The NHS as an anchor – taking forward the long term plan

If you read all the way to the very last paragraph of the NHS long-term plan, you will see a commitment from NHS England to work with the Health Foundation in developing the role of local NHS organisations as “anchor institutions”.

This is a welcome shift in thinking about the role of the NHS. Though the NHS is fundamentally a healthcare system, the influence it has over people’s health and wellbeing extends beyond the treatment it provides.

Anchor institutions are organisations such as universities and hospitals that are rooted in their local communities and have vast economic, social, human and institutional resources that can be leveraged to the benefit of local people.

The NHS acts as an anchor institution in its role as a large employer purchaser, and capital asset and investment holder, with considerable resources that can be channelled to boost the prospects of local economies and help them flourish.

While it’s true that many of the factors that impact health, such as education, housing and good employment, sit outside the control of the health system, the NHS still has important influence over the social, economic and environmental factors that make us healthy.

The opportunity – aligning organisational practices with population health

As the largest employer in England – employing nearly 1.3 million people – 7.5 per cent of the total workforce – the NHS has a role to play in creating job opportunities, particularly in areas of high deprivation. Given the established links between employment and good health, increasing the amount of hiring an NHS organisation does locally may support greater local economic opportunity and wellbeing of communities.

The NHS is short of 100,000 staff, so recruiting and retaining staff is one of the most significant priorities for managers. Establishing new pathways into employment will be key. Some trusts such as Bart’s Health and Leeds Teaching Hospitals are offering pre-employment support, apprenticeships and training programmes for local people who are unemployed and furthest from the career ladder.

The NHS can also contribute to broader social value in the way it utilises its land, real estate, capital assets and investments to support community health and wellbeing

The NHS’s influence as an employer comes not only from the number of jobs it creates, but the quality of work it can offer. The NHS often provides more stable employment and higher wages on average compared to other employers, particularly in more deprived areas. For example, an analysis of the impact of economic spending in the Black Country found that NHS staff earn 26 per cent more (including pension) than the average worker in the region.

It is also the case, however, that in 2017, 38 per cent of NHS staff reported feeling unwell due to work-related stress in the previous year, signalling that there is far more to do to ensure that the NHS supports the mental health and wellbeing for all who work in it. The plan’s commitment to building mental health support for NHS staff and expanding efforts to promote staff health and wellbeing is critical.

As a major procurer and purchaser of services, the NHS also has an indirect impact on the conditions of many more workers not formally employed by the health sector. By sourcing more goods and services locally, and with organisations that offer a living wage and quality work, NHS organisations could also have a greater impact on community wealth and local economies.

Whilst this isn’t possible for all purchasing and procurement decisions not least due to issues around economies of scale and variation, several trusts have begun to do this for “hotel services” such as laundering and catering. Sourcing locally also has a multiplier effect, as resources spent locally are reinvested in the local community at a faster rate than resources spent on national corporations.

The NHS can also contribute to broader social value in the way it utilises its land, real estate, capital assets and investments to support community health and wellbeing. Some NHS organisations have already taken steps to convert estate into affordable housing or community space for voluntary groups, job training, financial counselling and affordable food access services.

There are also a range of efforts across the sector to help make the NHS estate more environmentally sustainable, including adopting innovations to reduce waste, carbon and water, and single-use plastics.

Building on the long-term plan

This conversation on how the NHS can best support population health and local communities is taking place in the context of continued cuts to public health and local authority budgets. And though the plan rightfully makes clear that the NHS is not a substitute for the important role local government has in managing population health, these cuts have made the health service’s share of overall public funding increasingly important to local economies.

This makes it even more imperative to consider how the NHS’s resources can best be used to support broader population health and narrow health inequalities locally.

So how can the NHS leverage its potential as an anchor institution?

Some US hospitals, UK universities and local government have been doing this for some time, but less so in the NHS to date. For example, in Preston, local councils, universities and others came together to shift their “influenceable procurement spend” towards local suppliers, resulting in over £74 million being retained in the local economy between 2012-13 and 2016-17. And in the US, over 40 major health systems have come together to establish a network to share promising practices and establish tools and resources to support implementation of anchor strategies.

By virtue of its nature, the NHS acts as an anchor institution in local communities, but there are huge opportunities to realise this potential and more needs to done to support the NHS to build a practical understanding of how to do it and where the greatest opportunities for impact are.

The Health Foundation’s forthcoming research with CLES and The Democracy Collaborative is exploring this further, and we are pleased to be working with NHS England to build on the aims set in the plan to help maximise the role of the NHS as anchor in its local communities.