It was the PPP Foundation, now It is the Health Foundation, a healthcare research body out to spend £20m a year.Will its impact be as big as its wallet?

Published: 10/07/2003, Volume II3, No. 5862 Page 14, 15

A sleeping giant is about to wake in the world of healthcare research, one whose voice could have a profound impact on policy and practice development.

That the Health Foundation can expect to be so influential is down to a number of factors, but one above all - money. It expects to spend up to£20m every year, a sum which dwarfs funds at the disposal of more well-established healthcare research organisations such as the King's Fund.

Few will have heard of the Health Foundation - hardly surprising as it was born only yesterday. Before that it had been known as PPP Foundation, created in 1998 following a gargantuan£520m endowment released by the sale of the PPP Healthcare Group. For five years, the foundation struggled under the name that suggested either a close link to private medicine or the private finance initiative.

As chief executive, Stephen Thornton, better known to most HSJ readers for his five years as head of the NHS Confederation, says: 'The first half of any conversation was about what we were not.'

Following its rebirth, the Health Foundation is looking to raise its profile significantly, to move beyond its role as a traditional grant-making body to an organisation which is 'active in the policy arena'.

Does a move into the policy world signal that the foundation will be taking a stance on the big healthcare issues of the day?

Mr Thornton says it will 'rigorously defend its independence' and would not want to be 'thought of as an interest group which comes from a particular constituency'.

'We want to be judged on whether our research is based on a sound assessment of the evidence, ' says Mr Thornton, adding that too much current policy research has, 'fairly scant regard for evidence, often making do with a quick look at the literature, perhaps'.

The foundation is determined not to become a 'rent-a-quote', reacting to the hot issues of the day. Its research will focus on 'the medium term' and on 'policy areas with legs'.

Instead of commentating on individual government initiatives, Mr Thornton says the foundation will instead seek to explore the broader context of issues such as patient choice, perhaps using international experience to better interpret the government's plans.

However, occupying the ivory towers of independence is hard if you want to produce research which has meaning in the real world. On some issues, there simply is very little middle ground.Where does the foundation stand, for example, on the public/private debate?

'My implicit understanding, ' says Mr Thornton, 'is that to a man and woman on the [foundation] board, the view is that publicly funded healthcare is the right approach. But There is also a considerable degree of pragmatism about how and who delivers the care.'

The foundation's board also has 'a high proportion of members who are not from the world of medicine'. People who, in Mr Thornton's words, 'are challenging about consumerism, choice, the role of patients and [health] information for the public'.

The foundation has set out five research priorities, partly based on a survey of leading opinion makers.

The first is leadership.

'The big question is the link between good leadership and healthcare outcomes.We want to ask some fundamental questions about investment in traditional leadership development programmes. There is a great deal of money being put into this area, but just how evidencedbased is it?'

The second priority area is 'performance and quality improvement', particularly the need to get clinicians to understand, then lead, service improvement.

An end product of work in both areas should be more clinicians entering management.

'The majority of people in the NHS who have the potential to make a disproportionate difference for the better are from a clinical background. A large number of clinicians who have the potential to lead have been put off management. I remember the heady days of the internal market when quite a lot of doctors came over to management - but that interest has not been sustained.

'This is dangerous - because it leads to a fithem and usfl approach and means we are losing the people who can make the most difference, because they inhabit both [clinical and managerial] spheres. It also creates over-reliance on lay managers at a senior level.'

The third key area is primary care commissioning.Mr Thornton believes this had 'always been neglected' and that the risk of that neglect is much greater in a system in which you have a plurality of providers.

Fourth on the foundation's checklist is the empowerment of patients and what might be done to fundamentally change the relationship between the clinician and the patient.

The last priority is the 'incentives'used to drive healthcare reform, particularly the 'quasi-market dynamics' being introduced into the NHS.

Mr Thornton notes that many developed countries are experimenting with the introduction of market dynamics, even those with a long tradition of state control.

In the UK, he believes, the whole trend has not been properly communicated.

'Perhaps That is because we have a government which doesn't want to be accused of too strongly endorsing a market approach, ' he comments.

'Certainly the subtle wording they've used has done little to aid clarity.' l