Anchored in the local community: how NHS organisations can improve population health

26 March 2019

The Health Foundation is exploring the role of anchor institutions in the NHS. James Goodyear is Associate Director of Policy and Partnerships at Leeds Teaching Hospitals NHS Trust. We spoke to him about how his trust is making the most of its role as an anchor institution to improve the health and wellbeing of the local community.

What does it mean to be an anchor institution and how is it relevant to health?

People talk about anchor institutions being ‘sticky’, meaning they’re unlikely to change or suddenly leave an area. Our hospital’s been around for 250 years. We serve the people of Leeds and wider communities of West Yorkshire, and we have a vested interest in the health and wellbeing of our population because that’s really our core purpose. 

The NHS has traditionally focused on treating people when they became unwell. But we’re becoming increasingly aware of the wider social determinants of health and starting to think about how the NHS can also do more to help people stay well. Beyond our role as providers of care, NHS organisations have an opportunity to improve people’s health through the way we interact with our community and our economy – both as large employers and as organisations that spend large amounts of public money. 

How is the trust making the most of its role as an anchor institution?

We’ve been doing a lot of this stuff for some time. But we’ve only consciously started thinking about ourselves as an anchor institution over the last year, and that’s really because of a partnership with Leeds City Council. They’ve developed an inclusive growth strategy that aims to grow the city’s economy, while ensuring all the citizens of Leeds share the benefits of that growth. As part of this they invited us to join a network of anchor institutions. 

Working in a bigger partnership increases our opportunities to influence some of the key issues that affect the social determinants of health – things around health and equality that would otherwise be outside our scope. It’s helped us focus in on how we can increase the health of the poorest people the fastest.

The first thing we’ve done is try to take a baseline of our activities against five areas where anchor institutions can typically make a difference. These are: as an employer, as a purchaser, as the owner of buildings and estate, through our service delivery, and through our civic partnerships. 

What are you doing as an employer?

Employment is where we’re making the biggest progress. That includes how we provide good quality jobs, ensure we pay the living wage, and offer routes into employment that don’t rely solely on educational attainment. 

Apprenticeships are important because they give people with different backgrounds an opportunity to access rewarding careers. We’ve now built up a very large apprenticeship offer, covering everything from entry level apprenticeships right through to degree and masters level, from admin roles through to facilities, medical engineering and indeed clinical apprenticeships. We are currently a pilot site for the nurse apprenticeship programme. 

We’re also trying to ensure we offer career opportunities to local people from deprived or excluded communities. Some of the most deprived areas nationally are smack bang on our doorstep, Lincoln Green, for example, which has a high percentage of people who’ve recently emigrated to the UK. We’ve partnered with Leeds City Council’s Priority Neighbourhoods programme to run a recruitment drive in those areas, with the council offering English as a second language courses at the same time. 

How is the trust using its role as a purchaser and owner of a large estate? 

The trust’s turnover is around £1.3 billion a year, of which about £450 million is spent on goods and services. We are exploring how we might increase the value from that spend in terms of its health creating properties. Directing more spend towards local businesses creates social value, and benefits local employees of those companies. 

It’s possible that a local focus could also increase efficiency, reduce environmental impact and create jobs. For example, we currently send all our laundry several hundred miles down the M1 for processing, but we’re considering working with other anchor institutions locally to instead create jobs in Leeds and West Yorkshire to do that work closer to home. 

We also want to ensure that our estate and buildings operate as an asset for local communities as well as to provide health care. That might mean offering space for local schools or community groups to use. Or it might be the way that we link up with local suppliers – for example all our sites now have local businesses selling fruit and vegetables within the main foyers. That’s great because it supports local businesses and promotes healthy eating. 

What are some of the challenges to implementing this work? 

The most obvious one relates to procurement. Budgets are tight and the NHS is very focused on getting the best value for money. Many goods are purchased through national frameworks and there’s less opportunity to influence that. But equally there’s a lot we can do around the margins. And as a £1.3 billion organisation when you do stuff at the margins, you can still have a big impact. 
Another issue, which is more of an opportunity, is how to get the whole organisation on board. We already have high levels of staff engagement, so if we can embed this anchor approach and ethos in all our people, then we’ve got an opportunity to make a much bigger impact than if it’s just me and some other senior people supporting discreet projects. 

What do you want the trust to have achieved in the next 5-10 years?  

We’ve got a board workshop coming up where we’ll start to set some tangible objectives. For instance, we might want to set ambitions around the proportion of our influenceable procurement spend that we can ensure goes into our local economy. 

In terms of service delivery, I’d like to see us better targeting our resources to need. Often health services are used most by those who require them least (the inverse care law). Using population health management approaches, can we provide services differently based on where the needs are within our population? And what upstream interventions can we offer that might prevent someone’s health from worsening rather than just waiting for them to attend A&E? We’re already testing these approaches, focusing on improving outcomes for people with frailty, working in close partnership with our local primary care networks and community services.

What advice would you give to other NHS organisations looking to expand their role as anchors?

Really think about what can be achieved in partnership. There are lots of things we can’t do alone. Historically, we haven’t been great at engaging with our communities, but that’s something the council have a much better track record of, so we can tap into that. Also, in Leeds a lot of the colleges and universities are involved in the Anchor Network. So, when we’re thinking about workforce supply and the training needs of our people, some of the key parts of that supply chain are already involved in the conversation and working to the same aims, which just means we can achieve more. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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