NHS specialised services provide care for people with complex or rare medical conditions. Treatments for these conditions are often expensive: While specialised services support a small proportion of the population, approximately one-sixth of the total NHS budget - over £19 billon - was allocated to this area in 2019/20.

The reports published here, address two important and enduring questions about specialised services:

Early in the Covid pandemic, it became clear that people’s mental health would suffer. Whether through bereavement, unemployment, social isolation, not being able to access support services – or a host of other routes – an alarming picture began to emerge and attract attention.

Promoting whole-system action on the wider determinants of healthy life expectancy in the shadow of the COVID-19 pandemic

Health and care services get just one opportunity to support people at the end of their life. When this support is compassionate and appropriate, unnecessary suffering can be avoided and grieving can be eased. When this is not the case, harm and distress can result. The difference in these experiences can be profound.

Anchor institutions are large, typically non-profit, public sector organisations whose long-term sustainability is tied to the wellbeing of the populations they serve. They also have a significant impact on the health and wellbeing of their local communities.

During the COVID-19 pandemic we have seen rapid changes in ways of working. We have seen an increase in collaboration, particularly through digital platforms, the sharing of data, and people describing ‘true system working’.

So how do we capture innovations and changes in practice? How do we learn from them? How to we identify what should be continued and what should not? How do we sort promising, effective changes from those that are ineffective – or even potentially harmful?

Barriers to accessing mental health care during pregnancy and the first postnatal year (perinatal period) seem to be greater for ethnic minority women.

Working with the national collaboration to coordinate covid-related analysis, and the NHSE/I Midlands region, the Strategy Unit has produced a ‘systems dynamics’ model of waiting lists for planned care. The model is freely available for non-commercial use across the NHS. Here, Steven Wyatt and Mike Woodall explain what we did and how we did it.

The COVID-19 response required rapid change and innovation across health and care. As part of a wider package of evaluation support, from April to June, the Strategy Unit led some qualitative work (training and supporting CCG staff to conduct interviews) across an STP to capture learning from primary care (primarily PCN clinical leads) and community nursing leads about their experiences. The interviews explored the rapid move to total triage, video and online team communications, changes to day-to-day practices, working with care homes and their views on the backlog and unmet need.

This local decision-making framework aims to empower systems as they look to design new contracting approaches aimed at improving outcomes.