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Future Challenges
Nigel Edwards
Policy Director, NHS Confederation
Visiting Professor London School of Hygiene and Tropical Medicine
2 sets of challenges
• Challenges from changes in healthcare
• Challenges from workforce change
Some trends will have greater impact than others
•
High Impact
Low Uncertainty
“Wild Cards”
High Impact
High Uncertainty
Low Impact
Low Uncertainty
Low Impact
High 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
Technological & communications advances
Information for the professional
Information for the patient
Isolated care
Integrated care
Slow communication
Rapid communication
11
New patterns of service delivery
Industrial age medicine is transforming into information age healthcare
Individual self
Tertiary
Professional
Secondary
Care
care
Friends &
family
Self help
networks
Primary
Professionals as
facilitators
Professionals as
partners
Professionals as
authorities
Source: Jennings, Miller and Matema - Charging Healthcare, Santa Monica: Knowledge Exchange, 1997
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
New skills
•
•
•
•
•
•
Relationship with patients
Team work
Communications skills
Safety and systems design
Information management skills
Knowledge management and assessing
evidence
• Managerial skills
Attitudes to work
• New Roles
• Working environment
• Affiliation and attachment
– Feeling valued
– Job satisfaction
– Resources and pay
Global threats
• Aging workforce
• Increasing demand from China and India
• Impact of the USA on the rest of the world