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How can the NHS maximise its role as an anchor institution to boost local economies and reduce socioeconomic and health inequalities?

This project is delivered by the NIHR ARC National Priority Consortium for Health and Care Inequalities.

Find out more about the NIHR ARC National Priority Consortium for Health and Care Inequalities – which is led by ARC North East and North Cumbria.

Project title: How can the NHS maximise its role as an anchor institution to boost local economies and reduce socioeconomic and health inequalities?

Duration (start and end dates): 1 September 2021 –31 August 2023

Funding total: £286,911.43

Funded by NIHR ARC Health and Care Inequalities National Priority Consortium.

Led by ARC Greater Manchester, collaborating with ARC North East and North Cumbria, ARC Yorkshire and the Humber, ARC North West Coast, ARC East of England, ARC Kent, Surrey, and Sussex and ARC North Thames.

What does the project aim to achieve?

The main aim of the NHS is to provide comprehensive health care, free at the point of service, based on need and not ability to pay.

However, it has increasingly been recognised that the size of NHS hospitals and organisations means they can also make a big economic difference to their local communities. For example, hospitals employ lots of staff which give jobs to local people and support the local economy.

This is referred to the NHS acting as an ‘anchor institution’ because, like an anchor can have a steadying effect for a ship, the NHS can have a steadying effect and bring significant benefits to local communities.

Those making decisions about the NHS locally, regionally and nationally are trying to look at how they can maximise this ‘anchoring effect’ and use this to reduce social, economic, and health inequalities.

Building a hospital close to a community where there is high unemployment might be an example of this. Alternatively, closing a hospital in an area might have devastating consequences, both for the health outcomes of local people, but also for economic prospects of those local people as well as their trust in the NHS.

At this stage, there are important questions that remain unanswered. We don’t know whether:

  • NHS spending on non-health care (i.e. employment, housing, staff well-being, etc.) reduces deprivation in the communities where they are based
  • The NHS is an anchor in some communities and not in others and what made the difference
  • Changes to the way the services are delivered enable or prevent the NHS acting as an anchor moving forward.

We want to undertake three pieces of work to help answer these important questions.

  1. We will examine NHS spending and the impact of this on local communities by looking at employment-rates, wage levels, health inequalities and so on. This part of our study will also look at whether these links are stronger in certain communities, such as deprived areas, coastal towns, regions of England, towns whose economy is not as strong as other areas, etc. We are particularly interested in what happens to the economic fortunes of communities when local hospitals open or close.
  2. We will conduct in-depth interviews with people within 3-4 NHS Organisations to try and understand and explain the results found in the first piece of work. We will establish what has prevented and/or enabled NHS Organisations to do better for their local communities than others.
  3. We will combine the information from the first two pieces of work and create a model which will help NHS Organisations think about what might happen to local jobs and health in the future.

Who is it relevant to or who could it impact?

Our research is relevant to people working in and living near big NHS institutions, including hospitals and administrative centres. It is hoped that our results can be used to change national policy to help the NHS improve the lives of people by reducing inequality.

Why is this project important?

The NHS is the fifth largest employer in the world, and as such directly influences the working conditions and prospects of over 1.3 million people.

The money spent on pay and attracting new staff to work for the NHS can make a massive difference to people and communities. We know that the NHS is often one of the largest employers in certain communities and is therefore critically important, in terms of not only providing high quality care but also affecting the lives of people through its ability to provide employment and job security.

However, we do not yet know exactly how big of an effect the NHS can have on people and communities over and above providing care, nor do we know what works, in what circumstances, and for who.

Project Lead Dr Luke Munford from Manchester University and NIHR ARC Greater Manchester said:

“Understanding the ways in which the NHS can be a ‘force for good’ for local people and communities is key to enabling the massive potential of the fifth largest employer in the world to be unleashed. The NHS can make huge differences on health in terms of providing health care, but also in terms of employment opportunities, job security, and many other important ways that improve health – the so-called ‘social determinants of health.”

Lead contact for the project: Dr Luke Munford ([email protected])


Professor Matt Sutton (Professor of Health Economics), Paul Wilson (Senior Lecturer in Implementation Science) – both University of Manchester, ARC GM

Professor Clare Bambra (Professor of Public Health), Dr. Jo Wildman (Research Fellow NIHR ARC NENC Health Inequalities and Marginalised Communities), Professor John Wildman (Professor of Health Economics), Dr. Heather Brown (Senior Lecturer in Health Economics) – all Newcastle University, ARC NENC

Professor Kate Pickett (Professor of Epidemiology) – University of York, ARC YH

Professor Ben Barr (Professor of Applied Public Health Research) – University of Liverpool, ARC NWC

Dr. John Ford (Clinical Lecturer in Public Health) – University of Cambridge, ARC EoE

Professor Lindsay Forbes (Professor of Public Health) – University of Kent, ARC KSS

Professor Paula Lorgelly (Professor of Health Economics) – UCL, ARC-NT

Implementation activities will be led by Paul Wilson (ARC GM) and Public and Community input will be led by Professor Paula Lorgelly (ARC NT).

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