Embedding co-production within anchor institutions work
Blackpool Teaching Hospitals NHS Foundation Trust (Blackpool Teaching Hospitals) is a combined acute and community trust, situated in a coastal area in the North West of England. The trust provides services to a population of 350,000 people across Blackpool, Fylde and Wyre.
In 2021, the chief medical officer's annual report highlighted the health challenges faced in coastal communities, linked to declining employment opportunities, ageing populations, transport barriers, and lack of investment or policy attention (Department of Health and Social Care, 2021). Health inequalities are especially acute in Blackpool, which has some of the highest levels of deprivation in the country and the lowest life expectancy rate in England. Blackpool's Health and wellbeing strategy identifies key areas for improvement around smoking, alcohol and drug misuse, and socio-economic factors such as household income and housing quality (Lancashire and South Cumbria Integrated Care Board & Blackpool Council, 2024) – contributing to high rates of preventable morbidity and mortality. For example, in Blackpool 20% of women smoke at the time of birth, in comparison to 9% of women nationally (Blackpool Teaching Hospitals NHS Foundation Trust, 2022). To address this, the trust has set out strategic commitments to addressing health inequalities, prioritising action in maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension (Blackpool Teaching Hospitals NHS Foundation Trust, 2022).
As part of their overarching organisational commitment to reducing health inequalities, Blackpool Teaching Hospitals has developed its role as an anchor institution within the local area. The Anchoring on the coast programme has been co-designed and co-produced with local communities, staff and wider partners. Taking an anchor approach aims to address the wider determinants of health in the area, such as housing, employment, and boosting the local economy. The project was funded by the Health Foundation and NHSE, via the Test and learn programme.
The co-production approach had multiple strands. Firstly, the trust employed patients with lived experience in the project team, as community researchers. In total, there were four lived experience team members employed within the research and development and public health team. The community researchers were given an induction process and provided with IDs, laptops and email addresses. The trust had not utilised co-production methodologies before and was initially under-prepared for the bureaucracy and length of time induction processes took.
The second stage of the engagement work involved speaking to and hearing from the wider community. The trust engaged with communities facing multiple disadvantage, working in collaboration with VCSE partner organisations, to better understand local wealth creation opportunities. The project team prioritised engagement with economically vulnerable groups in the area, which was defined as including:
- young people aged 18-25 who have experience of not being in education, employment, or training
- young people aged 18-25 who are care leavers
- carers
- people who are insecurely employed or unemployed
- people who are homeless
- people leaving prison
- armed forces veterans
- Travellers
- and people who are from minority communities (Polish, Romanian, Hungarian and Italian).
The project team encountered barriers in trying to recruit and engage with people from some groups, including lack of representation and lack of trust of statutory institutions for some groups. They learned that providing different methods of engagement can work best for different groups, as can meeting people where they are already located in the community. Having community researchers with lived experience helped the project team to understand and overcome some of these barriers.
This stage of engagement also involved understanding the perspectives of staff members within the trust and of system partners, to better understand their role as anchor institutions. The co-production methods used included co-design workshops, surveys, focus groups and interviews. The community researchers took part in all parts of the research process, from designing the research methods, to facilitating the interviews and focus groups, to developing communication pieces, and analysing the feedback. A literature review of other anchor frameworks was also conducted.
Finally, the project team co-created their anchors framework, which was then prioritised with community members and stakeholders via a Delphi consensus survey. The published anchor framework has five priority areas for action (Blackpool Teaching Hospitals NHS Foundation Trust, 2023). Each of the areas has corresponding commitments beneath them, which the trust are currently embedding.
- Employment.
- Procurement.
- Environment.
- Buildings and assets.
- Partnership working.
The overall project was overseen by weekly project team meetings and monthly steering group meetings, involving the necessary stakeholders – including the deputy chief executive and a non-executive director with community experience from the trust. The weekly team meetings were noted as providing valuable peer-to-peer support and mentorship for the community researchers. The trust has taken a number of learnings from the co-production approach and plans to embed this way of working across the trust going forwards, including roles in co-production of services and pathways (Blackpool Teaching Hospitals NHS Foundation Trust, 2023).
Taking a co-production approach to developing the anchor framework in Blackpool has provided valuable learning for other trusts, or organisations, seeking to adopt an anchor approach – specifically those in coastal locations.
Advice from Blackpool Teaching Hospitals includes:
- "Be realistic about the amount of time needed to dedicate to co-production".
- "Co-production needs time and money but is worthwhile and gives real value to what is created".
- "The best co-production approach has both breadth and depth".
- "Maximising involvement needs crafting of messages for each group and taking the work to where they are".
- "Co-production cannot be a single exercise – it involves building expectations which must be met. There needs to be a plan for how the engagement and co-production will continue".
- "Allow enough time for a proportionate induction process for individuals involved in co-production".
For more information on Blackpool Teaching Hospital's work, please contact their social value team: bfwh.socialvalue@nhs.net.