By Hardeep Aiden, Joshua Butt and Louise Ashwell
In a recent webinar, we shared lessons from commissioning and implementing the complex system change programme, Shaping Places for Healthier Lives (SPHL) in England. We also explored the developmental evaluation approach we took to evaluating the SPHL England programme.
In this blog, we take a deeper dive into those lessons, reflecting on what this work means for those commissioning, delivering or evaluating systems change initiatives.
What was Shaping Places for Healthier Lives?
A substantial body of evidence shows that the strongest determinants of health and health inequalities are the social, economic, commercial and environmental conditions in which people live – often described as the wider determinants of health. These are complex issues, taking place within complex systems and involving multiple stakeholders, with outcomes being driven by multiple factors and non-linear relationships of cause and effect.[1]
In response, the Health Foundation and Local Government Association (LGA) commissioned SPHL England, which ran from 2021–24. The programme aimed to explore how local government-led partnerships could take action on the wider determinants of health in their local systems by employing a complex system approach.
SPHL England funded five local government-led partnerships to address a determinant of health they identified as a local priority. Local project teams were given significant freedom, defining the their system of interest, selecting their focus and deciding which activities to pursue. Rather than funding discrete interventions or services, SPHL England encouraged cross-sector working and experimentation with a view to supporting sustainable local change.
Why use a developmental evaluation approach?
Developmental evaluation supports innovation in complex and uncertain environments. Unlike formative or summative evaluations, where success is assessed at fixed points, developmental evaluations focus on real-time learning, asking evaluative questions and feeding insights back into programme delivery in real time as contexts and priorities evolve.
This made developmental evaluation particularly well suited to SPHL England. The programme involved multiple actors, shifting local contexts and no single, linear pathway to impact. Regular learning, adaptation and reflection were not just desirable but essential.
The learning and research partners, Cordis Bright, PPL and Cobic worked closely with the central programme team at the Health Foundation, the LGA, the Design Council (which provided additional support) and the five local project teams, but were not fully embedded in the way a prototypical developmental evaluation team often is.[2] This was primarily a practical decision, but the evaluation still aimed to provide up-to-date and ongoing learning.
Developmental evaluations demand openness to change, frequent reflection and a willingness to act on emerging insights. Although this approach is resource-intensive, it offers significant benefits in adaptability and relevance for programmes operating in dynamic, complex systems.
Lessons from taking a complex system approach
Given the flexibility of SPHL England, local approaches varied considerably, reflecting different contexts, priorities and interpretations of system change. However, several common features emerged across sites.
Understanding local systems
Each system of interest was different. Most of the teams started by looking at a place, and considering what the different actors and assets were in their area, and how these influenced a particular challenge within their area. Some took an alternative approach, looking at a specific health issue relating to a population. While this still had a geographical dimension to it, this wasn’t foregrounded in the same way.
However the teams framed what the system was and what it included, these initial mapping conversations helped to determine what the areas were that they could influence and what was potentially outside of their control.
Teams invested time in learning about their systems through methods such as system mapping and consulting local stakeholders, which together helped to surface relationships, build shared understanding and grow networks.
This work was important, not only to better understand the system that each team hoped to shape, but for the relationships built in the process. Understanding the system better was the first step towards reshaping the system.
What did a complex system approach involve?
Across the programme, local project teams reported greater progress where they were able to:
- Develop a deep understanding of their local system and identify where to focus effort for maximum impact
- Co-develop a clear, ambitious vision that remained at the forefront of the team’s work
- Work at multiple levels of the system simultaneously
- Treat relationship-building as core work, investing time in convening and connecting, along with seeking input from diverse stakeholders across all parts of the system
- Communicate in ways that inspired action among those they sought to influence
- Experiment with new ways of working that challenged traditional behaviours and adapt their approach over time
- Create space for regular reflection and, when doing so, reflect on whether what they are doing can engender long-term, sustainable change.
Enablers and obstacles
Over the course of the programme, several key enablers emerged as especially important in supporting a complex system change approach. Team members’ local knowledge and existing connections helped build trust between the councils and community members. Working with people who were connected with the community was a shortcut to progress.
At the same time, buy-in of key decision-makers increased project reach and credibility, which itself was more likely where local projects were aligned with existing local policy agendas. All of these were underpinned by the flexibility built into the SPHL programme design, which gave teams scope to experiment and learn. Teams were at their best when they stepped back, observed what else was going on in their system, and connected their work to areas where there was already energy and commitment.
Local project teams also navigated a number of obstacles, ranging from the ongoing pressures on local government from Covid-19 recovery and the cost of living crisis, limited time and resources, difficulties securing and sustaining buy-in and momentum, and the challenge of protecting time for regular reflection within busy roles in order to adapt approaches in response to local system changes.
Lessons from implementing a developmental evaluation
Evaluating SPHL presented challenges for several reasons, including:
- The inherent difficulty of evaluating complex system change approaches, particularly when teams’ approaches were developing alongside the evaluation
- The complexity of synthesising learning across five areas progressing at different paces and working in different ways
- The absence of a single, shared understanding of what complex system change meant in practice
- The limited capacity of busy delivery teams.
From this, we identified three key lessons for implementing developmental evaluation in multi-site programmes under these conditions.
The importance of shared language and flexibility
To support learning across sites taking different approaches, we needed a clearer common language for discussing complex systems change. Introducing a single theoretical framework helped the local project teams articulate their intentions, self-assess what they were doing, identify gaps and reflect on their progress to maximise their potential.
While sites were not required to change their programmes to fit the framework, using the framework did allow the evaluation team to better identify similarities and differences.
Flexibility was essential when collecting evaluation data. Most stakeholders outside local project teams did not conceptualise their work as “systems change” and a single shared understanding was neither realistic nor necessary. We therefore adapted how we framed conversations to meet people where they were and their understanding of systems change.
Embedding reflection into existing structures
Creating spaces to help teams step back and reflect was a challenge for busy teams delivering complex programmes. To reduce burden, we integrated learning and reflection into existing activities such as pre-existing reporting processes and governance meetings. This helped make reflection more routine and relevant.
Adapting data collection methods
Each project was different, with a varied set of stakeholders – some included a large group of different community members, professionals and volunteers, whereas others were a more tight-knit group. To understand what each project was doing and how it was contributing to change in the system, we needed to be flexible about our research methods, who we spoke with, and how we engaged with them depending on their understanding of systems, the SPHL England programme and the evaluation. We even reframed the evaluation as the ‘learning and research’ element of the programme to better describe what it was and to allay the fears of the local project teams about being judged.
Developmental evaluation as a mindset shift
Developmental evaluations represent a shift in how we understand and measure success in complex systems. Rather than acting solely as a retrospective assessment, evaluation becomes a forward-looking learning process that supports adaptation and improvement.
This mindset values uncertainty, collaboration, inclusivity and continuous learning. For commissioners, practitioners and policymakers, embedding developmental evaluation into programme design and delivery offers a way to respond to emerging challenges using robust evidence without sacrificing accountability.
In increasingly complex policy environments, this shift may be essential to designing and delivering interventions that are both effective and sustainable.
Further reading
About SPHL: https://www.local.gov.uk/shaping-places-healthier-lives
SPHL evaluation: https://www.health.org.uk/sites/default/files/2025-01/SPHL%20summative%20report.pdf
[1] https://www.health.org.uk/topics/wider-determinants-of-health
[2] https://www.betterevaluation.org/methods-approaches/approaches/developmental-evaluation