Anchor institutions: innovating through partnership in challenging times

Anchor institutions are large organisations such as NHS trusts, which are unlikely, by their nature, to relocate, have a significant stake in their local area as a result and have sizeable assets which can be used to support local community health and wellbeing, including tackling health inequalities.

Anchors can influence health and wellbeing outcomes in a range of ways, including:

• how they procure goods and services
• offering training, employment, and professional development opportunities
• how they use their buildings / land use
• reducing their environmental impact
• working in partnership with other anchors.

Harnessing the influence of anchors is being encouraged as a key policy initiative, and there is a clear link to the increasingly critical sustainability agenda. NHS England and NHS Improvement has underlined this through its recent work with the Health Foundation to create the Health Anchors Learning Network.

Opportunity or threat?

I have worked extensively with NHS organisations, helping them to develop strategies for integrated working across their local populations since the introduction of the Health and Social Care Act 2012. From the first ‘integration pioneers’ to ‘vanguards’ and accountable care structures, partnership working across NHS and partners, such as local authorities and the voluntary sector has increased, aiming to offer integrated services centred around people’s needs.

Many of these initiatives have been successful. However, it is not only through service redesign that organisations such as NHS trusts can support their local communities. As anchor institutions, they have many opportunities to positively influence the health and wellbeing of local people. And, in particular, anchor approaches to COVID-19 demonstrate this. But will the challenges of post-pandemic recovery, together with the impending structural changes through the health and care bill, serve to strengthen or hinder anchor progress?

There are undoubtedly some barriers to successful anchor approaches. For example, anchors could have a key role in tackling NHS staffing challenges by looking medium to long term and investing in local training and development, or other innovative approaches to attract new talent such as working with local partners to support affordable housing initiatives. However, the current chronic staff shortages risk short-term approaches to recruitment, sourcing staff from outside the locality and even from abroad to fill vacancies and tackle backlogs.

Collaboration between anchors themselves and other local partners will be key to success. By identifying initiatives, sharing ideas and collaborating, incremental work could be strengthened and extended. Anchors have much potential to positively impact the health and wellbeing of the communities they serve, but with so much going on at the moment (always!) competing priorities could pose a challenge.

The dissolution of clinical commissioning groups, the establishment of statutory integrated care boards (ICBs) and further development of place-based partnerships and provider collaboratives alongside a continuing pandemic is already placing the system under strain. However, ICBs, together with integrated care partnerships, have the potential to play a key role in supporting anchors to overcome some of the barriers they currently face.

Many integrated care systems already enable relationships between anchors themselves, and between anchors and local partners. ICBs should be well placed to share ideas and develop system-wide approaches to social value and workforce development, as well as harnessing population health data, supporting anchors and their partners to innovate. They should also influence central policy on behalf of their partner organisations, including anchors.

The development of place-based partnerships can also support anchor approaches. In Newcastle upon Tyne, the Collaborative Newcastle Partnership provided the forum for partners to come together to proactively design and establish the Integrated Covid Hub North East, creating over 1,000 new jobs for local people and investing in research and development in the city. Provider collaboratives will provide a further important forum for anchor collaboration, for example, via training opportunities through working at scale across trusts, looking creatively at the collective estate to support community initiatives or aligning sustainability strategies.

Sharing learning and successes

There are many opportunities for the legislative changes to support and enable anchor approaches. Clearly there is a risk that in the short term at least, the upheaval of transitioning to new organisations may mean that these opportunities are not realised. Coupled with the ongoing operational pressures of the pandemic/post-pandemic world, it could be challenging for anchors to make significant strides.

Anchors that are already operating as part of strong, established partnerships – whether at ICS, place, provider collaborative, neighbourhood, or otherwise – are likely to be best placed to overcome these challenges and continue to implement strategies to improve the health and wellbeing of the populations they serve. Sharing learning and successes will be key to help emerging NHS anchors understand and engage with the opportunities.

The original version of this article is published on NHS Voices. Previous blog can be viewed here.