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Leading up to COP26, it’s been great to see a heightened focus on the NHS’s role in addressing climate change. And rightly so: in England, the NHS is responsible for 40% of the public sector’s carbon footprint.

There are some great examples of ‘greener NHS’ work happening at all levels of the system and across the UK. One of the key ways the NHS can combat climate change is through its role as an anchor institution. Anchor institutions are large, public sector organisations that have a significant stake in a geographical area. They have an impact on their local area in many ways, including through the jobs they offer, the buildings and spaces they occupy, and the supply chains they use. As a result, they can consciously use their resources and influence to benefit communities.   

But what does approaching environmental sustainability as an anchor institution mean, and what value does it bring? In this blog we explore three key insights from the Health Foundation’s previous work on anchors and emerging learning from the UK-wide Health Anchors Learning Network (HALN) – a joint initiative with NHS England and NHS Improvement. We highlight how adopting anchor principles can help address the global climate crisis while also contributing to improved health and reducing health inequalities for local communities. 

1. Put health inequalities at the centre

Environmental sustainability is one of the five pillars of the NHS as an anchor institution, through which it can make a positive difference to local communities. But being a ‘good anchor’ isn’t just about doing ‘green’ projects. Transcending all five pillars is a sharp focus on health inequalities, equity and the health needs of local communities. This lies at the heart of what it means for the NHS to think and act like an anchor. There is a real opportunity to do environmental sustainability work that has local impact on people’s health and health inequalities, and also contributes to the regional, national and global efforts to fight the climate crisis.

Air pollution is a good example of this. Exposure to air pollution is estimated to cause 28,000 and 36,000 deaths in the UK each year. And more than 2,000 GP practices and 200 hospitals are in areas affected by toxic air. Air pollution also disproportionally affects people living in disadvantaged areas. For example, Guy’s and St Thomas’ NHS Foundation Trust are focusing their trial of traffic street filters in three areas of Southwark that have high levels of air pollution but also have high levels of socioeconomic deprivation and childhood obesity.

2. Be intentional

For the NHS to embrace and flourish in its role as an anchor institution, it must act intentionally. This means NHS organisations and systems consciously adopting an anchor mission, and prioritising, embedding and evaluating anchor projects. It also means working with partners and non-health anchors – such as councils, universities and housing associations – around shared goals to maximise the positive impact for local communities and places. West Yorkshire and Harrogate Health Care Partnership spoke to this point at a recent HALN event, outlining how their anchor approach underpinned their environmental sustainability work with local communities.

It’s vital for the NHS to proactively develop leadership and staff buy-in for environmental sustainability and influencing sustainable practices in the community. The anchor leadership role is particularly important, with opportunities to maximise impact beyond the walls of any specific institution or organisation. Dame Jackie Daniel is a great example of an NHS leader using their platform and influence as an anchor to inspire others – locally and nationally – to take action on climate change.

An intentional anchor approach also enables the connection of disparate (but related) activities to a broader organisational strategy, and allows sustainability to be embedded across an organisation or a local system. For example – thinking across the anchor pillars – there are opportunities to influence local supply chains to be greener, taking a more sustainable approach to procurement, sustainability of NHS estates and supporting green local economic growth. For example, Epsom and St Helier University Hospitals NHS Trust developed a local bus route to improve access for staff and patients but that was also more environmentally sustainable.

3. Use COP26 a catalyst for anchor action

We have learned that many places, institutions and systems are still at the beginning of their anchor journey. Although an intentional and purposeful anchor approach is very much the ‘gold standard’ of what it means to be an anchor, the reality of doing this is far more messy and complex. What’s been clear from the recent HALN learning sets is that being an anchor is as much a culture change and mindset shift as it is a strategic approach or set of initiatives. Changing mindsets and culture can take a long time, but the most important thing is to start somewhere. Environmental sustainability is a great place to start.

In addition to COP26 momentum, there is broad public support for the NHS to reduce its carbon footprint and staff are key to implementing these changes. In Wales for example, we are seeing staff driving the change to reduce the carbon footprint of the Welsh NHS.

Anchor action focusing on environmental sustainability has the potential to catalyse further anchor work, start conversations and get the buy-in, support and ideas needed to take the next step on the anchor journey.

All action that contributes to tackling the climate crisis is needed and important. But if the NHS, working with others, can adopt an anchor approach to its sustainability work, then it’ll be a win-win-win for our climate, local communities and reducing health inequalities.

The Health Anchors Learn Network is free for anyone to join to connect with others working on anchors, share best practice and learn together. You can sign up here.

Jenna Collins (@jen_collins) is a programme manager in the improvement team at the Health Foundation.

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