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There’s a well-worn mantra: ‘Foundations are focused on the long term’. Protected by an endowment, they have unusual space to see past the short term, and invest thought, analysis, and funds on big themes to improve the common good for the day after tomorrow.  

But then at the same time there is pressing need today, not least in a pandemic, that can’t be ignored.

A question then is what balance to strike? 

This question has pressed us at the Health Foundation far more in the last year than at any other time. Like other organisations we scrambled to help as much as possible: reorienting the portfolio of research analysis and grants to be directly relevant to the pandemic; donating £2.5m to organisations providing direct relief; and seconding our staff to other organisations to help, including the NHS, Public Health England and NHSX. At the same time our work continued on three big themes: improving health and reducing inequalities, speeding up improvements in care, and optimal longer run reform of the health and care system. 

Looking to the year ahead, these three themes endure, as you’ll see below and in more detail in the insider's guide to our plans in 2021.  

Improving health and reducing inequalities 

On health and inequalities our big focus will be to generate and collect evidence on the impact of the pandemic on inequalities (through our COVID-19 impact inquiry, which reports in July), and ensure an effective cross-government strategy to reduce the widening health gap. The latter is easy to say, very difficult to do given the complexity, but clearly central to the country’s recovery (economic, political and social) and we mustn’t miss this moment to make progress.  

Building on the insights from last February’s Marmot Review: Ten Years On, this month’s Health Foundation podcast ‘Deaths of Despair and what to do about it’ outlines some of the daunting agenda, featuring Nobel Laureate Professor Angus Deaton, and Sarah O’Connor, award winning Financial Times journalist. Boosting the NHS’s role in economic regeneration in local communities is also on our agenda as, with NHS England, we launch the Health Anchors Learning Network next month. 

Speeding up improvements in care 

As we all know the pandemic has cost the public purse at least £300bn. Currently the pressure for the government to pay back the debt is low as borrowing remains cheap. But pressure will mount over the next few years, which means a likely squeeze on the NHS, public health and social care, and knock-on pressure to find and implement value and productivity-enhancing innovations.  

Planning for this now will be important, building on the huge changes we’ve seen in the last year. 2021 will see new reports from the Health Foundation on what needs to be done to sustain and adapt the use of technology implemented during the pandemic, the potential for practical application of automation in health care, and on the potential of new workforce models to contribute to a more productive NHS.  

The Health Improvement Studies (THIS) Institute in Cambridge, and the Improvement Analytics Unit, both funded by the Health Foundation, will continue to be a resource, providing rapid evaluations of service innovations. Our Q community – now made up of over 4,000 people across the UK and Ireland who share insights, enhance skills and collaborate to make improvements to care – will continue to be a fantastic resource on this agenda. 

Reform of the health and care system 

The intense focus of managing the pandemic now shouldn’t detract from the need to keep an eagle eye on the overall shape and performance of the NHS and social care system. As we know there are big questions to answer on how the UK might imagine, assess and prepare for future threats to, and opportunities to improve, health.  

Improving longer-term planning and resilience is a core theme to the work of our REAL Centre (research and economic analysis for the long term) which will be doing more detailed analysis of likely supply and demand for health and social care over the next 30 years. Our futures programme will be publishing on how well government and the NHS is set up to do long-term planning effectively. 

And as you’d expect, we will be regularly assessing reform proposals in health and social care, pushing for further change (especially in social care), and suggesting improvements, all with an eye on international comparisons and developments. Our co-funding of international fellowships (the Harkness Fellowship programme and the Sciana Leaders programme) and the WHO EU Observatory on Health Systems and Policies will help. But we start the year close to home with analysis of the new legislative proposals for the NHS, publishing our assessment of the reform proposals, alongside another in depth piece on what the proposals may mean for Primary Care Networks. 

Exploring possible solutions together 

In shaping our portfolio in 2021, the late Jeremy Heywood’s phrase ‘polishing the problems’ has been uppermost in my mind. Sure, it is important to have good analysis, but a large chunk of our portfolio should also help outline and appraise possible solutions.  

To do this well, we need to do it hand-in-hand with many others to get as wide a perspective as possible, and that means you too.  

As well as receiving this regular newsletter, which will keep you posted on this full agenda plus related briefings, there are a few other ways to be involved more closely in our work. We’ve started a monthly podcast looking at the big questions in health and care, and hold regular webinars across all key themes you can join and participate in. Don’t forget the Q Community, and our fellowship programmes. And look out for upcoming funding calls for research and other service-based opportunities too. 

Looking forward to seeing more of you in the flesh as the year progresses. In the meantime, stay well and motivated (there’s a lot to do…). 


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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