Anchor institutions must re-imagine how public bodies immerse themselves within local communities

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Most people go into public service fired by a high ambition, wanting to change the world! But sadly, institutional life can narrow our aims. In the NHS in particular, we can slip into constant enquiry about role – is this our job, is it my job, who else’s job might it be? And so, bit by bit, year by year, the high aims are whittled down to what is possible and what is deemed relevant, and a fear of failure translates into a worry about experimenting. That is then why a transformational need like tackling health inequalities – a broad disrupter rather than a narrow project – becomes such a challenge to grip and focus on: it’s everyone’s job and so, perhaps, no-one’s. What if at first we do not succeed?  

But this desire to make a difference, the original purpose that we had, can be rekindled. In rekindling it, we lessen the sense of role purity and connect with the sense of mission that made us want to be here when we started. Working within an anchor institution may give us the freedom to do that, or the excuse. Anchors are defined as organisations unlikely to relocate and with a significant stake in their local area. They have sizeable assets to support their local community’s health and wellbeing, and offer a chance to reconnect us with purpose. 

The King’s Fund and many other organisations (including NHS England, the Health Foundation, and the NHS Confederation) are inviting public sector bodies locally to lean in to this opportunity: asking the question about whether ‘anchoring’ can contribute to levelling up and to narrowing the gap in inequalities. 

Before anchoring had that name, I helped to lead a large integrated care trust and a couple of what would now be called ‘places’. Our work on social value and public health garnered some attention and awards, and some of our projects feature routinely in best practice guidance some years on. So, what mattered most in building that value proposition?

The anchor, as we now label it, added profile, energy, spread, encouragement, maybe some time, rarely but sometimes money. It is a facilitator of what is already rich within the community – a backer.

After getting over the role debate, and simply accepting that the community’s health and wellbeing is our business, predictably, the question of money comes next. How do you get some, and for this work specifically? Leave aside that the return on investment from work on exclusion, poverty and inequality is compelling. Start the argument in a different place. With an annual budget of more than £150 billion the NHS is, understandably, seen as rich by those we work alongside. Most trusts run budgets of more than £300 million. On the high street that would make you a big beast. Only general practice operates on smaller sums. The issue is not funding, it is priorities. To be serious about inequality means making difficult choices. In truth the money involved in this work is small fry. Five figure sums, seed funding, money in time and opportunity cost of course. 

There is a simpler route, and one that I argue should be the whole essence of the anchor model. Because in every community there is plenty of existing gold and silver. There is community action  – it may be to tackle loneliness or environmental degradation, poverty or diabetes –  it just needs polishing.   

Looking across the anchor work that have I co-led, all of it happened through others who already were active around us. Each and every endeavour – on housing, employment, sustainability, primary prevention. The anchor, as we now label it, added profile, energy, spread, encouragement, maybe some time, rarely but sometimes money. It is a facilitator of what is already rich within the community – a backer. Anchors are immersed in this activity. Throw yourself and your leadership team into that. You are re-purposing what you spend and connecting others in the community with each other; more akin to a barter model, than the typical make or buy conundrum faced when we start something new.  

But to make anchoring not simply large ships turning slowly in the night, you need to engage with the community partners that the public sector so often neglects.

We know that the economic value of the NHS is significant. And many organisations are turning to local value procurement with that in mind. But to make anchoring not simply large ships turning slowly in the night, you need to engage with the community partners that the public sector so often neglects. The pandemic has made their essential value obvious anew. 

So reconnecting with purpose and community partnering are key. But this is also a cultural programme. It is not a project or a nice-to-have. In fact, importantly, it needs to be the top team’s programme. The work of principals. In NHS-speak, the board’s business. The noun anchor may not help much – this is a way of working, hence anchoring. As the metaphor implies sometimes you are using the anchor, sometimes it is simply there in abeyance. A well-led board brings the outside into the NHS. It is the space to permit and to challenge a re-connection with the community.     

Why bother? The community connection is fundamentally about prizing trust. A realisation in your community of your institutional interest, permanence and involvement in daily lives. Trust lies at the heart of care, in every contact, on every doorstep for a home visit. It comes at a cost but has huge value. The value of trust, earned in part through an anchoring connection into wards, neighbourhoods and streets, is well worth the time, and what tiny fraction of wealth you choose to share. 

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