Evidence in extraordinary times

The last year has been exceptional and terrible in many ways. One of the most extraordinary has been that questions of evidence, fact and understanding in health care – the sometimes quiet issues the Nuffield Trust has worked on for many years – have become dominant themes of politics, public life and history. Entire sectors of the economy were shuttered and tens of millions locked indoors based on projections of NHS bed use. Speeches on health policy were the most watched television programmes in the UK. Global stock markets now swing back and forth based on measurements of health care activity and health outcomes, not technology or trade.

Time to think

The crisis means there is no way we could hold our Health Policy Summit as the usual intensive, invite-only two-day programme of debate and speeches in a hotel outside London. So we have decided to open it up to people across the UK and the world as a series of online lectures, debates and roundtables, spread over the coming month. 

We want to move beyond observing what is happening to understanding it, seeing beyond the crisis to the future and using its value as a historic experiment, at an awful cost, that tells us what was working and what was failing. We hope this flexible, open series of events, able to call on the most insightful speakers from across the world, will provide a space for reflection and strategic thought for busy, hard-pressed people dealing with the endless demands of the pandemic. I would like to thank our sponsors MSD and Optum for supporting the series.

Truth and power

We will begin by focusing on how evidence, facts and science have been used during the pandemic. Our first session on March 9 will bring together Professor Martin McKee, one of Europe’s foremost public health experts and commentators and a tireless analyst over the course of the pandemic, with Dame Una O’Brien, former Permanent Secretary of the Department of Health, with deep experience of difficult decisions at the health of government. 

The relationship between decisions and evidence has been very contentious in the past year. Political leaders have used “following the science” as an almost talismanic phrase and slogan, yet late or misjudged decisions have seemed to fly in the face of scientific advice. The public themselves have absorbed an unprecedented amount of evidence and knowledge about health and wellness, yet disinformation has also spread rapidly. Why does this happen? How can we do it differently? What actions will it take to change course?

The next day we will put these questions to a panel of Jeremy Hunt MP, bringing a wealth of experience at the highest level in politics; Dr Ashish Jha, a foremost voice in medicine and public health in the USA where the challenges have been even more extraordinary; and Dr Alexandra Freeman, Director of the Winton Centre for Risk and Evidence Communication, who has been grappling with these issues for many years.

The future is already here

When we return on March 16 we will turn to the impact on health and health care. Professor Abigail Woods will tell us how extraordinary events like war and pandemics can transform the structures and relationships of health care for good, liquefying previously stable assumptions about how care can and should be provided.

Our panel of campaigners and senior doctors will discuss how promises and hopes about integrated and improved care that had become stuck in gridlock and endless consultations sometimes suddenly became true in the face of a crisis – and elsewhere remained stuck fast. What can we learn from that? How can we recreate the energy and sense of possibility without the appalling context, and without leaving people and services behind?

Are we the odd ones out?

As we draw towards a close, we will examine where Covid-19 has left the extraordinary institution that is the NHS. For years, we have noted how exceptionally centralised it is compared to global peers – something that may be reinforced further after the recent health and care white paper. During the pandemic, questions of central power and autonomy have become vital and immediate – with controversies over running testing and tracing as a separate top-down initiative, and yet the seemingly admirable power to roll out and prioritise vaccinations at a remarkable speed.

Professor Scott Greer will bring a truly international view as a leading expert on health devolution across Europe – and in particular in the UK’s devolutions of powers to Scotland, Wales and Northern Ireland, whose different paths during the pandemic have been so much debated.

I will then chair a panel discussion where we ask Sarah Pickup from the Local Government Association and Rob Sergeant of Optum UK for their perspective on the central/local tension in the health service, and how it has felt to be a partner of the NHS during this period. Layla McCay from the NHS Confederation will provide insight on other health systems, as well as the view from the NHS on how this tension could be better managed.

Bringing the best ideas together

It will be sad to miss the personal and intellectual intensity that comes from discussing these historic issues in person.

But the opportunity to bring in a wider audience to question, to react and to respond will give our discussions a breadth and a grounding in different realities that we could never achieve in a single room.

The Summit Series platform is now live, so please do register your place for what will be a unique and fascinating set of discussions presented in an exciting new way. I hope you will be able to join us.