Experts are arguing that NHS services could make a greater contribution to improving social and economic conditions for people in the areas in which they operate.
A report* published today by think tank the Health Foundation focuses on the idea of the NHS being an "anchor institution”, meaning a large, public sector organisation with sizeable assets that could be used to support community wealth building and development, thereby advancing the welfare of local people.
Primary care could be central to this ambition, says the report, with Primary Care Networks (PCNs) in England allowing the opportunity to implement strategies in primary care.
For their report, the authors commissioned research that included a review of evidence on the role and impact of "anchor institutions", as well as three case studies – University Hospitals Birmingham NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust and East Lancashire Hospitals NHS Trust.
Workshops and interviews were also carried out about existing practice from a range of perspectives, including primary care, the acute sector, community and mental health trusts, clinical commissioning groups, research, policy and local government.
The report says there is a “moral case” for maximising the role of the NHS in improving peoples’ health and wellbeing beyond just providing clinical care.
Although the root causes of poor health were primarily driven by factors outside of its control, it was the NHS that ultimately dealt with many of the consequences, said the authors.
With the NHS facing growing demands from an ageing population with increasingly complex conditions, it was important that it played a more central role in reducing preventable ill health and tackling inequalities, they argued.
Given the size, scale and reach of the NHS, it was uniquely positioned to positively influence the social, economic and environmental factors that help create the conditions for good health.
The report explores how NHS organisations can maximise their role as "anchor institutions" in local communities, in five key areas:
- widening access to quality employment – as the UK’s largest employer, the NHS is a vital source of economic opportunity
- purchasing and commissioning for social value – the NHS spends £27bn each year on goods and services in England. Decisions about what it buys, and how, impact on the health and wellbeing of local communities
- leveraging land and assets for community benefit – in England, the NHS estate includes 8,523 trust and primary care sits across 6,500 hectares of land
- leading on environmental sustainability
- as a local partner – working collaboratively, the NHS can use its influence and work with other local organisations to adopt similar practices and have greater impact.
The new report looks at examples where anchor practices are already being implemented by NHS institutions and explores what actions can be taken at each level of the system to maximise this potential.
Dominique Allwood, assistant director of Improvement at the Health Foundation and one of the report’s authors, said: “With growing economic inequality in the UK, we’re seeing widening health inequality, with people in deprived areas more likely to experience ill health. There is therefore a clear need for the NHS to make a broader contribution to people’s lives, leveraging its considerable resources to improve the economic and social conditions that impact so fundamentally on our health.”
Responding to the report, Michael Wood, head of health economic partnerships at the NHS Confederation, said: “The NHS is the largest employer in this country and this report taps the growing enthusiasm to maximise its importance in local communities and economies as a force for positive change on issues including workforce, affordable housing and reducing environmental impact.
“We also agree that the introduction of primary care networks in England may create new opportunities to work at scale and implement anchor strategies in primary care.”
*Building healthier communities: the role of the NHS as an anchor institution. The Health Foundation, August 2019.