingham, local colleges and the local housing association. This network builds on work these organisations have done with the Centre for Local Economic Strategies (CLES) funded by the Barrow Cadbury Trust to map their collective assets and understand their baseline contribution to the Birmingham and West Midlands economy. With combined annual budgets of £6bn and more than 50,000 employees, the network will support anchors to develop individual strategies and advocate for an anchor approach on workforce, procurement and management of land and assets. One collective priority is around construction, as a significant proportion of money leaks from the local economy from new building projects, and the upcoming Commonwealth 2022 games in Birmingham present an opportunity to shift practice. The network is also developing ways to measure the impact of different approaches to better understand how anchor practices can benefit communities.

Partnering with other NHS anchors

1. Developing networks to support shared learning and spread good practice

In addition to coming together across a place, there is an opportunity for NHS organisations to work together to develop their collective identity as anchor institutions to tackle common issues. Peer networks can be a powerful tool in generating knowledge and supporting a culture of learning. However, there is currently no formal network of health care anchors in the UK. The NHS Confederation and the SDU have been convening NHS organisations to facilitate shared learning, provide expertise and develop skills around local economic development and environmental and social sustainability, but our interviewees felt there could be more collaborative networks and communities of practice to help make an anchor mission an institutional priority across the NHS.

In the United States, The Democracy Collaborative (TDC, which supports a network of more than 40 health care systems) could serve as a model for the NHS. These health systems together employ 1.5 million people and purchase over $50bn worth of goods and services annually. The network allows health care organisations to share knowledge, work through common challenges, identify areas for joint working and co-develop tools that can be adapted by each organisation to accelerate progress. A key aim is to help members drive culture change within their respective organisations and adopt more intentional and conscious anchor strategies within their health system’s overarching strategy. Since its inception, members have implemented changes in their local areas, including investing in affordable housing, committing to living wages for all staff and creating new career pathways for non-clinical entry-level roles.

In the UK, there are also examples of anchor collaboration within other sectors. For instance, 37 vice-chancellors recently signed a Civic Universities Statement Agreement pledging to prioritise the social, economic, environmental and cultural life of their local communities. This includes specific commitments to collaborate with each other and other anchor institutions to support their aims. There are also dedicated programmes and networks in local government, housing, and the arts and culture sectors.

Summary and implications for practice and policy

NHS organisations can work with each other, and with other anchor organisations across a place, to share learning and establish common goals so that the anchor mission more directly informs how the NHS functions within a place. As many of the examples have demonstrated, where individual institutions have come together to collaborate on a shared vision and work together to hold each other to account, the benefits can be significant.

There is a real opportunity to capitalise on STPs and ICSs to help the NHS forge new partnerships across a place and develop shared approaches and anchor strategies as part of broader system plans. Anchor strategies may also provide a gateway for the NHS to take part in other place-based strategic discussions, including with LEP, to help align approaches with broader economic proposals that improve the health and wellbeing of communities. National leaders should work with partners to create space for NHS organisations to come together to share and spread ideas through action learning and to work through challenges unique to the NHS context.

Practical resources to support implementation

A Partnership Framework for an Inclusive and Sustainable Economy (Sheffield City Partnership)

Anchor Collaboratives: Building Bridges with Place-Based Partnerships and Anchor Institutions (The Democracy Collaborative)

Community Wealth Building Through Anchor Institutions (Centre for Local Economic Strategies)

Health In All Local Industrial Strategies? (NHS Confederation)

Healthcare Anchor Network (The Democracy Collaborative)

Leeds City Region Anchor Institution Progression Framework (Leeds City Council)

Local Growth Academy (NHS Confederation)

Learning from other sectors

Civic University Agreements – List of Signatories (Civic University Commission)

Great Places Commission Interim Report (National Housing Federation)

Inquiry into the Civic Role of Arts Organisations. Phase 2. What Happens Next? (Calouste Gulbenkian Foundation)

Leading Places programme (Local Government Association)

Local Access (Big Society Capital and Access)

‡‡ The NHS Confederation’s Health in all local industrial strategies? briefing offers examples of how health intersects with local industrial strategies and ways the NHS can engage with LEPs to shape their development around mutual aims. Source:

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