The NHS should contribute more to the prosperity of local communities New report argues the NHS could make a greater contribution to improving the socioeconomic conditions for people in the local areas in which it operates

A new report by the Health Foundation argues that the NHS could make a greater contribution to improving social and economic conditions for people in the local areas in which it operates.

The report explores the idea of the NHS as an ‘anchor institution’ – a large, public sector organisation with sizeable assets that could be used to support community wealth building and development, and in doing so, advance the welfare of local people.

Citing widening economic and health inequalities, growing pressures on health care services, and increasing acceptance that good health is largely influenced by socioeconomic factors, the independent charity says there is now a ‘moral case’ for maximising the role of the NHS in improving peoples’ health and wellbeing, beyond just providing clinical care.

The report’s authors note that while the root causes of poor health are primarily driven by factors outside of its control, it is the NHS that ultimately deals with many of the consequences. With the NHS facing growing demands from an ageing population with increasingly complex conditions, it is important that it plays a more central role in reducing preventable ill health and tackling inequalities – key objectives outlined in the recently published NHS Long Term Plan.

The Health Foundation also says that the size, scale and reach of the NHS means it is uniquely positioned to positively influence the social, economic and environmental factors that help create the conditions for good health. The report explores how NHS organisations can maximise their role as anchor institutions in local communities, in five key areas:

1. Widening access to quality employment – the NHS employs more than 1.6 million people making it the UK’s largest employer and a vital source of economic opportunity.

2. Purchasing and commissioning for social value – the NHS spends £27bn each year on goods and services in England alone. Decisions about what it buys, and how, impact on the health and wellbeing of local communities.

3. Leveraging land and assets for community benefit – in England alone the NHS estate includes 8,523 trust and primary care sites across 6,500 hectares of land. Buildings and land not used for clinical purposes can be used to create community assets, such as affordable housing and green space.

4. Leading on environmental sustainability – the NHS is responsible for 40% of public sector carbon emissions and any action the NHS takes on sustainability can have a significant overall impact.

5. As a local partner – working collaboratively, the NHS can use its influence and work with other local organisations to adopt similar practices and have greater impact.

The NHS Long Term Plan has also set out an ambition for the NHS to further explore its potential as an anchor institution. NHS England and NHS Improvement will be working in partnership with the Health Foundation to identify good practice that can be adopted across England. The Health Foundation’s report looks at examples where anchor practices are already being implemented by NHS institutions and explores what actions can be taken at each level of the system to maximise this potential. But it stresses that how the NHS chooses to operate and leverage its resources in the future will ultimately determine the impact it can have as an anchor, and that questions remain as to how it can best be supported and challenged to think differently about the value it brings to local populations.
 
Examples of successful anchor approaches include in Leeds where Leeds Teaching Hospitals Trust has joined with the local council, universities, colleges, and other organisations, forming a network that aims to maximise the local benefit of their collective assets. The network has provided individuals facing the greatest barriers with access to employability skills and job opportunities, widening access to professional roles at the trust, such as nursing. In a short space of time the trust has so far recruited 30 new hires from some of the most disadvantaged areas of Leeds. 
 
The report draws on research commissioned by the Health Foundation and produced by the Centre for Local Economic Strategies (CLES) and The Democracy Collaborative (TDC), as well as interviews with a range of stakeholders, and workshops with an expert advisory group. 
 
Dominique Allwood, Assistant Director of Improvement at the Health Foundation and one of the report’s authors, said:
 
‘Our health is shaped by the conditions in which we live, learn, work and age. Access to good medical care is also crucial but it ultimately plays a lesser role in our overall health than these wider societal factors. With growing economic inequality in the UK, we’re also seeing widening health inequality, with people in deprived areas more likely to experience ill health. There is therefore a clear need for the NHS to make a broader contribution to people’s lives, leveraging its considerable resources to improve the economic and social conditions that impact so fundamentally on our health. 
 
‘Our report highlights several NHS organisations that are recognising their importance to their local communities and doing fantastic work. But there is much more that can and needs to be done. It is vital that those leading the way inspire wider change and that the NHS consciously adopts an anchor mission and helps create more inclusive economies throughout the UK.’
 
Neil McInroy, Chief Executive of the Centre for Local Economic Strategies (CLES), said:
 
‘CLES are delighted to have worked with the Health Foundation on this important piece of research. The report recognises the role that anchor institutions in the field of health can play in improving the socioeconomic conditions and outcomes for the communities they serve. As part of a community wealth building approach, health institutions as anchors can help to repurpose our public services and generate significant social value. We urge the NHS to move forward in recognising any systematic changes that need to happen for it to maximise its potential as a significant anchor.’
 
Ted Howard, Co-Founder and President of The Democracy Collaborative, said:
 
‘In the US, The Democracy Collaborative is working through our Healthcare Anchor Network with some of the nation’s largest health systems to leverage their purchasing, hiring, and investment power to build community wealth. This report builds off of the lessons learned from this field of practice, and we hope that we can continue this transatlantic dialogue around the challenges and opportunities of anchor mission work. On both sides of the Atlantic, we know that improving health requires investing in a more equitable economy. Bold leadership and intentional resourcing are needed to reimagine the role that health systems can play in their local economies, and we encourage the NHS to support the anchor mission approach.’ 
 
The report concludes that while NHS organisations face many immediate pressures that can make it difficult for them to adopt anchor strategies, some of these challenges can be overcome by taking a pragmatic approach and aligning anchor practices with other organisational objectives – for example, programmes 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 of the change will be delivered by local NHS organisations, it notes that there is a key role for national and local leaders to cultivate an anchor mission, help scale approaches and create a supportive environment where anchor practices can become an embedded part of how the NHS operates.

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Simon Perry
simon.perry@health.org.uk
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