The Health Foundation podcast

Improving NHS productivity is a key national priority. But what’s behind the slowdown and can it be reversed?  Over the past few years, amid the turmoil of COVID-19, the NHS has seen substantial growth in funding and clinical staffing levels. Yet the numbers of patients treated haven’t risen in step – suggesting services, particularly NHS acute hospitals, have become less productive.  Government has announced a wide-ranging review of public sector productivity and asked services to develop plans to recover productivity performance. At the Spring Budget 2024, £3.4bn in capital funding was announced to support digital and technology projects intended to boost NHS productivity.  So why have activity levels not been keeping pace with recent increases in NHS funding and staffing, what can be done, and is implementing new technologies a solution worth banking on?  To discuss, our Chief Executive Jennifer Dixon is joined by: Anita Charlesworth, Chief Economist and Director of the REAL Centre at the Health Foundation. Neil Sebire, Professor of Pathology and Chief Research Information Officer at Great Ormond Street Hospital for Children NHS Foundation Trust.  Show notes Institute for Government (2023). The NHS productivity puzzle.  Institute for Fiscal Studies (2023). Is there really an NHS productivity crisis?  Health Foundation (2023). The unsustainable is not sustained: why productivity is fundamental to the future of the NHS.  Bennett Institute (2021). Productivity in UK healthcare during and after COVID-19 pandemic. Chancellor’s speech on productivity growth (2023).  Centre for Health Economics (2024). Productivity of the English National Health Service: 2021/22 update. 

What's happened to our economy and what does it mean for our health? Many developed economies have been growing more slowly since around 2008, but the UK economy has been struggling more than most. Wages haven't risen since 2008 leaving the average worker £14,000 worse off. Productivity growth – vital to rising living standards – has stalled. Regional inequalities are unusually large, and economic hardship is widespread with 2.8 million people reporting not working because of long-term sickness. So what’s driving this economic stagnation, how is it connected to our health, and what can politicians do to address the challenges? To discuss, our Chief Executive Jennifer Dixon is joined by: Diane Coyle, Bennett Professor of Public Policy at the University of Cambridge and Co-Director of the Bennett Institute. Torsten Bell, Chief Executive of the Resolution Foundation. Show notes The Health Foundation (2023). The unsustainable is not sustained: why productivity is fundamental to the future of the NHS.  The Resolution Foundation (2023). Ending stagnation: a new economic strategy for Britain.  The Health Foundation (2023). What we know about the UK’s working-age health challenge. Coyle D and Muhtar A (2022). Contemporary Social Science. Levelling up policies and the failure to learn. Bennett Institute for Public Policy (2023). A Universal Basic Infrastructure for the UK.  The Resolution Foundation (2024) (funded by the Health Foundation). We’ve only just begun: action to improve young people’s mental health, education and employment.

Given the huge pressures on the NHS it's perhaps inevitable people ask, what's the future of it? The NHS and social care are struggling to deliver care and support to people who need it. With services so stretched, waiting times at record highs, public satisfaction falling and a demoralised workforce, is now the time to ask some fundamental questions about the NHS? In the past month, two independent commissions on the future of the NHS have reported – the Times Commission in early February, and the first of several papers from the BMJ Commission at the end of January. We speak to the commission chairs about what they found out and what they’d like to see future governments prioritise on health. And given the tight squeeze on public funds, what will it take to truly put the NHS on a sustainable footing? To discuss, our Chief Executive Jennifer Dixon is joined by: Rachel Sylvester, political columnist at The Times, and chair of the Times Health Commission. Parveen Kumar, Emeritus Professor of Medicine and Education at Queen Mary, University of London, and co-chair of the BMJ Commission on the Future of the NHS. 

Sacha Romanovitch, Chief Executive of Fair4All Finance and Chair of the Commission for Healthier Working Lives, and Oliver Coppard, Mayor of South Yorkshire, dive into the crisis of economic inactivity affecting nearly 9 million in the UK. They explore the alarming rise of long-term illness and its impact on health inequities. The discussion highlights initiatives like 'Working Win' and innovative community health programs in South Yorkshire. Together, they emphasize the importance of supportive environments and collaboration across sectors to rejuvenate local economies.

Join us as we look back at the pick of the pod in 2023.  It's been a turbulent year: the NHS under pressure, the health of the population not improving as fast as we’d like and economic inactivity remaining stubbornly high, especially among working-age people.  But it's not all gloom. To some surprise, we saw government ditch its nanny state objections and take bold action on tobacco. And there have been breath-taking advances in technology, not least in artificial intelligence. A reminder that innovation and politics can open up new possibilities and hope for the future.  Join our Chief Executive Dr Jennifer Dixon as we reflect with guests who appeared on the podcast in 2023. Show notes Jeanelle de Gruchy and Kevin Fenton, Our health in 2040: are we getting sicker?  Alice Wiseman and Clare Bambra, Low life expectancy in the north east, and what to do about it Michelle Kelly-Irving and Nish Chaturvedi, How chronic stress weathers our health  Sarah Neville and Hettie O’Brien, Going private: what’s happening and is it a bad thing?  Rachel Wolf and Stephen Bush, What do the main political parties really have in store for health? Jagjit Chadha and Anita Charlesworth, NHS at 75: What are we up against? John Bell and Axel Heitmueller, AI in health care: hope or hype? Ashish Jha, Keeping up with AI in health care: what we need to do next Navina Evans and Penny Pereira, NHS at 75: The huge promise of technology Jane Dacre, Nikita Kanani and Gabrielle Mathews, International Women’s Day: Voices in health care Rachel Wolf and Stephen Bush, What do the main political parties really have in store for health?  Alan Milburn and Stephen Dorrell, NHS at 75: Is political leadership up to the challenge?

The podcast discusses the potential of AI in healthcare, including personalized treatment advice and automated systems. It addresses the challenges and risks associated with AI, such as public interest, inclusion, cost, accountability, autonomy, and privacy. Expert guests cover topics like ethical frameworks, regulatory landscapes in Switzerland, public engagement, safety, inclusivity, government intervention, and implications of AI in healthcare like addressing inequalities, legal accountability, safety concerns, and the NHS's incorporation of AI.

A general election is expected in 2024 and no party can ignore the NHS − but what do they plan to do on health? The health service regularly tops voter concerns, consumes a growing share of public spending and features daily in the media. The health of the nation is also moving up the agenda, with ill health the main reason why 2.6 million working-age people are economically inactive. So what are the main parties planning as we move towards an election and have the party conferences revealed anything new?  To discuss, our Chief Executive Jennifer Dixon is joined by: Rachel Wolf, Partner at Public First, a consultancy specialising in public policy, public opinion and campaign strategy. Stephen Bush, Associate Editor and Columnist at the Financial Times.  Show notes The Health Foundation (2023). Health in 2040: projected patterns of illness in England.  The Health Foundation (2023). Public perceptions of health and social care: what are the priorities ahead of a general election?  The Health Foundation (2023). What should be at the top of the political agenda for health and care?  The Health Foundation (2023). Health Foundation responds to the Prime Minister’s announcement of smoke-free measures.   The Health Foundation (2023). Social health insurance: be careful what you wish for.   Institute for Government (2023). The NHS productivity puzzle: why has hospital activity not increased in line with funding and staffing?  The Times. Tories as the party of change: that’s a hard sell (2023).   Ipsos. Ipsos issues tracker: July 2023 (2023).  

A record 7.7 million people are now waiting for elective care in England. With so many waiting for NHS care, polls show deep public concern over access to health services and many considering going private. Meantime policymakers are exploring how the independent sector can help get waiting lists down, and private equity investors are making moves in the independent health care provider market. So does this mean we’re slowly sliding towards a mixed model of health care in this country? And if so, is it a good thing or should we be worried? To discuss, our Chief Executive Jennifer Dixon is joined by: Sarah Neville, Global Health Editor at the Financial Times. Hettie O'Brien, Assistant Editor at the Guardian and currently researching a book investigating the role of private equity in the contemporary economy and public services. Show notes The Health Foundation (2023). Waiting for NHS hospital care: the role of the independent sector in delivering orthopaedic and ophthalmic care. The Health Foundation (2023). How the public views the NHS at 75. The Health Foundation (2022). Waiting for NHS hospital care: the role of the independent sector. BMJ (2023). Private providers see surge in demand as PM blames long NHS waiting lists on strikes. PHIN (2023). PHIN Private market update: September 2023. BMJ (2023). Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review. NBER (2023). Owner Incentives and Performance in Healthcare: Private Equity Investment in Nursing Homes. The Guardian (2023). Private equity has its sights on the NHS – and with it our faith in public services altogether. The Financial Times (2023). Private equity groups bet on UK healthcare as NHS waiting lists grow.

Whatever we are doing on health, it isn't enough to prepare for the wave of morbidity that is clearly in sight.  Recent Health Foundation modelling estimates 1 in 5 will be living with major illness by 2040, mostly because more of us will be older. But it's not just about age. A record 2.5 million working-age people are already not in work due to ill health. So what can be done to improve the state of nation’s health?   To discuss, our Chief Executive Jennifer Dixon is joined by: Jeanelle de Gruchy, Deputy Chief Medical Officer for England and lead for the Office for Health Improvement and Disparities at the Department of Health and Social Care.   Kevin Fenton, President of the UK Faculty of Public Health. Show notes The Health Foundation (2023). Health in 2040: projected patterns of illness in England. UK government (2023). Major conditions strategy: case for change and our strategic framework. ONS. Rising ill-health and economic inactivity because of long-term sickness, UK: 2019 to 2023. The Health Foundation (2022). Addressing the leading risk factors for ill health. The Health Foundation (2022). Is poor health driving a rise in economic inactivity? The Health Foundation (2022). Health is wealth? Strengthening the UK’s immune system.  UK government (2021). Chief Medical Officer’s annual report 2021: health in coastal communities.

In our series marking the NHS’s 75th birthday, we’ve been setting out the big challenges and opportunities ahead for the health service. In this third and final installment, we ask how the potential of technology might be unlocked to benefit patients, the public, staff and the taxpayer. We also share initial reflections on the recently published NHS Long Term Workforce Plan.  To discuss, our Chief Executive Jennifer Dixon is joined by: Navina Evans, Chief Workforce Training and Education Officer at NHS England. Navina is a doctor and a specialist in psychiatry, and was involved in the new NHS Long Term Workforce Plan.  Penny Pereira, Q Managing Director here at the Health Foundation. Penny is an expert in process and system redesign and health care, having worked in these areas for many years, both at the Foundation and previously within the NHS. Show notes The Health Foundation (2020). Understanding and sustaining the health care service shifts accelerated by COVID-19. The Health Foundation (2021). Securing a positive health care technology legacy from COVID-19. The Health Foundation (2023). Five principles for implementing the NHS Impact approach to improvement in England. NHS England (2023). NHS Long Term Workforce Plan.