Who is playing the long game?

Leila Luheshi

17 August 2016

A mere glance at the news these days is enough to bring home the message that, in its current form, our health system simply cannot deliver all the care people want (and need) at a cost the country can afford.

And what of the future? Is there any prospect of significant change and improvement? Something to reassure millennials – the health system frequent flyers of the future – that we have a ‘plan’ to fix the myriad shortcomings of our healthcare and public health systems?

Worryingly, the answer would appear to be: no. Listening to the House of Lords enquiry into the long term sustainability of our health system there is little evidence that policy makers are thinking about such ‘long term’ future scenarios at all. Understandable pre-occupations with delivering safe and effective healthcare today crowd out essential, transformative and radical thinking about what that future could and should look like. But no one seriously believes that a sustainable health system  for 2030 – one that meets rapidly changing individual and population needs, technological possibilities and social expectations – will, emerge from the one we are struggling with today without planned intervention… do they?

Revolution not evolution!

The current situation is not helped by our conservative approach to innovation and change, which tends to over-emphasise minimising risk and protecting the vested interests of powerful professional and commercial groups. Applying the social values, institutional structures, and professional roles of today’s system as ‘boundaries’ delimiting the socially and politically acceptable forms that our future health systems could take is starving society of opportunities to develop, test and critique the necessarily radical alternatives to the failing status quo. 

If new ideas continue to be reflexively batted away with cries of ‘how will GPs cope?’ or ‘we’ll fight to keep our local hospital at all c osts’ then who can blame policy makers for a lack of effort in imagining how we might transform healthcare in the longer term. It is simply not socially or politically acceptable to ask the difficult questions that must be at the centre of any plan for long term change. Imagine if GPs, or indeed local hospitals, were not at the centre of our future healthcare models? What Department of Health mandarin or politician would dare to voice such thoughts? We as citizens must shoulder at least some of the blame for this conservatism.

It is simply not socially or politically acceptable to ask the difficult questions that must be at the centre of any plan for long term change

The need for visionaries 

There is clearly a need to create an environment where alternative visions for a better way of doing healthcare can be nurtured. But whose job is it to envision the future and test the underlying hypotheses? Is it the work of think tanks, academics and silicon valley CEOs? To some extent, yes it is. But it MUST also be the work of practicing healthcare professionals and citizens, the users of healthcare systems. Surely they are best placed to offer positive and constructive alternative perspectives on our healthcare future? 

Where’s the evidence?

No ‘visionary’ has ever or will ever possess all (if any) of the evidence needed to substantiate feasibility. The self-righteousness with which advocates of the ‘better funded version of the status quo’ approach to future healthcare policy cry ‘show me the evidence’ or ‘we can never afford it’ is infuriating, and misses the point entirely. 

The future is not a threat - it is an inevitability and one we must confront and prepare for now, using all our creativity and ingenuity. We cannot make the necessary leaps in our thinking if we tie ourselves down by focusing on the opportunity costs - financial, personal, social or political - any innovative visions of the future appear to present, when calculated in the currency of units of healthcare delivered today. 

Mind the (generation) gap

The failure to develop policies to address the sustainability of our health system is, I believe, just one more manifestation of a wider failure of policy makers to place sufficient emphasis on creating a better future for young people of today. Political and demographic calculus dictates that our politicians throw all of their energy and resources in to propping up the dysfunctional healthcare / housing / energy (take your pick) systems of today to meet the increasing needs of the ageing baby boomer generation, at unquantifiable cost to the generations of children and grandchildren that will follow them. Policy makers, politicians and health service leaders have much to gain from investing their efforts in ‘tweaking’ the status quo and significantly less incentive to support long term transformative thinking about the healthcare system than those of us who expect to rely on it most heavily in 15-20 years’ time.  

What can we do?

We must find better ways to engage wider society in the re-shaping of our future health systems. Whitehall mandarins, eminent professors, patient advocacy groups and corporations all have important roles to play, but I am not convinced they’re sufficiently incentivised to produce the long term thinking and radical change we need. Health services research increasingly demands ‘patient participation’ in the evaluation of new models of care and interventions, but does it capture the voice of the patients of the future; patients who will have experiences and expectations of health and healthcare that differ dramatically from those of their parents. The good news is that this makes them ideally placed to shape and drive through radical changes in our health system, and to provide the creative and ingenious ideas that will be needed to realise their own, healthier future.