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Dominique Allwood

Director of population health, Imperial College Healthcare NHS Trust
Chief Medical Officer, UCLPartners Co-chair, Anchor Strategy and Change Network

Tucked away on the last page of NHS Long Term Plan, is a paragraph on the role of the NHS as an anchor institution. The Health Foundation's 2019 report Building healthier communities: the role of the NHS as an anchor institution was published around the same time. Since then, we've seen anchor strategies, networks, action, and commitments growing exponentially in the NHS. There is now an abundance of exciting and inspiring work happening at organisation, place, system, regional and national level. Together with partners and communities, anchors are demonstrating how they can maximise their contribution to social, economic and ecological conditions that can shape good health and influence health inequalities.

One of the 'value adds' of an anchor approach is that it provides a clear link between the social determinants of health (which we increasingly recognise in the NHS as a vital and urgent area for action), and the core operational functions of our health institutions. Anchor work should not be viewed as an additional one-off programme or project but how we better use assets to do what we already do – employ people, buy goods and services, manage our land, buildings and the environment, and form partnerships. This is both an opportunity, in that it does not necessarily require large pots of new investment, but also a challenge, as this work requires intentionality and sometimes doing things differently. It can be hard to define where anchor work starts and stops and what success looks like.

This report provides a welcome set of tangible case studies that illustrate how anchor theory has been translated into action, demonstrating how institutions are maximising opportunities and addressing these challenges.

These inspiring case studies have some common positive features. They recognise the essential importance of tackling inequalities and inequities. This does not happen automatically through anchor action and must be designed in. There are some great examples such as in Leeds, where they are targeting employment to the most deprived communities, Warrington and Halton health hubs which have been located in areas of poorer health outcomes and greater inequalities, and Imperial College Healthcare NHS Trust together with local anchor partners, focusing on halving the gap in life expectancy.

An area sometimes overlooked in the busyness of anchor activity and projects, is a specific focus on community engagement. In this report, it is both a standalone chapter and mentioned throughout. We know anchor work will be less effective if not built in partnership with communities. It needs to result in a shift of power and resource into the hands of those who are best placed to tackle the social determinants of health – our communities and organisations closely connected to them, like the local voluntary, community and social enterprise sector. The case studies featured include East London Foundation Trust co-designing social value principles with service users, Nottingham and Nottinghamshire Healthcare NHS Foundation Trust's green space work sitting with community voluntary services, and Imperial College Healthcare community learning lab.

Far from standing as islands alone, anchor institutions and anchor approaches benefit from collaboration, with wider partners and other anchor institutions to reduce duplication, work towards common ambitions, share expertise and resource, and maximise impact. Wider partnership working is essential for tackling complex social determinants of health where the NHS cannot act alone, like housing. Sussex Partnership NHS Foundation Trust has developed a strategic plan for housing with local government and housing partners, and Warrington and Halton Teaching Hospitals NHS Foundation Trust is working with Liverpool City Council on town centre regeneration.

All this work is to be celebrated but must be in the context of monitoring and evaluating progress, particularly when there are competing pressures for resource and attention. A number of the case studies describe their increasing commitment to measuring and capturing impact, like Leeds Beckett University evaluating the Leeds employment pilot, and East London Foundation Trust developing an evaluation framework for social value procurement, and Sheffield Hallam University evaluating Nottinghamshire Healthcare's green space work.

There has never been a more needed time for this work, and the achievements and approaches of these organisations in progressing their anchor mission should be widely shared, spread and adopted.