This month, the Health Foundation launched the REAL Centre (Research and Economic Analysis for the Long term), dedicating £20m of investment to its work supporting long-term planning in health and social care.  

The REAL Centre will provide independent projections to help identify future health and care needs, taking into account evidence of how policies have impacted in the past. The aim is to help health and social care policymakers make decisions grounded in facts and with a view to the future. 

The Centre was officially launched at our inaugural REAL Challenge Lecture from Sir Andrew Dilnot, chair of the REAL Centre’s oversight board, on 16 October. Andrew’s lecture outlined how some of the key challenges in health and social care are exacerbated by a short-termist approach, and why longer-term planning will help: 

'Health and social care in this country, as in much of the world, are huge activities. And in many ways this big thing is very beautiful, it does great things for us all. But it’s not well understood and we hugely lack long-term budgeting and long-term objectives. Too often we think of health as one great big lump. It’s not. It’s much richer and more complex than that… and we need to know much more about the detail of what’s going on.'

Why is the REAL Centre needed? 

Despite the fact that the country’s spend on health care makes up around 10% of our economy, planning around health and care has tended to be relatively short-term. That’s because long-term thinking means looking beyond the election cycle – often difficult for governments dealing with immediate challenges and facing political barriers to investing for long-term returns. But as Dr Jennifer Dixon points out, ‘taken as a whole, the NHS is the UK’s largest single ‘industry’ – what industry as significant as this would not conduct long-range planning of key resources?’ 

The report of the 2017 Lord’s Select Committee into the long-term sustainability of the NHS and adult social care highlighted this short-termism as a major problem. It recommended better, independent long-term planning to quantify the demands on the NHS and social care.  

This is what the work of the REAL Centre aims to support and enable.  

How can we plan for an uncertain future? 

With the current levels of uncertainty caused by the pandemic, it would be easy to think that any attempt at forward planning right now is futile. But as the Health Foundation’s Director of Research and REAL Centre, Anita Charlesworth, says in a recent piece for the Health Service Journal, 'failing to plan would have major consequences. The impact of COVID-19 on the NHS will evolve and presents significant and difficult choices for the future direction of the health service.'

In her recent blog, Dr Jennifer Dixon quotes Eisenhower when he says, 'plans are worthless, but planning is everything.'

'What he meant', she says, 'is that the discipline and rigour of planning are more important than plans in shaping decisions, whether those decisions are incremental or longer term strategies. And, of course, this is crucial given that some of the key assets that make the NHS and social care system work and be sustainable include the number and skills of the workforce, capital and kit, and investment in science and technology. These need a longer term horizon to plan than from year to year. 

'Part of planning is to use information to set out the issues, uncertainties and possibilities in order to prepare better and improve today’s decisions [...]. This isn’t just about anticipating risk, but also seeing potential opportunities and acting on them.'

Keeping an eye on the bigger picture 

An understanding of the past helps us to prepare for the future. The bigger picture, the REAL Centre's first report, looks back at NHS health care in England over the past two decades. Its findings show that health care per person has more than doubled since the millennium, with rapid growth in hospital care at the expense of other services. The report argues this shows a disconnect between the way services have developed and the changing health needs of the population. 

Anita Charlesworth explains further:  

'NHS fortunes have waxed and waned over the last two decades, with insufficient attention given to the big picture – the aim of building a service that is resilient and meets the changing needs of the population. The shifts in the delivery of care have not always been in line with those needed to make the biggest contribution to population health. For example, the increasing share of people with multiple long-term conditions suggests there should have been a shift towards more prevention and primary care services. This has been recognised by policymakers, but not followed through with the right action. 

'The strength of the NHS depends on good long-term decision-making. It takes more than a decade to train a doctor; and buildings, equipment and the IT infrastructure last for many years and shape the context in which care is provided. As COVID-19 has vividly shown, planning for the future is far from straightforward, but building resilience and sustainability into the NHS is more important than ever.'

Sign up to get the latest news and updates from the REAL Centre

 

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

Also in this newsletter

Newsletter blog

Using research to prepare for a post-pandemic world

29 October 2020
Newsletter blog

How the long-term research agenda needs to incorporate important questions about COVID-19 and the...

Newsletter feature

Overcoming short-termism in policymaking after COVID-19

29 October 2020
Newsletter feature

Could COVID-19 be a redefining moment for how the UK government plans for the long term and thus...

Analysis

The bigger picture

October 2020
Analysis

In the REAL Centre's first report, we look back at the care and treatment provided by the NHS in...

REAL Centre

Blog

Building back better by focusing on health

7 October 2020
Blog

Emma Spencelayh explores the critical role councils play in ensuring the economic recovery also...

Newsletter feature

Funding, news and events from October 2020

29 October 2020
Newsletter feature

The latest funding, news and events from the Health Foundation. 

Chart

NHS Test and Trace performance tracker

Chart

Our latest analysis on the performance of NHS Test and Trace (up to 11 November).

You might also like...

Event

Webinar: The government Spending Review

Event

The Health Foundation will host a webinar analysing the key headlines from the government's November...

Press release

Spending Review leaves NHS England £6bn short next year

Press release

Health Foundation response to the Chancellor's Spending Review.

Press release

New analysis reveals daunting scale of financial challenge facing health and care post-COVID

Press release

The Health Foundation's analysis reveals the scale of funding increases needed to meet the demands...

Kjell-bubble-diagramArtboard 101 copy

Get social

RT @Gummifot: I’m excited to share the results from a study I’ve been working on as part of the #ImprovementAnalytics Unit at @HealthFdn. I…

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more