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This month, NHS leaders published their long-term plan for the NHS in England. Meanwhile, confusion grows in parliament over the UK’s approach to Brexit. Unfortunately for the NHS, the success of the former depends on the outcome of the latter. A no-deal Brexit could stall the extra £20.5bn promised for the NHS and worsen its chronic workforce shortages.

Brexit is an extreme example of policymakers struggling to plan for the future. But the phenomenon is nothing new: despite some notable exceptions, successive governments in the UK have found it difficult to think long term – on infrastructure, tax, and other policy areas. And despite the name of the NHS’s new plan, policy on health and social care is no different.

Short-term thinking

Take public health. Public health interventions – like stop-smoking support – play a crucial role in keeping people healthy and reducing inequalities, with long-term benefits for people’s health and society. Yet public health services are often a target for spending cuts. Public health spending in England fell by a quarter per person between 2014/15 and 2019/20. And cuts to wider local government budgets – cuts of 32.6% since 2010/11 – have led to spending reductions in other key services with long-term health benefits, like early years development. These cuts come at a time when life expectancy improvements are stalling and health inequalities are growing. They could hardly be more short-sighted.

Social care is another case in point. It’s widely acknowledged that the social care system is unfair, unsustainable, and underfunded. Many vulnerable people go without the care they need, with knock-on effects for the NHS. Yet successive governments have avoided finding a long-term solution to funding for social care – opting instead for short-term cash injections while the system falls deeper into crisis. The current government is no different: its green paper on social care funding was first promised back in 2017, and has been delayed several times since. It may never arrive. Again: this is short-sighted policymaking in the extreme.

Other examples are easy to find (think workforce planning, capital investment, or addressing the long-term rise in mental health issues in children and young people).

Long-term questions

But thinking long term is hard in a sector as complex and challenging as health. When people’s lives and taxpayers’ money are on the line, it’s easy to focus on things that matter to people and politicians today and tomorrow, like reducing waiting times, or balancing the books. Addressing these issues is no simple task, particularly when funding for health and social care services barely keeps up with growing demand. These short-term issues are important. But the risk is that they crowd out the thinking needed to prepare for the future.

Some of the long-term issues affecting health and health services are relatively well-known – even if the policy solutions to address them are comparatively less well developed. The population is ageing. Growing numbers of people are living with multiple long-term health conditions. And avoidable differences in health outcomes are both persistent and widening.

But other emerging issues may be less visible to health policymakers. What impact might the gig economy or job automation have on people’s health? Will new technologies – artificial intelligence, robotics, and more – help us deliver better health services? Or could they worsen inequalities? What about the long-term health effects of public policy in other areas, like housing, transport, or the environment? In each of these areas, policy decisions taken (or not taken) today will shape our health and health services in the future – for better or for worse. And some changes that will fundamentally affect our health are currently unknown to policymakers and the public – but we still need to be prepared to spot them and respond.

Shaping Health Futures

To help provide space for the thinking needed to plan effectively for the future, the Health Foundation is scoping a new programme of work looking at some of the long-term issues shaping health and health services in the UK, and what they mean for policy. Our aim is to:

  • provide new analysis on some of the key issues shaping health and health services over the next 10–25 years, particularly in areas where current understanding is limited 
  • support policymakers to better prepare for the future by incorporating thinking on these issues and the choices they present into today’s plans and policy decisions 
  • test and develop the methods and approaches that can be used to think long term.

Our Shaping Health Futures programme is just one part of the Health Foundation’s wider commitment to securing the long-term sustainability of UK health and social care services. It is being developed alongside our new Sustainability Research Centre, which will provide independent projections, research and analysis on factors driving health system supply and demand, strongly rooted in quantitative modelling.

The Shaping Health Futures programme is in its early stages. We want to hear your views on where we should focus our research and analysis – whether that be climate change, data and digital technology, changes in politics, the economy and society, or any other areas that could affect our health and health services over the long term. Get in touch in the comments below, by email or on Twitter.

Hugh Alderwick (@hughalderwick) is Assistant Director of Strategy and Policy at the Health Foundation 

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