Trusts’ role as anchor institutions
The term anchor institution does not feature in guidance setting out how organisations will work at system and place to deliver services and meet communities’ needs. However, NHS England and NHS Improvement has partnered with the Health Foundation to form the health anchors learning network to support NHS anchors to develop strong local partnerships, develop capacity and capability to improve socio-economic conditions and reduce health inequalities. It also aims to grow the evidence base for the role and importance of NHS anchors and help scale anchors across the UK.
As large, public sector organisations rooted in a local area, with significant assets and influence in the local economy, trusts are ideally placed to act as anchor institutions. The pandemic and its wider social and economic impacts have widened inequalities in society (The Health Foundation, 2021) . A recovery planned with these inequalities in mind should therefore take a multi-pronged approach, not only restoring services to meet the needs of communities, but also playing a role within the wider local economy.
As organisations with large purchasing power, there is also an opportunity for trusts to build on the partnerships created with local businesses in response to the pressing needs of the pandemic and support the wellbeing of staff. For example, at the height of the first wave, Northumbria Healthcare NHS Foundation Trust worked with local textiles manufacturers (NHS Providers, 2020) to meet their immediate needs for personal protective equipment, creating local jobs and supporting local industry. The economic impact of the pandemic has been substantial and as anchors trusts can play a role in bolstering the resilience of local businesses and investing in local communities through by choosing local firms as contractors or suppliers and employing staff from the local area where possible. Trusts play a pivotal role in their local communities as employers and have substantial economic influence in their local area. Across England as a whole, health and social care provides 12% of all employment, and is uniquely placed to use its resources and influence to improve the wellbeing of the local population and reduce health inequalities.
A recovery planned with these inequalities in mind should therefore take a multi-pronged approach, not only restoring services to meet the needs of communities, but also playing a role within the wider local economy.
Addressing workforce inequalities
The NHS workforce is large and diverse and as such reflects wider society. NHS staff face the same inequalities as the broader population, and where there is clear evidence that COVID-19 had a disproportionate impact on Black, Asian and minority ethnic communities, this has also proved to be true for the NHS staff affected by coronavirus. While 21% of all NHS staff are from ethnic minority backgrounds, these individuals made up 63% of all healthcare workers, and 95% of doctors, who died in the first wave of the pandemic.
The pandemic had a profound impact on the NHS workforce, and research found disparities in how medical staff from BAME background experienced working in the NHS during the pandemic. For example, the British Medical Association found that doctors from Black, Asian and minority ethnic backgrounds felt less confident that adjustments had been made to mitigate risk, less confident about PPE provision and reported higher rates of bullying and harassment during the pandemic.
In response, NHS England and NHS Improvement asked all NHS employers to carry out risk assessments for staff and take steps to mitigate any risks identified, either through modified duties or redeployment. Trusts are clear on the need for compassionate leadership and effective staff engagement when supporting their workforce through a challenging period.
To address and monitor concerns about inequalities faced by Black, Asian and minority ethnic communities, the government set up a race disparity unit. This committed to publishing four quarterly reports over a year, reporting on progress to address COVID-19 health inequalities. Its report earlier this year was unhelpful in denying the link between structural racism and wider health inequalities. However more recently it has published a report that has summarised work across government and the health service to improve vaccine uptake among ethnic minorities. The NHS has worked with local partners to increase uptake of the COVID-19 vaccine in communities with higher levels of vaccine hesitancy. For example, during Ramadan, places of worship were used as vaccination centres (Strategy Unit, 2021). Since February, the NHS has allocated around £7m to ICSs to support targeted engagement (NHS England and NHS Improvement, 2021) in areas with health inequalities and high levels of vaccine hesitancy. However, it is worth noting that much of the outreach into communities with higher levels of hesitancy will happen at place, rather than ICS, level. This further highlights the importance of partnerships beyond the NHS to achieve health equity rather than relying on ICBs to deliver improvements alone.