Crisis, challenge and change: health services research and the COVID-19 pandemic

Author Helen Mthiyane
Posted 2020.03.30

HSR UK chair Kieran Walshe reflects on what the pandemic could mean for the future of health services research.


We are living through extraordinary and unprecedented changes in UK society. 

If anyone had suggested just a month ago that within weeks society would be in a near lockdown, that the NHS would be furiously re-engineering itself to deal with huge numbers of critically ill patients with respiratory problems, and that UK government would be spending hundreds of billions of pounds on a huge programme of financial support for workers and companies – they would have been laughed at for such apocalyptic predictions.

One immediate take-home message from the current crisis is that health research – in all its forms – is front and centre in finding solutions. Biomedical research on vaccines, clinical trials of potential therapeutics, epidemiological modelling of disease spread, and behavioural science and economic analyses of social distancing interventions are all playing their part. Politicians and the media have suddenly realised that experts are very useful, and that basing what you do on sound science rather than ideology is both the right thing to do and, politically astute.

Why research matters

Making sense of what’s happening – and thinking about what it means for the future of health and care in the UK – has always been a big part of what health services researchers and policy analysts contribute. At times of major change in the past – the purchaser provider split in the 1990s, the NHS Plan in the 2000s, or the Lansley reforms in this decade – we’ve been there to help policymakers, managers and system leaders to understand the policy options, use evidence as much as they are able to do so to make choices, and to evaluate the impact of health reforms.

But those past reforms pale into insignificance alongside the seismic organisational and societal changes that are happening right now, in real time, so fast that evaluating them is incredibly challenging. Much health research which is not COVID-19 related is understandably being paused – as clinical academics return to practice, research staff take on support roles, and everyone lends a hand.  

But, we should already be thinking about what and how we learn from this crisis. What does it mean for the way health services can be organised in the future? Which of the changes being rushed into practice now – like telephone triage, remote/video consultation, hospital reconfiguration, treatment pathway standardisation, professional role changes and retraining, and so on – will hold valuable lessons for the future after this crisis is over?

Why research networks matter too

One thing we at Health Services Research UK can do is to help bring the research community together – not just in the UK but with colleagues across Europe and internationally. We have taken the brave step of making our annual conference in July an entirely online/virtual event free to anyone to attend (something we have never tried before!). Find more details  in our events section. We hope that we will welcome to that conference loads of people who might never have come before.

We can also contribute by trying to spread and share ideas through our website – our regular newsletter will continue (sign up for free) and we will be posting blogs like this one regularly over coming weeks both from HSR UK board members and from others who want to contribute to these important debates (if you do, email us at with your idea and we’ll send you our style guide and details of the editorial process we follow).

Learning from history: paradigm shifts do happen

One final thought. I think it was Rudolf Klein who said that the British NHS was more than anything a product of the Second World War.  Before the war, the political consensus was for gradualist reform, building on the existing infrastructure of charitably run voluntary hospitals, municipal hospitals run by local authorities, national insurance, and the like. We might have ended up with a healthcare system that looked more like those of some European countries like Sweden, France or Italy. 

But the war forced the creation of the Emergency Bed Service, the virtual nationalisation of the hospital system, the creation at speed of whole new hospital facilities and structures, and the direct employment of many doctors and other healthcare professionals in public service.  By the end of the war, the political consensus had shifted decisively in favour of creating the NHS we know – nationally financed through taxation and organised and run by central government.

In its way, this pandemic may prove to be a similar turning point in British society – towards social solidarity and mutual support – and could have profound implications for future health policy.  Our NHS and social care system is could, in the long term, be very different as a consequence of this crisis.


Headshot of Kieran WalsheKieran Walshe is the chair of HSR UK. He is a Professor of Health Policy and Management at Alliance Manchester Business School and the Director of Health and Care Research Wales.