Kieron Boyle, Chief Executive, Guy's and St Thomas' Charity
Dec 13, 2019
As the decade draws to a close – by rough estimate, our eighty-sixth decade as a charity – I’ve been reflecting on what’s changed at the Charity over the past ten years, and what that might mean for the next ten.
The core of why and where we do things hasn’t changed and isn’t set to.
Alongside our support for Guy’s and St Thomas’ NHS Foundation Trust, we’ve spent the past ten years interrogating a simple idea: how do you keep people out of hospital in the first place? We’ve explored that in the inner-city London boroughs of Lambeth and Southwark – our home, and some of the UK’s most vibrant and diverse neighbourhoods.
What has evolved is how we go about this and with who. Track back ten years and the Charity was focused on catalysing innovation in health. Common with many other foundations at the time, this was a generalist and responsive strategy and had notable successes, not least SLIC, which was a precursor to many of the models of integrated care being established around the country today.
We learnt, however, that this model had limitations. The trade-off to breadth was a lack of depth and precision. It constrained our ability to iterate, learn and build. A predominant focus on local statutory funders, while important, also had implications for the diversity of perspectives brought to challenges.
The second half of the decade has therefore been characterised by a shift in emphasis. Ultimately, I would like to think that the approach has become more impact-led. As a foundation that worked on over 100 different health issues, we now focus on four. While still being open to applications, we’re more intentional about seeking out and building solutions. We’ve also brought additional partners into the picture – from supermarkets, to pension funds, urban planners, schools, local businesses, faith groups and many more.
Perhaps the biggest shift, though, is how we’ve genuinely tried to place a deeper understanding of people’s experience of health issues – and of health inequalities – at the heart of our work. This more than anything has helped us better understand the world as it is, and think more creatively about the world as it might be.
So what might this mean for the next ten years?
Firstly, expect to see more of us testing, learning and building. We’ll continue to spend time exploring how people and place interact. We’ll seek to understand this within the wider systems that frame our experiences of health, and build collaborations to come at these issues from multiple angles. We’ll test new approaches and use insights from our work to engage decision makers. Done well, it should be a coherent model of learning, acting, influencing and changing.
Secondly, we’ll deepen our work on childhood obesity, multiple health conditions, the health effects of air pollution and adolescent mental health. We’re not looking to add others: these are long-term programmes with long-term goals. The issues themselves are good exemplars of types of urban health challenges – by not only being some of the biggest health challenges in our boroughs, but also significant for other urban areas in the UK and around the world. We think of them, in turn, as coordination, exploration, innovation and targeting questions. As a portfolio they also cause us to engage more fully with the commercial, social, environmental and digital determinants of health – relevant issues to a wide range of audiences.
Thirdly, we will be stepping up how we engage with other cities around the UK and internationally. A clear community of practice is emerging around the field of urban health, focused on how global cities are responding to health inequities caused by global processes. We think our patch of London has quite a bit to contribute to that conversation.
Taken collectively, I hope this paints a picture of how practical work to address local health inequalities can have national, perhaps even global, relevance. I also hope it’s as compelling to others as it is to us – our impact only exists through the work of our partners: existing, new and future.
In summary, over the past ten years we’ve been fortunate to be part of some extraordinary partnerships. We’ve learnt a lot and have much to learn still. Looking at the next ten years, it seems that we’ve got even more to be excited about. Do please get in touch if you’d be interested to share that journey with us.
Chief Executive: Kieron Boyle
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