Should we bother about the future? If so, how much? Introducing Shaping Health Futures…

We’ve all been to futures meetings. You know the flavour – part geeky, part management consultancy, part utter fiction. They are almost always removed from what seems to be the real day job; a day out that’s frequently fun but often doesn’t add up to much. Glossy, unusually named publications with utopian/dystopian scenarios get shelved and then binned. In any case the only thing we know about the future is that it is unpredictable, right? So why bother about it?

But is the alternative to think in the present and design strategies with only a passing glance to the future? In the NHS this is not unusual. It’s not just that the day job crowds out the future, or that budgetary and planning timeframes are short, making longer term investments difficult at best. Or that 'we have a plan already, it’s called the NHS Long Term Plan' and we just need to implement it. There may also be an implicit view that you get to the future better through small proximal steps in near-time, rather than grand designs stretching into the future that could be, well, plain wrong. Why take the risk?

The modest response to this is that in the NHS strategies are written all the time, looking 3-5 years out, and it would be odd to think that the existing effort couldn’t be made more effective. The strategies developed by the national arms-length bodies in health care all look perfectly respectable, but insofar as they do look at the future, their approaches are highly variable. The time horizons the strategies cover vary, as do the issues discussed, the trends examined and the data sources used. The timing of strategy development by similar bodies is inconsistent, and there is varying reference to each other’s strategies or common resources across government (or other governments). Understandably there is group think.

The less modest response is that health and care is at the centre of some strong external headwinds. Changes in the population, society, the economy, technology, politics, information, the environment and other areas continue to interact in complex ways to affect health and care. We need to join the dots more than we are currently doing. And while the future is complex and uncertain, it is not predetermined. In many areas policy decisions taken (or not taken) today will shape health and care in the future, for better or worse. The sooner we get to grips not just with the known knowns, but the known unknowns and unknown unknowns, and how they all might interact, the better we may be able to shape today’s strategies.

Let’s break that down into three questions.

1. How can we understand more fully what might happen in the future (understanding that futures thinking is not always about predictions) that could affect health and care, from climate change to democratic change to quantum technologies?
2. What might be effective ways of doing this in an ongoing way, not through one-off big set piece futures events that seem dissociated from normal business?
3. How best to weave this information meaningfully into today’s strategies for health and social care, and iterate through time?

How do others do futures?

As the Health Foundation report Shaping Health Futures shows, various approaches have been developed to help decision makers do all of the above, developed in governments across the world, and in commercial organisations.

• In Germany, the Federal Ministry of Education and Research has a cyclical foresight process for looking 15 years ahead.
• In Finland, the Prime Minister submits a 'Report on the Future' to parliament once in a government term, presenting strategic policy issues for the next 10-20 years, supported by government departments and a parliamentary Committee on the Future.
• Japan runs a national foresight process for science and technology every five years.
• Long-term planning has been core to Singapore's approach to policymaking since 1965, with a focus on 'anticipate change, stay relevant'.
• Quite a number of countries use innovative ways to try to access diverse perspectives from the public.

How does the UK do futures?

The UK government has also had significant form in this area, in particular in the Ministry of Defence and the Government Office for Science. And clearly work occurs in the devolved nations and regions in England, and at regional and local level.

• For example, the Welsh Assembly Government in 2015 passed the Wellbeing of Future Generations Act – a legislative framework requiring public bodies to 'ensure the needs of the present are met without compromising the ability of future generations to meet their own needs'.
• Some cities have developed long-term plans, including One Planet Cardiff 2050, Glasgow 2011–2061: A fifty year vision for the future, and Newcastle City Futures 2065.
• Within the NHS, strategy teams in national level arms-length bodies are variously active. There is certainly action, but it is not consistent, is diffuse, and often fragmented.

How should we do futures?

The question is how can all this effort and learning from the UK and beyond be put to better use for the benefit of the health and care system? And the killer question, if so how much is enough? (aka what's the impact for the effort involved?)

Paradoxically now is a good time to be examining this. On the one hand, close to home the NHS has its Long Term Plan to be getting on with, so there is space to think about strategy. On the other, recent events and current trends such as populism, climate change, disinformation on social media and rising emotional disorders in teenagers are showing how these forces are affecting health and care now. They are likely to do so even more in future and their potency may well be in their synergy, more than their individual effect.

Our new programme

To help find answers the Health Foundation is starting Shaping Health Futures, a new programme of work stretching over two years. We aim to provide new thinking and analysis on some of the key issues shaping health and care over the next 10–25 years, and test the methods and approaches that can be used to do this, to support policymakers in an ongoing way. We’ll be working with a group of senior policymakers over 18 months to do this, carrying out deep dive analyses into key issues and emerging trends, and hosting a series of events to chew the cud on some key (and some left field) topics.

Dr Jennifer Dixon (@JenniferTHF) is Chief Executive of the Health Foundation

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