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

• Challenges from changes in healthcare
• Challenges from workforce change

Some trends will have greater impact than others
High Impact
• Trends with a high potential impact, which are more certain are:
– Rising patient expectations
Low Uncertainty
– 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
“Wild Cards”
High Impact
High Uncertainty
– 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
Low Impact
Low Uncertainty
• Trends with a lower potential impact, which are more certain are:
– Further use of Minimally Invasive Surgery
– Use of robotics
Low Impact
High Uncertainty
• 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
Isolated care
Slow communication
Information for the patient
Integrated care
Rapid communication
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New patterns of service delivery
Industrial age medicine is transforming into information age healthcare
Professional
Care
Tertiary
Secondary
Primary
Individual self care
Friends & family
Self help networks
Professionals as facilitators
Professionals as partners
Professionals as authorities
Source: Jennings, Miller and Matema - Charging Healthcare, Santa Monica: Knowledge Exchange, 1997

• 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

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

• New Roles
• Working environment
• Affiliation and attachment
– Feeling valued
– Job satisfaction
– Resources and pay

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