The NHS at 75: How research and policy shape healthcare in the UK

This week marks 75 years since the founding of the National Health Service (NHS). The NHS is a cherished institution in the United Kingdom, and is considered by many as the backbone of British society, providing free, universal healthcare to its citizens. According to a recent IPSOS survey, the NHS is what makes people most proud to be British.

On this anniversary, we’ve been reflecting on how research and policy intersect in the field of healthcare. The influence of research institutions and funding bodies cannot be understated, as policymakers strive to create evidence-based policies that ensure the delivery of quality healthcare to all. So, in this we explore how policymakers use research to create health policy, based on data from the Overton app. 

The Complex Process of Policy Formation 

Developing healthcare policies in the UK is a multifaceted process, encompassing several stages and engaging various stakeholders. Healthcare provision is devolved, with policy-making responsibilities in Wales, Scotland, and Northern Ireland resting with their respective administrations.

Collaborative Efforts in England

In England, healthcare policy-making is a collaborative effort between the Department of Health and Social Care and NHS England, with input from healthcare professionals and academics. Once approved by Parliament, the responsibility for policy implementation lies with NHS England, in partnership with local NHS Trusts. At the local level, NHS Trusts play a pivotal role in translating overarching policies into actionable initiatives tailored to their specific regions. Other bodies which influence healthcare policy include NICE, an independent executive non-departmental public body in the United Kingdom. It provides evidence-based guidance and recommendations on health and social care interventions, technologies, and treatments. NHS Clinical Commissioning Groups (CCGs) are organisations within the NHS in England that are responsible for planning and commissioning healthcare services for their local populations.

Research Institutions Influencing Policy

Using the Overton app, we explored which research institutions exert influence on healthcare policy in England and the wider UK. We looked specifically at policy from NHS England, for simplicity, excluding documents from places like the NHS Clinical Commissioning Groups or individual hospital trusts who might have their own policies. Among policies which we have sourced from the main NHS England website, the most commonly cited research institutions are University College London (referenced in 389 policy documents), University of Bristol (261), and University of York (243). The breadth of topics covered in policies referencing research from these institutions is wide, ranging from the social determinants of health to innovative cancer screening strategies. This demonstrates the significant influence that research from diverse disciplines can have on shaping healthcare policy.

Scotland's Approach

Policies sourced from NHS Scotland most frequently cite the University of Oxford (33), University of Edinburgh (25), and Imperial College London (24). Although the numbers are relatively smaller, they suggest that Scotland tends to reference local institutions in their healthcare policies to a greater extent. This trend is observed globally, as administrations often favour research conducted within their own countries.

Funding and Political Climate

The research cited by policies sourced from NHS England is predominantly funded by government bodies or programs such as the National Institute for Health Research (NIHR) (751), the Health Services and Delivery Research Programme (HS&DR) (422), and the Medical Research Council (MRC) (157). This indicates that the political climate has significant implications for healthcare research, as governments set priorities and allocate medium-to-long-term project funding accordingly.

NHS Long Term Workforce Plan

In exploring healthcare policy in the app, we were interested to discover the recently published ‘NHS Long Term Workforce Plan’, published by NHS England and indexed by Overton here. This policy document has been heralded as a once in a generation overhaul of how the NHS is staffed. It lays out strategies to combat the strain on the NHS, which is unlikely to ease without dramatic action, as the average age of the population continues to rise. 

Some steps outlined in the plan include the doubling of medical school places by 2031/2, improvements to the NHS Pension Scheme and administrative automation to free up clinicians time. Whilst these all have the potential to be valuable changes, the plan is high-level with little discussion of wider implications and so raises a number of questions. How will the university sector, which is still facing widespread strikes, be supported to facilitate expansion of medical school places? What does improvement to the pension scheme mean in material terms? 

While the recentness of this document means that it’s not currently cited anywhere else, it seems likely to elicit a response from policymakers and researchers in the field, given the significance of the issues. Of the ten scholarly articles cited in this report, eight of them are also already cited elsewhere (many of these in government policies) signalling that they’ve relied on ‘trusted’ sources. Indeed, much of the evidence is produced by familiar names in the UK healthcare sector such as the General Medical Council and Health Education England with some well known researchers also appearing, for example Chris Whitty (the Chief Medical Officer for England). 

One particularly highly cited paper is this PLOS One published article 'Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review'. It’s referenced in 23 policy sources worldwide, and explores how healthcare workers’ experience of work affects their patients. It’s cited in work from IGOs like the Organisation for Economic Co-operation and Development (OECD) and the World Health Organisation. Perhaps many of the issues affecting patients and medical professionals over the world are comparable, despite the different healthcare systems, economies and cultural contexts?