Healthcare System Futures

2016 Scenarios take shape

2011-09-22T07:52:00.000-07:00

The Healthcare System Futures 2016 scenarios are taking shape (and will form the basis of one set of stimulus materials for my session at next week’s eyeforpharma Engage with the new NHS conference on 27th / 28th September in London).

Here is the scenario grid that I have developed, and below the emerging stories:

The rise of the health consumer

Patients are able to exercise choice and readily do so, supported by their healthcare professionals. The health care system – including the NHS – increasingly recognises their pre-eminence as consumers.

The QIPP agenda to promote quality, innovation, productivity and prevention has been very successful, so the pace and scale of innovation in the healthcare sector has been rapid and significant.

The rate at which provider organisations are able to effectively respond to the evolving commissioning landscape has been positive leading to more choice of better services against increasing patient / consumer demand.

Where personal wealth allows, patients are willing to pay directly for / "top up" their healthcare.

New and existing players are actively seeking to expand their influence and the services they provide to meet growing demand driven by innovative commissioning and greater evidence of patients exercising choice.

Any takers?

Patients are generally unable or unwilling to exercise choice despite effective implementation of new commissioning arrangements. Even with the’ development of consumer capacity within the healthcare system, there is little confidence that the ability to exercise genuine choice is a reality.

The QIPP agenda to promote quality, innovation, productivity and prevention has been very successful, so the pace and scale of innovation in the healthcare sector has been rapid and significant.

The rate at which provider organisations are able to effectively respond to the evolving commissioning landscape has been positive leading to more choice of better services, but patient driven demand has been limited.

Patients remain reluctant to pay directly for / "top up" their healthcare, feeling that the original principles of public healthcare provision in the UK should remain in force.

New players are reluctant to enter the market due to evidence of limited choice being made by patients.

It’s all too much

Patients are generally unable or unwilling to exercise choice, a situation exacerbated by poor and ineffective implementation of new commissioning arrangements. There is no confidence that genuine choice will become a reality.

The QIPP agenda to promote quality, innovation, productivity and prevention has largely failed so the pace and scale of innovation in the healthcare sector has been very limited.

The rate at which provider organisations are able to effectively respond to the evolving commissioning landscape has been very limited as commissioners struggle to adopt to the new commissioning arrangements. However, patient driven demand has been limited so there has been limited patient backlash.

Patients remain reluctant to pay directly for / "top up" their healthcare, feeling that the original principles of public healthcare provision in the UK should remain in force.

Given this backdrop, new players have not entered the market.

Broken promises

Patients are aware of their ability to make choices in the treatment they receive in theory, but find the reality very different. Poor and ineffective implementation of new commissioning arrangements has been identified as a major hurdle in promoting choice which is giving rise to an increasingly frustrated patient population.

The QIPP agenda to promote quality, innovation, productivity and prevention has largely failed so the pace and scale of innovation in the healthcare sector has been very limited.

The rate at which provider organisations are able to effectively respond to the evolving commissioning landscape has been very limited as commissioners struggle to adopt to the new commissioning arrangements. However, patient driven demand has been high and tensions are rising amongst the public as the health service is roundly criticised for not meeting demand.

Where personal wealth allows, patients are willing to pay directly for / "top up" their healthcare to ensure they get the care they think they deserve.

Given this commissioning backdrop, new players have not entered the market.

If you want to get involed in this work or want to know more, contact me via the informing choices website.

2016 – Drivers impact and uncertainty plot

2011-09-16T02:37:00.000-07:00

Building on the work to introduce Journey Scenarios - scenarios to explore an interim point on the journey to 2030, I have looked at the drivers for the longer term work, added or revised some of the drivers, eliminated others and assessed them for impact and uncertainty against the guiding questions and a five year time horizon.

As a reminder, the guiding questions are:

How will the UK’s healthcare system manage the tension between the cost of care, the quality of care and the engagement of patients, carers and the public generally in 2016 / 2030?

What are the implications for providers and consumers of care over the next 5 / 20 years?

While the summary scenarios are taking shape – and I should be in a position to share these soon – here is the underpinning impact and uncertainty plot:

Don't forget, contact me if you have any questions, comments, you'd like to know more about this work or explore how we can support your own strategic futures work.

2016 interim scenarios – the two critical drivers

2011-09-07T03:35:00.000-07:00

The ability and desire of patients to exercise choice and the pace and scale with which effective commissioning arrangements are implemented are the critical drivers of healthcare over the next five years and so will form the basis for the development of the interim scenarios.

More soon.

Contact me for more information or to get involved.

Changing the blog title

2011-09-07T03:30:00.000-07:00

Given the last and my next post, I have decided to broaden the scope of the work to explicitly include observations about possible interim futures on the way to 2030.

So the blog loses its "2030" tag and becomes: Healthcare System Futures.

The Journey to 2030

2011-08-31T07:44:00.000-07:00

Stakeholders in healthcare are telling me that they are very much focussed on the near term, and while the long-range future is interesting and strategically important context for their long term planning, they just don’t have the organisational ability to focus there right now.

That started me thinking about the journey to 2030, and so I have taken the 20 year drivers and looked at what could be relevant over the next five years.

It’s still early days in this new piece of analysis, but the key issues look to be the economy, the dynamic between commissioners and providers in the context of health reform, the tension with and within the QIPP agenda in seeking innovation and efficiency.

I’m playing around with these drivers with the aim of creating some scenarios lite as a set of milestones between now and 2030.

If you have any comments or would like to get involved, contact me.

Second scenario available as video presentation

2011-05-11T08:26:00.000-07:00

Having made Who Chooses, Wins available as a video presentation, it made sense to look at National Hell Service, so here it is:

As I mentioned in my last post, I have added a few more drivers and re-assessed them so that analysis will be available soon. If you want to know more, contact me via my website, LinkedIn or Twitter.

Healthcare System Futures goes Audio / Visual

2011-05-10T06:26:00.000-07:00

As the scenario work has evolved, I have looked at different ways to share the information. So in addition to this blog and the Sharpcloud Roadmap model, I have also created a You Tube video, and here it is:

I have also added a few more drivers and re-assessed them so that analysis will be available soon.

What's interesting is that I am noticing an increase in interest in strategic futures work in health care. So if you want to know more, contact me via my website, LinkedIn or Twitter.

What’s next?

2011-03-24T03:37:00.000-07:00

With a little help from some friends, I have developed some scenario stories concerning POM to P switch and the use of nanotechnology in healthcare.

In both cases a global context / basic assumptions were developed for the issue, from which four stories relating to each scenario were written. You can see how these stories look by browsing the Healthcare System Futures 2030 roadmap.

Further supplementary work has suggested that the following areas would be interesting to follow up on:

Longevity
Demographic change
Payers / Commissioning and delivery
The regulatory environment

Contact me for more information or to get involved.

Stakeholder Sharpcloud models bite the dust

2011-03-24T03:18:00.000-07:00

In a number of the posts in this blog, I have mentioned the Stakeholder Models. These models ran alongside the main Healthcare System Futures 2030 roadmap and were designed to collect stakeholder perspectives on each scenario.

Because there were no dynamic links between the Healthcare System Futures 2030 model and the four Stakeholder Models, adminstration - as new driving forecs were added, for example - was a nightmare! Coupled with that, a number of new features have been added to the Sharpcloud application that helps to share these issues witihn the original model.

Given that, I have removed the Stakeholder Models so the links from previous blog posts will no longer work. The Healthcare System Futures 2030 roadmap remains in place and continues to be publically accessible.

Emerging Questions

2011-03-03T07:51:00.000-08:00

As this futures project progresses, a number of questions about demographics and society, healthcare product and service suppliers, the impact of climate change and technology have started to emerge.

I'm confident that others will come to the fore as well, particularly when specific issues are raised within the contecxt of the scenarios or even simply the existing driving forces.

Here are the current emerging questions:

Demographics and Society

What will the impact of increasing healthy life years be on society?
How does the dynamic between health and life span change?
How will the Birth, Health, Illness and Death system evolve?
How will the causes of death change over the next 20 years?
If death becomes elective, what does that mean for the health?

Healthcare Service and Product Suppliers

Who are the new players and industry sectors that will move into the health sector?
How will the Birth, Health, Illness and Death system evolve?

Impact of Climate Change

How will diseases migrate as a direct result of climate change?

New Technology

How will technologies to halt degenerative conditions be brought to market?
How will regenerative health technologies be brought to market?
What is left for pharma to discover?

If you are interested in knowing more about this project or getting involved, contact me.

Scenarios Development – Update

2010-12-15T06:32:00.000-08:00

The work on this projects continues to progress; albeit it slowly. Thanks to a very fruitful session with a former colleague, I have refined and added to the driving forces and futures events. Having looked again at the base model, I have also consolidated a number of future events and extended the descriptions of others to broaden their reach; the aim being to maintain a broad perspective on the healthcare system and associated environment in 2030.

As a follow up to this work, I have started to look at stakeholder stories for each of the four scenarios, to describe the impact of each world on the stakeholder. More on those as they develop.

In the meantime, here is the latest Impact / Uncertainty Plot.

Here are the latest – slightly tweaked – scenario overviews.

Who chooses, wins

This world is characterised by a buoyant national economy - the policy of prioritising debt clearance in the early 10’s reaping benefits - and by a growing sense of consumer power and consumer rights on the part of patients and the public.

There is a range of innovative public and private sector providers operating effective and efficient services to a receptive market. Who chooses, wins is the media induced mantra.

The consumers – motivated by the choice agenda from the 90’s and 00’s – are more informed than ever before and exercising their choice. Clinicians have embraced the prospect of informed patients, in part through the necessity to be competitive in attracting their consumers.

The programme to improve efficiency back in the mid 10’s was successful and provided scope for funding to be re-directed to innovative products and services. New biotech and nanotechnology products are revolutionising treatment of both chronic and acute conditions.

Breakthroughs in the diagnosis and treatment of Alzheimer's disease, paralysis and heart disease have been instrumental in improving the health of the nation, and in preventing 70’s and 80’s children dying before their parents.

Improving health into later years has allowed the older population to continue to work and fund their increasingly adventurous leisure activities.

National Hell Service

This world is characterised by a struggling national economy - the recovery in the 10’s never really happened - and apathy regarding consumer power and choice on the part of patients and the public.

The double edged sword of increasing demand and lower funding for health services has hit patients and providers hard, with mortality rates increasing rapidly. There is disillusionment with the state of the public health services as all the progress made at high cost to the economy during the 00’s has been reversed with round after round of funding reductions.

New players that had started to come into the Health Service market have withdrawn, adding to the burden on the NHS which the media has dubbed the National Hell Service. Innovation in products and services introduced and promised during the boom times have stalled and many have been reversed. Health insurance has become very expensive leaving the market available only to those with high disposable income.

There is extreme polarisation between those that can afford to fund their own healthcare and those that have to wait for sub-standard care. Health tourism for those that can afford it is growing significantly but any problems for the patient on their return to UK that are treated in the NHS cause resentment on the part of those on ever expanding waiting lists.

A generation of 70’s and 80’s children are dying before their parents.

Choice, what choice?

This world is characterised by a struggling national economy - the recovery of the 10’s never really happened – but by a growing sense of consumer power and consumer rights on the part of patients and the public.

The consumers – motivated by the promise of choice agenda from the 90’s and 00’s – are more informed than ever before but increasingly frustrated by the inability of the health service than to meet their expectations, claiming Choice, what choice?

A sense of being dis-enfranchised has led to regular demonstrations about access to care as services are cut in response to the poor economic health of the nation.

Innovation in products and services has stalled and despite there being an interested consumer base, the economics don't stack up and providers (existing and new) are struggling in the current financial climate to generate enough business within an expectant market. New biotech and nanotechnology products have trickled onto a depressed market and are failing to live up to expectations as a result. Global manufacturers and being ever more selective into which markets they launch their products, and the UK is missing out.

This hasn’t stopped health tourism becoming the option of choice for those that can afford it. But, any problems for the patient on their return to UK that are treated in the NHS cause resentment on the part of those on ever expanding waiting lists.

NHS Inc.

This world is characterised by a buoyant national economy - the policy of prioritising debt clearance reaping benefits – but apathy regarding consumer power and choice on the part of patients and the public.

Consumers never bought back into the choice agenda after national debt clearance policies of the 10’s reversed the momentum built up over the 00’s. The public health service is therefore built on the premise that the gatekeeper clinician prevails and it is he / she that directs patients to preferred providers.

New players have struggled to enter a market that is dominated by assertive public sector providers who have sewn up their local markets through effective collaboration across the sector. It’s NHS Inc. New biotech and nanotechnology products are revolutionising treatment for both chronic and acute conditions and the NHS is willing partner in getting these outcome priced treatments to patients.

Breakthroughs in the diagnosis and treatment of Alzheimer's disease, paralysis and heart disease have been instrumental in improving the health of the nation, and in preventing 70’s and 80’s children dying before their parents. Improving health into later years has allowed the older population to continue to work and fund their increasingly adventurous leisure activities.

Links

The underlying models have been developed in Sharpcloud’s collaborative strategic roadmapping application. (MS Silverlight required to view).

The Healthcare System Futures 2030 roadmap
Who chooses, wins – Stakeholder model
National Hell Service – Stakeholder model
Choice, what choice? – Stakeholder model
NHS Inc. – Stakeholder model

The first post of this blog - providing some background.

The informing choices website – http://www.informingchoices.com/.

If you are interested in knowing more about this project or getting involved, contact me.

The scenarios take shape

2010-11-05T08:39:00.000-07:00

I have now developed the framework scenarios based on the analysis competed so far, although there is still lots of work to do to generate the final stories.

Here are the scenario grid and the high level scenarios.

Who chooses, wins

This world is characterised by a buoyant national economy (the policy of prioritising debt clearance in the early 10’s reaping benefits) and by a growing sense of consumer power and consumer rights on the part of patients and the public. There is a range of innovative public and private sector providers operating effective and efficient services to a receptive market. Who chooses, wins is the media induced mantra.

Consumers – motivated by the choice agenda from the 90’s and 00’s – are more informed than ever before and exercising their choice. Clinicians have embraced the prospect of informed patients, in part through the necessity to be competitive in attracting their consumers.

The programme to improve efficiency back in the mid 10’s was successful and provided scope for funding to be re-directed to innovative products and services. New biotech and nanotechnology products are revolutionising treatment for both chronic and acute conditions. Breakthroughs in the diagnosis and treatment of Alzheimer's disease, paralysis and heart disease have been instrumental in improving the health of the nation, and in preventing 70’s and 80’s children dying before their parents.

Improving health into later years has allowed the older population to continue to work and fund their increasingly adventurous leisure activities.

National Hell Service

This world is characterised by a struggling national economy - the recovery in the 10’s never really happened - and apathy regarding consumer power and choice on the part of patients and the public.

The double edged sword of increasing demand and lower funding for health services has hit patients and providers hard, with mortality rates increasing rapidly. There is disillusionment with the state of the public health services as all the progress made at high cost to the economy during the 00’s has been reversed with round after round of funding reductions.

New players that had started to come into the Health Service market have withdrawn, adding to the burden on the NHS which the media has described as the National Hell Service.

Innovation in products and services introduced and promised during the boom times have stalled and many reversed. Health insurance has become very expensive leaving the market available only to those with high disposable income. There is extreme polarisation between those that can afford to fund their own healthcare and those that have to wait for sub-standard care. Health tourism for those that can afford it is growing significantly but any problems for the patient on their return to UK that are treated in the NHS cause resentment on the part of those on ever expanding waiting lists.

70’s and 80’s children are dying before their parents.

Choice, what choice?

This world is characterised by a struggling national economy (the recovery never really happened) and by a growing sense of consumer power and consumer rights on the part of patients and the public.

Consumers – motivated by the promise of choice agenda from the 90’s and 00’s – are more informed than ever before but more frustrated than ever before, claiming, Choice, what choice? A sense of being dis-enfranchised has led to regular demonstrations about access to care as services are cut in response to the poor economic conditions.

Innovation in products and services has stalled and despite there being an interested consumer base, the economics don't stack up and providers (existing and new) are struggling in the current financial climate to generate enough business with an expectant market.

New biotech and nanotechnology products have trickled onto a depressed market and are failing to live up to expectations as a result. Manufacturers and being ever more selective into which markets they launch their products.

This hasn’t stopped health tourism becoming the option of choice for those that can afford it. But, any problems for the patient on their return to UK that are treated in the NHS cause resentment on the part of those on ever expanding waiting lists.

NHS Inc.

This world is characterised by a buoyant national economy (the policy of prioritising debt clearance reaping benefits) and apathy regarding consumer power and choice on the part of patients and the public. Consumers never bought back into the choice agenda after national debt clearance policies of the 10’s reversed the momentum built up over the 00’s. The public health service is therefore built on the premise that the clinician prevails and as the all-knowing professional, directs patients to preferred providers. New players have therefore struggled to enter the market that is dominated by public sector providers who have sewn up their local markets through effective collaboration across the sector. It’s NHS Inc.

New biotech and nanotechnology products are revolutionising treatment for both chronic and acute conditions. Breakthroughs in the diagnosis and treatment of Alzheimer's disease, paralysis and heart disease have been instrumental in improving the health of the nation, and in preventing 70’s and 80’s children dying before their parents.

Improving health into later years has allowed the older population to continue to work and fund their increasingly adventurous leisure activities.

Here is the updated Impact and Uncertainty Plot from which the scenario grid was developed.

Here are some links that might be useful to you:

The Healthcare System Futures 2030 roadmap (MS Silverlight required to view).
The informing choices website – http://www.informingchoices.com/.
The first post of this blog - providing some background.
To contact me, click here.

The Scenario Grid – Version 1

2010-10-05T03:01:00.000-07:00

Before I get into the Scenario Grid, there was a little tweaking of the Analysis and Assessment – Impact and Uncertainty that shifted a number of drivers from one sector to another. The ability to download the events form the roadmap, take them into the Excel workbook and quickly sort them made the process of re-addressing the events very straight forward.

So firstly, here is the revised allocation of events for to each sector of the plot:

NB The events are not sorted within each sector.

The previous assessment and processing through the Excel workbook clearly showed Consumerism in Healthcare and National Economic Performance to be the most potentially impactful and uncertain drivers and it is therefore those that have formed the axes of the grid.

I am treating these characterisations as draft indicators of what each of the four potential futures is like. The emphasis may change as the stories develop from working through how each driver could play out in each work, but I imagine the essence will remain.

Here are some links that might be useful to you:

The Healthcare System Futures 2030 roadmap (MS Silverlight required to view).

The latest roadmap pdf.

The informing choices website – http://www.informingchoices.com/.

The first post of this blog - providing some background.

To contact me, click here.

The scenario process for this work

2010-10-01T02:48:00.000-07:00

I thought it would be helpful to share the process I have used to work through the development of the roadmap and scenarios. It has been an iterative process - so don't necessarily be fooled by the apparent linear nature of it - the flexibility of the Sharpcloud application helping me to develop and refine the roadmap's structure and analyse the information.

Analysis and Assessment – Impact and Uncertainty

2010-09-24T08:52:00.000-07:00

Having now collected the 90+ events and driving forces (I have still to really identify which are which within the roadmap), I have added my own sense to the feedback I have been receiving and assessed each for their impact on, and uncertainty around the core questions:

How will the UK’s healthcare system manage the tension between the cost of care, the quality of care and the engagement of patients, carers and the public generally in 2030?
What are the implications for providers and consumers of care over the next 20 years?

The roadmap now also includes a judgement about when across the time period (2010 to 2030) each event will be at its most significant. This becomes important when we look at making sense of how the scenarios link back to what we know is happening today.

The assessment phase became real to me having downloaded the event information to Excel, and built a Workbook to sort and categorise the events into one of four sectors of the Impact / Uncertainty plot.

Here are the events allocated to each sector of the plot:

NB The events are not sorted within each sector.

The next stage will be to create the scenario grid from the most impactful and uncertain events name each scenario and start the process of describing how the various stakeholders will be impacted by each driving force within each scenario.

Here are some links that might be useful to you:

The Healthcare System Futures 2030 roadmap (MS Silverlight required to view).

The latest roadmap pdf to describe what information is where and how it be viewed in the roadmap.

The informing choices website – http://www.informingchoices.com/.

The first post of this blog for some context to the work.

Contact me.

Future events and driving forces

2010-09-10T04:15:00.000-07:00

The initial stages of this project have involved developing a number of potential future events, driving forces and assumptions.

To date, 92 have been developed. They cover the full range of marco environmental categories: social, technology, economic, (natural) environment, political, legal (and regulatory). Issues addressed include what businesses hospitals might be in, the use of nanotechnology, personalised medicine, consumerism in healthcare and new players delivering new health services.

The range of issues is staggering and while many people will look at the full list and say, “yes, I’m not surprised this issue is addressed,” looking at them in one place illustrates perfectly the interconnectivity and complexity of the issue. And we’re not done yet!

I have just started an exercise to assess the potential impact and uncertainty of each event and driving force in the context of the two core questions I’m posing:

How will the UK’s healthcare system manage the tension between the cost of care, the quality of care and the engagement of patients, carers and the public generally in 2030?
What are the implications for providers and consumers of care over the next 20 years?

I’m also interested in assessing when the events will be most significant between now and 2030.

If you want to know more, you can contact me here or review the live roadmap now (MS Silverlight required). Click here.

For more information about Sharpcloud, see http://www.sharpcloud.com/.

WELCOME

2010-07-05T08:54:00.000-07:00

Informing Choices are running a futures project to explore the challenges and opportunities for providers and consumers of care over the next 20 years. We will be asking the following questions:

How will the UK’s healthcare system manage the tension between the cost of care, the quality of care and the engagement of patients, carers and the public generally in 2030?
What are the implications for providers and consumers of care over the next 20 years?

Our intention is to work collaboratively to develop a number of scenarios that can be used by the contributors to the work within their own organisations to help inform strategy or policy development.

To find out more, you can review the application by looking at a Review of the Roadmap we are developing and by looking at the Collaborative Working Framework document.

To conduct the work, we will be using the Sharpcloud strategy / futures visualisation application. Sharpcloud provides the capability to collaborate online to create and develop strategic roadmaps, identify and characterise event relationships, time-lines and plot futures events against a range of criteria.

You can see the evolving roadmap for the Healthcare System Futures 2030 work by looking at the live roadmap. (You will need MS Silverlight installed on your computer to view the Sharpcloud application. Silverlight is available to download free from Microsoft.)

To learn how the roadmap has been developed, see the Roadmap Design Principles document.

To find out more and to get involved, contact us here.