Why the NHS must do more to support communities, and how they can do it

Widening inequalities, declining living standards and the climate crisis are increasing pressures on health and care services, prompting a fundamental conversation about how the NHS can do more to “intervene upstream” and prevent the root causes of poor health.  

With growing acceptance that good health is driven primarily by factors outside of its control, the NHS could have a profound influence on the social and economic conditions that affect the life chances of the people where it operates. 

Last week, we launched a report that makes the case for how the NHS acts as an “anchor institution” in local communities and can improve population health in many ways beyond the clinical care it provides.

The NHS is the largest employer in the country, spends billions of pounds on goods and services each year, and controls significant lands and assets. The ability to influence these factors makes the NHS uniquely positioned to support more prosperous, healthy and sustainable communities.

NHS England and Improvement recognised how NHS organisations act as anchor institutions in both the long-term plan and interim people plan, and have committed to spreading learning from good practice where it is happening

But is the NHS making the most of its scale, size and reach to improve health? 

The answer – so far at least – is no, but there are signs that this is changing, with growing enthusiasm and acknowledgement of the broader role the NHS can play in improving the wider determinants of health.

NHS England and Improvement recognised how NHS organisations act as anchor institutions in both the long-term plan and interim people plan, and have committed to spreading learning from good practice where it is happening.

And good practice is happening.

There are numerous examples of NHS organisations supporting community development in the way that they hire, purchase, use their estate, promote environmental sustainability, and work with partners across their localities.

From anchor practices to anchor mission – six steps to change

Even with these positive developments, the NHS is far from being in a place where NHS organisations are collectively embracing an “anchor mission” as an institutional priority.

Where anchor practices are happening, they tend not to be intentionally applied or an embedded part of local system or organisational strategy.

More needs to be done to help them cultivate an anchor mission and know how best to leverage all of their assets for improving health, both within their organisations and in partnership with others.

Regardless of where NHS organisations are starting from, there are some key steps they can take to help meet their potential as anchor institutions:

1. Build a baseline understanding to know where to prioritise action and establish informed goals. Data are key to helping assess current practice. Organisations can conduct internal audits to understand where they’re starting from and reasonable places to shift behaviour. 

2. Develop metrics and evaluate the impact of interventions. Where anchor practices are happening, they are rarely being evaluated to understand their impact and help build a business case for future investment. To do this systematically, national and regional policy makers can help define metrics for tracking impact at local system and organisational levels.  

3. Establish clear and visible leadership to embed anchor practices within organisational and system strategies. As with any complex change, the importance of leadership cannot be overstated. Integrated Care System and Sustainability and Transformation Partnership leads can help embed anchor strategies as part of system plans, and NHS provider organisations can designate board-level and operational leads to ensure anchor practices are resourced and aligned across the organisation. 

4. Enable staff to act on a collective vision for enhancing community health and wellbeing. Staff need the time, skills and capability needed to embed anchor practices within their roles. Potential solutions should be designed directly with staff, so they feel ownership over the challenges and feel part of a collective vision for supporting community health and wellbeing.   

5. Support the sharing and spread of ideas through networks. Networks are needed to help the NHS connect with other anchor organisations locally to develop a shared vision and combine impact, as well as nationally to help NHS organisations learn from peers and spread anchor practices more effectively. 

6. Engage proactively with communities to ensure that anchor strategies meet the needs of local people and to maximise impact on narrowing inequalities. Anchor approaches require engaging with residents in new ways to explore their needs and reaching people who are seldom heard and poorly served – something that NHS organisations are not traditionally strong on. This makes partnership working with local government and voluntary sector organisations essential. 

Making it a reality – is this too much to ask? 

It’s very reasonable, under pressures as significant and continually escalating as those faced by the NHS, to question if we should expect more from the system than to simply meet the demands placed on it.

But if we don’t challenge the NHS to think differently about its role in local economies, we waste an opportunity to improve health across the NHS’ practices. 

Implementing anchor approaches undoubtedly requires time, resources and investment that can be hard to come by.

But what our report makes clear is that there is a strong foundation of existing practice from which to build, and NHS organisations have made progress by 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

For example, workforce strategies that widen recruitment into disadvantaged areas could help address widespread staff shortages across NHS trusts which currently stand at over 100,000 vacancies. 

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.

The NHS has a profound influence on local communities, simply by being there. But the extent to which that influence is positive will come down to how the NHS chooses to operate and leverage its resources.

And given the broader social and economic dynamics that are resulting in poor health, helping the NHS to meet its potential as an anchor should be a key aim.