When I restarted this blog in June last year I tried to indicate some of what I felt were becoming the wider responsibilities of the NHS. Given that the Prime Minister had announced 5 year increases in its finances, by 2023 the NHS would be consuming an even higher percentage of all public expenditure. As it had requested it, this laid a greater responsibility on the NHS to take a greater role in developing our society and it seemed important.
In January this is reflected in the final paragraph of the Appendix of the long-term plan where the phrase “anchor institution” is used.
Recognising the local importance of the NHS – beyond the provision of health services – is something that planners involved in hospital reconfigurations have been pushed to do for some time. Just a rumour going round town that the hospital will lose some services can bring thousands of protesters out onto the street. It will always be the case that some of those protesters are worried about their health services, but for others it is anxiety about losing their locality’s biggest, and hopefully most stable, employer. People go on the streets to save their own and their neighbours’ jobs.
The NHS provides a great many jobs and in many places is the main employer. This is one of the issues that the long-term plan is referring to when it talks about ‘anchor’ institutions.
Let’s think about anchors for a moment. What are they for? Ships have them so that when they are no longer under power or blown by the wind they can throw out the anchor to stop them being moved by tide or wind. An unanchored ship is at the mercy of wind and current and could end up anywhere. So to lose an anchor means losing any part of control over what is going on. Conversely, being ‘anchored’ means being in control – even if it means being still. Not being anchored is worrying and potentially dangerous.
Let’s apply those concepts to a town or a city in 2019. In the last 10 years or so many towns have talked about having their guts ripped out as economic , retail, social and public institutions have left them. Factories close, fewer trains and buses stop, the local shop that embodied its spirit of place has gone – and with it the main post office, Marks and Spencer shuts down and the job centre puts up the shutters.
Each of these represents the loss of something that gave the town its identity and meaning. Each loss is piled on the other. Each makes another more likely as a domino effect takes hold. Everyone left feels very unsettled ad worried for the future. What does our town mean anymore? What will go next?
Those on board a ship without an anchor have the same feeling. And it’s that feeling, not only of drift, but of feeling dangerously out of control that is a big worry for whole localities and the people living in them.
As economic winds grow stronger, the lack of an anchor grows more worrying.
The long-term plan states that in Blackpool 20% of the employed population work for the NHS. This is what is meant by the NHS being an anchor institution for Blackpool. So the NHS is giving some hope of stability to the town but do people feel that this anchor is safe?
In Blackpool being dependent on a national institution is a better feeling than being unanchored. But this dependency on an institution whose title (N=national) shows that it is run from London – a long way away – and that doesn’t make people in the town feel they are in charge of it..
I’ve talked before of living in Coventry in the 1970s. A city always seen as a car city. At its height about 25% of the employed population worked directly for the car industry but the whole town took its identity from that anchor. There were several firms that the city depended on and the city had hoped that these were several anchors that surely couldn’t all shift at once. But actually all those different firms – which looked like different anchors – were linked to just one – the international market for cars – and in one month all of those anchors started slipping. In five years a thriving, anchored city, became the Specials “Ghost Town”.
So here we are in 2019. 20% of the employed population in Blackpool work in the NHS. Let’s be clear this is NOT because compared with say Lancaster the NHS is very big in Blackpool, it’s because the rest of the economy is very small. It is this that makes the responsibility of the NHS as an anchor even greater.
And apart from size how does that NHS create a future for the town?
An anchor doesn’t just ‘steady the ship’ but, if it is going to work, it will help stabilise the economy of the town. NHS consultants for example are likely to be some of the best paid people in the town. As a group their spending power would have an impact on the economy of the city. It would regenerate shops and the whole retail trade of the city.
But how many doctors that work in Blackpool, live in Blackpool?
And, apart from working in Blackpool, what does their employment in the town add to the economy? If they don’t live there – not a lot. So how therefore does the ‘anchor’ work.
Continuing with the anchor theme how many children in Blackpool schools will go to medical school this year? What contribution will the NHS make to the upper end of the opportunity ladder in Blackpool?
In recent weeks I have been writing about the importance of creating real ladders of opportunity for working people to access, for example, nursing careers. How many nurse associates are being created in Blackpool?
And on another front how come – if the NHS is the anchor institution for the people of Blackpool – there are a higher proportion of people smoking in that town than anywhere else. The combination of the two statistics – high % of paid employees and high % of smokers, doesn’t suggest that we are carrying out our anchor responsibility as well as we might.
To really anchor a location the NHS needs to do more than just be there.