Jon Siddall, Director of Funding, Guy's and St Thomas' Charity
May 14, 2019
At Guy’s and St Thomas’ Charity, we’re leading some of the UK’s largest place-based, philanthropic programmes – focusing on the complex urban health issues like childhood obesity and multiple long-term conditions.
We’re now over two years into our current programmes and it’s been a steep learning curve. Some things have worked, some haven’t and on some it’s too early to tell. In the spirit of joint learning, I thought I'd share some reflections on a few things we've picked up along the way:
The importance of getting underneath the surface of the issue. We’ve learned the energy around an issue is not always focused on the major opportunity to achieve population level impact. For example, much of the work around multiple long-term conditions is focused on the end of the journey – on ageing and complex care management. However, our local research points to the need to start much earlier in order to slow down people’s progression to multiple conditions.
The value of bringing together data, evidence and lived experience. We’ve explored the relationship between all three to help us target our efforts, inform our approach and adapt interventions to our local context. For example, in our childhood obesity work, exploring local data helped us spot a local ‘corridor’ to focus our efforts. We then brought together existing evidence and the lived experience of people in those areas to help increase the options available to eat well and exercise more.
The benefit of 'thinking like a system, acting like an entrepreneur' – a phrase we’ve borrowed from the RSA and one that resonates with our experience in practice. Thinking like a system – defining system-level goals, like bringing the high rates of childhood obesity in areas of deprivation down to the levels in more affluent areas, and understanding routes to influencing systems change – is helping to focus our work and orientate our efforts. We think that’s enabling us to be more entrepreneurial in our approach, testing and iterating a range of ideas to explore their contribution to our programme goals – like prototyping a Community Living Room as part of our multiple long-term conditions programme.
The need to work on issues at different scales. Taking a place-based, whole-systems approach requires working with many different partners and operating at a variety of scales – driven by the nature of the change we’re trying to bring about and the intervention we’re looking to test. For example, through our multiple conditions programme we’ve found that strengthening agency requires us to work in individual neighbourhoods. In childhood obesity, we’ve found that creating more affordable, convenient and healthy food options has required us to also work at much larger scales – such as our work with The Consumer Goods Forum or ShareAction.
We’ve also started to consider what place-based approaches like ours can bring to health today and in future – including asking some great voices to share their views with us.
In this context, what are the implications for practice and policy of all this? Two, I think.
First, place-based working really allows you to get into the context of issues, and perhaps better understand the true nature of the national challenge.
Second, there is a speed to place-based learning – working alongside residents, civic society, the public sector and businesses – that can shift understanding in a short space of time. Given the urgency of so many issues, this feels an approach we should be making much greater use of.
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In our work addressing complex health issues prevalent in inner-city London, we take a place-based approach. We’re interested in exploring how others view place-based approaches and their value in helping to improve people’s health in the long term.