What Do You Actually Do!? Episode 18: Sam Thomas, Health Programme Manager

Today’s episode of What Do You Actually Do!? will be focusing on work within the health sector. We talked to Sam Thomas who works as a Programme Manager at the Health Foundation.

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About Sam

Sam Thomas leads funding programmes for the Health Foundation, an independent charity committed to bringing about better health and healthcare for people across the UK. He previously led policy influencing work for a coalition of national charities focused on social issues including homelessness, substance misuse and mental ill health. He is a graduate of the University of York.

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Hello and welcome to this episode of What Do You Actually Do? My name is Kate Morris, and I’ll be your host today. In today’s episode, we’ll be talking about policy and project management within the charity sector. Today, we’re joined by Sam Thomas, who works as a programme manager for the Health Foundation. So Sam, what do you actually do?


Hi Kate, thank you for having me. So I work for the Health Foundation, which is an independent charity that supports improvement in health and healthcare across the UK. And what I actually do all day is provide funding and support to projects and teams in the NHS and in charities who are trying to improve the care that they deliver to patients. My job is to make sure that the resources that we have as a charity, get to those organizations.


So do they write funding bids, and you decide on whether they’re kind of appropriate or not?


It’s a bit of a mixture, really. So some of what we do is open programmes where people can apply for funding from us, for instance, to develop a new way of providing care for people with diabetes. And we would look at the application and make a decision on the basis of whether it was a strong application, whether it made a good case for what somebody wants to do. But we also have programmes where we actually have an issue or a challenge in mind. We work very closely with people to develop a piece of work that fits. So we’re in the lucky position of having resources to help support that work. We always want to work really closely with the people that we’re funding to make sure that the money is going to be put to good use, and that it’s going to make a difference for patients and for professionals.


So it sounds like you’re very involved at the beginning to shape what the project will look like and who it’s going to benefit. Do you actually get involved? Are you on a steering group or anything to sort of keep a check on the project as it’s going along? Are you involved in helping deliver the project? How does that side of it work after they’ve got the funding?


That really varies depending on the programmes. So one of the programmes we run, which is called ‘Innovating for Improvement’, made a whole series of grants up to a total of 1.7 million to 23 organizations doing very, very different things, but all of which were focused on how you support people working in the health and social care sector. So with those projects, it’s actually relatively hands off. And we work with another organization who provides support and coaching to those teams to help them do their work. But for other programmes, it’s a much more hands on relationship. So one of the things I’m doing at the moment is setting up a new programme, which focuses on how you get clinicians, doctors, nurses, health care professionals, to work together with people with lived experience of health conditions. So that might be people who are living with with diabetes or with kidney disease, and also their families and members of the wider community to develop better care together. And that’s a programme that’s very new for us. We’re sort of just scoping it at the moment. And with that I’m working really closely and quite intensively with a number of organizations to really make sure we get that right and get the programme off to a good start. So it really varies depending on what we’re doing. But I certainly feel it’s really important for people who are making funding decisions to be as close as possible to the work that they’re supporting, so that they understand it and they know what the challenges are, while not interfering too much, if that makes sense.


So I’m kind of trying to visualize your working day. Are you going out and about, visiting different charities or health care providers? Kind of to see what their needs are and how the projects going? Are people coming to you? Are you sat behind a desk a lot reviewing reports? What’s the sort of day to day stuff? What does it look like?


Yeah, I try very hard not to be sat behind the desk any more than I need to be. So I spend quite a lot of time out visiting projects. That sometimes includes visiting people who are doing work that we’re not directly involved in, but is potentially of interest to people that we’re working with, or might help inform the decisions that we make. So I recently made a trip to the US, to visit some really interesting projects and teams out there. But also, there is a great deal of research and thought that goes into how we design our funding programs. So there’s also a need to sit down to review the evidence that’s coming in from work with funding. And also a lot of the sort of things that you would expect happen when you’re providing funding to people. So I was just literally, before I spoke to you, drawing up a contract for a piece of work we’re doing. So there’s a real mixture of stuff, I think I try to as far as possible, go and speak to people and work with people. Because I think generally that’s how you learn and how you do the best job that you can by understanding the people and the projects that you’re going to work with. But there’s always a balance between that and the day to day stuff.


And do you get to see the end results of your projects? Are they sort of money for a few months? Or a few years? What’s that side of it like?


Again, it really varies in the sense that some of the projects we are funding are for a year or 15 months. So actually, you kind of get to see the life cycle of those projects. I mean, I’ve been here for a year. So actually, I haven’t seen any projects all the way through yet. But certainly I’ve been to the events that we hold when we close the program and met the teams who’ve delivered a programme of work. And you know, there is a real sense of pride, I think that they have at the end of a piece of work, particularly if it’s one that’s demonstrated real improvements in care. And, you know, I think we also like to celebrate that and celebrate the fact that we’ve been able to support them. But I think the focus is always on the work that they’ve done. And the fact that we’ve been there to help them, that the victories are always theirs rather than ours, if that makes sense.


Yeah, but it must be really satisfying to sort of see something go from being an initial idea, having had a hand in helping it happen, and then seeing the impact that it’s had and the difference it’s made to people?


Yeah, absolutely. And I think particularly some of the work that we’ve done. And so I spent some time recently with a whole network of projects that are improving care for people on dialysis, so people who’ve had kidney problems and are needing to go into hospital regularly, in order to receive dialysis to help control their condition. And that can be a very sort of intense, stressful and often unpleasant experience for people, particularly at the start of that treatment. And one of the big programmes that we’ve supported is about helping patients to have more control over the treatment they’re receiving to be able to do things like put their own lines in or potentially take more responsibility for what happens when they go into the hospital and the procedure that goes on. And so it’s not just a nurse who’s looking after everything for them, and actually talking to some of the people who’ve benefited from that project and the difference it’s made to them. It really gives you a sense of how important some of this work that’s being done by doctors, nurses and by patients is in changing people’s lives.


So you did your degree in philosophy and politics didn’t you? How did that sort of lead you to where you are today? What’s your journey been like? How did you get into the programme management and realize that’s the area that you want to be in?


Well, it’s been a fairly interesting journey, and not a particularly deliberate one, if I’m honest. So I’ve worked in the voluntary sector, you know, for charities, now for about a decade. And really the thing that led me into it was a sense that, you know, I’ve always been interested in social policy and the ways in which political decisions, but also decisions that are taken in public services and charities affect people’s lives. That’s the thing that motivates me, that’s what I’m interested in. And so I suppose I gravitated fairly naturally from doing a politics degree to wanting to work in that area. But actually, I didn’t really have at the start a very clear sense of what a career looked like, for me. I remember having conversations with people at the time and sort of saying, Well, you know, I’ve got some ideas about things I care about, and I’m interested in, but I don’t really know what I want to be doing. And the big sort of turning point, I suppose for me was that after I’d been working for a couple of years for charity, particularly looking at sort of community engagement, I did a lot of work, going and spending time with groups in communities across the UK, who we’re trying to, in some way change their place for the better. And that was really interesting work that kind of exposed me to a huge variety of people and projects. And some of the challenges that they were facing in their communities. And I started working with substance misuse services. So the services that are there for people who’ve had problems with drug use, or alcohol, and are there to support them in their recovery. And I essentially got very involved in working with a project that we were involved in, and thought, this is actually something that really, not only do I  care about, but I I love working with the people who are delivering the services. I also enjoy spending time with people who’ve had often very difficult experiences in their lives, but have had amazing kind of stories and often done amazing things to transform their lives and seeing the support that they gave to each other and that the services gave to them. And so that sort of said to me, right, this is the thing that I’m really interested in. And I was very lucky then to get a job working with a coalition of charities across the country, to try and involve people with experience of those issues, and also people who experienced homelessness and contact with the criminal justice system, to get them more involved in developing policy. So it was something like everything connected up actually that, you know, I had a background in thinking about politics and policy, but also a sense that the thing that I was really interested in was people and the way that people responded to the circumstances they found them in themselves in and got support for the problems they were facing. So it was almost a kind of way of bringing all of those things together.


So I think sometimes within the charity sector, it can be a choice between you either going to a frontline facing role, you’ve got that people side, but there’s perhaps a limit to your career progression and how much money you can earn. Or you go into the sort of more abstract roles in strategy, policy development, that kind of thing, but then you miss out on the people contact. And it sounds like the role that you’ve got now is a bit of a combination of both of those things, if I understood it correctly?


I think that’s so true, Kate, actually it’s a really unfortunate choice that people often end up making. And yeah, I think I felt that very acutely, when I was becoming increasingly involved in policy around some really challenging issues. So I did a lot of work around welfare policy and things like Universal Credit, and the impact that the changes that have been made to the way people get support when they’re at work. We’re affecting people who were facing difficulties with housing and mental health problems. And that’s a really difficult area to be working in terms of policy, because there’s quite a lot of consensus about what’s going wrong, but it’s actually quite difficult to shift some of the decisions and the policies that are affecting that, particularly if you’re doing that in a charity, trying to campaign. But the thing that always struck me is that the most powerful case that you can make for why things need to be different is the experience of people who are affected by those changes, affected by those issues, but also the people who are working in Job Centres, the people who are working in housing providers, who are seeing these issues every day, and helping people through them. And there’s always a disconnect, exactly in the way that you described between the way that those decisions are made under the experience and knowledge of the people who are on the ground. So I suppose yeah, as far as I’ve made any conscious effort to do anything in my career, it is to try and bring those two things a bit closer together. I think it’s very difficult, though, because the way we set up organizations doesn’t make that straightforward.


It’s crazy, isn’t it, because most people who enter a charity sector do it because it’s in line with their values, and they want to help people. But when you remove that element of seeing how you are helping people and how your work is making an impact, I imagine it becomes on one level less satisfying. And if you just focus on the face to face stuff, you maybe only get to affect small changes, because you’re not involved in the big sort of strategy and policy stuff. So it sounds like you’ve got a good role there.


Well, I hope so. But I also think, you know, there’s a lot of potential in the organizations that I’ve worked in. And I’ve worked with some incredible people and some really inspiring people. And I think there’s a sense of which the organization’s you work with are only as good as the approach that you bring to it. So I try not to get too complacent, I suppose. It’s easy sometimes to think when I’ve got to a place in my career where I feel like I’ve got a good balance between the things that interest me, but I try as far as I can to also think, well, what is going to make the way we do this better? How are we going to be a better voice for the people that we’re working on behalf of, but ideally, also, how are we going to work with them. I think that’s a big focus of my work at the moment- looking at how the Health Foundation as a charity, but also organizations that we’re working with, can make sure that the views and the knowledge and the experience of people who are affected by social issues are part of the solution. And they’re not just recipients of care, or people who are being consulted, they’re people who have been actively engaged in making things better.


That’s interesting, because it sort of links with the approach that international development has taken, where it’s moved from this model of like, all of the highly educated people coming in from one country, coming to help the poor people in another country is about training and developing of local people in their local cultures to make long term, real changes, rather than that sort of ‘we will helicopter in, resolve things and then go away again’. So it’s interesting that we’re starting to see, yeah, that’s a good model. And we should use that at home as well as for international charities.


I mean, it seems kind of obvious, doesn’t it, but if you want to solve the problem, you probably ought to be talking to and working with the people who are experiencing that? But I think also maybe there are some parallels with international development here and it’s also about the way that you see people who are experiencing difficulties in their lives. So all the people who are having problems, and I think that’s often the way that we’re encouraged to think about people. I’ve done a lot of work around homelessness, and if you look at the way that homelessness is portrayed in the media, often I think it’s getting better. But often, there’s a sort of sense in which, you know, this is a problem, a tragedy, kind of a disgrace. And all of those things are true. But it also reflects, you know, the experience of people who have done other things in their lives, that are not sleeping rough, and that have potential that has nothing to do with that. And I think there is a bit of a shift going on, where we stop seeing the people who are having difficulties in their lives as problems, we start seeing them as people who need support and people who need the state and voluntary sector to be on their side. But also people who have huge assets and capabilities of their own, which they need to be given the opportunity to use and to take advantage of those. And it’s difficult, because I think a lot of the reasons that people end up experiencing homelessness or being involved in problematic drug use, a lot of those things stemmed from really early experiences and also from poverty. And there are such clear links between what happens to you really early in your life and where you end up later. So it’s not about saying that people have to be responsible for their own lives, because, you know, we know that, that some of the cards are stacked against people from the start. But it’s about saying, you know, regardless of the circumstances, people have been in the challenges they’ve had, how can you make the most of the abilities that they do have and what will be the best support that we can give to them.


So it’s a more holistic approach, rather than just sticking a sticky plaster on it. And dealing with that one particular symptom, you’re looking at causes and all parts of the person as an individual, rather than just that one particular issue.


I think it’s about recognizing that people often have a lot of the solutions to problems that they’re facing in their communities. They know what they are, but what they need is the opportunity to persuade somebody else that something needs to be done, but also to be treated with the trust and the respect that says, we’re going to work with you, not do something to you. And I think that’s the thing, you know, all of the organizations and projects that I’ve worked with, that you feel when you spend time with them, they’re really making a difference to the places where they’re working. They work in that way. They don’t come in and try and solve the problem. They come in, and they stand alongside people, and they say what’s going to make a difference? How can we help?


So you’ve mentioned how important actual workers within this sector are. What kind of personal qualities or strengths would you say someone needs to actually have to work in this kind of sector?


I think it can depend a great deal on what you’re doing, because the voluntary sector is so diverse in terms of the range of jobs that people are doing, but also the different cultures and styles of organizations. I think one thing that’s always been important for me, I think, is being a bit versatile. I think one of the things that I found very early in my career was that, when you’re working particularly for small charities that don’t have a great deal of funding, being the kind of person who can be useful, is absolutely invaluable, like having somebody around who says, ‘Oh, I can help with that, you know, that might not be my official job, but I could help you with that, I have a bit of experience, working on web design, or I know how to run events, or I’ve got a really good idea for how we could solve this problem, even though it’s not really my job to solve it. I think in other contexts where that might be discouraged, I feel often, charities tend to encourage that kind of behaviour. Because, you know, increasingly, organizations in the voluntary sector are surviving on pretty thin resources. And having people who want to solve problems and want to get things done is really important. And I think you’ll see that at all levels. Obviously, it’s particularly important, you know, if you’re managing a hostel, that’s your day to day experience of trying to make things work and give people the best support that you can. But I think it’s equally true of people who are working in policy and more strategic roles, in the sense that there’s still in most organizations in the voluntary sector, not a great deal of capacity, do that kind of work. And some of the most interesting and exciting organizations really struggled to do it, because they’re so focused on the frontline work and what they’re delivering that they don’t actually have the chance to sit back and reflect. So I think versatility is really important. I think also, it’s important to know why you’re turning up to work. And I’m not sure that’s about necessarily saying this is the most important issue to me. I mean, there are people I’ve worked with who, thinking of a very dear friend of mine, who has wanted to work in the kind of homelessness sector since she was a young girl and wrote a letter to the queen, saying, you know, I want to grow up, and I want to be the kind of person who’s making sure people aren’t sleeping on the streets. There are people who are like that, and they’re amazing, but there are also people who are motivated by different things. So they’re motivated by the challenge of solving a new problem every day or they’re motivated by the fact they like people. I think that’s part of what I love about working in the charity sector – I enjoy spending time with people, particularly people who’ve had different experiences to me, and whose views on the world challenge mine. And that’s a lot of what engages me and motivates me. So I think that’s also important, knowing why you show up. And what it is that that means is you care about doing the best job you can.


Do you think resilience is important, because some of the scenarios you’ve described, some of the different people that you’re meeting and the glimpses into their lives that you’re seeing, I imagine can be quite challenging. And you sort of mention colleagues who work in Job Centres, etc. On the front line, you know, is that a challenge for yourself to deal with seeing people in extreme circumstances or who are very unwell, etc. and then kind of living your own life at the end of the day? Or is that something that is kind of easy to switch off from?


I think, speaking for myself, I have to be careful, because I think a lot of the work I’ve done, although it’s often involved working really closely with people who are in very distressing and upsetting situations, I’ve not usually been the person who is responsible for supporting them and helping them through it. And I think those roles are incredibly demanding. So I spent a lot of time working with social workers, outreach workers, people who, on a day to day basis, are helping people through some of the most difficult moments in their lives. And you really can’t underestimate the amount of stress and the emotional demands that it places on people, but certainly I recognize from some of the work I’ve done, particularly with people who have had really challenging experiences and trying to use those experiences to help others, is that it does weigh on you. And I think I’ve always felt the responsibility very heavily, not just to be present for what those people are saying, and to understand and to be alongside them as they’re talking about it. But also to make sure that if, for instance, as I did in one of my previous roles, we were asking people to come and meet with an MP and talk about experiences they’ve had, that I make sure I have a duty of care to that person to ensure they’re looked after properly, that they have the support they need. And they know that I’m there on their side. So at times, yeah, that has felt really demanding. And I definitely had days where I’ve gone home and thought, you know, I really don’t have anything left. And I think nobody should have that, to the extent where they’re not able to find space and time to recover. And I think one of the things I feel really strongly about is that people working in any job in any setting, particularly in really demanding jobs in the voluntary sector, should have the support and the care that they need to be well at work. And that’s something that’s always been really important to me, certainly.


So what do you think are the key challenges moving forward for the sector over the next few years, perhaps aimed at students or people who’ve recently finished their degree thinking about if they want to break into this sector in the future? What should they be anticipating?


I think is very difficult to predict exactly what’s going to happen at the moment for anybody. I think the general direction of certainly the voluntary sector over the last few years has been one of increasing demands and tighter constraints and limited resources, which is a really difficult place to be. And I think what you’re seeing is a lot of organizations dealing with that in different ways, some by campaigning really loudly and strongly for the resources that we need to tackle the problems we have in this country, and others by maybe acknowledging that, but also saying that we need to think differently about the way that we provide support to people. And I think there’s a really strong movement within the charity sector, but also in public services more widely, to think about, well, just the model that we have for how we support people and help them through difficult times in their lives. Does that model still work? And certainly working as I do now, with the NHS and with healthcare organizations? I think that question is being asked really, really urgently, because it’s quite clear that the setup we have for a health service that’s free at the point of use that worked 50 years ago, is not working now, mainly because we can’t pay for it. So I think there’s a lot of change happening. That’s something that I think anybody going into, certainly a career in the voluntary sector, but also the Public Service more widely, needs to be really aware of that the ground is shifting very rapidly. I think the other thing that I’ve always felt is that there’s a temptation sometimes to follow what the newest sort of skill set, so you know, for instance, at the moment, there’s a lot of interest in design and service design in the voluntary sector. The kind of tools that you can use to help improve the way that services are delivered by working with people to think of a better way of providing something and using design techniques to think that through and potentially use technology to support it. And so I think that will be a big kind of shift for the next couple of years. Over the last 10 years, I’ve seen a few different approaches to that come through. And I’m not sure they ever last that long, I think the principles always remain the same. And the things that matter always remain the same about using your creativity, understanding that relationships are important and being prepared to ask difficult questions – those kind of skills are always valuable. And I think having a degree in philosophy was sometimes helpful in confronting some of that. But actually, the skills that you’ll need to do any job in in the voluntary sector in 10 years will be different to the way they are now. So I always encourage people to focus on the stuff that they can bring to bear on a job rather than the job itself.


And I guess that links to your earlier point about versatility as well. Because if you’ve got that, you’re able to adapt perhaps more easily than someone who’s just very rigidly sticking at their one set of skills and their one particular job description.


I think, if you want to, if what motivates you is using a particular skill, and you want to develop that skill, brilliant, and I would never advise anybody against doing that. But I think having that flexibility and being open minded about how you might use your skills, and the places in which you might use them is always going to stand you in good stead. But particularly in a sector that moves as fast as the voluntary sector does sometimes. Other times, it can be very slowly. But that’s a different story.


And any sort of final words of advice for anyone thinking about getting into programme management or other roles within the charity sector?


I think not to underestimate the importance of relationships. I’ve always been surprised how small a world it can be when you’re working in charities or in the public sector. And not just that, you know, it’s important to build a knowledge of the people who are working in the fields that you’re interested in, because those people being aware of who you are, and understanding what you’re interested in will help when you need to get advice. But I think also being open to the fact that sometimes it’s a real advantage to have a diverse network of people who challenged your way of thinking, and might make you reflect on what you’re doing or the career that you want to have in ways that you didn’t expect. I’ve been really lucky over the years to have met lots of people, some of them co-workers, some of them bosses, some of them just people who I’ve met at random events, who have helped me to think differently about what’s important to me, and what I should be doing in my working life. And sometimes in my personal life too. And keeping those kinds of relationships, and being open to building them, I think is the single most important thing in the decisions that I’ve made so far, because so many of those decisions have been supported by other people and a lot of the work that I’ve been able to do has been because other people have inspired me or given me ideas with challenges that have allowed me to take any opportunity. So I think that’s so important. And I’m sure it’s important in any walk of life, I think, particularly if you want to work on improving the society that we live in, you need to have as many points of information and challenge about what that society is like and diverse viewpoints on what you’re going to do.


Well, thank you. Thanks a lot for joining us today. It’s been really lovely talk to you. And I’m going to add some relevant links to the episode description and so people can find out more about the Health Foundation and the work that you’re doing, and a link to the full transcript of today’s show. But thanks again, Sam.


Thank you. It’s been a pleasure.


Thanks for joining us this week on What Do You Actually Do? This episode was hosted by myself Kate Morris and edited and produced by the Careers and Placements team. If you love this podcast, spread the word and subscribe. Are you eager to get more tips? Follow University of York Careers & Placements on YouTube, Twitter, Facebook and Instagram. All useful links are in this episode’s description. This has been produced at the University of York Careers & Placements. For more information visit york.ac.uk/careers.