Health and health services: The next 20 years

Looking forward, looking back: a competition for tomorrow’s leaders

In June 2012, Finnamore turned 20. To celebrate, they hosted a competition inviting aspiring leaders to define “what success in health and health services will look like 20 years hence”. The competition was judged by Sir David Nicholson, Mike Farrar, Alastair McLellan and Bruce Finnamore, and the winning paper was published in the HSJ on 17 January 2013. But neither the story nor the journey ended there.

Fresh minds and the voice of experience

To foster the innovative thinking encouraged throughout the competition, all shortlisted candidates were invited to an informal debate with some of today’s most eminent healthcare leaders. The ideas generated during this dialogue demonstrated a shared passion for building a world-class health and social care system, driving a lively discussion in which the vision of tomorrow’s leaders met with the voice of experience and realism. Ideas emerging from this debate are set out below, under three key themes: technology; integration; and patient empowerment.

‘The whole experience has given me much to think about and has certainly inspired me - I would highly recommend the opportunity to other junior clinicians’

Eleanor Southgate, Diploma in Tropical Medicine and Hygiene Student, Liverpool School of Tropical Medicine

A shared vision of how health’s future might look

1. Technology

In twenty years, personalised medicine will have become the norm. Gene sequencing technologies will be cheap and readily available, with data being used to underpin personalised medicines. We will have better information about which treatments work for which patients and the ability to target specific cells and illnesses will have developed to its full potential. This will be supported by earlier identification of disease using biomarkers, with personalised preventative care packages being developed based on gene sequencing. Whilst delivering significant benefits, such personalised health forecasting will require management of citizens’ awareness of their genetic predisposition to specified illnesses in advance of symptom onset.

Information technology often struggles to live up to transformational aspirations. However, by 2032 virtual care or telehealth will rival face-to-face presentation as the leading form of clinical engagement. People will work globally, with connected virtual services across geographic areas and time-zones creating a national and international network of super-specialists that will enable people to access the best quality care regardless of location. Elderly patients may continue to experience challenges using remote technologies, but the normalisation of digitalised remote consultations for many patients will free up clinical resource to enable more direct intervention with patients who are less technologically able. For those who can navigate remote consultations, the need to see a doctor in person will become the exception; for those who cannot, face-to-face consultation resource will be released.

Near patient testing will also characterise healthcare twenty years from now, with test analysis increasingly being performed at hospital bedsides, in clinics, in shopping centres or by patients themselves at home. The more accessible near patient testing becomes, the more affordable it will be, meaning that tests will be ‘bundled’ together to screen for multiple outcomes simultaneously. As well as harbouring significant advantages, this will also require management of risks relating to over-analysis using indiscriminate “cheap diagnostics”. Home diagnostic equipment will interface directly with implanted technologies or with pocket devices, enabling patients to hold their own personal data and to walk into a shopping centre to purchase care without the need for GP diagnosis or referral.

2. Integration

Service integration, particularly between health and social care, will have become the norm by 2032. Care will be organised around population groups, with providers having a joint remit to improve outcomes for every patient within the population for specific conditions, diseases or need profiles. Joint capitated budgets will have become the norm, with health and social care providers receiving a joint fee per patient. The move away from an organisation-based financial model and towards a “price per patient” model will mean that “joint investment, joint reward” has become the standard by 2032. Budgets will be pooled for an individual’s lifetime, not for discrete episodes of care, with primary and secondary care risk sharing meaning that providers will be rewarded on how well they jointly keep people over the course of a lifetime.

Integrated health informatics will underpin integrated services, and the next twenty years will see a data revolution, which will leave behind today’s data sharing challenges. By 2032, individuals will own their own healthcare data, keeping a personalised health and social care record which will be readily accessible to all service providers for planned and emergency care.

3. Empowerment

In twenty years, patient empowerment will have become a reality - the system will move around the patient, rather than the patient moving around the system. Personal accountability will be a mainstay of the healthcare landscape, with individuals having the tools and support they need to manage their care and being rewarded for maintaining or improving their own health outcomes.

In addition to preventative empowerment, patients will have more visibility and power within the NHS system of care. Patient leaders and patient advocates will be a routine presence within the NHS, not only helping peers to navigate the health system, but also educating peers about how to take control of their own care. The NHS will have developed a core role in training the community to care for the community, developing a national health training infrastructure for community and home-based teams. This will be particularly powerful for long term conditions management and complex conditions. Furthermore, access to personal health records will be complemented by access to information about the service landscape, enabling individuals to take responsibility for the care they choose and to ensure its delivery aligns with their requirements and their rights.

The role of leadership

The health system in twenty years’ time will be a place where today’s intelligent solutions and technological innovations have been exploited to their full; where multiple providers share responsibility for keeping populations healthy; and where the individual plays a leading role in his or her own health management. Getting to this future state will require a new way of doing things, a leadership that encourages transformational change, and potentially a new pool of leaders whose skill sets reflect the challenges of the new health and social care landscape.

‘This was a unique opportunity to explore some of today’s really pressing health challenges with a room full of fresh minds - we all learnt from sharing our unique perspectives and ideas’

Tony Bell, Chief Executive, Chelsea and Westminster Hospital NHS Foundation Trust

Leading up to 2032, leaders will increasingly require skills to work across organisations and services, with a focus on delivering the overall vision of the system, rather than that of discrete organisations. Whilst general management may continue to provide a rich pool of talent, leaders may increasingly come from clinical routes in the future, applying frontline experience of service delivery to shape the future landscape of provision.

The potential held by today’s leaders is to give power to the innovators - to drive through evidence-based medicine but also to legitimise a degree of trial and error, and to sanction an exploratory approach to development that draws upon the dynamic and nimble approach to adaptation displayed within, for instance, military health. It is this same ability to adapt and change that today’s leaders can demonstrate, leading the NHS into a new era of responsiveness to be inherited by the enthusiastic health minds that are emerging from discussions such as this one.