The Health Foundation podcast

We look back at our pick of the pod from 2024.  As 2024 draws to a close, what to make of the year’s developments in health and care?   As yet, a murky picture on NHS reform and on how the new Labour government’s five missions will work in practice; a pressing need to improve the health of the working-age population; and some promising ways forward for technology to improve care, quality and productivity in the NHS. In this episode, we also revisit how to drive the economic growth we need to fund high-quality public services, search for clues about what might be behind the worrying rise in cancer rates among younger adults, and explore what the latest evidence tells us about inequalities in health across ethnic groups in the UK. This episode also marks our 50th – meaning there’s a great back catalogue for you to enjoy. Join our Chief Executive Dr Jennifer Dixon as we reflect with guests who appeared on the podcast in 2024. All-time top performing episodes  Health Foundation (2020). Low life expectancy in Glasgow, and what to do about it.  Health Foundation (2021). Inside the teen mind: what’s happening to mental health? Health Foundation (2020). What should nanny do next? The government and obesity. Health Foundation (2023). AI in health care: hope or hype? Health Foundation (2021). We are what we eat: food, health and inequality. Show notes John Burn-Murdoch (2024). What if the UK isn’t actually the sick man of Europe? Financial Times.  Barnsley MBC (2024). Pathways to Work: Commission Report.  Edwards & Dayan (2024). Leagues tables for the NHS.

Health secretary Wes Streeting has set out three big shifts the NHS must deliver – including moving from analogue to digital. National strategy on health technology and digital is developing at pace, with a 10-Year Plan for the NHS expected to set out new priorities in the spring. We’ve seen no shortage of initiatives, roadmaps and plans for tech and innovation in recent years – yet delivery has often lagged behind. Today, acute pressures on health and care services, demographic headwinds and trends in disease burden mean there’s an imperative to deliver at pace. Much recent attention has focused on AI and its revolutionary potential, but leveraging this depends on a range of other digital capabilities that not all NHS trusts and services have.  So, where is the NHS on its journey to digitisation? And, given all of this, what will it take for the NHS to become a truly digital health system?    To discuss, our Chief Executive Jennifer Dixon is joined by: Holly Krelle, Assistant Director at the Center for Healthcare Innovation & Delivery Science at New York University's Langone Medical Center. Erik Mayer, Consultant Surgeon at Imperial College Healthcare and the Royal Marsden NHS trusts, and Director of Imperial's clinical analytics unit.  Show notes Darzi et al (2024). Independent investigation of the NHS in England.   The Health Foundation (2025). Briefing on digital maturity in the NHS [forthcoming].   The Health Foundation (2023). What do technology and AI mean for the future of work in health care? Horwitz & Krelle (2023). Using rapid randomised trials to improve health care systems. Annual Review of Public Health.  Honeyford et al (2022). Challenges and recommendations for high quality research using EHRs. Frontiers in Digital Health. NHS Confederation (2024). Frontline digitisation: creating the conditions for a digital NHS.  Dearing & Cox (2018). Diffusion of innovations theory, principles and practice. Health Affairs. 

The UK is becoming more ethnically diverse: nearly 20% of the population reports being from a minority ethnic background and projections suggest growing diversity is the future. People from minority backgrounds in the UK experience a variety of inequalities. But what is the latest evidence telling us?   A comprehensive analysis of race and ethnicity, recently published as part of The IFS Deaton Review of inequality, finds no single story of advantage or disadvantage across ethnicities. Instead, it presents a complex picture of inequality across and within ethnic minority groups. The findings highlight entrenched inequalities – including access to the building blocks of health such as a good education, stable employment, secure housing and fair pay.  So what do we know about the groups that experience inequalities, what drives these – and how do they relate to health? And what do policymakers need to understand to respond effectively?  To discuss, our Chief Executive Jennifer Dixon is joined by: Heidi Safia Mirza, Emeritus Professor of Equalities Studies in Education at IOE (UCL Institute of Education) and co-author of the race and ethnic inequalities chapter of the Deaton Review. Shabna Begum, Chief Executive Officer, Runnymede Trust, a charitable think tank working to reduce racial inequality in the UK. Show notes Oxford Open Economics (2024). Dimensions of Inequality: The IFS Deaton Review.   Mirza H S, Warwick R (2024). Race and ethnic inequalities.  Runnymede Trust (2022). Broken Ladders.  Runnymede Trust (2020).  Colour of Money.  The King’s Fund (2023). The health of people from ethnic minority groups in England.  Runnymede Trust (2024). Health Foundation supported report on ethnic inequalities and the wider determinants of health. (Forthcoming.) 

Since the early 1990s, there’s been a concerning uptick in cancer incidence among adults younger than 50 years. Scientists are racing to understand what’s driving these trends. Some evidence points to roles for established risk factors – including smoking and obesity. But some research is also exploring environmental exposures – such as microplastics and forever chemicals – and asking if these could be changing the microbiome and potentially causing inflammation within the body.  So what do these trends mean for cancer research, for health services and national policy? And faced with such stark trends, where are there grounds for hope?  To discuss, our Chief Executive Jennifer Dixon is joined by: Kimmie Ng, specialist in oncology and Director of the Young-Onset Colorectal Cancer Centre at the Dana Farber Cancer Institute in Boston, and Associate Professor of Medicine at Harvard Medical School.  Charles Swanton, Deputy Clinical Director at Francis Crick Institute, Chief Clinician at Cancer Research UK, and a consultant oncologist at University College London Hospitals NHS Foundation Trust. Show notes Nature Reviews Clinical Oncology (2022). Is early-onset cancer an emerging global epidemic? Current evidence and future implications. BMJ Oncology (2023). Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019. Gupta S et al (2023). Birth Cohort Colorectal Cancer (CRC): Implications for research and practice. Financial Times (2023). The unexplained rise of cancer among millennials.The New England Journal of Medicine (2024). Microplastics and nanoplastics in atheromas and cardiovascular events. Cancer Grand Challenges. Team OPTIMISTICC: Opportunity to investigate the microbiome’s impact on science and treatment in colorectal cancer. The Health Foundation (2023). How chronic stress weathers our health.  The Health Foundation (2024). Rising cancer incidence in younger adults: what is going on?  (Forthcoming)

There’s a new Prime Minister in Downing Street and a new political reality in the UK. But what does it all mean for health and care? The incoming government faces a range of complex policy challenges – many of them linked to health and care – and a daunting fiscal inheritance.  While the public might show patience for a few months, they will expect to see some results quickly – and health is a top priority for voters. So how is the new government going to navigate these tensions? What will being ‘mission-led’ mean in practice? And where is the money going to come from? To discuss, our Chief Executive Jennifer Dixon is joined by: Hannah White, Director and CEO of the Institute for Government.  John McTernan, Senior Adviser at BCW Global. John was formerly director of political operations for the Labour government from 2005 to 2007.

As the general election approaches, what are the main parties planning on health and will it make a difference? Polling day is rapidly approaching and all the main party manifestos have now been published. But when it comes to health and care, do we know what we’re voting for? Many commentators have expressed deep frustration at the opacity of the political debate – not just about the state we are in, but on the plans to get out of it. This matters because whoever wins the election faces a daunting series of challenges. Not least cratering public satisfaction with NHS services, an elective care waiting list standing at 7.6 million, rising levels of ill health among working-age people, and an economy growing too slowly to support the funding and investment public services will require. So what are the main parties promising on health, are their pledges in tune with the public mood, and are their plans equal to the scale of the challenges?   To discuss, our Chief Executive Jennifer Dixon is joined by: Sam Freedman, Senior Fellow at the Institute for Government and former Senior Policy Adviser to Michael Gove at the Department for Education.  Paul Corrigan, Management Consultant and former Special Adviser to Alan Milburn and Tony Blair under New Labour. Paul is currently advising the Labour Party on health policy. Show notes The Health Foundation (2024). General election 2024 collection.  The Health Foundation (2024). What's in the party manifestos on health and care? The Health Foundation (2024). Do the manifestos cut it on health? Institute For Government (2023). The NHS productivity puzzle: Why has hospital activity not increased in line with funding and staffing? Institute For Government and CIPFA (2023). Performance Tracker 2023: Hospitals.  Timmins, N (2021). The Health Foundation. The most expensive breakfast in history: revisiting the Wanless review 20 years on. The Health Foundation. 

More long-term, mission-led policymaking is sorely needed, but how best to do it? The Sure Start programme was set up with the aim of giving young children the best possible start in life, narrowing gaps in outcomes for disadvantaged children. First announced by the New Labour government in 1998, it has evolved regularly over the past two decades. Recent evaluations have found early versions of Sure Start delivered positive impacts for children – supporting improved educational attainment, employment outcomes and long-term health.    So what lessons does Sure Start hold for long-term policymaking? How can national policymakers drive long-term change in social outcomes, what pitfalls need to be avoided, and where should any new government be looking if they want to improve children’s lives and health today?  To discuss, our Chief Executive Jennifer Dixon is joined by: Naomi Eisenstadt, former director for Sure Start and current Chair of Northamptonshire integrated care board (ICB). Donna Molloy, Deputy Chief Executive at Foundations – What Works Centre for Children & Families. Show notes IFS (2021). The health impacts of Sure Start.  IFS (2024). The short- and medium-term impacts of Sure Start on educational outcomes.  Eisenstadt (2022). Sure Start Review, The Therapeutic Journal.  The Health Foundation (2024). Sure Start shows that to improve health, governments must keep the faith (blog).  Molloy & Asmussen (2021). Worth the wait: new evaluation data shows positive impacts of Family Nurse Partnership, EIF/WWCSC Hadley et al (2016). Implementing the UK's teenage pregnancy strategy for England. Reproductive Health. 

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.