Anchor organisations are rooted in a place, with strong ties to the area in which they operate and large enough to make a significant contribution to the local economy through their purchasing power. They exert a substantial draw on local people for work and training, beyond just the services they provide.
NHS trusts are some of the most significant anchor institutions in the country, and can positively influence the local social, economic and environmental conditions for population health. The anchor agenda has been noted by many trusts as an organising framework for their work to reduce inequity in their services by looking upstream at what drives poorer outcomes.
The Health and Care Act 2022 lays the foundations to improve population health outcomes by joining up NHS, social care and public health services at a local level. It strengthens duties on NHS organisations to consider the impact of their decisions on health inequalities. From July 2022, integrated care systems (ICSs) were placed on a statutory footing with four main aims:
- improve outcomes in population health and healthcare
- tackle inequalities in outcomes, experience and access
- enhance productivity and value for money
- help the NHS support broader social and economic development.
Trusts' role in reducing inequalities in access to, experience of, and outcomes from healthcare services is an important way for them to make an impact. However, the fourth purpose of ICSs – supporting broader social and economic development, offers another dimension in which the NHS can shape the health of local populations through its influence on the availability of quality work, clean air, and investment in the local economy and the places in which people live.
Current economic pressures have exacerbated the stark health inequalities brought to light by the Covid-19 pandemic and reinforced the impact of the building blocks of health, such as quality work, fair pay, housing and education, on the social and economic wellbeing of local places. For example, our survey on the impact of the rising cost of living found 95% of trust leaders said that they had seen a widening of health inequalities in their local area. Recent data also highlights the relationship between the labour market and ill health, and reflects the importance of improving population health to support economic recovery.
Maximising trusts' role as anchor institutions recognises that health is shaped by the circumstances people live in. The NHS can work to reduce health inequalities for the people who live and work in the places they serve not only through the services they provide, but in their role as employers, landowners, and purchasers of goods and services. While it is not new to consider the NHS's contribution to population health, the statutory formation of ICSs provides an opportunity for trusts, and their systems, to look outwards at their local communities' needs and work closely with other local anchors including councils, the education sector and other major employers, to support better health beyond traditional organisational boundaries.
The purpose of this report is to showcase just some of the many innovative approaches taken by trusts as they work to realise the benefits of their role as anchors in local communities. The case studies aim to share learning and practical examples to support other trusts who are looking to progress their work in this area. It focuses on some of the key pillars of anchor working, including:
- widening access to good employment
- using buildings and estates to support local health
- contracting for local benefit and social value
- supporting local housing
- partnerships to support healthy places
- community engagement to support anchor working.
It also looks in more detail at the enabling factors required to make a success of these projects, including what it looks like to embed an 'anchor approach' and deploy initiatives at scale as part of a cultural shift.