Four key questions on COVID-19

It’s obvious the coronavirus pandemic is having profound effects now, not just on health and health care in the UK, but also on society. And its long shadow will extend far into the future. As an independent foundation, how are we responding?

Foundations usually focus on the long-term agenda, making progress on issues that need constancy of purpose and commitment rather than short termism. But the pandemic demands a more immediate response as well, so we’ve had to adapt. One of the first things we did was to start making a range of donations to charities, particularly those providing emergency support to the most vulnerable in society. This has continued, and we plan on making further donations in the coming weeks, including support for the Big Issue and National Emergencies Trust. 
 
We’ve also adapted our work programme to focus on four main questions:

1.    How is COVID-19 affecting different communities, and what does this reveal about inequalities in society?

We are funding research and carrying out in-house analysis on the differential impact of the pandemic on different population groups – in short assessing its short and longer-term effect on inequalities in health. 

What is emerging is the disproportionate impact of COVID-19 on older people, men, black and minority ethnic populations, particular occupational groups (such as social care workers), and those with multiple chronic medical conditions. 

A common feature across many of these groups is socioeconomic deprivation, and underlying the pattern of deprivation are wider structural effects in society, for example the shape of the economy and what has happened to wage growth and labour compensation. The IFS Deaton review of inequalities is studying these wider structural effects. The Resolution Foundation amongst others are examining intergenerational effects of the pandemic, specifically the long-term effect on young people.

At the Health Foundation, our contribution can be to generate and summarise evidence (both quantitative and qualitative) in more detail on the impact of COVID-19 on health that can lead to policy solutions. These must surely include a more developed offer by government of ‘social protection’ – the range of policies and programmes needed to reduce the lifelong consequences of poverty and exclusion.

2.    How are health and care services adapting?

What is clear is that over a period of just weeks, there have been swift and extensive shifts of care and rapid innovation across the NHS and social care to respond to the pandemic. In part this has been about technology, but we’ve also seen a lot more rapid decision making. 

What has happened and why, what impact it’s had, what is worth keeping, and how to bake in a faster speed of improvement into usual care are all key questions. Using our assets to commission analysis, by networking with others at a national level and sharing learning focused on these questions (for example through our work with the near 4,000 strong Q community and THIS Institute’s citizen science platform ‘Thiscovery’), and using in-house analysis, we will be working to help provide answers.

Already our workshops on how to implement video consultations effectively, for example, are in high demand. But as we know, identifying demonstrably useful change is one thing, spreading it is another. Our longstanding work on the right conditions for spread will help.

Alongside this, we’re also working with the Point of Care Foundation and others to explore how NHS organisations can best support staff wellbeing during this period of huge pressure and rapid change.

3.    How effectively is the pandemic being managed?

There will be huge lessons to learn from how the pandemic was responded to and managed by policymakers and others. As an independent foundation we have a role with others in amassing the objective evidence as to what happened, and lessons for the future. 

We’ve begun this with our COVID-19 policy tracker and will be combining it with much other analysis. International comparisons will also be a feature, enabled by our strong links with and co-funding of the WHO European Observatory on Health Systems and Policies. We’re also looking at how the government has been using data and technology to manage the pandemic and how its approach can be improved particularly in social care.

4.    How will the pandemic influence the future shape of health and care services?

Finally, among the many things the pandemic has illuminated is the state’s capacity to prepare and plan for the future, as well as weaknesses in some areas of policy (social protection) and infrastructure. 

On preparation and planning, our REAL Centre is doing careful work projecting the likely demand for and supply of health and social care over the long term including the resources needed for reserve capacity to allow for emergencies. For example what are the staffing and bed requirements in different scenarios such as a further outbreak of coronavirus?

Our Policy team is working with national health and care system organisations to work out how best to prepare for the future using foresight, horizon scanning and other techniques that help give leaders more ability to imagine the risks and opportunities ahead. And clearly our teams will be working on the implications of the pandemic on reform of the NHS, via the NHS Long Term Plan, and pressing for reform of social care which is very long overdue.

It’s a full agenda and we look forward to working with you to make progress on all these areas.

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.