The role of the NHS in post-Covid-19 local economic recovery


This article originally appeared in the HSJ

During this pandemic the need to mobilise health service capacity has been a key priority and the need for ongoing NHS readiness remains. However, we should now also start to consider the wider role of health institutions in local economic, and social, recovery and reform.

Covid-19 and the determinants of health

As recent work by CLES, The Democracy Collaborative and the Health Foundation has shown, health institutions are considerable anchor organisations with presence and heft within the local economy.  Anchors can exert sizable influence through their commissioning and purchasing of goods and services, through their workforce and employment capacity, and by creative use of their facilities and land assets. Positive use of these aspects can affect change within the wider economic, social and environmental determinants of health.

Whilst Covid-19 has presented initially as a public health crisis, its impact is now spawning economic and social crises. This will inevitably take its toll on the nation’s health. With the Chancellor warning of a recession ‘the likes of which we have not seen’, unemployment and poverty will make the nation sicker, heaping yet more burden onto a struggling NHS.

The role of anchor institutions

The NHS has always been part focussed on this wider anchor role. Indeed, it is a social contract with the British people to deliver well-being. Across its wide range of services, its mission extends beyond making us better when we are ill, it is also about making sure we do not fall ill in the first place.

The work we delivered last year has spawned significant interest locally across numerous health institutions. And, by establishing the proof of concept, our work influenced the recent commitment in the NHS Long Term Plan to accelerate good anchor practice across the English NHS.

However, the NHS – mainly in England – remains throttled by a muddled policy context and the absence of a clear implementation plan, enabling amplification of anchor practice at scale. This is particularly true in relation to its ability to adopt progressive local spend policies, where the call for the NHS to drive increasing amounts of procurement activity through its centralised system runs counter to this imperative.

Learning from NHS Wales

Cut to the devolved nations and things are different, however. In Wales, for example, despite also having a centralised procurement system, their national commitment to a wellbeing economy has sparked conversations as to how NHS procurement could, along with the spend of other key anchor institutions, be flexed to contribute to a made-in-wales supply chain, to support employment and the local economy.

With the onset of Covid-19, things have ramped-up, particularly around the need for the supply of PPE. A packaging company in Ystrad Mynach has, for example, changed its production to provide a million face shields a week to support the health service. Transcend Packaging is an ethical, forward looking business, committed to environmental sustainability and a key employer in south-east Wales.

Whilst the primary driver here may have been to get PPE into the health service to protect lives, it underlies an important point: that NHS spend can be used at scale to benefit the local economy, thereby addressing the wider determinants of health.

Copy and paste?

This classic anchor role, as regards purchasing and influencing the local economy, should be copied and repeated in localities across the UK.  In this, however, more work is required to explore how specific policy and structural constraints may need to be flexed. For instance, in England, the NHS is still very much wedded to the implications of the Carter Review and the directive to use NHS procurement to drive cost and efficiency savings. This affects the ability for local NHS trusts to explore more progressive spending policies.

What is more, we also need to look at closer partnership working between the NHS and local government. Local economic development activity needs to be harnessed to support greater social, economic and environmental value within NHS supply chains – providing opportunities for local enterprises, creating and maintaining jobs, and advancing zero carbon objectives.

Now, more than ever, we must ensure that every single pound of public money is used wisely and well. NHS spend must not be the exception.