Listening to the future: Introducing the REAL Centre

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.'

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