The pantomime facade of Greater London House in Camden, north London, complete with giant mock-Egyptian sphinxes, is an incongruous home for the British Heart Foundation HQ. Built in 1928 as the Carreras Tobacco Company factory, it churned out the Black Cat brand of cigarettes. Today a small Black Cat advert remains propped up on the desk of Simon Gillespie, chief executive of the BHF, as a reminder of how far society still has to go, despite some victories, in the fight against one of the main causes of cardiovascular disease.
Some of the BHF's advertising is almost as famous now as Black Cat billboards once were in the 1920s and 1930s. One of its most memorable – and effective – campaigns was in 2004, featuring billboards and TV spots showing fat oozing out of cigarettes and then being pressed out of a clogged-up artery. It arguably helped clear the path for the ban on smoking in public places in 2007.
One of Gillespie's strongest desires is to exert a bigger influence on government health policy in favour of heart-friendly measures ranging from diet to transport policy.
But it is medical research rather than campaigning or service delivery that is both the BHF's biggest passion and its greatest expenditure. The charity's total charitable expenditure was more than £120m in the year to April 2013; of this, a quarter was spent on prevention and care and three-quarters went on research, making it the single biggest independent funder of cardiovascular research in the UK.
Gillespie has now had a year to review the BHF's strategy since joining it as chief executive in April 2013, and says he intends to cap expenditure on prevention and care at its current level of about £30m a year. Any increase in income will go into research expenditure. "The more we raise, the more we will be putting into research," he says. "I could even see the ratio of research to prevention expenditure going as far as 85:15. We hope that, 20 years down the line, all of our research will be there as a treatment for cardiovascular disease."
Gillespie started out in the sector as director of operations at the Charity Commission in 2000 after almost 25 years in the Royal Navy and the Ministry of Defence, including two years advising Tony Blair's Cabinet. His former Navy boss, Paul Boissier, is also now head of a charity, the RNLI. Gillespie says the draw of the sector for former military men is that it is one of the few places able to "match the commitment to the cause", something that drives people in the armed forces.
As chief executive of the Multiple Sclerosis Society from 2006 to 2013, his commitment to the cause was personal. As a child he had an aunt with MS, and the impact it had on her life and the lives of his cousins stayed with him. "It is particularly important for a leader of an organisation that is as values-based and as cause-driven as a charity to be able to convincingly say to themselves, their staff, volunteers and supporters why the job is so important to them", he says.
He helped to restructure the MS Society by shifting its focus towards research, but left after six years feeling there was a fair amount of work still to do. "I think we quadrupled research expenditure, but we could and should have been doing more," he says.
Instead, he hit the ground running at the BHF. Again, the cause was personal. "My father died of a heart attack in 1979 when I was in my first year at university," he says. "At the time, about 70 per cent of people didn't survive a heart attack and very few were discharged from hospital. That has now been reversed. It was BHF research that demonstrated that a clot caused the heart attack, not the other way around. And it was BHF research that found the death rate could be reduced by 25 per cent just by making people take aspirin at the earliest opportunity."
The power of research is something Gillespie returns to again and again with an almost evangelical zeal. It is, he says, "ultimately where everything comes from"; prevention and care are clearly important, but it is research that must inform them and research that leads to treatments. To some extent, the British public seems to agree. Medical research attracts the UK's largest proportion of charitable donations, 17 per cent, and 38 per cent of donors.
Most of that research money goes to cancer, however, and Gillespie is well aware of the fact that the BHF lives in the shadow of Cancer Research UK, whose total income of £514m is almost double that of his charity. "If you develop cardiovascular disease it's almost seen as the inevitable consequence of a type of lifestyle - being a smoker or being overweight", says Gillespie. "You are seen to be a victim of cancer, but you are seen as being at least partly responsible for your own heart disease."
Changing such prejudices is one of his objectives. But the BHF's mission - to encourage the uptake of healthy lifestyles without blaming those who can't or won't change, while also primarily researching the causes of and treatments for cardiovascular disease - lacks much of the punchy clarity of "the fight against cancer". To counteract this, the BHF under Gillespie will now talk less about prevention and more about promoting cardiovascular health, he says: "We are trying to move much more into positive promotion, rather than talking only about avoiding the negative."
High-profile campaigns, such as Hands Only CPR (cardiopulmonary resuscitation) with Vinnie Jones, Rock Up In Red, Fight for Every Heartbeat and the London to Brighton Bike Ride, will remain central to the BHF's engagement strategy. But after Betty McBride, its influential director of policy and communications, retired in May, Gillespie signalled a shift in approach by separating the role into director of marketing and engagement and director of policy. He also created a new role of director of prevention, survival and support. Appointments are expected shortly.
Cardiovascular disease doesn't just come and go. We've got to provide an underlying awareness
"When we're running a campaign, people know about us, but that awareness can tail away quite quickly", he says. "A choice for us and the incoming directors is whether to continue with that campaign-led approach or look for something that is there all the time. The reality of cardiovascular disease is that it doesn't just come and go. We can focus on particular things at particular times, but we've got to provide an underlying awareness."
Part of this shift can already be seen in the BHF's charity shops, each of which now has a local thank-you message. A short walk up Camden High Street from the BHF headquarters, the local BHF shop has a poster by the door saying "thank you" for funding 24 life-saving defibrillators and 12 local BHF healthcare professionals. "It is important to connect with people to tell them that we are a national organisation but have funded these things locally," says Gillespie.
Charity shops also form a significant part of the charity's revenue. The BHF opened its first charity shop in 1986; its retail outlets now provide 23 per cent of its total income. The rest comes from its fundraising (31 per cent), legacies (41 per cent) and investments (5 per cent).
In the economic downturn, charity shops boomed. In 2004, the BHF had only 467 shops, but now it has 740 – the UK's largest charity retail portfolio. Gillespie thinks, however, that this growth has almost reached its peak. "In order to be successful in the retail area, charities will need to be very careful about the channels to market," he says. "In the same way that Next runs a multi-channel organisation, charity shops might need to do that too. We have issued all our shops with digital cameras and instructions that if they get an individual, valuable item, they can upload it to our eBay site – the market is not just within a couple of miles of the store; it's potentially global."
How the money is spent is always controversial for a charity the size of the BHF. In 2013, from total incoming resources of £255m, £120m was the ultimate total charitable expenditure – less than the £157m total cost of generating funds, such as rent, utilities, running costs and fundraising costs. In 2014, the BHF put its weight behind National Heart Month, rebranding 7 February as Ramp Up the Red, a national day that gets the public involved, organising events and wearing clothes and face-paint in the BHF's trademark red branding. This day – similar to Comic Relief's more popular Red Nose Day – raised a total of £1.4m for the charity, but cost £2.5m in marketing, promotion and campaigning.
But Gillespie defends the figures. "We have always approached campaigns with split objectives – some of it is around fundraising, some is around brand awareness and awareness of heart disease more generally," he says. "We want to grow National Heart Month, for example, to be something very significant from next year and beyond. The long-term prospects are very good. For us it's a way of engaging people, not just a flash in the pan: will they volunteer at a shop or an event? Will they run a marathon?"
This, however, touches on another bugbear for smaller charities. The marketing spend of big hitters such as the BHF means that when people run a marathon or carry out any sponsored event, they do so for the big names. Small charities that have better ratios of charitable spend to operating costs barely get a look in.
"It's always a very difficult issue," says Gillespie, who recently ran a marathon for the BHF. "One thing that constitutionally all charities have in common is that we have the responsibility to do the very best we can for our beneficiaries. Quite often that means we partner with smaller organisations to deliver things in ways that would be difficult for us to do alone." Indeed, in the last financial year, about £4.5m of BHF grants went to external organisations, including hospitals, charities and community groups.
"The sector should not just see it as a big guys versus small guys debate," he says. "You see it in national organisations and small organisations - where the charity has a hard ring-fence around it and people inside it don't see the bigger benefits of collaborating because they think they will have to give things up. But that's the nature of it. If we give a grant to somebody to do some work for three years, we are giving something up. We could do it ourselves and plaster our logo all over it. But I think people need to be a little bit more forward-thinking."
The same goes for government policy. He believes some voluntary codes – for example, that for the food industry – have proved ineffective. "The government needs to look again at the public health responsibility deal," he says of the coalition's flagship voluntary commitment for business to improve public health. "That fits the political complexion of the government at the minute, but I think a re-examination is needed to see what it has really achieved. It was a useful starting point, but now let's move on."
Given that the responsibility deal pledges are voluntary and apply only to companies that choose to participate, the BHF believes the lack of robust evaluation means the impact can't be assessed. There is also no penalty for companies that fail to meet their pledge requirements. Instead, the BHF wants regulation and is lobbying for steps to prevent junk food being marketed to children, a ban on advertising for junk food before the 9pm watershed, tighter online regulations and a new watchdog.
Taking a tougher line with the food industry is the least the government could do, Gillespie says, given the free support it gets from BHF: "The NHS and, in some cases, ministers should be ashamed sometimes, by the way that charities have to fill in. We will do our level best to persuade the NHS to fulfil its responsibilities. But there seems to be a lot of resistance in some areas."
Front-line community care workers and nurses paid for by the BHF are just the start. Gillespie points out that the charity has also recently agreed to fund an IT system to join up the various ambulance service databases showing where defibrillators are located. Currently, each of the nine UK ambulance services holds only its own separate data; a 999 call in busy times can go through to a neighbouring service that doesn't hold that potentially life-critical information. Why is the BHF funding this, rather than the NHS? "Ask the NHS," says Gillespie. "'It's difficult; can't afford it; not worth it.' But for us the question is 'how much longer are you prepared to let this situation go on?'"
Gillespie also praises the national clinical director for heart disease for NHS England, Professor Huon Gray, but says: "When the NCDs were appointed last year, they didn't actually get anything by way of support. So we've had to do that. We actually provide the infrastructure support for the NCD for heart disease. He holds most of his meetings here because they didn't provide meeting rooms."
The situation is far from ideal, he says – a bit like being housed in an icon of the cigarette industry, or attributing the blame for heart disease unfairly to sufferers. But, as Gillespie says: "You can be purist about this stuff while a lot of people die."