Conclusion: actions and opportunities for change

Consciously adopting an anchor mission

In this report we have explored a range of opportunities for the NHS to harness its considerable influence to have an even greater impact on the health and wellbeing of communities. There are many anchor activities already taking place across the sector that provide an important foundation on which the NHS can build. NHS organisations are all at different stages in embracing their role as anchors, but where strategies are being adopted, they tend to be discrete and narrow in scope, rather than joined up and embedded as part of central, local system or organisational strategies. Anchor approaches are often being applied in one area only (for example, workforce). While NHS organisations will have to start somewhere, the greatest impact will come from pursuing changes in each domain of anchor influence and with other anchors and partners across a place. It is also the case that anchor practices are not yet being evaluated systematically to understand what actions have the strongest impact on population outcomes. More needs to be done to help NHS organisations cultivate an anchor mission and know where to prioritise efforts, both within their organisations and in their local communities.

This report has also identified cross-cutting opportunities – regardless of the area of anchor activity being pursued – to make anchor practices more embedded in the NHS, and these are summarised below. While most actions will be delivered at the level of NHS organisations and networks, national, regional and local system leaders have a strong role in signalling the anchor mission as a priority and supporting an environment where these changes can happen. These opportunities are set out in Table 4.

Adopting new ways of working for an anchor mission requires time, resources and upfront investment that can be hard for NHS organisations to come by. The report has highlighted tensions the NHS may have to work through to balance priorities and direct its anchor efforts (described in Table 3). These tensions play out at different levels of the system and are not always inevitable, but when they do arise can often be mitigated or managed with careful implementation and planning. For instance, the NHS can boost international recruitment to address shortages in certain jobs and geographies while also taking steps to increase local workforce supply over the long term. The examples given throughout the report show how the NHS can shift practice by taking a pragmatic approach and aligning anchor practices with other system goals.

Table 3: Potential tensions between anchor practices and the current policy/practice context

Anchor practices

Tensions to balance

A desire to develop the local labour market and create pipelines into NHS jobs and careers.

The need to fill vacancies quickly to address severe workforce shortages requires a focus on external labour sources, including international recruitment.

An aspiration to increase social value by taking a wider range of factors into account when making decisions on purchasing and procurement.

A push to reduce costs and increase efficiency, given the wider economic climate and financial pressures on the health service.

A desire to increase capability in the local supply chain, leading to more local purchasing and procurement.

A need to avoid potentially anti-competitive behaviour.

A focus on developing strong and resilient local places in specific geographical areas.

The risk of widening inequalities (as those places with the largest or best-resourced anchors will benefit most and may draw resources away from neighbouring areas).

A desire to allow flexibility for NHS anchors to adapt activity to meet local context and local needs.

A national drive for greater standardisation of activities to reduce variation.

What can the NHS do now to develop its role as an anchor?

  1. Build a baseline understanding of current practice to know where to prioritise action and establish informed goals.

    Data are key to helping organisations understand their baseline levels of activity and assess their readiness to change. Baseline audits can generate information on purchasing behaviour, use of estates, employment practices and environmental impact. This can then inform goal-setting and targets for shifting behaviours based on current levels of practice.

    Baseline data can also help signal where there may be more immediate opportunities and where change will have to happen over the longer term. NHS organisations may find it easier to start in domains such as employment, where there is clear data on vacancies and local unemployment to show where to target efforts, and where anchor actions align with broader organisational strategies. Within procurement, NHS organisations can use data to establish achievable targets of how much spend can be shifted locally, identifying which contracts are up for renewal that may lend themselves to working with local suppliers. People with improvement skills are well placed to support the development of aims and measures to inform goals, and the ability to facilitate change.

  2. Develop metrics and evaluate the impact of interventions

    Data are also vital for measuring the impact of interventions and building the business case for future investment. National leaders can help establish metrics in each area of anchor activity for local NHS organisations and STP/ICS leads to use to assess progress, and fund evaluations of the wider impact and return on investment. This could build on existing work such as the framework developed in Leeds (see page 55) that defines metrics across different anchor dimensions to help organisations measure progress around shared goals. Within procurement, some local system leaders have already defined metrics to help guide purchasing decisions and build an understanding of the broader social impact of public spend (see Chapter 4). STPs and ICSs can help track progress across a place by creating dashboards that pool data from partner organisations and help guide future strategy. Evaluation requires significant resources and time, so it is important that teams are funded and supported with the skills and capacity necessary to use data effectively to inform decision making.

  3. Establish clear and visible leadership to embed anchor practices within organisational and system strategies

    Leadership is needed at each level of the system to make anchor practices visible and an integrated part of organisational and system strategies. Unless leaders see an anchor mission as a core part of the NHS’s role and responsibility to local communities, little will be achieved. At the organisational level, gaining board support will be an essential early step to ensure that efforts are adequately resourced and prioritised over the long term. Nominating a board-level lead for anchor strategy can help cement that support, while raising the profile of anchor practices across the organisation and connecting them up. Beyond board support, having a designated manager – for example, an anchor or sustainability lead – to oversee and coordinate anchor practices across an organisation can be a key driver in getting efforts off the ground and integrating anchor strategies into operating models.

    Linking anchor practices to existing organisational priorities and goals can be useful in gaining senior buy-in. For example, showcasing how anchor practices that build local workforce supply or provide more affordable housing for staff can address staff recruitment and retention challenges at the same time as helping to reduce inequalities, can gain traction for these ideas. And when there are tensions between short-term performance pressures and longer-term improvements to population health, having board-level support can give staff the permission and air-cover needed to prioritise practices in support of an anchor mission.

    At the local system level, STP and ICS leads have an opportunity to work with system partners to create a shared view around an anchor mission and embed strategies as part of delivery plans. This requires building consensus around common aims and identifying which anchor strategies are best done in partnership to achieve more ambitious and long-term goals. Local system leaders have a role in articulating a clear vision for inclusive development while permitting flexibility for organisations, to account for different contexts.

    While most anchor practices will be delivered at the organisational and local system levels, national leaders can be instrumental in helping to shape the collective vision of how the NHS acts as an anchor and setting expectations about its broader role in the local community. The explicit references to anchor institutions in the NHS Long Term Plan and Interim NHS People Plan are positive developments that help signal the anchor mission as a priority. There may be more opportunities to incorporate an anchor approach into other national frameworks and guidance – for example, through the CCG improvement and assessment framework, or STP/ICS guidance. These frameworks should be backed by proactive support to ensure that teams have the resources and capability needed to support effective implementation. There is also a role for national leaders to help clarify definitions and provide guidance and templates to ensure consistency in anchor practices and how they can be integrated into NHS practice.

  4. Enable staff to act on a collective vision for enhancing community health and wellbeing

    Change will not happen unless staff are engaged in the anchor mission and have the time, skills and capability needed to embed anchor practices within daily roles. The anchor mission may offer an opportunity to tap into employees’ intrinsic motivation, by connecting operational functions like HR, procurement and facilities management to the aims for front-line delivery – that is, improving the health and wellbeing of local communities. One way to do this is to co-produce and design potential solutions directly with staff so that they feel ownership over the challenges and feel part of the collective vision for supporting wider community health and wellbeing.

    It is also the case that anchor practices may be new territory for staff, who may need support to incorporate considerations for population health and social value effectively into their daily roles. We have cited numerous resources and tools throughout this report to help staff put these ideas into practice. NHS organisations should use these tools as a starting point, and national and system leaders should ensure that local teams have the skills and capabilities needed to carry out these practice changes and develop methods that support a consistent approach.

    Where there are gaps in skills and expertise, working in partnership can also help the NHS build greater capacity. Working with partners can bring different perspectives and skills from outside health care that are invaluable and give NHS organisations greater reach into local communities. Many of the examples of anchor activity we have highlighted involve NHS organisations collaborating with local community, public sector or commercial partners on a specific initiative. Whether this is working with housing associations to ensure that NHS land is developed for affordable housing, or engaging local government around improving public transport for staff and patients, effective partnership is often a core component of success.

  5. Support the sharing and spread of ideas through networks

    Sharing knowledge and ideas can help the NHS more intentionally adopt and apply anchor strategies in practice. Networks could add value and support the NHS to maximise its anchor role at different levels: locally, by convening anchors across a place to support community cohesion, align practices around a shared vision and maximise combined impact; and nationally, to facilitate peer learning and help health care organisations carry out anchor activities more effectively and efficiently.

    STPs/ICSs can play a key role in convening and establishing these relationships across anchors in a locality. The introduction of PCNs may also create an opportunity to align operational practices and strategy in general practice around an anchor mission, and feed into broader goals of improving population health at the STP/ICS level. Regional and national leaders are well situated to encourage and support NHS organisations from different localities to convene and share learning and expertise across NHS peers. Whether national or local, networks may benefit from working with an independent third-party facilitator to build consensus and sustain engagement over the long term.

  6. Engage proactively with communities to ensure that anchor strategies meet the needs of local people and to maximise impact on narrowing inequalities

Maximising the NHS’s contribution to community health and wellbeing requires a deep understanding of local priorities and needs. This means engaging with residents in new ways to explore their needs and developing a shared vision and strategy for how the NHS can be a better partner for and leader in change. For example, being a better and more inclusive employer requires an understanding of the needs of residents who face the greatest barriers to employment. It means getting residents’ views on how NHS estate and land can add most value, and creating access to community spaces for those who need them most. This type of engagement requires connecting with people who are seldom heard and poorly served – something that many NHS organisations may not currently be equipped to do, which makes partnership working and local collaboration essential. Local organisations should prioritise this engagement as part of the design and delivery of different interventions, and local system leaders may also be well placed to coordinate engagement strategies across a place.

Table 4: Opportunities for action by different stakeholders



For action by

Build a baseline understanding of current practice to know where to prioritise action and establish informed goals

Conduct internal audits to set targets and goals for shifting practice.

NHS provider organisations and networks

Develop metrics and evaluate practices to understand the impact of different interventions

Continuously monitor and collect data to track impact of anchor strategies, ensuring teams have the resources and capacity needed to make effective use of data and make evaluation a priority.

NHS provider organisations and networks

Establish dashboards that pool data and track progress across a place.

Local system leaders

Help define metrics for tracking and measuring impact at the local system and organisational levels.

National/regional policy makers

Establish clear and visible leadership to embed anchor practices within organisational and system strategies

Designate a board-level lead for anchor strategy and operational lead to help coordinate and align efforts across an organisation.

NHS provider organisations and networks

Embed anchor strategies as part of local system plans to help deliver broader aims on population health and prevention.

Local system leaders

Establish clarity around common definitions to build system understanding of what anchor practices look like, and how they support broader social value and community benefit.

National policy makers

Send clear signals through national policy, guidance and frameworks that the anchor mission is a priority for the NHS.

National policy makers

Enable staff to act on a collective vision for enhancing community health and wellbeing

Co-design solutions directly with teams, appealing to intrinsic motivation among staff.

NHS provider organisations and networks

Use existing tools, resources and guidance to build capability, awareness and knowledge around anchor practices.

NHS provider organisations and networks

Work in partnership with other organisations that may have greater community reach or skills and expertise to support implementation of anchor practices.

NHS provider organisations and networks

Local system leaders

Deliver support programmes that equip teams with the resources, skills and expertise needed to operationalise anchor practices and strategies.

National policy makers

Local system leaders

Support the sharing and spread of ideas through networks

Establish place-based networks that convene anchors across a locality to develop a shared vision and objectives for improving community health and wellbeing.

Local system leaders

Encourage and support NHS organisations to convene through networks to learn and share practice for applying anchor strategies in the NHS context.

National policy makers

Engage proactively with communities to ensure that anchor strategies meet local needs and to maximise impact on narrowing inequalities

Work in partnership to engage with communities, particularly seldom heard groups, to ensure that all residents have a voice in shaping anchor approaches and strategies.

Local NHS providers and networks

Local system leaders

§§ Trusts, GP practices, PCNs, etc.

¶¶ STP/ICS leads, CCGs, etc.

*** NHS England and NHS Improvement, for example.

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