The Health Foundation podcast

In meeting the huge challenges facing the NHS, technology is often looked to as the great hope. Yet studies suggest good management is a more active ingredient for success.  Over the years numerous reports have called for more clinicians to manage the NHS, highlighting their deep knowledge of clinical care, and insight and credibility to make effective change.   Now, over a third of all NHS chief executives hold a clinical qualification and about a third of jobbing clinicians have part-time management roles too. But that’s still only a third, and getting trained in management is patchy and haphazard – a finding echoed in the recent Messenger Review of health and social care leadership.  How can we support more clinicians to manage the NHS, and learn from those who already do it well?  To discuss, our chief executive Dr Jennifer Dixon is joined by:  Dr Stephen Swensen, Senior Fellow at the Institute for Healthcare Improvement. Stephen worked at the world-leading Mayo Clinic in Minnesota for three decades, overseeing the development of over 4,000 physicians and 200 leaders.  Dr Dominique Allwood, Chief Medical Officer and Academic Health Science Network Deputy at UCLPartners, where her focus is on clinical engagement and management. Dominique is an experienced medical leader and an expert in quality improvement. Show notes Management Lessons from Mayo Clinic Inside One of the World's Most Admired Service Organizations (2017) Leonard L. Berry, Kent D. Seltman Mayo Clinic Strategies To Reduce Burnout: 12 Actions to Create the Ideal Workplace (2020) Stephen Swenson, Tait Shanafelt Strengthening NHS management and leadership: Priorities for reform (2022) The Health Foundation Leadership for a collaborative and inclusive future (2022) Sir Gordon Messenger Five recommendations for strengthening NHS management and leadership (2022) The Health Foundation

The pandemic challenged every health care system in the world. But what can we learn from one another aboutin the way we responded, and how we might improve for future threats?   In this episode we look up close at the experience of two large academic teaching hospitals embedded in two different health care systems – the Charité in Berlin, Germany’s largest teaching hospital, and Imperial College Healthcare NHS Trust in London, one of the UK’s largest.  How do these two health care systems compare when dealing with the pandemic and its aftermath? And what can we learn?  Our Chief Executive Dr Jennifer Dixon is joined by:  Professor Heyo Kroemer, chief executive of Charité – Universitätsmedizin Berlin, one of the largest hospitals in Europe. A pharmacologist by trade, Heyo joined Charité in 2019 from the University of Göttingen’s Medical Center, where he held the positions of Dean and Chairman of the Managing Board.  Professor Tim Orchard, chief executive of Imperial College Healthcare. NHS Trust. A consultant physician and gastroenterologist, Tim was appointed chief executive in June 2018 after having been the director of clinical studies at St Mary’s Hospital.  Show notes How does the NHS compare internationally? big election questions (2017) The King’s Fund  NHS hospital beds data analysis (2022) BMA  How does the UK compare internationally for health funding, staffing and hospital beds? (2017) The Health Foundation  Performance of UK National Health Service compared with other high income countries: observational study (2019) BMJ  What can England learn from the long-term care system in Germany? (2019) Nuffield Trust  Taxes and health care funding: how does the UK compare? (2021) The Health Foundation 

Ask the public about health, and they often put the responsibility on the individual and the NHS. And yet we know the context in which we live and make choices really matters. The context that governments, businesses, employers and investors have a big hand in shaping.   Polling shows the public is increasingly seeing the government as having an important role to play in improving people's health, and there's public appetite to reduce the health inequalities highlighted by the pandemic.  So how does the public think about health? And what can be done to engage local communities in improving health?  Our Chief Executive Dr Jennifer Dixon is joined by:  Dr Jacqui Dyer MBE, co-founder and CEO of Black Thrive Global, a community interest company established in 2016 to address the inequalities affecting the mental health and wellbeing of black people in Lambeth. Jacqui is also a local councillor.    John Hume, Chief Executive of the People's Health Trust, a charity focused on reducing health inequalities through community development.  Show notes A matter of life and death: explaining the wider determinants of health in the UK (2022) FrameWorks Institute Addressing the leading risk factors for ill health (2022) The Health Foundation What Works Centre for Wellbeing The NHS as an anchor institution (2020) The Health Foundation

The NHS is experiencing an unusual set of pressures at the moment, with waiting lists of 6.5 million, staff shortages, ambulance delays, long waits and much more. Meanwhile, public satisfaction with the NHS has nosedived, according to the recent British Social Attitudes survey. While politicians acknowledge the challenges and repeat their support for the NHS, outriders on the political right are flexing muscles and calling for more fundamental reform – despite the ink only just drying on the last set of NHS reforms with the Health and Care Bill receiving royal assent. Lord Norman Warner has been top civil servant, health minister from 2003 to 2007 and in the House of Lords for over 20 years, and has written about it all in his new book In Pursuit of Competence. He joins our Chief Executive Dr Jennifer Dixon to share his insights and reflect on what might be ahead. Show notes Norman Warner (2022) In Pursuit of Competence: A Life as a Westminster Nomad NHS (2019) The NHS Long Term Plan NatCen Social Research (2021) British Social Attitudes Survey 38 The Health Foundation (2021) Health and social care funding projections 2021 Department of Health and Social Care (2006) Our health, our care, our say: a new direction for community services Duncan Campbell-Smith (2009) Follow the money: the Audit Commission, Public Money and the Management of Public Services, 1983-2008

This year households across the UK are facing the biggest squeeze in living standards since the 1950s. Most of us will feel the impact, but poor households are being hit the hardest. We know that poverty and the stress of debt harms our health in the short and long term.  One role of the state is to provide a welfare safety net. After last month's Spring Statement, what should the government do now to support those experiencing the worst effects of rising costs? What impact on households and health are we already seeing? And what more can be done to help? Our Chief Executive Dr Jennifer Dixon discusses this with expert guests: Dame Clare Moriarty is chief executive of Citizen’s Advice. She’s a former senior civil servant and served as permanent secretary at the Department for Environment, Food and Rural Affairs and the Department for Exiting the European Union. She was also chair of our COVID-19 Impact Inquiry.  Bim Afolami MP has been the Conservative MP for Hitchin and Harpenden since 2017. He's on the advisory board of the Money and Mental Health Policy Institute and is chair of the All-Party Parliamentary Group for Financial Markets and Service. He's also patron of two mental health charities in his constituency. Show notes The Health Foundation (2022) Response to the Spring Statement Resolution Foundation (2022) Inflation Nation: Putting Spring Statement 2022 in context Institute for Fiscal Studies (2022) Analysis of the Spring Statement The Health Foundation (2022) Debt The Health Foundation (2022) Debt and health The Health Foundation (2020) Living in poverty was bad for your health long before COVID-19 Financial Times (2022) Chancellor provides minimal help to households on cost of living crisis The Trussell Trust (2022) Debt to government, deductions and destitution 

For the last decade, gains in life expectancy have been stalling. We’re living more years in poor health too, with a 20 year gap in healthy life expectancy between women living in the richest and poorest areas.  The biggest risk factors driving the UK‘s high burden of ill health are smoking, poor diet, physical inactivity and harmful alcohol use. All are socioeconomically patterned and contribute significantly to widening health inequalities.  There have been many policies proposed to help over the years, and the government has already set a target to increase healthy life expectancy by five years by 2035 and reduce inequality. But at the current rate of progress this will take nearly 200 years, not 12, to reach.  Is it time to get much tougher on the risk factors? And if so, how? A recent Health Foundation report showed that the government could do a lot more to be effective, but will politics allow national government to do what it takes? Our Chief Executive Dr Jennifer Dixon is joined by: Professor Kevin Fenton is regional director for London at the Office for Health Improvement and Disparities, having previously held the same position at Public Health England. He has also been elected to be the next President of the UK Faculty of Public Health and is due to take up the position in June 2022.  Richard Sloggett is the founder and director of Future Health. Between 2018 and 2019 he was Special Advisor to the then Secretary of State for Health and Social Care, working on the prevention green paper.  Show notes Anderson P, O'Donnell A, Kaner E, Llopis E, Manthey J, Rehm J. Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: controlled interrupted time series analyses. Lancet, Volume 6, Issue 8, E557-E565; 2021 Everest G, Marshall L, Fraser C, Briggs A. Addressing the leading risk factors for ill health: A review of government policies tackling smoking, poor diet, physical inactivity and harmful alcohol use in England. The Health Foundation; 2022 Lewis T, Buck D, Wenzel L. Equity and endurance: how can we tackle health inequalities this time? The King’s Fund; 2022 Theis, D R and White M. Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies,1992–2020. The Milbank Quarterly, 99: 126-170; 2021 Javid S. Health and Social Care Secretary speech on Health Reform, 8 March 2022

Like many other countries, the UK has a growing drug problem. In England around 3 million people take drugs and drug deaths are the highest on record at nearly 3,000 a year. In the last decade, heroin-related deaths have more than doubled and cocaine-related deaths have grown fivefold. The situation in Scotland is even worse – now the drug death capital of Europe.   The UK government tackles drugs as a criminal justice matter focused on punishment, rather than a public health matter focused on support. But many countries are taking a different approach, most famously Portugal which in 2000 decriminalised all drugs and concentrated instead on public health and harm reduction. The result? From one of the highest drug death rates in Europe to one of the lowest.   How did they do it and what can we learn?   Our Chief Executive Dr Jennifer Dixon is joined by: Dame Carol Black, who was commissioned by the Home Office and the Department of Health and Social Care to undertake a two part independent review of drugs, to inform the government’s thinking on what more can be done to tackle the harm that drugs cause. Dr João Castel-Branco Goulão, a Portuguese physician and the current national drug coordinator for Portugal. He is credited as being the main architect of Portugal’s drugs policy established in 2000 and since then has advised on drug policy for successive governments. Show notes Independent review of drugs by Professor Dame Carol Black From harm to hope: A 10-year drugs plan to cut crime and save lives (December 2021) Ferreira, S. Portugal’s radical drugs policy is working. Why hasn’t the world copied it? (December 2017) National Records of Scotland, Drug-related deaths in Scotland in 2020 (July 2021) Nutt, D. UK drugs strategy promises to be tough on criminals, but evidence shows this doesn't work. BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n3066  The House of Commons Scottish Affairs Committee report on Problem drug use in Scotland (October 2019) includes an outline of some international case studies.

Those of us working in health often focus on the government as the main agent to get things done, especially when it comes to public health. But think of all the others out there with power, particularly commercial and investment power.  There are signs that businesses and institutional investors do seem to be getting more interested in health, with some businesses starting to consider their impact on health in their environmental, social and governance (ESG) reporting. Are we now at a turning point? Or is interest in health temporary? If businesses and investors really want to improve health, how do they best move forward? And can government do more to support them? Our Chief Executive Dr Jennifer Dixon discusses this with expert guests: Catherine Howarth joined ShareAction as Chief Executive in 2008. ShareAction coordinates civil society activism to promote responsible investment across Europe. Catherine also serves on HM Treasury's Asset Management Taskforce.  John Godfrey joined Legal & General in 2006 and is now Director of Corporate Affairs. John has worked in the City of London for over 30 years and from 2016-17 worked at Number Ten Downing Street as Head of Policy for Prime Minister Theresa May.  Show notes APPG on Longevity, Levelling up health, (April 2021) British Academy: The Future of the Corporation programme and reports Policy & Practice for Purposeful Business (2021), Principles for Purposeful Business (2019) and Reforming business for the 21st century (2018) Business for Health, Business Framework for Health: Supporting businesses and employers in their role to enhance and level up the health of the nation (October 2021) Health Foundation, Using economic development to improve health and reduce health inequalities (2020) Institute of Health Equity, Health Equity in England: The Marmot Review 10 Years On (2020) ShareAction, Health: An Untapped Asset – How investors can strengthen returns by improving health outcomes (September 2021) 

In another year shaped by the COVID-19 pandemic, we explore some key health policy developments and look ahead to what 2022 might have in store.  With Omicron dominating the headlines and a public inquiry into the handling of COVID-19 on the horizon, has government learned – and acted on – the lessons from the start of the pandemic?   As the NHS faces the huge task of COVID-19 recovery, how will the debate about NHS performance and funding play out? Will the Health and Care Bill going through parliament be ready to come into effect next April, and what might it mean for the health system?  And do the social care cap and recently published white paper move us any closer to the ‘fix’ that is so desperately needed for social care? Our Chief Executive Dr Jennifer Dixon is joined by: Lord Victor Adebowale, Chair of the NHS Confederation. Victor was awarded a CBE for services to the unemployed and homeless people and became a crossbench peer in 2001. Hugh Alderwick, Head of Policy at the Health Foundation. Hugh leads our policy team’s work to understand and inform national policies on health and social care in England. Useful links Read about the Health Foundation's COVID-19 Impact Inquiry, including the final report. Explore the Health Foundation's ongoing work on the Health and Care Bill. Lady Hallett was announced as chair of the COVID Inquiry following our recording. Read more. Taxes and health care funding: how does the UK compare? (The Health Foundation, 2021) Adult social care and COVID-19 after the first wave: assessing the policy response in England (The Health Foundation, 2021) New vision for social care will feel like hollow words without the money to deliver it (The Health Foundation, 2021)

For years public satisfaction with the NHS has been highest for general practice.  But even before the pandemic, rising workloads and workforce shortages had left many GPs dissatisfied and stressed. Then add a pandemic into the mix, with GPs instructed to move rapidly from face-to-face consultations to telephone or digital advice as a first step. As the pandemic eases, signs of public frustration are now spilling over to the tabloids, MPs’ in-trays and adding to demand to hospital A&E departments.  Is this a sign of general practice crumbling or are we seeing its rebirth as the old model of care enters the digital age? Do we need a fuller vision for the future of primary care? And what are the government and the NHS doing to manage the fallout from growing frustration among the public and GPs? Our Chief Executive Dr Jennifer Dixon discusses with three expert guests:  Professor Katherine Checkland is Professor of Health Policy and Primary Care at the University of Manchester and until recently was a practising GP in rural Derbyshire.  Shaun Lintern is Health Correspondent at The Independent.  Dr Rebecca Fisher is Senior Policy Fellow at the Health Foundation, leading policy work on primary care, and is a practising doctor, working two days a week as a GP in an area of high urban deprivation. Useful links Rebecca Fisher (2021) 'Levelling up' general practice in England  Rebecca Fisher, Ruth Thorlby and Hugh Alderwick (2019) Understanding primary care networks Martin Roland, HEE Primary Care Workforce Commission (2015) The future of primary care NHS England (2014) Five Year Forward View