A place-based and co-design approach to health commissioning

A 60 minute Case Study by:

Cat Drew


Jessica Attard

Healthy London Partnership

About this Case Study

In 2016, the Healthy London Partnership commissioned Uscreates (a service design and innovation agency specialising in health and wellbeing) to work with it to explore innovative ways of improving childhood obesity.

The problem

According to the UK government's obesity strategy, nearly a third of children aged 2 to 15 are overweight or obese. In Scotland in 2015, 28% of children aged 2-15 were at risk of becoming overweight or obese. The drivers leading to widespread obesity are complex and evolving; they include social, environmental and economic factors - meaning that a preventative approach to obesity cannot be achieved by the formal health sector alone.

The Healthy London Partnership wanted to explore how innovative commissioning models could involve partners from outside the health service as agents for health-related change. They also recognised that a human-centred and collaborative design approach - with its focus on underlying behaviours, iterative ways of exploring ideas and use of local community assets - is best placed to tackle this myriad of issues in a sustainable way.

Healthy London Partnership commissioned Uscreates to run a co-design project across 3 of the most deprived areas of London (Seven Sisters, Isle of Dogs and Haggerston) with the ultimate aim of developing interventions that would help local residents lead healthier lives.

The approach

Uscreates adopted an agile and design-led approach with 2 phases to better understand and deliver design solutions for each of the communities:

  • ethnography with local people and community based co-design
  • prototyping with social incubation

The approach differed from both the traditional commissioning model and service design process in that:

  • The research phase gathered insight but was also used as an opportunity to build relationships and trust within the community. Additionally, while early stage prototyping served to communicate our ideas, it also heightened excitement, energy and assets (eg buildings, volunteer support) from the community.
  • The interventions were community asset based and tapped into local resources and capabilities.
  • We incorporated social incubation into how we delivered it and made these initiatives sustainable.
  • Our approach used behavioural economics theory to understand how to change local community behaviours to healthy eating.

The impact

The project has achieved impact within the local communities, and the learnings have informed guidance for health commissioners about how to adopt a place-based approach to commissioning, fully using the assets of the voluntary, community and social enterprise (VCSE) sector.

Two of the 3 initiatives are running independently since Uscreates' support finished, which is a particular achievement given that only 1 in 3 social enterprises usually succeeds. One initiative - Make Kit - has showed that it has potential to change people's eating behaviour (for example, 83% of survey respondents said they had more confidence in cooking healthy meals) and has gone on to secure a further £30k in funding.

The project has also informed guidance for health commissioners on how they can work with VCSE organisations to commission sustainable outcomes, and provide wider support to create a thriving VCSE sector, incubating initiatives that can improve health outcomes so that they are sustainable in the long-term without direct health funding. This is a radical change in health commissioning and there is an opportunity for service design to be at its heart.

This session will share the approach and learnings from co-designing the 3 initiatives, and then allow a collective discussion of how service designers can work between health commissioners and local communities to deliver sustainable health improvements. There are clear opportunities, but also some challenges in working in this way, around which service designers might need to evolve their practice.

You will:

  • learn how community-based initiatives can be developed to improve social outcomes
  • understand how service design can evolve to move into social incubation and commissioning
  • understand how to activate local communities to deliver sustainable change once the design phase is over
  • discuss how to frame service design within the context of a changing commissioning landscape

About the Speakers

Cat Drew

Cat Drew is Delivery Director at Uscreates, where she oversees all major projects. Previously, she was Head of Projects at the UK government's Policy Lab, where she introduced next practice design methods into government, including a focus on data and design. She has given over 100 talks in the UK and internationally (including a TedX talk). Cat has spent a further 12 years in government working for the Government Digital Service, No.10 and the Cabinet Office, and as Head of Police Digitisation at the Home Office.


Jessica Attard

Jessica has worked across health and social care, specialising in partnership working across organisational boundaries and with the public, private and voluntary sectors. Originally trained as a dietitian, Jessica has a passion for improving health and wellbeing at the individual and population level through place-based approaches to integrated care.