The Health Foundation podcast

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

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