Health, wealth and wellbeing: The NHS' role in economic and social recovery

Background

It is well documented that NHS revenue spending accounts for around 50% of the Welsh Government’s budget, currently £9.1 billion, and additional funding has been made available to support the NHS response to the COVID-19 pandemic. However, there is less awareness of the significant contribution the NHS makes to local and national economies as an anchor institution, as well as the significant role it will play in wider recovery of local economies and communities following the pandemic.

In our election briefing, “Valuing, Engaging and Delivering: A health and care system for future generations”, published in September 2020, NHS leaders set out their vision for the health and care system in Wales. The vision covered the NHS’ role in economic recovery, through:

• Creating social value in local communities to provide improvements in health, the environment and prosperity.
• Using resources responsibly, efficiently and fairly to ensure sustainable services.
• Being outward-facing, working with the wider world to ensure economic partnerships, investment, research and promoting Wales across the globe.

Health, wellbeing and the economy are bound tightly together; a healthy (physically, psychologically and socially) population results in a more economically active population. Interventions designed to improve health, inclusive growth and wellbeing in Wales are in the interests of all local, regional and national partners, businesses and communities and
should be a shared priority. In light of COVID-19, the NHS is seeking to reset its services and priorities, with a focus on how it can influence wider community issues in its role as an anchor institution. This includes how its resource allocation and utilisation can support local economic development, influence social and economic determinants of health and help build sustainable communities.

The size, scale and reach of the NHS means that it has a significant influence on the health and wellbeing of local populations and could have a key role in actively supporting and driving the nation's critical economic and social recovery, post COVID-19.

This briefing examines the importance of the nation's healthcare system and its role in local economies; as an employer, a purchaser of goods and services, a driver and consumer of innovation, a landowner and as a vital element in improving population health, the environment and health equity.

There is a clear link between health and wealth - we know that a health population is a productive and prosperous one and vice versa.

NHS organisations are anchor institutions because they are large organisations whose long-term sustainability is tied to the wellbeing of the population through being one of the largest employers in local areas, a key purchaser of goods and services, and a capital estate holder and developer. However, the socio-economic impacts of NHS Wales spread far beyond its economic scale and scope to include wider impacts, including employment stability, regional wages, occupational structure, and economic activity rates. Collectively, these factors positively impact Welsh productivity and the economy, with organisations and businesses benefitting significantly from healthier and more productive workforces. In many ways, health can be seen as the ‘new wealth’.

The COVID-19 pandemic, EU exit and climate change are anticipated to contribute to a future social and economic downturn. The NHS must use the system and partnership approach that emerged during the pandemic to drive up population health and wellbeing. We have a fantastic opportunity in Wales for a more focused ‘health and wellbeing in all policies’ approach to future national and local decision-making, through legislative frameworks such as the Wellbeing of Future Generations Act 2015, Social Services and Wellbeing Act 2014 and the introduction of the Socio-Economic Duty in March 2021.

There are opportunities for Public Service Boards, Regional Partnership Boards and other innovative local partnerships to consider issues such as workforce and supply chain development, community working, new forms of funding and strengthening population health through prevention and early intervention. In addition, there is an opportunity to start looking at the social value within procurement and the service the NHS is providing to help capture the wider impact, including socio-economic factors, to use and strengthen local supply chains and spread and scale best practice across Wales.

The Welsh NHS Confederation supports its Members, the NHS organisations in Wales, to understand and maximise their role as anchor institutions – working in partnership with other health and care organisations and, critically, other local anchors. Together, we can make a huge difference to the health, wealth and wellbeing of local communities.

Key recommendations
 

At a national level, the Welsh Government should:

• Place health and sustainability at the heart of all national COVID-19 recovery and economic plans, through embedding health and care within national and local regeneration planning, ensuring a much greater alignment between health and care strategies and those relating to wider economic development.

• Support a more integrated, inclusive, and targeted approach to population health management and prevention, backed by investment in those areas with greatest need.

• Empower local leaders by providing the skills and tools to improve health outcomes and deliver inclusive growth and wider prosperity.

• Support leaders to source local supply chains and help businesses better understand the NHS and social care needs.

• Give priority to wellbeing in investment decisions and support public bodies, including the NHS, to secure excellence and value from its suppliers in ways that promote social, cultural, environmental and civic value.
 

At a local level, public bodies, including the NHS, should:

• Develop an anchor network within a regional footprint, with a joint, data-driven vision for how they can support the local economy and population.

• Align strategies with local partners to deliver more inclusive, sustainable economies. Anchor institutions should collaborate on transformative change in areas not within their core domain.

• Seize the opportunity to actively engage in discussions about the development of communities and stress the importance of its role as an anchor in the economic and social recovery of communities.

• Work in partnership with a range of local partners to protect, improve and promote population health and health equity.

• Understand, diversify and strengthen local supply chains. Specific attention should be given to how procurement and processes can be used and flexed to provide support to local business, voluntary organisations and partners through social value policy and aligning with the wellbeing goals.