Future Challenges Nigel Edwards Policy Director, NHS Confederation Visiting Professor London School of Hygiene and Tropi

1. Future Challenges Nigel Edwards Policy Director, NHS Confederation Visiting Professor London School of Hygiene and Tropical Medicine

2. 2 sets of challenges • Challenges from changes in healthcare • Challenges from workforce change

3. Some trends will have greater impact than others High Impact Low Uncertainty • Trends with a high potential impact, which are more certain are: • Rising patient expectations • E health and the use of IT networks • Widespread use of intelligent devices and expert systems • Miniaturisation of diagnostic tools • Ageing population and increase in chronic disease • Common use of remote consultations and home monitoring for patients • New ways of working and changing health professions • Major pharmaceutical innovation reaching market • The widespread use of genetic screening and mainstream use of pharmacogenomics • Trends with a high potential impact, which are more uncertain are: • Expert Patients generating a significant increase in self care • Emergence of new infectious disease • Trends with a lower potential impact, which are more certain are: • Further use of Minimally Invasive Surgery • Use of robotics • Trends with lower potential impact, which are more uncertain are: • Use of stem cell technology to regrow body parts and repair injury • (Re-) Emergence of infectious disease “Wild Cards” High Impact High Uncertainty Low Impact Low Uncertainty Low Impact High Uncertainty

4. Information for the professional Information for the patient Isolated care Integrated care Slow communication Rapid communication Technological & communications advances 11

5. Primary Tertiary Secondary Individual self care Friends & family Professionals as authorities Professionals as facilitators Professionals as partners Self help networks New patterns of service delivery Industrial age medicine is transforming into information age healthcare Professional Care Source: Jennings, Miller and Matema - Charging Healthcare, Santa Monica: Knowledge Exchange, 1997

6. Other changes in healthcare delivery • Patient centred and consumer driven • Growth in chronic disease means a need for co-ordination and integration between traditional interfaces • Safety and Healthcare acquired infection • Systemisation • More multi-professional teams • More of a population focus

7. New skills • Relationship with patients • Team work • Communications skills • Safety and systems design • Information management skills • Knowledge management and assessing evidence • Managerial skills

8. Attitudes to work • New Roles • Working environment • Affiliation and attachment • Feeling valued • Job satisfaction • Resources and pay

9. Global threats • Aging workforce • Increasing demand from China and India • Impact of the USA on the rest of the world