Clearly we aren’t yet out of the woods with the pandemic – as I write cases and hospitalisations are again rising – but it’s right to be looking to the future. What will be needed to improve health? Support NHS recovery? Boost resilience to future emergency or longer term threats to health? Here’s the latest on some related work at the Health Foundation. 

Making sense of the evidence 

Like any emergency on a large scale, the pandemic has had far reaching direct and indirect effects on health. We are doing our bit to document this. For the past 9 months our COVID-19 impact inquiry team has been patiently gathering evidence – literature, testimony, in-house analysis, external statistics – to assess the impact on health now and in the future. The resulting report will be published early next month, and here colleagues talk about the work that’s gone into gathering and analysing such a wealth of important evidence.  

The basic message is that the pandemic made worse existing problems, particularly for the most vulnerable. In the last decade in particular, socioeconomic stressors frayed the health fabric of the nation. This helped SARS-Cov-2 spread and cause damage. Much of the vulnerability to COVID-19 – whether resulting from poverty, chronic ill health, insecure early life, or low quality precarious work and housing – reflects in part the choices made by local and national government. 

Preparing for future shocks  

Yet in carrying out the COVID-19 impact inquiry, we were aware of an imbalance in research and analysis particularly on wider social, political, economic and public health issues during the early phase of the pandemic. So building on the components of the UN’s research roadmap for the COVID-19 recovery, we are leading a new programme, supported by Ipsos MORI, to help identify key gaps, and the evidence we now need to help the UK recover from the pandemic. Importantly this work engages not just major research funders and policymakers in the UK, but also communities and individuals who are often underrepresented in identifying priority research questions. 

Thinking about prosperity in the wider sense 

As the government seeks to build back better, our new paper (to be published next month) argues that the aim of its forthcoming levelling up strategy should be prosperity in a wider sense than just economic growth. This includes improving health and social capital, as well as investing in infrastructure and green spaces. Obvious you might think, but so far the approach taken is skewed towards infrastructure capital. 

A better balance is needed, including a focus on health. That’s not just because improving health is the right thing to do, but because health is also linked to economic prosperity and productivity. As our recent podcast showed, city regions like Greater Manchester are making progress on this, central government needs to do far more. 

Linked to this, also needed is a much more comprehensive cross-government health policy to improve health and reduce inequality. This should go much wider than the current Department of Health and Social Care policy on prevention. Last quarter we put out a consultation document setting out the basic contours of such a cross-government policy, and will publish the result later this year. Without that, the government’s own target of achieving an extra 5 years to healthy life expectancy and reducing inequalities in health, must be in doubt. 

Better long-term planning 

As well as building resilience by improving the health stock or capital of the nation, a key task ahead is obviously for the health and care system to recover and deal with the backlog and other challenges ahead. Given the burnout of staff, one issue again highlighted recently by the Chair of the Health Select Committee, Jeremy Hunt MP, is to address chronic staff shortages through better long-term planning. Like others we’ve long advocated this, and have the calculations to match. Don’t forget the REAL Centre here at the Foundation is set up to help with projections of long-term supply and demand for NHS and social care and the investment needed. 

A long-term settlement for investing in the NHS and social care system, based on robust modelling is vanishingly rare. One exception was the Wanless Review Securing our Public Health published almost 20 years ago. Commissioned by the Treasury, the analysis not only secured unprecedented funding increases for the NHS (over 5 years) and respectable increases for social care (over 3 years), but the tax rises to pay for it proved electorally appealing.  

How and why it came about is the subject of a rollicking good read that we published this month by Nick Timmins. There is also a rollicking good podcast this month entitled ‘Is it time for another Wanless Review?’. This features our very own Anita Charlesworth (who when at the Treasury led the secretariat supporting the Wanless Review) and Nick Macpherson, who served as the Permanent Secretary to the Treasury from 2005 to 2016. 

Supporting the NHS to move forward 

The NHS is beginning to show promising signs of recovery after the extreme strain placed on it by COVID-19. But the latest figures show a growing backlog in routine hospital care, with nearly 5 million patients now on the waiting list and over 400,000 waiting longer than a year for treatment.  

After managing the pandemic, getting wait times back down for care must be political priority number one for the NHS, followed by mitigating the risk of future winter pressures. This means more staff, more investment, and a strong focus on delivery – all a priority for whoever is the new chief executive of NHS England.  

The future must mean a renewed focus on management, and on using technologies. The Foundation has a suite of work in this area, with more to come. Current work includes analysis showing the potential for automating activities in general practice, and work testing how AI and machine learning can be used to spot substandard asthma care. Our recent report on automation and AI, and our webinar on tech and NHS recovery also both examined what more the NHS could do to identify and implement effective technological change. 

More fundamentally, recovery and building resilience in health and care is the task that will define efforts over the next few years. Join us and watch this space for more. 

Jennifer Dixon (@JenniferTHF) is Chief Executive of the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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