The Health Foundation podcast

It's 2 years since Keir Starmer first set out his five missions for government, including a health mission to build ‘an NHS fit for the future' and ‘a fairer Britain, where everyone lives well for longer'. Missions were supposed to mean a new way of doing government – focused on ambitious, long-term objectives that provide a driving sense of purpose for the country. So, with Labour now in office for 9 months, what have we learned about how mission-driven government works in practice? Are clues emerging about how government plans to improve the nation's health beyond the confines of the NHS? And do missions show signs of bringing about durable changes in policy and how the state works?  To discuss, our Chief Executive Jennifer Dixon is joined by: Hannah White, Director at the Institute for Government.  Jo Bibby, Director of Health at the Health Foundation.  Show notes Institute for Government (2025). Inside Briefing. Keir Starmer rewires the state.  Institute for Government (2024). What does a mission-driven approach to government mean and how can it be delivered? Health Foundation (2024). Health at the heart of government.  UK Government (2024). Plan for change: Milestones for mission-led government.  Future Governance Forum (2024). Mission-critical: statecraft for the 21st century. 

There are around 350,000 synthetic chemicals in use today and only a small fraction have been robustly tested for their long-term effects on our health. Many of these are used in manufacturing plastics and microplastics – the production of which has doubled since 2008 and is projected to triple by 2060.  Unknowns remain, but research is suggesting pervasive exposures to these manufactured substances is shaping human health. In particular, links are being identified with a range of non-communicable diseases, including some cancer types, metabolic disorders, neurological conditions and reproductive and developmental issues.  So, what do we know about how the chemical environment is influencing our health? Could AI and other emerging technologies shed new light on the effects of synthetic substances? And what does it all mean for regulation and wider policy protecting public health?  To discuss, our Chief Executive Jennifer Dixon is joined by: Tracey Woodruff, Professor at University of California, San Francisco, and Director of the Program on Reproductive Health and the Environment (PRHE).  Thomas Hartung, Professor at Johns Hopkins University, and Director of the Centre for Alternatives to Animal Testing (CAAT).   Show notes Woodruff et al (2025). Manufactured chemicals and children's health – the need for new law.  Kleinstreuer & Hartung (2024). AI – it's the end of tox as we know it (and I feel fine).  Nihart et al (2025). Bioaccumulation of microplastics in decedent human brains.  Financial Times (2023). ‘Global sperm counts are falling. This scientist believes she knows why.'  Programme on Reproductive Health and the Environment (PRHE). Scientific principles to protect public health.  Programme on Reproductive Health and the Environment (PRHE). Toxic matters. 

There's been no shortage of NHS plans over the years – what needs to be different this time? Health and care services are facing acute pressures and the NHS tops the public's list of priorities. The government has pledged to ‘reimagine' the NHS via a 10-year plan, expected in the spring.  The pressure is now on to develop a credible reform plan. It will need to address the huge challenges of changing health care needs and capitalise on the opportunities ahead, including those stemming from new technologies. All within a challenging fiscal context.  So what needs to be in the plan on key priorities – primary care, community services, and improving hospital services? What are the lessons from past NHS plans? And how can policymakers bring front-line staff with them and provide hope their working lives will improve?   To discuss, our Chief Executive Jennifer Dixon is joined by: Nigel Edwards, former Chief Executive of the Nuffield Trust. Hugh Alderwick, Director of Policy at the Health Foundation.   Show notes The Health Foundation (2024). Public perceptions of health and social care: five findings the new government should know.  The Health Foundation (2024). The public's views on the future of the NHS in England.  Nigel Edwards. The Nuffield Trust (2018). Avoiding groundhog day: learning the lessons of NHS reforms. The Health Foundation (2025). Health Foundation response to consultation on 10-year health plan. The Health Foundation. Policy Navigator – NHS reform.

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. 

About a fifth of us of working age – just under 9 million people in the UK – are not looking for or are not able to work. Recently the biggest growth has been among those reporting long-term illness, now at a record high of around 2.7 million. This decline in working-age health is causing concern among employers, politicians and policymakers. Earlier this month the Health Foundation launched an independent Commission for Healthier Working Lives to build consensus around the kind of action needed. So what's going on, and what do the solutions look like both at a local and national level?  To discuss, our Chief Executive Jennifer Dixon is joined by: Sacha Romanovitch, Chief Executive of Fair4All Finance. Sacha is a member of the government's levelling up Advisory Council, and Chair of the Commission for Healthier Working Lives, which is supported by the Health Foundation. Oliver Coppard, Mayor of South Yorkshire. Oliver was elected as the Labour Co-op mayoral candidate in May 2022. Oliver sits on a commission led by Alan Milburn, former Secretary of State for Health, investigating economic activity in Barnsley. 

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?

AI technologies are advancing rapidly. Yet when it comes to AI in health care we're still in the early stages. The prize could be big – the question is what will it take to realise the benefits? The applications of AI in health care will be far-reaching and profound, from high-quality personalised treatment advice made instantly available to automated systems that can cut bureaucracy, free up staff time and reduce costs.  All this is exciting and could help with some of the big challenges ahead. But what of the risks? The current emphasis among policymakers is on AI safety – but a range of other considerations will need attention like serving the public interest, inclusion, cost, accountability, autonomy, privacy and more. And how can the NHS and social care rapidly get up to speed with all these developments?  Join our Chief Executive Jennifer Dixon on location with expert guests including: Effy Vayena (Professor of Bioethics at the Swiss Institute of Technology); Alastair Denniston (Consultant Ophthalmologist and Honorary Professor at the University of Birmingham); Ashish Jha (Dean of Public Health at Brown University) and David Cutler (Professor of Applied Economics at Harvard University). Show notes The Health Foundation (2023). What do technology and AI mean for the future of work in health care? House of Commons Science, Innovation and Technology Select Committee (2023). The governance of artificial intelligence: interim report.  UK government (2023). UK's AI Safety Summit 2023. Institute for Government (2023). How is the UK government approaching regulation of AI? Financial Times (2023). How will AI be regulated? Air Street Capital (2023). State of AI report. OECD. OECD Artificial Intelligence Papers. The White House (2023). Fact Sheet: President Biden Issues Executive Order on Safe, Secure, and Trustworthy Artificial Intelligence. 

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.

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

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

Climate change is a global health emergency. What can we learn from how ‘green' has gone up the agenda? And how might we apply useful lessons to getting further improvements in another complex and difficult challenge – improving the health of the UK population and reducing inequalities?    The increasing frequency and intensity of heatwaves, floods, droughts and storms is already devastating lives and livelihoods around the world. While other countries are far more vulnerable to the health risks of climate change, the UK is not immune.    The UK government and the health and social care system must actively contribute to climate change solutions as part of our global responsibility. In the weeks ahead the UK (along with Italy as a partner) will host COP26, and countries will be showing what action they are taking towards the Paris Agreement goal to limit global warming. Making progress on climate change will be very challenging. Like improving health, it is a complex problem needing long-term policy commitment and action. What can we learn from efforts and progress so far? And can going greener actually improve the health of people in the UK? In the latest episode of our podcast, our Chief Executive Dr Jennifer Dixon discusses these issues with two expert guests: Dr Fiona Godlee is Editor in Chief of the British Medical Journal, a post she's held since 2005. Fiona is on the board and executive committee of the Climate and Health Council and the UK Health Alliance on Climate Change.  Professor Andy Haines is Professor of Environmental Change and Public Health at the London School of Hygiene and Tropical Medicine. Andy is a member of several major international and national committees, including the UN Intergovernmental Panel on Climate Change. Useful links: The Health Foundation (2021) What do the public think about the NHS and climate change? UN Environment Programme (2021) The production gap 2021 Academy of Medical Sciences and the Royal Society (2021) Climate change and health HM Government (2021) Net Zero Strategy: Build Back Greener  HM Government (2020) The Ten Point Plan for a Green Industrial Revolution Council for Science and Technology (2020): Achieving net zero carbon emissions through a whole systems approach

Being chief executive of the NHS is one of the most challenging jobs in the country.    Since the role started in 1985 there have been nine postholders, with Amanda Pritchard taking over from Sir Simon Stevens this year. Like her predecessors she faces formidable challenges ahead: managing the pandemic's impact, tackling waiting lists, boosting technology, managing a growing population of older people with multiple conditions and dealing with workforce shortages to name a few.   The role means being a leader and a national figure, working with the NHS itself as well as with government, the media and the wider health sector. The bandwidth needed to do the job is huge. How is it doable? Our Chief Executive Dr Jennifer Dixon discusses with Sir Alan Langlands, NHS chief executive number four, from 1994–2000. After leaving the NHS, Alan went onto a number of roles including Principal and Vice Chancellor of the University of Dundee, chief executive of the Higher Education Funding Council, Vice Chancellor of the University of Leeds and chair of the Health Foundation (2009–2017).   Related content Listen to our podcast episode on the Wanless Review and read the related publication, The most expensive breakfast in history Listen to our podcast episode with Rt Hon Jeremy Hunt MP Read more about the role of health secretary in Glaziers and window breakers Explore NHS policy developments in the Thatcher years, Major years and Blair years in our Policy Navigator Read more about 'targets and terror' Read more about the NHS internal market (see 'the context' by Jennifer Dixon)

Food is crucial to our health, but it is also a driver of ill health, health inequalities, and damage to the environment.  The second part of the National Food Strategy, led by Henry Dimbleby, was published in July 2021. It is the most comprehensive review of the entire food and drink system in the UK for many years. It recognises the upsides of the food system in providing affordable, convenient food for a growing population. But it is strong on the downsides – the current system is unsustainable and the food produced and consumed is injuring health and the environment. The strategy made 14 radical recommendations for England's food system – many requiring legislation. The government is currently reviewing the report and is due to produce a White Paper in early 2022.  In this podcast, we discuss two areas covered by the review – reducing the amount of junk food, and diet-related inequality – as well as viewing this alongside the government's 2020 obesity strategy. What should the government do next to make a difference to these large and complex challenges? Our Chief Executive Dr Jennifer Dixon discusses this with two expert guests: Anna Taylor is Executive Director of the Food Foundation, where she'd been since 2015, and is a national and international expert in nutrition. She's advised the Mayor of London and the GLA, on the food matters that affect Londoners, and also served as Chief Independent Adviser to Henry Dimbleby for the development of the National Food Strategy. Sarah Hickey has been leading the childhood obesity programme at Guys and St Thomas's Foundation as Programme Director since 2016. This programme aims to close the inequality gap in childhood obesity in Lambeth and Southwark working with communities, schools business and others on the ground. She previously worked as a Senior Policy Advisor in the Cabinet Office. Related content Find out more about the National Food Strategy Find out more about the government's obesity strategy Listen to our podcast episode on the government's approach to tackling obesity Find out more about our podcast

If you think of health in the UK as a fabric, it is the most threadbare in Glasgow. Here, life expectancy is lowest, and one in four men will die before their sixty-fifth birthday. But even after adjusting for poverty and deprivation, next to comparable deindustrialised cities such as Liverpool and Manchester, Glaswegians have a 30% risk of dying prematurely. That's from cancer heart disease stroke as well as deaths of despair: suicide, drugs alcohol. It isn't getting any better, and that's not even taking into account the pandemic. In this episode, we explore: What is fraying health to this degree in Glasgow? What is being done to help? And what can we all learn from Glasgow's longstanding efforts to try to mend the health fabric, as we all attempt to build back better after the pandemic? Our Chief Executive Dr Jennifer Dixon discusses this with two expert guests who have for many years been central to this story: Dr David Walsh is Honorary Senior Lecturer at the University of Glasgow, and a senior academic at the Glasgow Centre for Population Health. Over the years David has carried out a large body of work aimed at understanding Scotland's (and Glasgow's) high levels of ‘excess' mortality, deindustrialisation and health across European regions, and the impact of government ‘austerity' measures on mortality.  Sir Harry Burns is the Professor of Global Public Health, University of Strathclyde. Harry was the Chief Medical Officer for Scotland for almost ten years from September 2005 to April 2014, and is well known for his tireless work on health inequalities. He is a member of the Council of Economic Advisers in Scotland. Recommended reading: Walsh D, Bendel N, Jones R, Hanlon P. Investigating a 'Glasgow effect'. Glasgow Centre for Population Health; 2016. Walsh D, McCartney G, Collins C, Taulbut M, Batty GD. History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow. Glasgow Centre for Population Health; 2016. Walsh D, Lowther M, McCartney G, Reid K. Policy recommendations for population health: progress and challenges. Glasgow Centre for Population Health; 2016. Dixon J, Everest G. The government's levelling up agenda: An opportunity to improve health in England. The Health Foundation; 2021. Suleman M, Sonthalia S, Webb C, Tinson A, Kane M, Bunbury S, Finch D, Bibby J. Unequal pandemic, fairer recovery: The COVID-19 impact inquiry report. The Health Foundation; 2021. Useful links: Wising up to levelling up - with Professor Diane Coyle and Sir Howard Bernstein [Episode 7] 'Deaths of despair': A tale of two countries - with Professor Sir Angus Deaton and Sarah O'Connor [Episode 4] Find out more about the Health Foundation podcast

It's easy to forget the state the NHS was in 20 years ago – long waiting lists, heartrending delays in care, winter crises – and heated debate on whether the NHS model was obsolete.   But the Wanless Review set the NHS on course to receive record catch up funding. So in this episode, we ask, given the pandemic and the mounting challenges facing the NHS to deal with a huge backlog of care, is it time for another Wanless? Our Chief Executive Dr Jennifer Dixon discusses this with two expert guests and former Treasury officials, who were very close to the original Wanless Review: Anita Charlesworth, Director of the Health Foundation's REAL Centre and our Director of Research. Anita led the secretariat for the original Wanless Review within the Treasury, where she was Director of Public Spending from 1998 to 2007. Nick Macpherson, Permanent Secretary to the Treasury from 2005 to 2016. Nick was Permanent Secretary to three chancellors, and managed the department through the financial and wider economic crisis which began in 2007. Nick joined the House of Lords in 2016 as Baron of Earls Court. Useful links: The most expensive breakfast in history. The Health Foundation, 2021. Find out more about the REAL Centre Find out more about our podcast A note on audio quality in this episode Unfortunately, we were unable to record this episode using our normal recording platform, so the audio quality is lower than we would like. We'll be back recording the podcast in our normal way next episode.

The pandemic has created profound challenges for young people over the past year – with education, work, relationships and social time all affected. We also know about the wider economic trends which pile pressure on teens to make it to college to have a better job in the future, and the social trends which might undermine their security as they transition from child to adult. Combined with big changes in how young people are living their lives – such as a huge increase in the use of social media – it's perhaps unsurprising that we've seen trends of increasing levels of depression, self harm, anxiety, eating disorders and other mental health issues in teens. In the latest episode of our podcast, our Chief Executive Dr Jennifer Dixon discusses these issues with two expert guests: Jean Twenge is a professor of psychology at San Diego State University, who has focused much of her research on generational differences, including work values, life goals, and speed of development. She is also known for her books including iGen and Generation me. Yvonne Kelly is Professor of Lifecourse Epidemiology, Department of Epidemiology and Public Health at University College London. She is Director of International Centre for Lifecourse Studies and leads work on health and development during childhood and adolescence, on which she has written extensively.  Reading materials referenced in this episode: iGen. Twenge J. Atria Books, 2017. Generation me. Twenge J. The Free Press. 2006, updated 2014. Children of Katrina. Fothergill A, Peek L. University of Texas Press, 2015. A healthy foundation for the future. The Health Foundation, 2019. Useful links: Find out more about our COVID-19 impact inquiry Watch our Surviving COVID film about the impact of the pandemic on young people Find out more about the Health Foundation podcast

‘Levelling up' has become an earworm. It featured highly in the Conservative manifesto in 2019, which was referring to improving infrastructure, skills, productivity and economic growth across the country. The idea is to make the UK economy less lop-sided, and less focused on London and the South East.  The aim of ‘levelling up' has gained even more potency because of the pandemic. For those working in health, policies to level up might also help tackle avoidable inequalities set out by Marmot and others, caused by factors injuring health like poor housing, low quality work, and low skills. In short, poverty and deprivation. But the government's levelling up strategy is still under construction. The recently announced Levelling Up Fund is mainly focused on basic infrastructure like transport, not health. So is levelling up a real and serious aspiration? What would a strategy look like that might also help reduce health inequalities? In the latest episode of our podcast, our Chief Executive Dr Jennifer Dixon discusses these issues with two expert guests: Professor Diane Coyle is an economist and the Bennett Professor of Public Policy at the University of Cambridge. Diane has many other distinguished roles, including advising the government on economic policy during the pandemic, and leading an independent review for Greater Manchester, which shaped its industrial strategy Sir Howard Bernstein was the Chief Executive of Manchester City Council from 1998 to 2017 and is honorary chair in politics at University of Manchester. He led the devolution of power and budgets to Greater Manchester – the ‘DevoManc' deal signed between the Government and Greater Manchester Combined Authority in November 2014. He is also a member of a new taskforce set up by the government to advise on the regeneration and development of town and city centres in the wake of COVID-19. 

The new Biden administration has a lot to deal with in the next four years: the US economy, the environment, public services and infrastructure, and healing America's cultural and political divisions. Then there's health, inequalities and ensuring the US's recovery from the pandemic. On health and care alone there's a long list of wrongs to right, and progress to make. The recent Lancet Commission report Public policy in the Trump era was searingly critical on President Trump's legacy – not just in managing the pandemic, but in reversing progress on covering uninsured Americans, and much more. But what can the Biden administration really do on health and health care? What will be its priorities? And what lessons might there be for us in the UK, as ideas so often seed from across the Atlantic? In the latest episode of our podcast, Health Foundation Chief Executive Dr Jennifer Dixon discusses these issues with two US health policy experts: Dr David Blumenthal is President of the Commonwealth Fund, a Foundation based in New York that carries out independent research on health and social policy issues. He is a distinguished physician and academic, and amongst many other things has recently published the book Heart of power: Health and politics in the Oval Office. Professor Ashish Jha is currently Dean of the School of Public Health, and Professor of Health Services Policy and Practice, at Brown University in Providence, Rhode Island. Ashish is on the frontline of the COVID-19 response, leading national and international analysis of key issues and advising state and federal policymakers. Useful links: Listen to our interview with Sir Angus Deaton on why life expectancy stalling more in the US and UK compared to other OECD countries Listen to Jeremy Hunt's interview about the role of the health secretary in the UK in our first podcast episode Find out more about the Health Foundation podcast

We all need care at some point in our lives – when we're young, when we're ill and when we grow older. And caring calls for many of the qualities at the very core of what it is to be human: empathy, compassion, selflessness and commitment. And yet care is so often undervalued, skimped on, commoditised or ignored. Examples of that indifference are everywhere: at home, in the NHS and in social care. And just at a time when the need for care is growing fast, many commentators feel that we have is a ‘crisis of care'. Why is that? And what can be done about it? In the latest episode of our podcast, our Chief Executive Jennifer Dixon discusses this issue with: Madeleine Bunting – prizewinning author, broadcaster, and former Guardian journalist. In 2020, she released the book Labours of love: The crisis of care Professor Dame Anne Marie Rafferty – Professor of Nursing Policy, King's College London, and currently President of the Royal College of Nursing. Useful links: Labours of love: The crisis of care Listen to Jeremy Hunt's comments on care in our first podcast episode Find out more about the Health Foundation podcast

Life expectancy is a key indicator of our health and wellbeing. Across most OECD countries in the last ten years, life expectancy has been stalling – and stalling most in the US and the UK. Last March, Professors Anne Case and Angus Deaton, two distinguished economists from Princeton University, published what became the must-read book of the year. That book was called Deaths of Despair and the Future of Capitalism. It showed that health has deteriorated fastest in middle-aged white Americans, and that in this population, death rates from all causes are actually rising. The biggest increases were in deaths from suicide, drugs and alcohol driven by a lack of opportunity, growing inequalities, and bleak social and economic outlook. The so-called ‘deaths of despair'. In the meantime, here in the UK, The Marmot Review: 10 Years On was published last February looking at national health trends in England. The review revealed stalling growth in life expectancy nationally – and a reversal among people living in the poorer areas of England, in particular women. Is this due to the public spending cuts of recent years, or a long-term structural trend? What needs to be done? And might the pandemic accelerate solutions? In this episode, our Chief Executive Dr Jennifer Dixon is joined by two expert guests: Professor Sir Angus Deaton, co-author of Deaths of Despair, and Emeritus Professor of Economics at Princeton University. Professor Deaton was awarded the Nobel Prize for Economics in 2015. Sarah O'Connor, Employment Columnist for the Financial Times. Useful links: The Health Foundation's COVID-19 impact inquiry Deaths of Despair and the Future of Capitalism Jennifer's book review of Deaths of Despair for Political Quarterly The Marmot Review: 10 Years On Left behind: can anyone save the towns the economy forgot? Find out more about the Health Foundation podcast Recommended reading: White Working Class: Overcoming Class Cluelessness in America Hillbilly Elegy: A Memoir of a Family and Culture in Crisis Janesville: An American story The Tyranny of Merit American Overdose. The opioid tragedy in three acts The Road to Somewhere. The New Tribes Shaping British Politics 

What happens when the emergency phase of COVID is over? Has the pandemic set health and social care on a new course or will most things snap back to the way they were before?  In a global emergency we have to deal with the short term first, but what's the long-term path for the NHS in particular? And what are the deeper threats and opportunities we should be thinking about? In this episode, our Chief Executive Jennifer Dixon is joined by two expert guests: Nick Timmins, author and former public policy editor at the Financial Times, and currently Senior Policy Fellow at The King's Fund Dame Jackie Daniel, Chief Executive of Newcastle Upon Tyne Hospitals NHS Foundation Trust. Useful links: Watch Surviving COVID: Behind each statistic lies a human story short film Find out more about the Health Foundation podcast