Broader horizons

Foundations like the Health Foundation are privileged. We are independent, have freedom to chart our own course, have stable income, are set up to do wider good, and can take a long term and plural view. From the pressurised position of today’s public and commercial sectors, foundations appear like atavistic oases of calm.

But with the privilege comes at least three potential risks all foundations face: irrelevance, inertia, and poor value for money. Inertia is a function of the staff hired, leadership and culture. Value for money in part relates to whether the right activities are funded, they are impactful, as well as securing the best deal. Irrelevance can occur if the strategy is wrong: too much long term thinking unconnected to present challenges can make foundations seem remote and indulgent; too much attention to the short term abdicates responsibility for thinking about the future, which few others have space for.

So while foundations don’t face the same external pressures as other sectors, their missions demand as great if not greater contribution. What are we doing at the Health Foundation to step up to the plate?

We are broadening our horizon, and using a more plural approach to support change rooted in evidence.

In the last 10 years the Foundation has focused almost exclusively on health care. From 2016 we will begin to work also on improving health. We’ll begin by charting the key territory, bringing together evidence, worldviews, and coalitions to help think through the adequacy of current approaches as well as point to what action might be more effective in future. Earlier this year I visited the Robert Wood Johnson Foundation to understand their work to build a ‘culture of health’ in the USA. The extent of cross sector action across the US and ambition is impressive. Our reconnaissance in 2016 will pave the way to more investment by the Foundation in 2017 to make change. 

Also in the last decade, the Foundation has majored on testing, developing and promoting quality improvement techniques in front line clinical care, and developing networks and leaders who know about these approaches. The main emphasis has been on improving safety in hospitals, and more latterly encouraging care to be more person-centred. We have seen the powerful impact of some of the projects we have funded, examples beautifully brought out in these short films. This will continue to be a key part of our strategy, with grant funding to match.

But while safety is perhaps the most important domain of quality of care, there are others such as effectiveness, efficiency and equity of access. We now have to think much more about whole pathways of care, including in the community and primary care, rather than just in hospitals. And we know that quality improvement techniques are necessary but not sufficient to improve care. A plural set of interlocking approaches are needed – effective from front line to national policy.

So the Foundation will be broadening its activities to include these issues: different aspects of quality; a greater focus on whole pathways of care and out of hospital based care; and actively using a range of disciplines to help gain insights and make change including economics, policy analysis and data analytics. Being an effective channel between the front line and policymakers is a key aim. You might notice we’ve refreshed our brand to reflect our broader scope.

So whoever you are, there should be something going on at the Foundation to help you in your work to help improve the UK’s health and health care. Join us and keep in touch.

Jennifer is Chief Executive at the Health Foundation