How to measure the effectiveness of healthcare providers acting as an 'anchor institution' : a case study of the NHS in Greater Manchester, England

<b>Objectives </b>To improve social determinants of health, healthcare organisations can support societal and economic goals in their role as anchor institutions (large organisations with an important presence and ties to a place). In England, the National Health Service (NHS) Long Term Plan highlighted the role of the NHS as an Anchor. Despite a clear policy mandate on this, less is known about specific indicators to measure and benchmark anchor performance. A set of metrics were developed to quantify anchor activity using the Greater Manchester (GM) region in England as a case study.<br/><br/><b>Design </b>Descriptive cross-sectional study<br/><br/><b>Setting </b>Data were received on employment and procurement for the financial year 2022/23 from NHS trusts located in Greater Manchester.<br/><b><br/>Primary and secondary outcome measures</b> Performance against two anchor metrics, local spending and employment, was assessed. ‘Local’ was defined as the Integrated Care Board (ICB) footprint in which the trusts are located. The proportion of procurement spend to the local economy was derived from procurement data. Employment data was aggregated by ethnicity codes and deprivation levels and compared to ICB-level ethnicity and deprivation profiles using the Index of Multiple Deprivation based on 2021 Census data.<br/><br/><b>Results </b>The included trusts employed 65,597 residents of GM and spent £389 million on local procurement, demonstrating their importance as anchor organisations. Considerable variation was observed between trusts in local spending, ranging from 6.4% (95% CI 6.4- 6.41) to 52.7% (95% CI 52.69 - 52.72) (with the mean at 21%). The percentage of locally employed staff ranged from 82.7% (95% CI 81.45 - 83.90) to 89.5% (95% CI 89.12 - 89.95). All trusts demonstrate strong workforce representation from minoritised ethnic groups, but most employed a lower proportion of staff from the most deprived areas than expected based on the local population profile.<br/><br/><b>Conclusions </b> It is feasible to quantify aspects of anchor activity using routine NHS data, and meaningful variation exists across trusts, even within a single health system. Greater Manchester provides a useful case study, but further work is needed to embed anchor metrics in routine reporting and to extend measurement to other domains such as estates and sustainability.<br/>