Asking the Right Questions

One of the toughest decisions facing public sector leaders is often not what to do – but what not to do. When resources are limited and ‘difficult decisions’ must be made the ability to focus effort for maximum effect really matters. The knowledge needed to do that is born of a deep understanding of how the organisation/programme/project in question makes a difference.

These types of questions are at the heart of much of the work we do. They often come after the event, when a client has done something they know has been impactful and need help explaining it to the rest of the world. But that isn’t always the case.

Sometimes clients look for help in understanding how they add value (or what they could do to increase the benefits of what they do) when planning a project or during the early stages of implementation.

Our recent work on the NHS Anchors programme is case in point.

Anchor Organisations

Anchor organisations are (typically) large, non-profit organisations whose long-term purpose is tied to the wellbeing of the populations they serve. The term originated in the US where it was used to describe how hospitals and universities can help improve local socio-economic conditions by providing employment, generating income, supporting supply chains, and providing vital public services. The approach has enjoyed some success in the UK with recent evaluation evidence pointing to reductions in the prevalence of depression and improved life satisfaction as potential impacts.

The Anchors Programme is a partnership between PHS and the Scottish Government. It is designed to help NHS Boards become more effective anchor organisations.

We were commissioned to help PHS understand if and how the programme should be evaluated. Our main conclusion was that it could (and we provided recommendations about how) but the real value of our work was in providing greater clarity on what should be evaluated.

Making a Difference

To do this we needed to understand how the programme could make a difference.

Our conclusion was that although the programme is based on a strong underlying rationale, not everyone involved in the project had the same understanding of what this rationale is.

The strength of the underlying rationale for the programme lies in the role PHS and the Scottish Government can play in making it easier for organisations to become more effective anchor organisations.

Fundamentally the programme is about enabling change. Partners can add value by making it easier for NHS boards to become more effective anchor organisations, not by seeking to transform organisations themselves. This is a subtle but important distinction that can easily become blurred.

Our recommendations were designed to help provide clarity on this and help PHS ensure efforts remain focused on where they will have the greatest impact. We hope they will help and commend PHS for having the foresight to ask the right questions.

Further Information

Our full report to PHS can be downloaded here: https://biggareconomics.co.uk/wp-content/uploads/2024/11/NHS-Health-and-Social-Care-Anchors-Programme-Evaluability-Assessment.July-2024.pdf

For further information or to find out whether we might be able to support your organisation please contact us at info@biggareconomic.co.uk