We need further action research to identify the practical mechanisms that NHS institutions could adopt here and now to drive forward progressive change, writes Tom Lloyd Goodwin
The NHS is not just a service that provides healthcare free at the point of need. It is a social contract with the British people to deliver well-being.
Across its wide range of services, its mission extends beyond making us better when we are ill, it is also about making sure we do not fall ill in the first place – playing a key part in addressing the wider social, economic and environmental determinants of health.
Research that we published last year – in conjunction with The Democracy Collaborative and the Health Foundation – examined the concept of the NHS as an anchor institution and the role it can play in addressing these wider determinants.
By establishing proof of concept, our work influenced the recent commitment in the NHS long-term plan to accelerate good anchor practice across the English NHS.
Anchor institutions are organisations that have presence and heft within the local economy, generating positive impacts for people and place.
Anchors can exert sizable influence by using their commissioning and procurement processes, their workforce and employment capacity, and their real assets such as facilities and land, to affect the economic, social and environmental wellbeing of the localities they operate within.
Here at the Centre for Local Economic Strategies, we are now being contacted by NHS trusts and clinical commissioning groups who are looking for advice and guidance around the implementation of anchor strategies, particularly in light of the long-term plan commitment.
Last week, I joined colleagues from the King’s Fund, NHS England and the Health Foundation, along with a number of NHS trusts, CCGs and regional NHS partnerships, to explore ways in which good anchor practice could be advanced across the NHS.
Later this year CLES will be establishing an NHS community of practice as part of our community wealth building centre of excellence, to drive innovation.
But whilst we should celebrate this growing interest and activity, the notion of the NHS as an anchor institution remains somewhat under powered. We’re a long way off progressive anchor practice being deployed wholescale across the NHS.
In short, the NHS remains throttled by a muddled policy context and the absence of a clear implementation plan, enabling amplification of anchor practice at scale.
A muddled policy context
Although the long-term plan makes a commitment to the NHS as an anchor institution, other NHS policy agendas hinder the adoption of progressive anchor practice, particularly the drive for cost and efficiency savings.
Moving forward, we know that the current goal is for the NHS to deliver £700m in savings from improving procurement by the end of the financial year 2020-2021.
This is to be achieved largely by driving increasing amounts of spend through its centralised procurement system – the New Operating Model. This will make it even more difficult for NHS trusts, for example, to adopt progressive local spend policies that seek to incorporate social value and thereby address the wider determinants of health.
As such, there needs to be further discussion amongst senior policy makers to explore how this tension could be resolved, with a view to the NHS maximising the impact of its £114bn annual spend.
Linked to this spending power, the role of the NHS as a key economic agent needs to be more vociferously asserted.
Building on the work of the NHS Confederation we need further effort to link the NHS with local economies, with the NHS represented in local economic partnerships and their impact harnessed as part of progressive local industrial strategies.
As noted above, there is growing interest around anchor institutions in the NHS and many hospitals and CCGs are committed to doing what they can, despite the muddled policy context in which they operate.
They want to know how they can forge a pathway through to progressive practice, although in many cases they are unsure how to do this and where to start.
This is particularly true in relation to spend, for example. How does an NHS trust use what discretion it does have around its procurement activity to deliver social value?
We know that many local authorities have for years been using social value frameworks and local spend policies to achieve this. But how could health institutions within an NHS context do the same, or at least do what they can?
Herein, therefore, lies the challenge: how do we successfully enable the spread of good practice when the inner workings, cultures, and realities that dominate the day to day life of an institution like the NHS differ from that of local government?
Whilst our community of practice will help, we also need further action research to identify the practical mechanisms that NHS institutions could adopt here and now to drive forward progressive change.
As such we need to establish a series of demonstrator sites to explore the implementation challenges around the adoption of anchor strategies and to generate more direct evidence about their effectiveness.
As an employer of 1.4 million people and with an annual budget of £114bn the opportunity for the NHS to impact local communities is cast into sharp relief.
There are ways in which the NHS could accelerate progress on its anchor institution journey, addressing the obstacles described here is where it needs to start.