The case studies in this report set out the diverse ways trusts are using their anchor status to improve population health and wellbeing beyond the healthcare services they provide. Local circumstances differ widely, meaning that how trusts and systems respond to this opportunity is being tailored to the needs of local people and places. However, all of the trusts included in this report describe factors which have enabled them to gain momentum as an effective anchor.
Visible leadership and gaining board buy-in
Gaining board buy-in was key to the success of many of these projects. It is important to identify and articulate how being an anchor institution fits within the organisation's strategic objectives, and why it matters to the board from commercial, recruitment, financial and clinical perspectives.
Gaining recognition for the opportunities presented by taking a population health approach is helpful: according to one trust leader, framing work to prevent ill health as a means to reduce overcrowding in A&E, despite being a longer-term solution, helped to articulate the business case for working in new ways in the short-term.
Individuals leading the work we have showcased in this report also said that the visibility and commitment of senior leaders in their organisations helped to increase momentum and enthusiasm across a broader range of networks.
Making anchor working part of 'business as usual'
For some trusts, embedding 'anchor' objectives as part of their organisational strategy ensured a strategic focus and enabled them to scale initiatives more widely. In the context of new ICS strategic plans and the legal status of the four core purposes of ICSs, there is an increased impetus for many trusts' boards to cement their role as key players in local health and wellbeing.
For others, the clinical and ethical benefits of the initiative were the primary motivation to act, rather than planning the work explicitly under an 'anchor institutions' banner. However, most agreed that having a practical means to help people understand how 'anchor principles apply to their discipline, tapping into the core motivation of health and care staff to improve people's health, was key to making progress. For example, speaking to a property manager about the health benefits of providing community groups with access to trust-owned space to run activities helped one trust to use its estates in a more community-focused way.
Having a list of tangible things trusts can do to be a better 'anchor' and continuing to expose people across a trust to the objective of keeping communities healthy and helping people out of the poverty cycle, have proven to be important elements to embedding anchor working as a central aim.
Building relationships
The interrelated nature of the wider determinants of health means that being an effective anchor demands strong cross-organisation collaboration. The NHS has embarked on its journey to navigate the differences in culture, governance and processes across systems in order to bring together vital services. Developing shared objectives and outcomes for the projects helps many trust leaders to ensure that the benefits outweigh these challenges and make it worthwhile to persevere. Having a framework giving a common language and guide for practical action has been a useful tool in navigating different ways of working.
Trusts that contributed to this report said collaboration with system partners has allowed them to tap into resources and infrastructure they otherwise would not have had access to, as well as maximising their reach into communities to understand their needs. Having a collaborative forum or network that brings together other health and care partners can help systems spread the knowledge and expertise of the different organisations involved.
One trust emphasised the importance of building relationships with the local community and holding a good physical presence. Its aims to achieve this through 'walkarounds' of the local areas so partners can learn about the community and the place they live, ensuring people's experience remains central in shaping their anchor approach.
Empowering staff to innovate
While good leadership can help get trusts' anchor strategies off the ground, staff across clinical teams, estates, procurement and people and organisational development functions all play a pivotal role in putting anchor principles into practice in their day-to-day roles.
Recognising the influence of the front line on the overall success of anchor working, many trusts appreciate the importance of enabling staff to innovate by identifying common goals and offering a forum for them to come together and share enthusiasm and ideas. One trust is empowering its staff to take action locally by establishing a 'green champions network' of likeminded staff across the trust. The principles of anchor working resonate with many people, and many staff are residents of the local areas that anchor programmes benefit. Promoting staff involvement can therefore help to increase trusts' insight into the needs of local people and harness staff energy and commitment.