How can we make it easier to think long term about health and care?

After several years of research and detailed analysis, the REAL Centre’s landmark report on ageing and multimorbidity, in partnership with the University of Liverpool, has finally been published.

Our journey to get here began in 2018 when we started to think about how we could build a better understanding of what the health of England’s population would look like over coming decades. We realised that we had an opportunity to support policymakers to better prepare for the future and help create a space where policy change could lead to improved outcomes. Planning, especially in health and care, takes time and relies on high-quality evidence and insight, which is what the REAL Centre is set up to provide. The report, the first instalment from this new programme of research, has several key takeaways.

The number of people with major illness will grow significantly

The health service has become very good at dealing with the consequences of illness and delaying death, allowing more people to live longer with long-term conditions. We project that by 2040, people will live on average over 12 years with major illness, up from 10 years in 2010. As more and more people will live into older age, illness and demand for its treatment and management will grow.

Many of the levers to improve health lie largely outside the health care system, as our health is substantially determined by social, economic and commercial factors. Rising obesity, for example, is an increasingly important driver of ill health. Looking to the future, many more people who have spent prolonged periods with obesity are now reaching old age, increasing their lifetime risk of cardiovascular disease, cancer and type 2 diabetes.

Under successive governments, food environments in England (the factors that affect people's access to quality food) have developed more or less unchecked over the past 30 years. This is counteracting improving trends in some other leading causes of poor health, including fewer people smoking. The rising number of people with chronic conditions will mean greater pressure on the NHS.

Planning for the future

This all points to a need for a long-term programme to reform, modernise and invest in the NHS, alongside a cross-government strategy to improve health. Policymakers across government need to think and act more radically for the future, and that means a bold new approach that invests in the nation’s health and wellbeing over the long term.

The systemic workforce shortages across the NHS are an example of historic short-sightedness. Back in 2007, the House of Commons Health Committee said, ‘There has been a disastrous failure of workforce planning. Little if any thought has been given to long-term or strategic planning.’ Last month, we finally saw the publication of the NHS Long Term Workforce Plan. The REAL Centre played a key role in independently assessing the projections underpinning the plan. It is a significant step in the right direction, with implications not just for the NHS but also social care.

But more needs to be done to ensure the right measures are in place both to train and retain the required numbers of clinical staff on which the commitments hinge. A first step would be making sure the higher education sector has the right support to deliver the required training of clinical staff.

The importance of high-quality evidence

The publication of the Long Term Workforce Plan is a clear signal that government and policymakers are taking the NHS workforce crisis seriously. And crucially, there is cross-party consensus that England needs to train more staff across all professional groups: doctors, nurses and allied health professionals.

The Long Term Workforce Plan’s commitment to transparency and being reviewed every 2 years will be vital to maintain that consensus for future governments. The outcome of these reviews will depend on the quality of the projections that underpin the plan, and quality projections require robust evidence of the kind the REAL Centre is committed to providing.

The NHS has struggled to recover from the pandemic despite higher levels of staffing over the past couple of years. In June, the Institute for Government published a Health Foundation-funded report about why health care productivity was falling before 2020 and has remained low even after the pandemic. It highlighted that a lot of the issues the health service faces are a result of short-term decision making – such as underinvestment in staff, management and capital – that has resulted in long-term consequences.

What’s ahead?

In the lead up to the next general election, we will continue to build on the insights from Health in 2040 with projections of health inequality over the same period and implications for NHS funding and resourcing.

The UK is not the only country facing an ageing population with growing morbidity, but we invested less than our peers over the decade leading up to the pandemic. In follow-up work to be published in the next few months, we will investigate the resulting international differences in efficiency and resilience. We will share this and our other updates in our REAL Centre newsletter.