How often do we really stop and think about the distant future? Most of the time I am too concerned with my next work deadline, my social schedule or stretching my money to cover this month’s rent. Governments are similar; mainly focused on their five-year term with little appetite to look beyond the next election. Some may argue that deep thinking about the future isn’t really necessary, but what benefits are there for those who think further ahead, and how could this foresight benefit the health and social care system?
Organisations such as the tech giant Apple prove that focusing on the future pays off. Apple’s success arguably lies with its attitude to ‘thinking differently’, creating products – including the iPod®, FaceTime® and Siri® – that people didn’t even know they wanted. Apple's continual success shows that consumers will buy the latest must-have gadget, even in periods of austerity.
Recently I attended Future Fest – a two-day NESTA conference that asked attendees to think provocatively about the future. It was incredible – there, in front of my very eyes, Bertolt Meyer’s prosthetic hand was rotating 360 degrees. The prosthetic hand could make about 20 distinct movements, and an app on Bertolt’s iPhone allowed it to do even more. There were other stories: a young man who had chosen to have a damaged limb amputated and replaced with a fully functioning bionic alternative. Could the future see more cases of people choosing prosthetics over semi-functioning limbs?
Bertolt also told the inspiring tale of Matthew James, a 14-year-old born without a left hand and unsatisfied with the prosthetic limb offered by the NHS. The Formula 1® enthusiast wrote to Ross Brawn, the boss of F1 team Mercedes GP Petronas, asking for £35,000 to pay for a top-of-the range artificial limb, offering it as a sponsorship opportunity. Mercedes was impressed with his entrepreneurial streak and agreed to fund the limb – without the logo. It’s an interesting case study, but what does it mean for other patients in this situation? Is it fair for the NHS to offer only basic limbs, given that high-end technology might offer a superior quality of life? We already know that people’s expectations of health care are rising, and that the demand for new technologies and treatments is putting unsustainable pressure on NHS finances. Will we start seeing more inequality in health care as those who can afford to pay get the best technology, while others are left behind?
These examples left me astounded. I thought that films like Bladerunner and I, Robot were fictional and that ‘life extension’ as described in 2001’s Vanilla Sky was just too far-fetched. I hadn’t appreciated that much of the technology – like 3-D printing of bones and nanotechnology to transform stem cells to bone – already exists, and could have a huge impact on treatments and life expectancy. But how will the NHS respond to these advances when it is already under financial strain? And when will we start debating these difficult ethical questions?
What is certain is that medical, technological and digital advances are happening at pace. Industries new to the health care arena are developing products, tools and services that are changing the delivery of care. Anticipating, or at least thinking about, this change could influence our ways of working and perhaps enable us to take a bolder approach to service delivery. Foresight will also ensure that the health and social care workforce is appropriately skilled to deal with this changing service.
It’s time to start thinking about the challenges, opportunities and difficult choices that lie ahead in the not-too-distant future; this will go some way to ensure that the NHS is more like Apple and avoids a fate similar to that of Blackberry. It also means that a public debate about what is expected of the health and social care system and how much money we should spend on it needs to happen soon. The King’s Fund hopes to support the NHS and social care in making change happen through the work of our Time to Think Differently programme and the Commission on the Future of Health and Social Care in England.