The new government's in tray End-of-year insights from the Health Foundation

As the year closes, we mull over some of the insights we’ve gleaned in 2019 and what issues might, or at least should, be in the new government’s in tray.

Improve the health of the population

We know that improvements in life expectancy are slowing, stalling, or even reversing since 2011 for people living in more socioeconomically deprived areas, but why? Analysis we commissioned from LSE concluded that no one factor is to blame – not just austerity nor flu – but many factors. The slowdown is similar across Europe, but more pronounced in the UK and US. Many people living in areas where life expectancy is stalling the most – such as the north west – have ‘lent’ the new government their votes. It would be canny for the government to get to grips with understanding and tackling the tractable causes over the next 5 years. Not just because it is the right thing to do, but because it makes economic and political sense.

But what to do? Our Creating healthy lives report in September outlined an approach. The key need is coherent cross-government policy, and a medium to longer-term horizon. The report outlines five big shifts that need to happen:

• expand the way success is measured, not just via economic growth
• embed long-term health considerations in legislation and policy across the whole of government
• invest in the wider determinants of health: the social, economic, commercial and environmental conditions in which people live
• boost the role played by the NHS in preventing ill health as well as treating illness
• focus more on place-based approaches to improving the health of communities.

Our conclusions from a 2-year major inquiry into the health of young people, published in the autumn, had similar messages. Not rocket science, not new, but more political will, oomph and pragmatic nous are urgently needed to tackle these issues.

And as the nation’s largest employer, the NHS has a role beyond providing health care to support the health and wellbeing of communities. How to do this was the subject of one of our most downloaded reports, published in August Building healthier communities: The role of the NHS as an anchor institution. We’re pleased to be working with NHS England to help make this a reality. How major businesses might help, for example, to make inclusive growth happen, particularly in the midlands and north east and north west, must clearly now be in the sights of national government.

Fix social care

At the very top of the new government’s in tray must be fixing social care, as the Prime Minister indicated earlier this year. In 2019, we also set out five practical actions for the new government beginning on day one: stabilise the current system with a cash injection; improve access; provide state protection from high care costs; treat the capped cost model as a flexible approach to reform, and explore a range of options for raising future revenue that could command public support.

Get objective, independent projections on NHS demand, supply and spend

We know that growth in health care spending in the UK is faster than growth in the wider economy, and our analysis with the Institute for Fiscal Studies in 2018 showed that this has been at the expense of growth in other public services. But given likely trends in supply and demand in future, what resources will the NHS and social care need? In 2019 the Health Foundation agreed to fund a new centre that will carry out detailed and independent modelling to answer this question. The centre, to be launched in 2020, is the first of its kind to offer this type of analysis. Given that the NHS itself is Europe’s largest ‘industry’ and employer, as well as being the top priority for the public, expert objective scrutiny of future demand, supply and likely expenditure trends must surely be valuable for any incoming government.

Support improvement at the front line

Across most OECD nations, health spending is squeezing investment in other public services, some just as vital to health. One way to extract more value out of health spending is to accelerate productivity and improvement at the clinical front line. A consistent focus of our work over the last decade has been how to skill up front line staff to make improvements every day, as well as develop and adopt innovations. We invest over £8m per year in this and in 2019 committed to 10 years of further funding to the Q community – a supportive learning network of currently 3,500 people across the UK trying to accelerate change.

This year we also took time to identify what factors help NHS staff to make the most sustained improvements. We studied three English NHS trusts with an outstanding CQC rating that have implemented an organisational approach to improvement and our conclusions are published in The improvement journey. In 2020 we will be using these insights to support NHS E/I develop a national improvement framework. As the new government develops its thinking on the NHS, before reaching for any major reform or technology solutions, these insights should be mandatory reading.

Harness the power of data and make the required capital investment

Obviously, technology can help –to make treatments more effective for patients and also to improve the processes of care and productivity. Harnessing and using data, in ways we already know, or artificial intelligence and machine learning, will be part of the answer to extracting more value from spend. In May our Data Analytics team published Untapped potential which explores this in more detail. The team also funded the latest round of our Advancing Applied Analytics grant programme, which is now funding 33 teams around the UK to apply innovative analytics to tackling real-world problems facing the health system.

In 2019 we were also excited to launch the Networked Data Lab where we will be working with networked analytical teams across the UK to deliver data driven insights on common problems in health care. And our partnership with NHS England on the Improvement Analytics Unit (IAU) produced not only four evaluations of new care models, but groundbreaking analysis of emergency hospital use by care home residents. Insights from the latter show the clear opportunity for integrated care to reduce avoidable emergency admissions, particularly if care is boosted in residential care homes.

Data, and greater productivity, requires capital investment. A key focus for us in 2019 was to highlight and provide robust evidence on the infrastructure, workforce, and public health investment needed. For example, on infrastructure, our analysis highlighted that capital spending on health care in the UK was only 0.31% of GDP, compared to 0.51% in similar OECD countries, and since 2010/11 the value of capital per worker in NHS Trusts has fallen by 17%. On workforce we set out recommendations to help fill the 100,000 vacancies reported by NHS trusts in our Closing the gap report, with the King’s Fund and Nuffield Trust, and published our annual report setting out the long-term trends and key pressure points for the NHS and social care workforce.

If all that isn’t enough for you, keep tuned in 2020 as we provide further insight on these priorities. Meantime, enjoy those mince pies.