Executive summary

What this report is about and why it matters

Widening health inequalities and growing pressures on health care services have prompted a fundamental conversation about the role of the NHS in prevention and its broader influence in local communities. The British economy is one where wages and living standards are stagnating and 22% of the population live in poverty. People from the most socially deprived areas of England die nearly a decade earlier and spend 18 fewer years in good health than people born in the least deprived areas. And while health care services on their own are insufficient to overcome these inequalities, the NHS could make a far greater contribution to this goal: it is the largest employer in the country, spends billions on goods and services each year and controls significant land and physical assets – all of which make it a powerful ‘anchor institution’.

Anchor institutions are large, public sector organisations that are called such because they are unlikely to relocate and have a significant stake in a geographical area – they are effectively ‘anchored’ in their surrounding community. They have sizeable assets that can be used to support local community wealth building and development, through procurement and spending power, workforce and training, and 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 locally. The NHS can also lead by example, and help spread and champion the principle of anchor institutions in local economies.

The idea of anchor institutions is not new. In the UK, however, other public sectors (such as local government and universities) have arguably been more conscious of their role as anchors., There are signs that this is changing; there is growing enthusiasm across the NHS for how health care organisations make up a key part of the social and economic fabric of communities, and can do more to channel their strategic influence to improve population health.

This report explores how NHS organisations act as anchor institutions. It gives examples of what anchor practices look like in a health care context, and how anchor institutions can maximise their influence on the wider determinants of health, as follows.

  • Chapters 1 and 2 introduce the concept of anchor institutions and set out the case for change.
  • Chapter 3 discusses employment, and how the NHS can widen access to quality work for communities furthest from the labour market, and be a better employer and place to build a career for more local residents.
  • Chapter 4 looks at how procurement and commissioning can derive greater social value by shifting more NHS spend locally and towards organisations that provide greater community benefit.
  • Chapter 5 considers how the NHS can make better use of its capital and estate by supporting the development of community assets like affordable housing and creating community spaces for local groups and businesses.
  • Chapter 6 looks at how the NHS can promote environmental sustainability in its own operations and in the broader community.
  • Chapter 7 discusses how the NHS can accelerate progress and impact at scale by working more effectively as a partner across a place, both within its own structures and with other anchor institutions in the local economy.

The central argument of this report

The size, scale and reach of the NHS means that it has a significant influence on the health and wellbeing of local populations. But how it chooses to function and leverage its resources will determine the extent of that impact. More can be done to support and challenge the NHS to embrace its role as an anchor institution and maximise the social and economic value it brings to local communities.

There are a range of promising anchor activities taking place across the NHS that provide an important foundation from which to advance progress. Though NHS organisations are all in very different stages of their role as anchors, where anchor practices are happening, they tend to be discrete, narrow in scope and not intentionally applied or integrated into central and local systems or organisational strategies. Nor are anchor approaches being evaluated in any systematic way to know where to prioritise efforts and what actions are likely to have the greatest impact on population outcomes.

There are opportunities at each level of the system to help the NHS more consciously adopt an anchor mission and to understand the impact of different approaches so that they become a central part of how NHS organisations function.

Considerations for practice and policy and taking it forward

Supporting NHS organisations to embrace their anchor mission is key to harnessing the NHS’s powerful influence on community health and wellbeing. While NHS organisations face many immediate pressures that can make it difficult to adopt anchor strategies, the examples in this report show how parts of the NHS are taking a pragmatic approach and aligning anchor practices with other strategic objectives. While most change will be delivered at the organisational level, there is a key role for local system, regional and national leaders to help scale approaches, cultivate an anchor mission and support an environment where these practices become an embedded part of how the NHS operates.

This report draws on examples of promising practice and identifies key opportunities to help NHS organisations meet their potential as anchor institutions, regardless of the area of anchor activity being pursued (summarised in Table 1 below). We also surface some of the key tensions that may have to be worked through to balance priorities and direct efforts along an anchor mission, and present some examples of where practices have overcome them. These are summarised in Table 3 and discussed in more detail throughout the report. The report proposes key actions for national and regional policymakers, local system leaders, and NHS providers and networks to help the NHS advance its role as an anchor institution.

Table 1: Steps towards realising the NHS’s potential as an anchor institution

  1. Build a baseline understanding of current practice to know where to prioritise action and establish informed goals.
  2. Develop metrics and evaluate the impact of interventions.
  3. Establish clear and visible leadership to embed anchor practices within organisational and system strategies.
  4. Enable staff to act on a collective vision for enhancing community health and wellbeing.
  5. Support the sharing and spread of ideas through networks.
  6. Engage proactively with communities to ensure that anchor strategies meet the needs of local people and to maximise impact on narrowing inequalities.

Figure 1: What makes the NHS an anchor institution?

Figure 1: What makes the NHS an anchor institution?
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