‘So, what are you going to do?!’ That is probably the question I’ve been asked most since starting as the Health Foundation’s Director of Innovation and Improvement, eight weeks ago. It’s a bit unusual, too, given that usually people know exactly what you’re going to do in your new role. But this is a time of change, for us as much as for the world around us. We are in the process of developing our strategy and plans for the next 3 years, at a time when health and care services are faced with an uncertain economic and political outlook, with intense pressure to recover from the pandemic.   

These two things coming together is partly just a coincidence of timing, but it raises an underlying, bigger question too. How do we build on our work so far, and evolve our approach in this period of post-pandemic crisis?  

I want to share some early reflections on this question with particular focus on our work in innovation and improvement, based on my conversations with colleagues and stakeholders so far. 

Bringing tomorrow to today 

The health and care system faces significant challenges today – workforce, funding, long waiting times and lists, and rising demand with a lot more need than the system currently supports. Naturally, these urgent pressures take up most care staff, manager and leader (not to mention political and media) attention.  

In contrast, when we talk about improvement, we often talk about developing the underlying capabilities for improvement, from data to culture. The problem is, these things take time, and it is time we can barely afford.  

Of course, one of the Health Foundation’s unique contributions is a long-term view, across financial years and spending reviews. But that doesn’t absolve us of the question of how our work is relevant to today’s operational pressures, not least to gain traction with the busy working lives of health and care staff. This isn’t an easy balance, and we must continue to adapt to ensure our support helps make a practical difference – both by investing in building tomorrow’s capabilities and by demonstrating how they make a difference today.  

Innovation vs improvement 

Over the last decade, and accelerated by the pandemic, a new paradigm has also entered into health and social care discourse. It says that to ensure an affordable system for the future, ever-growing efficiency and effectiveness (while important) is not enough. There is also a need for a significant change in care models, supported by new technologies, data and innovation.  

This contrasts with a perception of efforts to establish a culture of improvement, seen as focused on incremental change, improving the processes in place today. But thinking of improvement and innovation as being in opposition in this way is a mistake, and risks alienating the health and care staff at the forefront of implementing changes. Yes, significant change in most industries has come in moments of disruption (technological or otherwise), and the pandemic has shown that this may be the case for health and care services too. But no such change has been sustainably embedded without detailed diagnosis of existing systems and refinement of the resulting new processes and ways of working. And as anyone in tech will tell you, ongoing user-centric data, feedback and design are the key to great customer-facing products. Both of these points are, of course, the hallmarks of successful improvement approaches. The right approach to innovation and improvement is to evolve them hand in hand, and our strategy needs to take account of this. 

Demonstrating the future 

So we need to think about the relevance of our work, and how it achieves the transformative change the system needs. This raises another question. What does this future of health and care services that we want to help to bring about look like?  

There is a bit of blue sky thinking to this, imagining the world in 2050. The arguably trickier aspect is how we can help realise the first steps towards new models of health and care that take us from today to the beginnings of tomorrow. Not how to build more virtual wards (important as they are), but to demonstrate aspects of a new approach to care at home and in the community (of which virtual wards are just a first step). I believe that we have a contribution to make in this space, drawing on our expertise across improvement, evaluation and sharing learning, and also potential funding for developing solutions with partners that would struggle with a traditional business case. This is experimental, no doubt, and holds more risks. It’s certainly also worth exploring. 

New partnerships 

Which brings me to my last reflection. With the introduction of integrated care systems (ICSs) in England, a new group of stakeholders has entered the picture. (In Scotland, Wales and Northern Ireland this more integrated way of working has been in place for a while, and much can be learned from it.)  

It provides an important new perspective for how to think about improvement and innovation across organisations in a local area, how to collaborate to demonstrate future care models, and how we can help scale them across a region. What would it take to spread a new approach in primary care, say, from 5% of an ICS region to 40%? (This doesn’t mean moving to a purely localised agenda – after all, the new approach may have come from elsewhere, and learning across places and regions will remain essential.)  

Alongside this, the majority of organisations driving technology and data innovations right now are private sector companies, start ups or research collaborations. To maximise their potential benefits for health and care services and their recipients, we should explore working with them too. (Of course, to the benefit of all, not a particular company.) This, too, is new for us, but holds exciting opportunities. 


To come back to my original question. The role of the Health Foundation in a time of post-pandemic crisis resolutely remains to bring about better health and health care for people in the UK – but how we do this (as well as the tools and methods we use, and programmes and partnerships we offer) will have to continue to evolve and adapt.  

I would love to hear your ideas and feedback to help with our thinking over the next few months.  


Malte Gerhold (@Dr_Malte) is Director of Innovation and Improvement at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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