The NHS as an anchor and institution

Gill Steward profile picture

13 February 2019

Gill Steward
Centre for Local Economic Strategies

As chair of Centre for Local Economic Strategies (CLES), the UK’s leading independent think and do tank, my role is to guide our organisation to help communities to create local economies and deliver effective public services. We’ve been doing this very successfully for 10 years so far by reorganising local economies to create local wealth that benefits the people in that place.

Places like Manchester, Preston, Oldham, Birmingham have spearheaded this work in the UK. They have brought together anchor institutions (that’s local organisations who have sizable budgets and employ large numbers of people) and changed the way they procure good and services, employ staff and utilise  assets to make their local economies and places wealthier and stronger. For example, in 2012 CLES analysed the collective £750m spend of six anchor institutions based in Preston. Only £37.5m was spent in the local area! That’s less than 5%. Five years later after changing the way these anchor institutions procure goods and services, £135m is now spent locally, creating 1,700 new local jobs. Preston also worked with local employers to make sure that local people benefited from this additional investment by encouraging firms to employ locally, pay the living wage, take on local apprentices and create employment opportunities for those who are harder to reach and employ. 95% of employees of organisations who have benefited from this additional investment live in Preston or the wider Lancashire area – a huge impact on the local economy.

My role is to guide our organisation to help communities to create local economies and deliver effective public services. This work is now being extended to NHS organisations.

Gill Steward    Chair, CLES

This work is now being extended to the NHS organisations. Funded by the Health Foundation and working with the American Organisation Democracy Collaborative, CLES has been carrying out a research project to explore how the NHS can make a difference in the communities they are rooted in.

In North America, the Democracy Collaborative has played a leading role in demonstrating that anchor institutions in the healthcare sector have the potential to leverage their considerable assets to reshape local places and empower communities to build a more equitable, inclusive, and democratic economy. As Ted Howard, co-founder and president of The Democracy Collaborative says: "For a healthcare institution, using their hiring, purchasing, and investment resources to support a thriving local economy isn’t just the right thing to do: it also helps build the stable economic foundations a healthy community needs."

This work is gaining momentum. The NHS long term plan sets out commitment from NHS England to work with the Health Foundation in developing the role of local NHS organisations as "anchor institutions". This recognises that the NHS can do something about the social and environmental factors that impact the health of their population and highlights the opportunities NHS organisations have to change the way they do business.

The NHS long term plan sets out commitment from NHS England to work with the Health Foundation in developing the role of local NHS organisations as "anchor institutions".

Gill Steward    Chair, CLES


So what steps can NHS provider organisations practically take?

  • Review employment practices so they focus on the local population, putting in place supportive pathways so local unemployed people can take advantage of the job opportunities on offer. Offer more local apprenticeships and work  with local schools, colleges and universities to provide the necessary training and development local people need. This can also help with recruitment and retention issues.
  • Analyse how you source goods and services and identify what’s possible to source locally. Of course this won’t be possible for everything but many services, such laundering or catering can be bought locally. Sourcing locally also has a multiplier effect as resources spent locally are reinvested in the local community at a faster rate than resources spent on big national companies. When you do buy locally you can encourage suppliers to pay the living wage and play their role in supporting the local community too.
  • Review how you use your estates and land. Converting surplus estates into affordable housing or community space for voluntary groups, job training, financial counselling and affordable food access services will support your local community, reduce health inequalities and redirect wealth back into your local area.


These changes do require time, effort and commitment but the potential is huge and every part of the NHS has a responsibility to improve the health and wellbeing of its community. The community wealth building movement is growing – come join us!

Later this year CLES will be launching the Community Wealth Building Centre of Excellence providing tools and techniques and a community of support to help organisations on the journey. If you want to find out more about how your organisation can play a bigger role in improving the health and wellbeing of your community. You can find out more information on the CLES website.

About the author

Gill Steward profile picture

Gill Steward

Gill Steward is an experienced public sector leader. She has held two local government chief executive roles, five local government corporate director roles and was chief executive of a police authority. Gill Steward is the chair of the Centre for Local Economic Strategies (CLES) – a leading charity think tank for progressive economic policy and practice that works across the UK and Internationally.

We use cookies to ensure you have the best possible experience on our website. By continuing we’ll assume that you are happy to receive them. Read our updated privacy and cookie policy. Close