FUNDING A MORE EQUITABLE FUTURE

Rowena Estwick, director of diversity, equity and inclusion (DEI), Guy’s & St Thomas’ Foundation, co-hosted* a discussion on equitable working, power and philanthropy at the ACF conference in November. She shares some key insights from the session and her foundation’s own DEI journey.

A large part of Guy’s & St Thomas’ Foundation’s original endowment was gained through the profts of the transatlantic slave trade and colonialism. The legacy of colonialism has concentrated both wealth and deprivation across the world and, in part, has contributed to the social, economic and racial disparities that add to the health inequalities and inequities we see today in our London boroughs of Lambeth and Southwark.

As an urban health foundation, our aim is to create a healthier society for all. Therefore, it’s important to acknowledge the link between the origins of our wealth, the legacy of colonialism, racism and slavery and to understand its impact on health and healthcare today.

With this background, our conference session centered around our position as an endowed foundation focused on these diverse London boroughs in the context of health equity and the systemic inequalities that disproportionately impact people from racially minoritised and marginalised groups.

Questions on the day considered equitable engagement with communities and diversity of our partners, our history, wealth, power, and how we build trust. On refection, our ability to share learnings from our projects and hold these conversations came from the work we have started within our own foundation on increasing diversity, building equity and creating a culture of inclusion. We believe that we cannot credibly or successfully work on health inequities if our own internal structures are inequitable. As a foundation, we need to take intentional actions on embedding values of DEI in how we operate internally – as well as who and what we fund externally. Failing to do so means we are likely to reinforce or perpetuate the inequities we’re trying to address.

Since starting our DEI journey in 2018, we’ve learnt a lot. We’ve made progress in some areas, been slow in others, and have a lot more to do. The refections shared here are not the result of a challenge-free process. They are the products of wins, losses, hard won battles, and failures. We share our refections as we think these are issues relevant to many foundations, regardless of size, progress on their own DEI journeys, or the origins of their wealth. We hope that our examples can help other organisations fnd additional routes to progress their social missions.

Our frst step was to create a common understanding of the why, what and how of DEI. For us, like many foundations, DEI is critical to the success of our mission. We’ve learnt that this common understanding needs to be owned at the top and widely understood across the organisation. Equal to this is understanding what success looks like at different points in the journey and how we get there. Actions need to be clearly communicated, visibly owned and with transparent accountability.

Essential to progressing this is:

Brave leadership. The tone must be set and led from the top and confdence, not comfort, is key. This work can be uncomfortable. The exposure that comes from doing it can be a barrier for some senior leaders. Brave, honest and curious leadership is crucial. This is bolstered through building capability, capacity and collective responsibility. Practically, this means clarity on the necessary skills and competencies required of our leaders, clear objectives for accountability and appropriate support for them on their own personal journeys.

Collective effort. In addition to visible leadership, there must be support and recognition of ‘informal’ leaders, role models and advocates across the organisation. This is a collective endeavour and everyone within the organisation plays a role, from our grant managers to our offce managers. A narrative of “it’s everyone’s responsibility” means it becomes no one’s responsibility. We’ve learnt that it’s important to build a clear understanding of the collective effort needed, supported by collective and individual accountability.

Clear and consistent communication. This cannot be underestimated. We’ve learnt that poor and/or inconsistent communication can undermine progress. Making the work visible and landing the right balance on how you lead with DEI or link to DEI is also key to ensuring that it’s embedded rather than an add-on to the ‘real work’.

Leaning into honest conversations. We’ve had to grapple with tensions and make necessary trade-offs throughout the process. Acknowledging the link between the impact of our wealth creation and our current work has made us open conversations – both internally and externally. These conversations are about how we use our wealth, our role in this space, where racism and racial justice sits within our external work and internal structures, what we can and cannot do within our charitable objects, as well as what we choose to do or not, and why. We’ve learnt that these conversations cannot be ignored or delayed and, where possible, taking a proactive approach in starting these discussions builds a strong culture with principles of radical candour. Adequate resourcing. This is a longterm investment into the health of our foundation and our ability to continue to make progress on our mission over the next 500 years. This is cultural change. It’s not linear, and it takes time, and therefore it needs resource. Our people are our most important asset and we’ve learnt that goodwill and personal commitment alone cannot drive this work. Practically, this means defning and paying for a DEI role, rather than have it as an add-on to the day job. It means acknowledging that making adjustments to embed this into everyday work will take time, therefore giving people time and space to build this into businessas-usual activities. It requires different skills and competencies, which could mean upskilling existing staff, updating current and future job descriptions or creating new roles to lead and drive the work.

Compassion and understanding. We’ve learnt that this DEI work may be experienced differently by people within the same foundation. Applying DEI strategies and processes without understanding the context within which you’re operating, or acknowledging the human element of this work, can be a barrier to progress. We’ve learnt that underpinning our approach with the values of compassion and understanding allows people to learn that a change of direction is not seen as a failure and creates a journey that’s not defned by its mistakes. These are just a few examples from our experiences which we believe may be areas of focus relevant to many foundations. While we recognise and acknowledge that we’ve not always got everything right, we’re committed to this work. We’re now focusing on how we can build this into the organisational muscle memory, so that all changes made today will remain in place for our next 500 years and allow us to continue to serve our communities of Lambeth and Southwark.

This year, we’re revising our DEI strategy which we crafted three years ago. We aim to share more on our DEI journey and continue to adjust our work as we learn. We’ll also be looking more into our heritage and the origins of our wealth.

We think this is important to our mission of urban health equity. This will involve further research into our links to the trade in enslaved people, building our understanding of reparative justice, and what this means for us as a foundation. We’re keen to share our journey as we explore our history and would welcome working with others in this area.

At Guy’s & St Thomas’ Foundation our mission is clear – to build the foundations of a healthier society. For over 500 years, we’ve been a constant in London’s ever-changing landscape, at the leading edge of health. Our home in the heart of a global city is vibrant and diverse, but it is also a place with stark health inequity.

Our commitment and work are backed by our endowment, which allows us to take a long-term view while addressing the real and urgent health issues of today. We focus on backing people and ideas to drive more equitable health.

As an independent foundation, we invest, partner, engage and infuence so we can come at big health challenges from all angles. Through our family of forward-looking organisations, we collaborate with our communities, partners and hospitals, and use our assets to transform lives.

Across everything we do, we look to increase our impact by sharing and connecting with others working on better health – from our part of the city to cities around the world. Because a healthier society is our collective endeavour.