Guy’s and St Thomas’ Charity (GSTC) is a an independent charitable foundation that is committed to radical innovation in health and health care for the people living in two boroughs of South London, Lambeth and Southwark.
We’ve been around since the 16th century, and in that time we’ve largely supported the local hospitals with whom we share our name. But just as the hospitals have changed dramatically in the past 500 years, so has GSTC. As a result, we’re in the early stages of developing our own community-led health intervention to sit alongside our support for the hospitals. Our current strategy seeks to work beyond the hospitals’ walls, supporting projects that are community-focused and that bring together many different elements of health.
The regular income generated from our endowment means that we have the capital to make long-term bets that potentially have big pay-offs—the kind of bets that are too risky for other sources of capital. This usually manifests as support for clinical science, but we’ve found that we have an equally valuable role in investing in the long-term health and well-being of communities, based on what those communities value, rather than what medical professionals prioritize. At present, few foundations invest in health this way, and we hope that our story will inspire others to embark on a similar journey.
The Limits of Health Care
GSTC works as a catalyst for innovation, and is currently in year three of a five-year, $149 million spending cycle in Lambeth and Southwark. These boroughs have a population of 600,000—with all of the diversity and inequality typically associated with large urban areas.
Over the last five years, we have supported health care providers to deliver a wide range of projects to improve the health of these communities. The Diabetes Modernisation Initiative, for example, brought together hospital and family physicians to improve the diagnosis and treatment of people with diabetes. Another example is Southwark and Lambeth Integrated Care, an ongoing effort in which health and social care professionals work to improve the care for older people by applying models similar to accountable-care organizations. While these have delivered a lot of benefits, they have also exposed limitations of what traditional health care providers can achieve. Two barriers are most apparent: 1) It is hard for existing organizations to break out of established ways of working, and 2) we understand very little about what is important to citizens, and how this affects their behavior and engagement with the health care system.
Essentially, we’ve realized that the issue we face is that health care is structured around institutions rather than individuals. This is not a unique problem for Lambeth and Southwark; it is true across England and perhaps the world.
This realization led us to invest in trying to understand what a different approach to improving health might look like. We undertook a small piece of public insight research that sought to understand what people prioritize in their lives and how health relates to that. Results showed that people wanted a fulfilling life that is financially secure and includes nourishing relationships.
But the research also demonstrated that people didn’t contextualize what they wanted from health care in terms of life fulfilment; instead, they focused on wanting to avoid or treat illness, such that it became the end in itself. To some extent, this is understandable; illness, or fear of it, can have such a dramatic impact on life that evading or treating it can become a person’s sole focus. However, this propensity for health care to dominate thinking can lead to services that, while valuable, neglect what people truly prioritize—a fulfilling life, with health care as only one means to it.
To understand how others were approaching this problem, we invested in Wellthcare, an exploration of new ways to create and value health, specifically with a view to create a meeting of like-minded organizations. The group that formed evolved into the Creating Health Collaborative, which looks to understand health beyond health care (and which co-curated this series).
The Special Nature of Place-based Capital
Reflecting on our journey, I am struck by how important our roots in Lambeth and Southwark have been in driving our thinking. If our organization were focused on a particular disease, I’m not convinced that we would be going as far in challenging the institution-dominated definition and approach to health.
To me this suggests that there is a special role that “place-based capital”—capital that is inextricably tied to a particular location, often because of limitations placed on the original endowment—can play. While organizations with place-based capital can and must continue to work closely with health-care institutions, an approach that has roots in a particular place also gives it special license to prioritize the people of the locality rather than the organizations that currently serve them. This creates space to discover and suggest new approaches to improving the health and well-being of local residents.
The critical step for any place-based investor is to have conversations with the people who live there. It is easy for local professionals to mediate and organization’s understanding of local need. But while that perspective is important, it is only one perspective. You can only truly prioritize the health and well-being of local residents when you know what that means to them.
As a result of our experiences, GSTC is in the early stages of developing an approach to community-led interventions for the people of Lambeth and Southwark, based on their priorities. We are only in the foothills of our journey, but we encourage other foundations that can make long-term bets—especially those with a place-based mandate—to join us.