Defining our direction

As we look to the year ahead, the Health Foundation’s Chief Executive Dr Jennifer Dixon talks to Cathy Irving, Director of Communications, about our strategic direction and plans for 2017.

At a time when the health service in the UK is facing an unprecedented financial squeeze and there are huge pressures on the people working in it, what role do you see the Health Foundation playing?

The obvious point is that the NHS is facing acute financial constraints, accompanied by rising demand not just from patients but also from staff who want to improve care through innovations in medicine and how care is delivered. You’d have to live on Mars not to see that right now the NHS is under huge strain, with people working flat out to protect and care for patients. But perspective is also important – the longer run trend is that the quality of health care in the UK is improving, and progress is also being made in some vital areas of prevention, such as the reduction seen in smoking in recent years.

But with spending per head on health care in the UK lower than in most western European nations, and relative funding growth for the NHS over this decade at one-third of previous decades, there’s no doubt there are some very challenging problems ahead. The Health Foundation, through our basic broad mission to help improve the health care and health of the UK population, can help. We give grants, we can provide independent analysis, we can convene national and international partners to help us, and we can take a longer term view to focus on the complex issues that need deeper thinking.  

How will you go about supporting the health service to improve in 2017?

We offer several things. First, we can offer practical support now to those working at the front line, by supporting them to make the changes they need to improve patient care. We have several popular rolling open grant programmes which teams can apply for each year. We are also funding some networked communities of people with skills to help make changes, for example Q, the UK-wide improvement community, led by the Foundation and co-funded by NHS Improvement. We’re also funding the Sheffield microsystems academy, which develops front-line health care professionals to become improvement coaches who work with teams to help them improve the quality of patient care. These initiatives aim to be a source of skills and support to teams trying to improve care.

Second, we can purposely trial ‘best bets’ on a wider scale, funding projects to scale and spread their improvements through a range of approaches.

Third, we fund leaders through a variety of programmes to sharpen the skills needed in a 21^st century health care system to make faster change.

Fourth, we fund and do research and analysis on wider policy issues with insight gained from working directly with those at the front line of care. By being policy-savvy, we can help to articulate what might be needed, at both a local and national level, to help accelerate needed change.

We are in the lucky position of being able to step back and try to understand why the problems exist and what might help to solve them. That’s the critical role of an independent foundation like ours, but it is very important that we do this rooted in practical knowledge of what is happening in the NHS at the front line. Linking policy and practice is a cliché, but that’s what we try to do with our span of work.

We’re supporting people at the front line to make change happen and improve care. Could you say a bit more about how some of our major programmes of work are helping to bring this about?

We’re developing our thinking about the elements of an effective learning health care system, the theme of our annual conference last week. It is a system that supports people working to make faster change and learn through discovery and by doing. We think there is huge potential in three broad ingredients: fast communicating networks of patients and clinicians; real-time data and knowledge management; and quality improvement and leadership skills, which enable everyday changes to be made to increase health, quality of care and reduce waste. And this year we’re launching a new grant programme to support people to test some of these ingredients.

We’ll also be founding an Improvement Research Institute, which will be a thriving UK academic hub that systematically develops knowledge with front-line staff in the NHS on what works in improvement, and transmits it back to that community. This is a new type of research, right at the front line and on a massive scale.

With NHS Improvement, we fund the Q community, which brings together individuals who have quality improvement skills across the UK. We will be launching Q Labs – to focus on how to make improvements in some high-priority areas of care. This is a new development that will provide space – the physical and virtual – for designing and ‘beta’ testing new methods of care that could help to improve services.

The other asset we are building is the Improvement Analytics Unit (IAU), which we’re developing in partnership with NHS England. We know that progress to improve care often requires decent measurement, and the IAU is using near real-time quantitative data to assess the progress of complex service interventions, not least the new models of care. The IAU will provide information to front-line teams and to NHS England, to help them course-correct, to see where changes are being made or where there is delay.

The Health Foundation works to influence both the health policy landscape and to drive improvement at the front line. What is the common thread between these?

The Health Foundation is oriented towards front-line clinical care, but we all know that the policy environment in which people work can help or hinder change. We carry out policy analysis and research to give insights as to how policies might best support progress, as well as draw on the insight we gain from working with people at the front line of service delivery, such as through our grant programmes.

This year, we will be looking at two major areas of policy. One is quality of care, looking at an overview across the country and then looking in detail at critical issues, such as pressures in acute care. The second area will be the finances of care and we’ll be looking at what’s happening to the flows of money, to deficits and also to productivity across the system.

We devote a significant proportion of our resources – both in-house and through grants – to the research base underpinning health policy and health services improvement. What areas are the Health Foundation investing in at the moment?

The Health Foundation makes three big investments. The bulk of our resources at present go on grants to support practical improvements in front-line health care, the second is in building evidence and policy analysis, and the third is investment in people.

We have a number of planned areas of research in 2017, on top of setting up the new Improvement Research Institute. For example our research programme will include a significant investment in behavioural insights to help to promote quality and efficiency within the health system. We also have a programme of efficiency research and we will have a new call going out this year on informatics and analytics in health and health care.

So could you tell me a bit more about the investment in people made by the Foundation?  

We invest in people, across our work in health care policy and service improvement, to help develop the leaders of the future. We fund a number of fellowships and PhDs and we are co-funders of the Harkness programme with the National Institute for Health Research. This year we’re expanding our health policy fellowships offer further. We’re about to launch a new leadership programme, Sciana, to promote international understanding, across health systems, along with partners, the Robert Bosch Stiftung in Germany, and Careum Stiftung in Switzerland. Sciana is a funny name – it’s an Esperanto amalgam of two words meaning health and knowledge.

A big strategic shift for the Health Foundation has been towards improving people’s health. Could you tell us a little about that and what you have planned for this year?

We spent last year doing reconnaissance in this very wide field, looking at what others are doing and what opportunities there might be for us to make a difference.

We’ve initially settled on three areas for 2017. The first is to focus on individuals in their early 20s who may not be in a great place. We’ll be discussing with people in this age group about their transitions into adulthood and identify with them the factors that might have had the greatest bearing on their current situation. Our programme will look at the age group from around 12-24 years. We’re pleased that Julia Unwin, former chief executive of the Joseph Rowntree Foundation, is going to be helping us with this work.

The second area we will be doing some serious work on is the return on investment of health – whether through public sector or private funding (through employers, for example) of activities to promote health or reduce ill health. How can society do better at identifying economic or other wider benefits of investment to keep people healthy? This is an important question, because more hard-edged analysis might unlock more investment.

The third area, which is also very exciting, is that we feel we could have a strong leadership role in helping to convene a range of stakeholders, who might be mobilised more fully to invest in health, particularly in geographical areas. In 2017, we’ll be developing our role in building a culture of health within communities working with these stakeholders.