Barbara Reichwein, Multiple long-term conditions Programme Director, Guy’s and St Thomas’ Charity
Sep 20, 2019
On average, we spend just two hours a year with healthcare professionals in contrast with the more than 8,000 hours a year we spend at work, at home, with family, friends and in our communities.
So where should an urban health foundation such as ours focus its resource to tackle the complex health issue of multiple long-term conditions?
As we approach two years into our multiple long-term conditions programme, our team and partners have all played a part in informing the evolution of our programme strategy. Here’s what we have learned and how we’re applying it to test solutions in Lambeth and Southwark.
Our programme aims to slow down people’s progression from one to many long-term conditions. To do this, we are focusing our work on people who are at greatest risk of rapid progression.
How and why people progress to multiple long-term conditions is not well understood. Ten years ago, the Marmot Review into health inequalities in England made a compelling case about social determinants driving health. While this and other evidence on the social determinants of health is conclusive at a macro level, we don’t know what practical actions in our local place will prevent ill health tomorrow by tackling social risks today.
Knowing which social risks can improve for people of working age, and therefore protect their health, isn’t easy. This is because, generally speaking, there isn’t enough evidence about who is at greatest risk, at what moments in their lives. The inter-play of multiple conditions with each other over time and the complexity of people’s lives are what make it difficult to say what’s most effective in slowing down progression.
Over the past couple of years, our own research into how local people progress to multiple conditions, and research with our partners in the national Taskforce on Multiple Conditions has contributed to understanding this complex issue and its impact on people.
Our recent research explores the links between personal finances and health. While we know that debt advice can improve someone’s finances, there is little evidence on how it affects mental health and no evidence how it relates to physical health such as high blood pressure, diabetes or chronic pain.
Similarly, we want to explore how initiatives that enable good quality, meaningful work in our place might protect people’s health. Our research explores interventions that can support people with health conditions to stay in or reconnect with meaningful work, for example by making workplaces more accommodating.
We’re exploring these issues with learning projects in Lambeth and Southwark, where health inequalities are stark – a picture that is similar to other cities.
Our social and healthcare systems are predominantly focused on kicking in at crisis point, when urgent care or support are needed, and have limited capacity to intervene early.
This programme focuses on prevention and early intervention. We plan to intervene in two ways:
We think community and neighbourhood-based approaches are vital for both. We layer activity hyper-locally, so that people at risk are reached in more than one way. We concentrate our efforts, strengthening individuals, households, professionals and neighbourhoods, so they can cumulatively play their part in making people and communities more resilient to health and social risks.
So we can measure the impact of our work and deliver a targeted programme of activity, we are focusing first on a specific cohort of people: those living with either diabetes or chronic pain, health risk factors such as smoking or high blood pressure, and who live in areas with higher levels of deprivation.
We believe that when people are at a working age, there are things that can change to decrease the likelihood of developing multiple long-term conditions.
You can read more about how we narrowed our focus to target our programme here.
To test this approach, we’ll be working with a range of local and national partners, healthcare professionals, local enterprises and employers, community groups, landlords and housing providers, digital platforms, and financial providers such as credit unions, banks and ethical lenders.
The big questions we’re looking to answer over time are: is activity across preventative healthcare and social risk factors sufficient to measurably slow down progression to multiple long-term conditions and how can it be done locally?
In the coming weeks, colleagues at the Charity will be sharing what we’ve learned so far across our two strands of work, and how we want to create better healthcare and meaningful work – as well as the types of projects we’re keen to partner with in future – so keep an eye out for additional content coming soon.
Programme Director: Barbara Reichwein
23 April, 2020
As a funder, our priority is to support our partners and the communities most affected by COVID-19. Our Portfolio Director, Louise Mousseau, sets out the actions we've taken to date and how we're adapting our work in response to a changing environment.
25 February, 2020
Our Programme Director for multiple long-term conditions, Barbara Reichwein, reflects on persisting health inequalities ten years on from the Marmot Review.