Building sustainable health and care systems into the future
Report from a Pilot Foresight workshop, Monday 25 March 2019, Green Templeton College
The sun was shining as 40 policymakers, researchers and practitioners arrived at Green Templeton College on Monday 25 March. They brought perspectives from developed and emerging economies in the UK, Germany, India, Brazil, Nigeria and more; combined with an enthusiasm to think about the future of health and care. What emerged was a collective commitment to improving the capacity of health and care systems to respond to challenges over the next 30-50 years, and support for Green Templeton as a body that can help to make that happen.
The event was badged as the ‘Foresight Pilot’ – the first in what we hope will be a programme of work, established by Fellows at Green Templeton, to support the long-term future of health and care systems around the world. The aim is to provide a platform for bringing together policy, practice and research to help better understand and address long-term challenges such as demographic ageing, use of technology, rise in populism and the growing impact of climate change.
There is currently a lack of long-term, strategic thinking in this area. Much current research is skewed towards biomedical innovations, with too little attention paid to the broader challenges for policy and systems. Green Templeton is very well-placed to help address this, with our distinctive academic profile centred around issues of human welfare and social, economic and environmental well-being.
Grounded in a commitment to human welfare, we used a participatory Foresight methodology, encouraging people from a wide range of countries, systems and perspectives to engage in dialogue and actively work together to develop alternative futures. We sought to build in related initiatives oriented to the future of health and care; interviewed participants beforehand to begin the process of drawing out ideas, tensions and debates; and produced an overview of the issues that people identified. Future issues and challenges clustered around four topics:
1. long-term trends within health and care systems such as innovation, public expectations and demographic ageing, as well as issues outside of those systems such as rising income inequality, climate change and populism;
2. people and person-centred care, the organisational divide between health and care, professional structures and the patient empowerment;
3. technology and innovation, the use of data, and better aligning innovation systems with health and care needs; and
4. understanding health and care systems as complex systems, and how to bring about constructive change in such a complex system.
On the day of the event, as participants connected and began to unpack these issues together in small groups, the focus shifted. Rather than looking for ‘the answer’ to what the future holds, we began to focus much more on how we can live and work with future uncertainties, and strengthen the capacity and resilience of our health and care systems – and those who work within and around them – to respond to the challenges they will inevitably encounter. What emerged by the end of the day was a firm consensus that there is a unique contribution that a college such as Green Templeton can make in providing a platform for learning and engaging with change, and for building capacity for change within health and care systems.
Of course there remains much to do, not only to take this consensus forward, but also to widen who we work with and how. What participants hoped the Green Templeton College Foresight Programme might take forward included:
- Providing a platform to support change in health and care systems, e.g., developing a set of case studies (not only about where things have gone well, but also where things have gone wrong), establishing ‘open source’ learning materials around strategic challenges and how to engage with them to be used within health and care systems around the world;
- Convening networks of people interested in particular issues, e.g., focusing on how to reorganise services to provide person-centred care, or implementing new technologies such as electronic health records; and using the space at Green Templeton to convene events, support evolving networks and bring people together to learn from each other and share experiences about developing sustainable systems;
- Strengthening capacity and skills within the system, facilitating or providing training (e.g., via fellowships) about how health and care systems work, enabling skills around how to bring about change in these complex systems, and supporting future system leaders to reach their full potential. Rather than seeing education as something that happens once at the start of an increasingly long life, the aim here is that we support interdisciplinary, life-long learning that can support people working within health and care to build flexibility and resilience required for systems to be sustainable well into the future;
- Developing Green Templeton as a ‘change laboratory’ for health and care systems, enabling methods, skills and practical support for bringing about change by supporting the people working in those systems to better understand them and the processes for collaboratively working together to improve them;
- Reaching out beyond the ‘global elite’, recognising that Green Templeton may have significant convening power, but that there are other individuals, groups and institutions across health and care systems facing the greatest challenges that we will need to connect and work with in order to address the long-term challenges that we all face.
There is only so much that we can say in a short blog. Other materials will follow that will give more detailed insights into the discussion of the day, the challenges we all face and what colleagues feel we need to do to begin to address them.
Other blogs from the Foresight Pilot:
- Doctors, nurses and their training – could the NHS workforce be in need of a makeover?, Jonny Bowley, graduate assistant
- ‘Who we are?’ Reflections on who a Foresight Programme might involve, and why, Jackie Walumbe, Emmanuel Abalo, Muriel Levy, graduate assistants
- ‘What do you mean you don’t know?’ Reflections on dealing with uncertainty in healthcare, Emma Ladds, Academic Clinical Fellow, University of Oxford
The sun was still shining at the close of the day as we reflected on next steps. The clear message back to us was that there is a deep need for collective commitment to build health and care system capacity. And that Green Templeton College brings together the right combinations of people, skills and spaces to do that. We hope to develop the Foresight Programme accordingly, building on this event to develop the overall academic vision of Green Templeton College, and working with colleagues across the world to do so.
Sara Shaw & Nick Fahy
26 March 2019