Health Service Focus

Importance of building healthier communities

Source: NHE SEPT-OCT 19 

Sarah Reed, improvement fellow at the Health Foundation, describes how the NHS can realise its potential as an anchor institution.

There is widening acceptance that good health is shaped by the conditions in which we live, work and play, with the clinical care we receive playing a crucial but ultimately lesser role.

 While the NHS is at its core, the place where people go when they become sick, it also has a profound influence on these wider determinants of health. The NHS is the largest employer in the country, spends billions on goods and services each year, and controls significant land and physical assets, all of which give it enormous economic clout in local communities.

Through its scale, size and relationship with local populations, the NHS acts as an ‘anchor institution’ and can positively influence the socio-economic and environmental conditions that create good health in the first place.

 Anchor institutions are large public sector organisations like hospitals, universities, and local councils that are unlikely to relocate and have a significant stake in a geographical area – they are effectively ‘anchored’ in their communities. They have sizeable assets that can be leveraged to support local community wealth building and development and are well placed to have a powerful voice in where and how resources are spent.

 Now is a crucial time to be considering the broader role the NHS plays in local communities given the current context: health inequalities are widening, with people born in the most deprived 10% of local areas in England expected to die nearly a decade earlier and have 18 fewer years of good health.

 While these inequalities are largely driven by factors outside of the health system’s control, it is the NHS that will deal with many of the consequences. With services facing growing demand from preventable and socio-economic causes, there is a strong moral and economic case for the NHS to play a more central role in tackling inequalities and preventing the root causes of poor health – which are the key objectives outlined in the NHS Long Term Plan.

 So what does this look like in practice, and how can the NHS make the most of its reach to improve health?

 Last month the Health Foundation launched a report that explores how the NHS functions as an anchor institution and how it might broaden its social and economic benefit in five main areas: employment, procurement, capital, environmental sustainability, and local partnerships.

 Though there is a way to go before the NHS is meeting its full potential as an anchor institution, our findings make clear that there is a range of practices already taking place that provides an important foundation from which to progress.

 Employment

 The NHS employs more than 1.6 million people in the UK and, with more than 350 career options, is a critical source of economic opportunity for local people. By helping more residents – particularly those furthest from the labour market – into quality work, the health system can improve peoples’ welfare and begin to narrow inequalities.

 Many NHS organisations have developed strategies to help more residents acquire the skills needed to work in the NHS.

 For example, Barts Health NHS Trust is widening workforce participation by ring-fencing a proportion of entry-level jobs for local unemployed applicants, working with local authorities to match potential candidates based on skills, interests and need. The trust is also working with schools and community partners to increase career opportunities for young people from disadvantaged backgrounds, offering employability skills training and job placements and raising the visibility of different career opportunities within the NHS through school career fairs and mentoring programmes.

 These efforts are helping to advance the social mobility of residents while helping to address the trust’s workforce pressures where staff vacancy and turnover rates stand at over 10% and 13% respectively – a key challenge confronting many trusts.

 Procurement

 Applying anchor strategies to NHS procurement is not without challenges, as this is an area where NHS organisations have less flexibility as purchasing protocols become increasingly centralised.

 Regardless, a number of NHS organisations have enacted changes to derive greater community benefit from their spend by shifting more towards purchasing locally, and working with organisations in their supply chain that promote economic, social and environmental value.

 For example, Royal Liverpool and Broadgreen University Hospitals NHS Trust has embedded social value into their procurement process, scoring potential suppliers on the extent that they support community development – for example, by creating local jobs and training opportunities for residents, paying a living wage and adopting environmentally sustainable practices.

 To achieve this, purchasing teams have needed the time and space to build their knowledge of social value and explicit permission to integrate these outcomes into their contracting decisions.

 It has also required the mapping of community assets to know which services can be procured locally, and direct engagement with local suppliers on how to compete for and secure NHS organisations, which can be far from straightforward.

 Capital

 NHS organisations also have significant physical assets that can be managed and developed to support broader social, economic and environmental aims – for example, working with partners to support more high-quality, affordable housing and widening access to community spaces.

 This can be a challenge given the lack of funding for NHS estates that have encouraged organisations to raise capital through sales of land and assets. However, some have taken steps to expand community access to NHS property, and convert and sell its estate for community benefit.

 For example, when NHS Property Services sold the former St George’s hospital site in Hornchurch for £40m, 15% was allocated for social housing and 1.6 hectares of land retained to host a new community health centre.

 And Bromley-by-Bow Centre – a GP practice and community charity based in a socially deprived area in east London – owns three acres of land that it has converted into green space, with a children’s play area, an allotment and a garden.

 Moving forwards

 There are many more ways that NHS organisations are taking steps to maximise their potential as anchor institutions. But even with these developments, the NHS is far from fully embracing its potential as an anchor.

 Where anchor practices are happening, they tend not to be intentionally applied or an embedded part of local system or organisational strategy. More needs to be done to help NHS organisations consciously adopt anchor missions and effectively leverage their assets for improving health, both within their organisations and in partnership with others.

 This is why we plan to take forward the findings from this report and build on the commitment made in the NHS Long Term Plan, working in partnership with NHS England and NHS Improvement to further identify good practice that can be adopted across the country. Watch this space.

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