Went to an excellent session a month or two back
Ted Howard of the Democracy Collaboraborative was the headline act
With a few able support acts
I learned a lot in a short space of time
In the spirit of democratising knowledge, here is my note of the meeting
1. What is the Democracy Collaboraborative
35 staff. Action oriented think tank
Mission = How do you democratise the economy of USA – address exclusion and inequity
Large local institutions have important role to play in this
Focused on the strategic approach to this issue
The operational grass roots level to this is around community resilience and learning from other non health movements – e.g. Much to learn from restorative justice
Historical areas of work
Greening supply chain of health care
Sustainability of health care
Localising of economic activity of health system
2. Why is this issue important
We know inclusive growth is important. We know “the economy” is one of the fundamental determainrat of health (that one is turning into a monster of a blog that I need to finish)
We know that there’s a great deal that can be achieved though the economic power of anchor institution
To address health inequalities you need to address social and economic inequalities
20% is health care – access and quality
Here is an opportuinity to directly address the economic influences on health with your existing budget
Strategic question to the anchor is
Can we incentivise the 80% to optimise impact on health and well being.
What can NHS system 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.
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…..
This has been going on for 8 years in the states.
The hospital network described above been going on for 2yrs
3. Economic anchor institutions tend to be:
- 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
Domains of the business to look for progress and opportunity
- Annual spend
- Annual procurement
- Investment and portfolios and endowments
- I.e. Not really the core mission of delivering great services.
All the assets of your institution should be “in” – eg
- HR /
- Community benefit
- Govt relations
- Service delivery
Economic assets are probably key
- Hiring and workforce
- Procurement and purchasing
- Place based investment
- 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 indicator that were set were met.
4. Toolkits have been published
Full of practical aspects and ideas
Three main areas with some practical examples
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
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
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
5. The Healthcare 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, as well as the clinical aim
Overall network Meet twice a year
Define the org imperative
Build the evidence base
Collaborative with wide range of stakeholder
Working groups – for significant themes
Community investment in land trust – purchase land to secure sustainable and affordable housing
What can hospital do in the housing economy??
6) Michael Wood NHS local growth advisor from NHS Confed then posed som excellent questions for us to ask local
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 £
STP is the iteration and NHS version of this.
- Is STP about service sustainability or transforming the model
- The NHS matters to local economy
- Social inclusion
- 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
- Liverpool have good CCG local framework
He advised we look out for NHS Confed products
Local growth academy
Local growth and the NHS
He also advised we check the Local Growth white paper – we need to check in our aspirations against this
One size doesn’t fit all
Give local leaders power to make decision
Shift power local
LEP, combine authority, locally elected mayors, localisation of fiscal policy (brr context)
The NHS is not within this context
7) Emily Huff ended with the strategic question of What is the NHS for
Moving from care and repair system to asset based health system
8 some excellent Points raised in Q&A after
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
Anchor strategy population
Tends to work at min of 400k or more perhaps
Power imbalance between big institutions and communities
At it’s most strategic level – tricky to get right
Easy to see how this might work local level.
Local procurement of food, carbon miles etc
Different way in, but mission broadly the same
Getting providers who aren’t interested in long term investment but are interested in immediate cost base.
Rest of the public sector is talking about economic, local, growth, cost v investment
NHS is way behind here. Give tools to the NHS to catch up.
Where are the regulators have to say on this matter in NHS context. This might be a driving factor.
Key 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
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
Focus on BOTH rational side to journey (business case, metrics and governance) and emotional side – the right thing.
Appeal to all ideologies
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.
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.
CSR – Tesco have made great strides, the NHS has barely started
24m ROI argument. – Financially / Health and well being of community /
Carbon ….. 24 case studies……….SDU website
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)
In times of plenty, we didn’t make the mainstream better, we funded stuff at the margins to correct the deficiencies of the mainstream.
And thus we never corrected the problems in our view of allocative value in the mainstream (in everyday language we failed to shift upstream).
Make it not a feature of left or right, or greens, or middle
Find arguments for all brands of ideology. Make it practical fiscal and economic and political sense from lots of different perspectives.
why local matters
Large national providers not invested in place
Can’t respond and flex locally
Not in tune with our local ethos
National v local policy differences.
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
Opportunities for NHS
In ACO model what we trade is health services
in a wider model the traded commodity is health and well being
Link it to a contemporary policy and service problem
Inclusive growth is huge opportunity and role / place of NHS debate
Skill escalators – short term apprenticeships
“There are 3 organisations that will b here in 20y time – hospital, job centre, local govt. better structural links between the 3 critical”
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
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
NHSE and NHSI – not at top of shop but some levels below
Unleash the creative potential that already exists.
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
Poor state of repair
Water / leccy shut off non pay of bills
Lots of interesting and fresh learning packed into a short space
Thanks Health Foundation for the event, and the invite.
Some of (well most of) my twitter buddies were there so they may comment further