Anchor Institutions, their contribution to inclusive economy strategies
this is a speaking note from a presentation for a Health Foundation webinar on the interface between economic policy and health
again, short form. No full sentences
please steal in any way you want
1 Why
Why is this issue important?
SDOH
Previous approaches have not been seemingly successful as we
wanted
Map of deprivation from the 80s is largely akin to now – aka
regeneration has failed
Funding injections didn’t address the mainstream commitment
of £ base – the institutions we want to continue to support
This is a route into permanent change of the way an economy
works (at least the public economy)
And thus we never corrected the problems in our view of allocative value in the
mainstream (in everyday language we failed to shift upstream).
To
address health inequalities you need to address social and economic
inequalities
20% is
health care – access and quality
Here is
an opportunity to directly address the economic influences on health with your
existing budget
There’s a growing narrative re. alternative models of
economic growth
We know inclusive growth is
important.
We know the way the economy works
is one of the fundamental determinants of well being
We know there are deep inequities
in income and wealth
We know that there’s a great deal
that can be achieved though the economic power of anchor institutions
To address health inequalities
you need to address social and economic inequalities
For those anchors here is an opportunity
to directly address the economic influences on health with your existing budget
Why now?
Why not. Impact
of pandemic on poverty and employment.
In times of plenty, we didn’t make the mainstream better, we
funded stuff at the margins to correct the deficiencies of the mainstream.
The economy is a determinant of health and wellbeing, we
know the economy and our economic model leads to inequality.
This plays out in many policy areas, across all sectors of
the economy.
This is
an under the radar and doable strategy that can address some of the underlying
economic determinants of health that may never happen nationally given the
political deadlock nationally…..
Why
bother? The community connection is fundamentally about prizing trust. KF blog of yesterday from Toby
Lewis.
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
Strategic
question to the anchor is
Can we
incentivise the 80% to optimise impact on health and well being.
What can you DO about social and economic determinants
Frontline
level, service level, policy level (anchor institution
Dear anchor
conduct your business in a way that reflects your anchor
status and builds capacity to address social determinants. Not just as a side
issue but 100% of your activity
This leads to better economy –
and should be done for economic reasons in addition to intrinsic health
reasons.
2 What
Economic anchor institutions tend to be:
“There are 3 organisations that will b here in 20y time –
hospital, job centre, local govt. better structural links between the 3
critical”
Non profit or public
Sticky capital, rooted in place. Tend to not move on
account of economic factors, they don’t leave when the economic going gets
tough. Economic engines – large purchasers, employers and investors
Hospitals, uni sector, local govt
Often large purchasing power
City level and Neighbourhood level
Less anole to tie up with other org locally across nhs,
local gov, or vcs
If there is to be national contracts, local role is to
ensure standards, rules, ethos is fit for local circumstances
Issue Here in terms of what can / can’t be contracted for
Domains of the business to look for progress and
opportunity
I.e. Not really the core mission of delivering great
services.
All the assets of your institution should be “in” – eg
Employer Annual
spend
Annual procurement Investment
and portfolios and endowments
Place based investment Technology
Treasury Research
Community benefit Govt
relations
Comms Environmental
Service delivery Procurement
and purchasing
Hiring and workforce
Economic assets are felt to be key
Hiring and workforce
Procurement and purchasing
Place based investment.
Investments/endowments/portfolios
3 How
A strategy with political appeal on both sides, (but try
to de politicise)
Find arguments for all brands of ideology. Make it
practical fiscal and economic and political sense from lots of different
perspectives.
Appeal to all ideologies – This is an alternative model
to free market economics. Arguably an approach that all ideologies can agree on
and something in it for all sides of argument (liberal and conservative)… not
another big federal investment, good for CSR, more efficient way of harnessing and
utilising resources in local economy…..then the social reasons…..
Frame not as big “government programmes” but about
getting more efficient use of £ already committed AND local multiplier effect
AND social gains.
Managerial
effort
Mix of
leadership and development staff and architecture to make it happen, make it
institutional and not “a project”
Historic- the approach has been through a small office, not bending the mainstream
mission
Aim should be to transform the mission of the organisation
towards social benefit
ALL functions of the institutions
Part of the business propositions – triple bottom line.
Be accountable for all out impact – Social, Environmental,
Economic, Health, Ecological
Domains
of the business to look for progress and opportunity
All the assets of your institution should be “in”
– e.g.
I.e. Not really the core mission of delivering great
services, but something much wider.
Turning from slightly left field
mission to one of using the core architecture to make better/develop/grow
Apply
Principals of:
Powerful narrative/alternative vision (the boss may need
to change the narrative)
Multiplier effect re keeping to local – creating local
jobs, tax base
Full economic and social case,
not just the money
Triple bottom line addressing the
externalities in a way procurement officers don’t often account for.
Barriers
include
Corporate
ritual/custom and practice
Policy
Legislation
Benefit of Brexit? – EU Procurement – we have more
latitude
2013 Legislation re Social Value Procurement
– Not well known about or enacted. Using this can change the nature of process–
we can do these things
Create workarounds where
legislation is a barrier – e.g, disadvantaged business entities (example given
when someone pointed out that positive discrimination in favour of black owned
businesses was illegal in New Orleans)
set
up an anchor network?
To help each participant accelerate their own mission and
spread the model more widely
And invest wisely to achieve the broader social aim
Meet x times a year
Define the org imperative
Build the evidence base
Collaborative with wide range of stakeholder
Working groups – for significant themes
How
does/could/should this fit with existing partnership structures? And local
leadership programmes.
How do we avoid duplicating
effort but have maximum impact?
There are many, many opportunities (through existing
networks and with new networks), the q of “what” is reasonably settled
(the toolkits are available, opportunities will arise)
Bit by bit and building into the
woodwork so as it becomes part of the mission not “a project”
‘progressive procurement’ and ‘joined-up education, skills and work’
– need to push this forward and influence across the organisations, as well as
looking for new opportunities to start pushing on some of the other themes.
Risk appetite – what is the risk appetite ?
Where are the opportunities?
Risk of doing it vs risk of doing
nothing
Move away from project approach
but building maximum approach
Political conversation about
whether we want to push on this model.
What are our assets and existing
projects?
How well Organised are we to
leverage these assets?
Not about current story, there’s
good stuff going on. How do we share, How do we scale, how to we set the
trajectory towards Better?
Leverage collaboration – ? at
expense of competition, use the collaboration to attract external funding
Define
indicators
See Hospital
toolkit and Dem Collab playbook
Indicators of
inclusive growth more broadly
% of staff who are located in community and live locally
What % of local sum of resource ends up
in local economy
housing well being indicators – Foreclosed / Abandoned
/ Poor state of repair
An
early ask was of the Cleveland Clinic ($1.8bn) = how they incentivise
themselves around local supply chain
25% of supply chain has to conform to green and local
metrics
Hard edged indicators that were
set were met.
What is/can be the role of anchor
re: Building, Housing, poverty, Employment/training
4 Specific thoughts
Procurement - Getting started - Small projects with
big impact
1. Create department and staff
positions dedicated to inclusive, local sourcing
2. Require that local and/or diverse vendors are considered in Request for
Proposal (RFP) pool
3. Make inclusive, local sourcing an explicit goal in the strategic plan and
other policy document
Quick Practice Upgrades - Small projects with big impact
• Adjust payment periods and
invoicing processes to accommodate small businesses
• Incorporate local and diverse spending objective into job descriptions
and evaluations for supply chain
• Communicate with community partners about contracting opportunities and
supply chain needs
Place based investing- Simple Policy FIxes - Small
projects with big impact
Build a relationship with a
financial intermediary, such as a community development financial
institution (CDFI)
Allocate assets from investment
portfolio for place-based investments
Connect capacity building with
direct lending
Switch to an investment advisor
with expertise and capacity pertaining to sustainable, responsible, and
impact investing
Quick Practice Upgrades - Small projects with big impact
Foster working relationships
between community outreach and investment staff
Move cash and cash equivalent
assets into local banks and credit unions
Engage key nonprofit partners on
their long-term plans and investment needs
Join impact investment networks
and engage in collaborative community investment initiative
Local purchasing
Connect vendors with contract
opportunities within your institution
Build capacity in supply chain to
access larger contracts
Identify gaps in the market…..can
local suppliers help institutions fill gaps
Systematically work through
supply chain and make public commitments
Lowest cost for every unit
vs full economic impact of every purchasing decision you make.
i.e. factor in the externalities
How do we use the cities money as
we purchase to buy from our own institutions as opposed to the w midlands, or
Mexico
Keep £ in the local system.
92% of recent massive
infrastructure investment was kept local
Economic and skill benefit
The local lettuce story – Cleveland experience
Cleveland can buy lettuces from
California $0.03 cheaper
But carbon cost (the externality)
not accounted for
And by growing local you get 7
extra days of freshness (thus less wastage)
And grow local creates jobs and
economic stimulus, multiplier effect.
Develop the local supply chain
Full Business Model – thus
important
practical examples - How is the endowment invested
Hedge funds or local social
capital
Credit unions - invest in credit
unions.
Invest in local businesses and
local economy
Healthy Neighbourhood
collaborations
Community investment in land
trust - purchase land to secure sustainable and affordable housing
What can hospital do in the
housing economy??
Inclusive local hiring
Equip local residents for q high
demand front line jobs that are connected to job pipelines
Connect frontline workers to
pathways for career advancement within the institution
Partner with local intermediary
to train
Use cohort training model focused
on specific positions
Paid internship programme with
pathways to hire
“John Hopkins local”
Build, buy, hire
Community
investment in land trust – purchase land to secure sustainable and
affordable housing
What
can hospital do in the housing economy??
5 Critique
Could be concern that this about changing the dynamic of
economy towards isolationism (although things have swung very far the other
way)
Is this just total place again (although clearly we still
have much left to do)?
Issues to contend with
Rules and regulations regarding procurement
Competing priorities
Local vs cheapest. Local =? Define. Set metrics
Short vs long term
Overcoming the inertia of large institutions
Leadership – needs visible commitment
Organise within the institution – may need resource, more
likely need mindset shift.
Visible and tangible goals – specific.
In the Business Plan
Incentive structure – is it right to encourage success in
this space?
Breakdown of contracts to smaller more meaningful chunks,
smaller lots – maybe issue re greater administration workload on
institutions?
Embed the mission into SOP and structures
Local knowledge and context are a part of the criterion of
contract
Targets – set them(same as some have done for green)
DON’T displace local business and plan for success (there
can be unitended consequences, e.g. gentrification
Business case – its more expensive
What is the formal system of
accountability where you combine financial accountability with social and wider
economic accountability – Triple bottom line accounting
Got to make it hard edged enough
that the CFO say this is the right thing, and doesn’t unravel when times get
tough.
CSR – Tesco have made great
strides, the NHS has barely started
NHS Sustainability Unit have made
some interesting arguments with respect to the 24 month Return on Investment,
expressed Financially / Health and well being of community / Carbon. There are
a number of case studies. See references at bottom
Benefits may not be readily
tangible
The ‘Ah but we can’t see the
benefits, they are intangible or long term…., thus we shouldn’t’ line –
Compare the Risk and benefit of
doing this
Compare this to the risks and
benefits of not heading down this path
Focus on BOTH rational side to journey (business case,
metrics and governance) and emotional side – the right thing.
What is the formal system of accountability where you
combine financial accountability with social and wider economic accountability
– Triple bottom line accounting
Got to make it hard edged enough that the CFO say this is
the right thing, and doesn’t unravel when times get tough.
6 NHS and
anchors
For the
NHS – What can NHS system DO about social and economic determinants?
Can we
incentivise the way in which you use your funds, systems and processes to
impact on health and well being in a more positive way than if you do nothing?
Localism is a challenge to nationally centralised system
like the NHS . NHS is massively centralised
Challenge for NHS is how it responds to devolution and this
agenda.
Natural path will be to centralise
This agenda is part of health creation.
Help needed from national bodies
Regulatory bodies need to acknowledge the concept of social
value in their inspection regime or how they regulate the orgs.
Triple bottom line accountability is well documented in the
private sector…..is it not built into the mission of the NHS…. much to learn.
NHSE and NHSI – not at top of shop but some levels below.
Unleash the creative potential that already exists.
How do local partners see the NHS
Is it a cost or an investment
Is the NHS involved in a discussion about raising £ or
spending £
Is ICS about service sustainability or transforming the
model
The NHS matters to local economy
Estates Social
inclusion
Workforce Estates (Naylor
report)
Local spend (do we know and
understand our local supply chain and impact)
Commercialisation of research
How does the NHS £ impact on
local issues and problems.
There will be no central message
telling us to deliver this, or measure it
Cleveland model = leveraging econ power of anchor
institutions
greenest, local employment –
access to employment opportunities for those left behind, buy local, Land trust
investment, Employee ownership as better way of organising
Preston – based around 15 anchor
institutions
Building on Cleveland. Go
further.
Moved £12-15m of spend that used
to leave the city into the city
Multiplier effect on local
economy
Starting a public bank to address
economic exclusion (Dakota state public bank – Dakota less impacted on by
global turndown than elsewhere in state, the publicly owned bank kept lending
to local businesses.
Preston exploring this – NHS and
LA puts its £ into this to do banking…important leveraging effect
Localism is a challenge to nationally centralised system
NHS is massively centralised
Challenge for NHS is how it
responds to devolution and this agenda.
Natural path will be to
centralise
how best to take on in NHS (or other econ anchor)
What is the potential for FT
model to co invest in social outcomes that achieve health and well being ends.
NHS is large % of local economic
power
Larger % further north as private
economy weaker
Kaiser has monetised health not
illness – Prevention reduces the income stream of many of our providers
7 Role of VCS
Why local matters
Large national providers or commissioners are not invested
in place
Can’t respond and flex locally
Not in tune with our local ethos
National v local policy differences.
National providers less able to tie up with other orgs
locally across nhs, local gov, or vcs
If there is to be national contracts, local role is to
ensure standards, rules, ethos is fit for local circumstances
In the Paris climate change talks, it was the case put by
the USA Mayors that changed the game
National is to set the context,
local is what matters.
The creativity is local.
Best way of protecting from
market forces, Brexit, etc is local……
this cannot be done from a
centrally managed system
This agenda is part of health
creation.
Help needed from national bodies
Regulatory bodies need to acknowledge
the concept of social value in their inspection regime or how they regulate the
orgs
Triple bottom line accountability
is well documented in the private sector…..is it not built into the mission of
the NHS…. much to learn
8 advice from Ted Howard
Keep creating and recreating a big picture vision of what is
possible
Keep sharing examples of where things have worked despite
local or national defaults
If you want to do this job – you need to be intentional and
hold feet to fire
This path is NOT the path of least resistance
Make public commitments
Hold yourself to account to progress back to the community
A way to create more “health” that goes beyond the
service delivery aspect of your organisation
Reading
list
the Hospital
Toolkit. Set of practical ideas. Together the resources are about 500 pages
of info. You can read them yourself if you want.
GF blog 1 Ideas list
https://gregfellpublichealth.files.wordpress.com/2018/10/anchor-institutions-ideas-list2.docx
GF blog2 https://gregfellpublichealth.wordpress.com/2017/10/05/anchor-institutions-and-inclusive-growth/
SDU (2012). NHS
England Marginal Abatement Cost Curve.
SDU (2015). Healthy
Returns from Sustainability Actions.
SDU-Smart Healthcare – Low-Carbon and Resilience Strategies
for the Health Sector, see p25-16.
slides
on “triple bottom line” health and care
http://democracycollaborative.org/
Anchor institutions must re-imagine how public bodies
immerse themselves within local communities -https://www.kingsfund.org.uk/blog/2021/11/anchor-institutions-local-communities?utm_source=dlvr.it&utm_medium=twitter&s=03
Democracy Collaborative Anchor
Mission Playbook
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