The coronavirus (COVID-19) pandemic has created a dual challenge of tackling a global public health emergency and protecting communities from the associated economic and social harms. COVID-19 is not a ‘great leveler’ – there are clear inequalities in exposure to infection, the ability to ‘socially distance’, and in who will bear the brunt of the longer term negative impacts. Death rates are higher for those from black, Asian and minority ethnic groups, and those working in lower paid jobs. There is a considerable risk that long-standing health inequalities will be exacerbated.
As the initial peak of the virus passes, we must consider how best to rebuild. NHS organisations have been central to the immediate response to COVID-19 and also have an essential role in the recovery. This includes through their wider impact as employers, purchasers, holders of physical assets, and community partners within local health economies.
Being clear and purposeful about the role of the NHS as an anchor institution – a large, public sector organisation with a significant stake in local communities and potential to influence their health and wellbeing – could help to mitigate some of the negative social and economic impacts of the pandemic. It could also reduce local health inequalities through action on the wider determinants of health and rebuild a system that is more resilient in the face of future shocks. COVID-19 has created both an increased need and new opportunities to act, for example:
Employment –The economic downturn has seen the highest number of people claiming unemployment benefits in the UK for 27 years. Huge support for key workers has contributed to a surge in applications of people wanting to work in the NHS. In the wake of COVID-19, some NHS organisations such as Barts Health have launched targeted local employment programmes to help people develop careers in the NHS. There is a clear opportunity for NHS organisations to use their role as employers to target volunteering and stable employment opportunities at local residents, particularly those furthest from the labour market.
Procurement and commissioning – The NHS has significant purchasing power, spending nearly £30bn a year on procurement pre-COVID-19. While the government is pledging to increase funding for the NHS and other public services, many businesses are suffering as a result of COVID-19. Promising initiatives, such as a sustainable packing company in Wales changing production to provide a million face shields a week, have shown how the NHS and local businesses can work together in ways that were not imaginable pre-COVID-19. The NHS has an opportunity to build resilience and increase community benefit by diversifying and strengthening local supply chains.
Estate and workplace – The NHS holds significant physical assets. While the NHS has greatly increased the number of ventilated beds by creatively utilising space, keeping staff and patients safe during COVID-19 has also reduced the use of other spaces through increased remote consultations and working virtually. As these trends are likely to continue, NHS organisations have an increased responsibility to ensure these digital solutions can reach all patients and staff. For example, the East London Foundation Trust is working to increase access to smartphones, tablets and laptops for service users in an attempt to tackle digital exclusion.
Environmental sustainability – NHS organisations have a significant impact on the environment. The need for PPE has necessitated an increase in single-use plastics with adverse environmental effects likely to be felt for years to come. In response, some NHS organisations have been exploring decontamination as a more sustainable solution. On the other hand, positive benefits of lockdown, such as an increase in walking and cycling, have led to reduced air pollution. Some organisations are providing increased access to bikes for NHS Staff. In future, NHS organisations have an opportunity to promote positive behaviour change and ensure that initiatives are used by all staff and patient groups.
Partnering in a place – Building partnerships with local organisations and communities can help NHS organisations to improve the design and delivery of anchor strategies. COVID-19 has led to a significant increase in community action, mutual aid groups and community organising to demand change on related issues such as structural racism and the disproportionate impact of COVID-19 on black, Asian and minority ethnic groups. Learning from and working with local community groups and organisations can help the NHS to gain insight on local experiences of COVID-19, care, and inequalities through local recovery strategies. Strong alliances to achieve these aims can be built with local government, schools and workplaces, the private sector, and other local partners.
At the Health Foundation, we are working with NHS England and NHS Improvement to understand how we can support the NHS in its role as an anchor institution and identify good practice that can be adopted. If you have examples of anchor approaches that you would like to share, or are interested in finding out more, please contact us.