Shaping Places for health and wellbeing Supporting local action on the building blocks of health

This programme demonstrated that there was real value for the five partnerships (led by local authorities) in working more widely across their systems. We found that complex systems approaches have value across a range of geographies and modest resources can drive system changes in a short time to tackle different wider determinants.  

A major outcome of the systems approaches taken was a change in mindset around tackling the wider determinants of health — by cultivating problem-solving mindsets that consider change at every level of a system — and changing norms around using systems thinking and approaches. Project stakeholders were rightly cautious about having influenced health outcomes by the end of the programme, but all had worked hard to create the right conditions for future change. 

Being involved in the programme promoted a greater sense of agency for people who participated in the work. Coupled with improved relationships, this led to increased stakeholder buy-in and engagement, and shifts in the beliefs and attitudes of citizens, service providers and strategic leaders about how to address the wider determinants of health. These changes included persuading decision makers about the merits of a system change approach, reframing public health concerns or promoting their importance, and encouraging greater confidence and agency among community members. There is confidence that these positive outcomes will be sustained.

• It’s not easy to adopt a complex systems approach and not all aspects of a complex systems approach were adopted by all of the local authority led partnerships we funded. Some of the key barriers included: 
• Contextual challenges like the COVID-19 pandemic and the cost-of-living crisis. These created difficult conditions for implementing system change approaches, limiting community engagement and resources.  
• Resource constraints that placed demands on teams’ already limited capacity and made project scale-up challenging: the complexity and scale of projects exceeded available resources, making long term sustainability and strategic reflection challenging. 
• Challenges securing widespread buy-in from key stakeholders and maintain momentum beyond the programme's duration. Resource constraints, high turnover among partners, and difficulty engaging certain system actors all complicated other system actors taking teams’ work forward beyond the end of the Shaping Places for Healthier Lives programme.  
• Protecting time to keep stepping back and reflecting on the system as a whole. Project stakeholders identified that they have often struggled to create sufficient bandwidth to recognise how the system is changing and reflect on whether their approach needs to adapt in response.

Stakeholders identified a range of enablers to implementing a complex system approach, including: 

• The skills and local connections of team members. Teams benefited from staff with strong local knowledge and connections, enabling effective engagement with both staff and the community. These individuals played a crucial role in bridging divides and fostering collaboration. 
• Alignment with supportive local policy environments. Complementary policy agendas and regeneration initiatives provided opportunities for teams to progress their work, along with encouraging stakeholder buy-in.   
• The backing of strategic system leaders. Project and programme stakeholders noted that gaining key decision makers’ buy-in increased project reach and credibility.

Aside from the funding that the Health Foundation contributed to this programme, there were other ways in which we were able to work with programme partners to add value to this programme. This included design support from the Local government Association and Design Council, and learning support from Cordis Bright and PPL. Giving the partnerships the freedom to adapt and innovate, and not have to demonstrate improvements in outcomes, was unusual within a local government context but highly valued.

• Reframing the issues is important — telling a persuasive story and changing mindsets is a great way to get buy-in to tackle the building blocks of health in a collaborative way. 
• Getting people to think about how their work connects to the social determinants of health is vital and collective activities eg action learning sets, can help make this happen.
• Building relationships should be purposive, with the aim of creating a network of stakeholders across the system with the willingness to make and maintain changes at every level of the system. 
• Providing more opportunities for local decision makers and key communities to engage with each other directly (eg by creating a youth panel).