The Health Foundation podcast

As we approach the NHS’s 75th birthday in July, we’re releasing a series of three podcast episodes setting out the big questions facing the health service. This second episode explores the role of political leadership in addressing the big challenges in health care, whether political leadership is up to the task of getting the NHS to its 100th anniversary – and if not, how could it improve?  To discuss, our chief executive Dr Jennifer Dixon is joined by:     Alan Milburn, Labour MP for nearly 20 years to 2010. During the Blair government, Alan held a number of ministerial roles including Secretary of State for Health from 1999 to 2003. Alan currently serves as chair of the Social Mobility Foundation and Chancellor of Lancaster University. Stephen Dorrell, Conservative MP for over three decades to 2015. Stephen served as Secretary of State for Health from 1995 until the 1997 general election, and as chair of the House of Commons Health Select Committee from 2010 to 2014. Since leaving parliament, Stephen spent time as chair of NHS Confederation, and joined the Liberal Democrats.  Show notes Institute for Government (2019) Becoming secretary of state   The Health Foundation (2020) Glaziers and window breakers: former health secretaries in their own words  The Health Foundation (2021) The most expensive breakfast in history

The fact the NHS survives by a kind of miracle is one of its endearing British features – so said former health secretary, Kenneth Clarke. Well, can that miracle continue? As we approach the NHS’s 75th birthday in July, we’re launching a series of three podcast episodes setting out the big questions facing the health service. This first episode explores current pressures on the NHS, economy and wider society and what the future might hold. What are the questions that policymakers may face as the population’s health and care needs change over the coming decade? How can the UK economy power the investment needed for health services to survive and thrive? And how can more long-term thinking help to foster good health and economic productivity? To discuss, our chief executive Dr Jennifer Dixon is joined by: Professor Jagjit Chadha, Director of the National Institute of Economic and Social Research and chair of the UK Productivity Commission  Anita Charlesworth, Director of Research and the REAL Centre at the Health Foundation. Show notes NIESR (2023). UK economic outlook – Spring 2023  Chadha (2023). ‘Commentary: fixing the mix’. National Institute Economic Review.    Office for National Statistics (2022) National population projections  Health Foundation (2022). How many hospital beds will the NHS need over the coming decade?   Health Foundation (2022). How does UK health spending compare across Europe over the past decade?   Health Foundation (2022). NHS workforce projections 2022   Health Foundation (2022). Health is wealth? Strengthening the UK’s immune system  

How healthy we are in part depends on the many different exposures we've had over our life – including to physical, psychological and social factors. Chronic exposure to psychosocial stress – for example, poverty or other disadvantage – leads to prolonged strain on the body. This weathering can make us physically ill before our time and prematurely age us. So what is psychosocial stress, how does it harm our health and what can be done about it? To discuss, our chief executive Dr Jennifer Dixon is joined by:  Dr Michelle Kelly-Irving, a life course epidemiologist working on health inequalities and the social determinants of health. Michelle is a director at Inserm in Toulouse, part of France's National Institute of Health and Medical Research. Professor Nish Chaturvedi, Professor of Clinical Epidemiology at University College London and Director of the Medical Research Council Unit for Lifelong Health and Ageing. Show notes Kelly-Irving (2019). Allostatic load: how stress in childhood affects health outcomes. The Health Foundation.   Gustafsson et al (2011). ‘Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort.’ Journal of Epidemiology and Community Health. 65: 986-992.   Guidi et al (2021). ‘Allostatic load and its impact on health: a systematic review.’ Psychotherapy and Psychosomatics. 90: 11-27.   McEwen & Stellar (1993). ‘Stress and the individual – mechanisms leading to disease’. Archives of Internal Medicine.153: 2093-2101  Tampubolon & Maharani (2018). ‘Trajectories of allostatic load among older American and Britons: longitudinal cohort studies.’ BMC Geriatrics. 255.

News of artificial intelligence (AI) is everywhere. We seem to be on the cusp of a revolution in how the latest AI models will change our lives – and health and care could be at the centre of those changes. AI will transform medicine, AI will allow doctorless screening and personalised prevention, AI will boost productivity, AI will make thousands of jobs redundant – so go all the claims.   But is this hype or real hope? How will AI transform health and care services and the experiences of staff and patients? What’s been the progress so far? And how best to move forward safely? And with growing demand, staff shortages and a public spending squeeze, could AI be a key answer to sustaining the NHS itself? To discuss, our chief executive Dr Jennifer Dixon is joined by: Professor Sir John Bell, Regius Professor of Medicine at the University of Oxford and an adviser to the government on life sciences strategy, and to Sir Patrick Vallance’s current review of how to regulate emerging technologies.  Dr Axel Heitmueller, Managing Director of Imperial College Health Partners. Axel has also worked as a senior analyst in the Cabinet Officer and Number 10 Downing Street. Show notes European Parliamentary Research Services (2022) AI in healthcare: applications, risks and ethical and societal impacts Health Education England (2022) AI Roadmap: methodology and findings report Health Education England (2019) The Topol Review: Preparing the healthcare workforce to deliver the digital future The Health Foundation (2021) Switched on: how do we get the best out of automation and AI in health care? HM Government (2021) National AI Strategy HM Government (2018) Artificial intelligence sector deal HM Government (2017) Industrial Strategy: Building a Britain fit for the future

Today, women make up around half of all doctors and two-thirds of all medical students. So, has equality in health care finally been achieved?  When International Women’s Day began in 1909, women were still barred from entering medical school. Today women make up a growing share of the medical workforce and students in the UK. Despite this considerable progress, research indicates that today women in health care are under-represented in leadership roles, are paid less than male colleagues on average, and still all too often encounter sexism and discrimination.  To mark International Women’s Day 2023, we invited three female leaders at different stages of their careers in health care to reflect on the expectations, experiences and challenges that have shaped their professional journeys and what needs to happen to continue building a truly inclusive workforce. To discuss, our chief executive Dr Jennifer Dixon is joined by: Dame Jane Dacre, emeritus professor at UCL Medical School, chair of the Health and Social Care Select Committee’s expert panel and former president of the Royal College of Physicians Dr Nikita Kanani, director of clinical integration at NHS England and deputy senior responsible officer for the NHS COVID-19 vaccination programme and a GP in south east London Dr Gabrielle Mathews, NHS Assembly Member (NHS England) and a doctor at North Middlesex University Hospital NHS Trust. Show notes World Health Organisation (2019) Gender equity in the health workforce  World Health Organisation (2019) Delivered by women, led by men: A gender equity analysis of the global health and social workforce  British Medical Association (2021) Sexism in medicine  General Medical Council (2022) The state of medical education and practice in the UK: the workforce report  Royal College of Physicians (2009) Women and medicine: the future The Nuffield Trust (2018) The gender pay gap in the English NHS  Institute for Fiscal Studies (2023) Progress of parents in NHS medical and nursing careers Dacre et al (2020) Independent review into gender pay gaps in medicine

Improvements to life expectancy slowed in the last decade, and in some communities even went into reverse.   In England, the north east region has the lowest life expectancy. The last decade and a half has seen a worrying increase in mortality among younger people, and in particular men who are dying before their time. A big chunk of this excess mortality seems to be down to so called ‘deaths of despair’ – that’s deaths by suicide, violent injury and substance misuse.  So what's going on? And what can be done about it? To discuss, our chief executive Dr Jennifer Dixon is joined by: Alice Wiseman, Director of Public Health at Gateshead Council.  Professor Clare Bambra, professor of public health at Newcastle University. Show notes Local healthy life expectancy at birth by region and sex (2022) The Health Foundation Map of healthy life expectancy (2022) The Health Foundation Major study outlines wide health inequalities in England (2022) The Health Foundation Health inequalities are worsening in the North East of England (2020) NIHR Making health services work for deprived populations in the North East (2022) NHS England Deaths of Despair: Conceptual and Clinical Implications (2021) Cognitive Behavioural Practice Health Equity in England: The Marmot Review 10 Years On (2022) The Health Foundation What is happening to life expectancy in England? (2022) The King’s Fund Life expectancy declining in many English communities even before pandemic (2021) Imperial College London Our approach to reducing healthcare inequalities by NHS England Historic £1.4 billion devolution deal for North East (2022) Department for Levelling Up, Housing and Communities

What a rollercoaster year it's been. In this Christmas round-up, we're looking back over our 2022 podcast episodes and pulling out some top insights for you to reflect on.  Our chief executive Dr Jennifer Dixon shares clips from: Catherine Howarth and John Godfrey, Are businesses and investors really serious about improving our health?  Dame Carol Black and Dr João Castel-Branco Goulão, Tackling the drug problem in the UK and Portugal  Professor Kevin Fenton and Richard Sloggett, Time to get tougher on the risk factors fraying our health?  Dame Clare Moriarty and Bim Afolami MP, Will the rising cost of living be paid for by our health?  Lord Norman Warner, Reforming health care: reflections from a former health minister  Dr Jacqui Dyer and John Hume, How the public thinks about health, and why it matters  Professor Heyo Kroemer and Professor Tim Orchard, A tale of two hospitals: the pandemic and its aftermath in Berlin and London  Dr Stephen Swensen and Dr Dominique Allwood, From white coat to grey suit: should more clinicians manage the NHS?  Rachel Wolf and Isabel Hardman, Does a new Prime Minister signal change in health and social care?  Richard Smith and Libby Sallnow, What to do about dying?  Sarah O’Connor and Professor James Banks, Is ill health driving economic inactivity, and what can be done? 

We're all familiar with some of the challenges ahead in the UK: a fiscal squeeze, limp productivity, a labour shortage and an ageing population with increasing needs.  As Andy Haldane put it in our recent REAL Challenge lecture, two routes to prosperity for the UK include increasing the number of workers and their productivity. But both of these routes now appear to be hampered by increasing ill health.  Since the pandemic, 600,000 working people have become economically inactive – that’s the size of the city of Manchester taken out of the economy. Two-thirds are the over 50s who've left and aren't looking for work. And at the other end of life, younger people entering work are reporting markedly more ill health due to depression and anxiety, and more young men in particular are economically inactive. Can we carry on like this if our economy is to recover? Or is it now time for us to get serious about these trends, and how? To discuss, our chief executive Dr Jennifer Dixon is joined by:  Sarah O’Connor, employment columnist at the Financial Times.  James Banks, Professor of Economics at the University of Manchester and Senior Research Fellow at the Institute for Fiscal Studies. Show notes Health is wealth? REAL Challenge annual lecture (2022) The Health Foundation  Is poor health driving a rise in economic inactivity? (2022) The Health Foundation  Proportion of UK workers on low pay at lowest level since 1997 (2022) Financial Times  There is a deepening mental health recession (2022) Financial Times  Is worsening health leading to more older workers quitting work, driving up rates of economic inactivity? (2022) IFS  The rise in economic inactivity among people in their 50s and 60s (2022) IFS  Half a million more people are out of the labour force because of long-term sickness (2022) ONS  Reasons for workers aged over 50 years leaving employment since the start of the coronavirus pandemic: wave 2  New Polling for Phoenix Insights (2022) Public First  Mental health conditions, work and the workplace (2022) Health and Safety Executive  Labour Market Statistics, October 2022 (2022) Institute for employment studies  Economic inactivity and the labour market experience of the long-term sick (2022) Jonathan Haskel and Josh Martin (this piece is currently a work in progress and a preliminary download has been made available by the authors) 

We don’t like to think about death. To many, death and dying have no value and are relegated to the margins of our lives. But about half a million of us in Britain die each year, mostly in our 80s, with half of us dying in our usual place of residence – in our own bed. With palliative care stretched and family and friends often left unsupported, what could be an enriching and meaningful phase of life can become over-medicalised, transactional and feared. There have been many attempts over recent years to normalise conversations on death, and in January this year The Lancet published its commission on the value of death following a five-year inquiry. So how could we die better in the UK? Or as The Lancet commission puts it, how do we bring death back into life? To discuss, our chief executive Dr Jennifer Dixon is joined by the two lead authors of the commission:  Richard Smith, currently Chair of the UK Health Alliance on Climate Change. Richard’s former roles include editor of the BMJ, chair of the board of trustees of the International Centre for Diarrhoeal Disease Research, Bangladesh and director of the UnitedHealth Chronic Disease Initiative.  Libby Sallnow, Palliative medicine consultant at CNWL & UCLH and honorary senior clinical lecturer in new public health approaches at St Christopher's & UCL. Show notes The Lancet Commission on the Value of Death (2022) The Lancet Overdiagnosis and overtreatment during the covid-19 pandemic (2021) BMJ Neighborhood Network in Palliative Care (2022) Centre for Health Market Innovations What is an End of Life Doula? (2022) End of Life Doula UK The Lancet Commission on Palliative Care and Pain Relief (2018) The Lancet

A new Prime Minister, government and health secretary, all facing a formidable array of challenges. Prime Minister Liz Truss has said that putting the NHS ‘on a firm footing’ is one of her top three priorities (alongside the economy and energy). Meanwhile, Health Secretary Thérèse Coffey has said her priorities are ABCD (ambulances, backlog, care and doctors and dentists), and since the podcast recording she has set out the government's plans. So how will this translate to the NHS, social care and improving the UK’s health? Will government have the bandwidth before an election to address more than the day-to-day pressures? And if a Truss government won a general election with a mandate to do more, what form would it take? To discuss, our chief executive Dr Jennifer Dixon is joined by: Rachel Wolf, Founding Partner at Public First. Rachel is also on the Board of the Centre for Policy Studies, co-authored the Conservative Party’s Election Manifesto in 2019 and was previously education and innovation adviser to the Prime Minister at 10 Downing Street.  Isabel Hardman, Assistant Editor at The Spectator. Isabel has authored two books – Why We Get the Wrong Politicians and The Natural Health Service – and is currently finishing a third on the NHS. Show notes Rachel Wolf, Public First, A few thoughts on the Downing Street policy unit Rachel Wolf, Conservative Home, Truss’s in tray 3) Rachel Wolf: Levelling Up. There is no time for another new approach. The new Prime Minister must focus on delivery Isabel Hardman, The Spectator, Is Coffey good for health? Thérèse Coffey is expected to become Deputy Prime Minister and Health Secretary. What's the significance? Isabel Hardman, The Spectator, Can Liz Truss deliver, deliver, deliver? Hugh Alderwick, Health policy priorities for the next prime minister: Avoid zombie policies and invest in growing the workforce and reducing inequalities. BMJ MJ 2022;378:o1726 The Health Foundation, Public perceptions of health and social care: what the new government should know The Health Foundation, Waiting for NHS hospital care: the role of the independent sector