National vision, local delivery: The role of anchor organisations in a changing context
This month saw the launch of ‘Fit for the Future’ - the Government’s 10 year health plan for England. The ambitions for the role of anchor institutions - fair employment, local procurement, community investment - haven’t changed. But the context they’re working in has - once again. What does it take for anchor approaches to stay relevant and effective in this moment? In this blog we offer a few reflections based on what we are seeing and hearing through the Health Anchors Learning Network.
1. All change (again)
Fit for the Future sets out the challenges facing the NHS and is structured around three big shifts focusing on digital innovation, shifting care into community based settings, and prioritising prevention. Successful delivery of the latter two shifts rely on close collaborations and deep partnerships between NHS anchor institutions and other local organisations. The plan is also explicit in its expectations of “hospitals to do more as anchor institutions to support wider societal and economic goals”.
At the same time Integrated Care Boards (ICBs) are being asked to operate at greater scale and focus on their role as strategic commissioners - all whilst reducing running costs - raising questions about their ongoing capacity and responsibility for coordinating and supporting anchor activity across healthcare providers within their local system. As ICBs step back from their original “fourth purpose”, systems will need to ensure the anchor partnerships they helped establish remain supported and sustained.
Other areas of policy, including Get Britain Working and the Power and Partnerships devolution white paper, also signal that the work anchor organisations have put into developing place-based partnerships won’t go to waste, and will be essential if this Government’s ambitions are to be realised. But to remain effective, anchor organisations and anchor networks will have to continue adapting and responding to changes in local government structures.
In short, the policy environment is rich in ambition for anchor approaches - but messier on the question of delivery.
2. Why anchors matter more than ever
As NHS and local government structures continue to shift, anchor institutions remain one of the few stable forces we can rely on to keep driving progress towards healthier communities and more inclusive local economies. They have - in many cases - invested in deep, relational infrastructure across local delivery partners, and can move quickly to activate these relationships. NHS Trusts and hospitals remain essential place-based anchors, as do many councils, higher education institutions, housing associations, and arts and culture institutions. One of the most powerful features of anchor organisations is their durability, and the ability this gives them to invest in their place over the long term. Amidst policy and structural change at the national level, place-based structures largely remain the same - and that continuity is essential.
3. Health inequalities aren’t going away
If anything, they are still a key focal point. The recent Communities and Devolution Bill guidance released by the government confirms that it will be a legal requirement for “almost all Strategic Authorities to ‘have regard’ to the need to improve the health of people in their areas and reduce health inequalities between people living in their areas when they act”.
But financial pressures mean that anchors will need to use their resources in the broadest sense to continue to make inroads in this area. Anchors have assets that go beyond service delivery: land, jobs, procurement budgets, institutional power - and can continue to use these to take action on local determinants of health. Used well, these can directly shape the social and economic conditions in a place.
For example at HALN we’ve seen a growing number of local authorities use their convening and influencing power to increase the number of local employers paying the minimum wage, offering more flexibility to staff, and making procurement processes more accessible for SMEs.
4. It’s about the economy, stupid
If we’re looking for a unifying theme across current policy, it’s this: focus on economic inclusion and jobs. Both national policy and local demand are pushing anchors to prioritise job creation, skills, and addressing economic inactivity.
Many anchors in HALN are already doing this. We’ve seen anchors:
Supporting carers, returners and people far from the labour market to get jobs and progress in work
Developing local pathways into work with colleges and providers
Using procurement as a lever for increasing economic inclusion
Anchors are being asked to play a bigger role in tackling unemployment, especially in ‘left behind’ places. There’s an opportunity here to shift from passive recruitment to actively designing fairer local labour markets - something which many anchors are already doing. Those that can align their strategies with emerging national priorities around economic activity will be well positioned to maximise their impact.
5. Delivery in a grey space: stepping in to lead
Finally, anchors bring something less tangible but just as important: relational leadership. The most successful anchor work happens not because of policies, but because people build trust across boundaries. In a system full of grey areas - where no one has full control - this kind of leadership becomes essential. There are opportunities to be grasped, and leadership to be exercised. When national policy changes we often see systems going in one of two directions: inertia, or action.
As the policy landscape continues to shift, the role of anchor organisations becomes more critical - not less. Their durability, rootedness in place, and ability to mobilise long-term partnerships position them to lead in uncertain times. The challenge now is not just to stay the course, but to step forward: using institutional resources boldly, building trust across systems, and shaping fairer local economies. National vision may set the direction, but it is anchor institutions that will determine whether meaningful, lasting change takes hold in our communities.
Health Anchors Learning Network is supporting local authorities, health organisations, businesses and others to develop anchor action. Interested in learning more? Register for our newsletter to receive the latest case studies, events and resources, or get in touch at hello@haln.org.uk.