A key theme of the Health Foundation’s work is securing a sustainable health and care system that better meets people’s needs now and in the future. Last year we launched our new REAL Centre (Research and Economic Analysis for the Long term), which will provide independent analysis and research to support better long-term decision making in health and social care.  

Finding the balance

In the middle of a global pandemic it has sometimes felt strange to be thinking long-term. For those at the front line, getting through the next hour or day must have seemed like a major triumph. Having any time or emotional reserves to look beyond the here and now has at times seemed an unimaginable luxury.  

At the Health Foundation we have tried to balance providing practical help for those in immediate need with a continual focus on the long term. We felt that was important for two reasons.  

First, in some ways the challenges we’ve faced through the pandemic are a textbook example of how years of failure to invest and plan for the long term have left us more vulnerable to COVID-19. I recently wrote a piece on this, and Jennifer Dixon and colleagues wrote an excellent long read on what better long-term planning would look like.  

Second, when people in the health and care system have so little time and headspace to focus beyond the day-to-day, one of the key roles an independent foundation can fulfil is to look ahead. At the Health Foundation we can do some of the thinking and preparation to support the system as it emerges from the crisis and rescue phase of COVID-19.  

As we come out of lockdown, national attention is beginning to shift from rescue to recovery; towards building a more resilient NHS and social care system. That work has several themes that will be at the heart of strategic debate and decisions over the coming months and years.   

Thinking about what change we want to keep 

COVID-19 required the NHS to work in new ways to redesign and run services. We need to learn from that to embed and strengthen the best of that experience. The shift of services from face-to-face to online has been pronounced. Our new long read looks at the learning from this rapid period of change.

The pandemic has also required organisations across the NHS and care system to work together in different ways – deepening and extending partnerships across the country. The government and the NHS are thinking about the way the NHS is governed and run to build on that experience.  

In February, there was a white paper proposing a further shift away from the 2012 Health and Social Care Act’s model of competition, to a greater emphasis on collaboration, with Integrated Care Systems becoming statutory bodies. We held a webinar to discuss the legislative changes earlier this month (which you can watch again here). We’re also due to publish a new piece of analysis on how the NHS payment system needs to change to support this new collaborative vision for the NHS. 

Tough decisions about funding and prioritisation 

Recovering services in the face of the huge backlog of care will be a massive challenge. The March statistics show the waiting list is now almost 4.6 million and over 300,000 patients have been waiting for more than a year. 

A big part of better preparing the NHS and social care system for the future will involve tough decisions about funding and prioritisation. Over the last month these issues have been at the centre of national politics. The budget, earlier this month, said very little about the NHS, and nothing about social care. But in the budget detail there are worrying signs. We’ve written an assessment of what this might mean for the NHS and social care.  

In the autumn there will be a spending review which sets funding totals for all public services including the NHS and social care system – this will be a defining moment for both sectors.  

We are currently working on new projections for health and social care spending for the rest of this decade. We’re analysing what the underlying trends in demand and supply would mean for funding and exploring how COVID-19's legacy will affect that. We will publish these in the summer, hopefully in time to inform the spending review process and debates.   

Better planning for the NHS’s most valuable resource 

Money matters but in terms of capacity the really important resource for the NHS and care system is people. Another key strand of our projections work this year is looking at the long-term workforce needs.  

In the autumn we will publish new projections using a much more sophisticated model of the nursing workforce in England. In the meantime, we’ve been thinking about how to improve long-term workforce planning, and giving evidence to the Health and Social Care Select Committee. The chair Jeremy Hunt is keen for there to be an independent body to look at workforce needs.   

NHS workforce issues have become very political, with the government submitting evidence to the independent review body proposing a below inflation 1% uplift. While these are tough decisions to make, with borrowing at record levels, workforce pressures are the biggest challenge facing the NHS and these proposals will do little to boost retention or recruitment in the future. These are debates that are going to run for quite some time to come.  

Anita Charlesworth (@AnitaCTHF) is Director of Research and REAL Centre (Research and Economic Analysis for the Long term) at 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.

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