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WHO seminar by the CfWI 12 December 2014

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WHO seminar by the CfWI 12 December 2014

  1. 1. Making the right decisions in a complex world WHO seminar, Geneva 12thDecember, 2014 Dr. Graham WillisHead of Research and Development, CfWI Matt EdwardsHead of Horizon scanning and International, CfWI
  2. 2. Many years ago…
  3. 3. How many trained hospital doctors will we have by 2040? Cost
  4. 4. How many do we need? Do we trust this? Trained hospital doctors (thousands) 60 50 40 30 Year 20142040 Supply Demand ?
  5. 5. Policy What if the future is not what we expect? Failure Megatrends Problem System Events
  6. 6. Consider many futures… Expected future Use plausible, challenging and consistent futures to test policies
  7. 7. Principles Systemic Future-oriented Flexible Transparent Inclusive Comprehensive Understandable
  8. 8. Robust workforce planning Understand the system Explore the future Simulate the possibilities Make robust decisions Focal question Transparent and participatory
  9. 9. Horizon scanning Context Issues Factors Events Ideas bank System mapping
  10. 10. Scenario generationStakeholder workshops Influencing factors Key factors Consistency check Narrative scenarios Quantified scenarios
  11. 11. Scenario generation workshopKey factors LowImpactHigh Low UncertaintyHigh Predetermined Key factors Secondary
  12. 12. Scenario generation workshop Population GDP growth Energy usage Carbonemissions High Low C A B Consistency analysis
  13. 13. Scenario generation workshop Vary across different futures Formal elicitation protocol Monte Carlo simulation Probability Value Quantify critical parameters
  14. 14. Modeling and simulation Demand side Outputs Supply side
  15. 15. Policy outcomes Policy analysis Policy options: A B C D
  16. 16. Pharmacy example Scenarios Scenario 1 Narrower Scenario 2 Internet-driven Scenario 3 Broader Pharmacists role Enabling technology Projection 1 Projection 2 Scenario 4 e-Pharmacy
  17. 17. Number of pharmacists (full-time equivalent) 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 100,000 80,000 60,000 40,000 20,000 0 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 100,000 80,000 60,000 40,000 20,000 0 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 100,000 80,000 60,000 40,000 20,000 0 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 100,000 80,000 60,000 40,000 20,000 0 Year Scenario 1 Scenario 3 Scenario 2 Scenario 4 Pharmacy example How uncertain is the future?
  18. 18. Pharmacy example Policy options 20% 35% 50% 5% 10% 15% A B C D E F 3% One-off supply reduction Phased supply reduction 5 Years 10 Years
  19. 19. Policy outcomes Pharmacy example 2 3 1 4 Policy options: A B C D E F Policy analysis
  20. 20. What about the rest of the system? Health Public health Social care 2% 98% Workforces not yet modelled Workforces modelled to date
  21. 21. What about the rest of the system? Health Public health Social care 10% Other health and support 21% Paid adult care and support 24% Volunteer adult care and support 43% Unpaid adult care and support 2% Workforces modelled to date
  22. 22. Not just workforce numbers What skills and competences are needed? Competences Skills Facilitation Leadership Wellbeing Knowledge Personal Types of skill Level of skill Low to High Quantitative skills Qualitative skills
  23. 23. Not just the skills What drives the demand? Demand for skills Long-term conditions Infectious diseases Births One-off events
  24. 24. Not just the skills What drives the supply? Supply of skills Up or down skilling Education & training Workforce supply Capacity to learn
  25. 25. Population Learning disabilities Oral health Singular demand for service Maternal and perinatal Infectious disease Mental long-term conditions Physical long-term conditions Skill level: 12 3 4 5 We need a new framework Prevent Enable Assess Plan Treat Rehabilitate Relieve Link Unpaid adult social care workforce Nurses Dentists Medical generalists Medical specialists Volunteer care and support workforce Other workforce groups Horizon 2035 workforce groups Increasing concentration and experience
  26. 26. A new challenge: Horizon 2035 What skills and competences do we have? What might we need in future?
  27. 27. Future demand for skills Skill hours/Year (Billions) 2012201620202024202820322036 Time (Year) Probability: 80% 100% Central estimate:
  28. 28. 5 Skill levels 4 3 2 1 Super-specialist Specialist Generalist Increasing length of training Skill dimensions Visualising the system Learning disabilities Oral health Singular demand for service Maternal and perinatal Infectious disease Mental long-term conditions Physical long-term conditions Demand sources Medical Specialist
  29. 29. Visualising the system Learning disabilities Oral health Singular demand for service Maternal and perinatal Infectious disease Mental long-term conditions Physical long-term conditions Demand sources Super-specialist Specialist Generalist Up-skilling targets Midwife
  30. 30. Super-specialist Specialist Generalist Up-skilling targets Visualising the system Learning disabilities Oral health Singular demand for service Maternal and perinatal Infectious disease Mental long-term conditions Physical long-term conditions Demand sources Paid care and support
  31. 31. Stress testing
  32. 32. European perspective
  33. 33. EU Joint Action Work packages Objectives Increased knowledge Improved tools Higher effectiveness Horizon scanning and qualitative Quantitative Data, migration and mobility Coordination Dissemination Evaluation Sustainability 69 partners Funded by the Health Programme of the European Union
  34. 34. Work package 6 –Horizon scanning Horizon scanning and qualitative Qualitative methods Pilot study Future skills
  35. 35. User guidelines –qualitative methods Published 27 November 2014 www.euhwforce.euwww.horizonscanning.org Examples of methods in use across EU e.g. scenarios, surveys, Delphi Helps deal with inherent complexity and uncertainty of workforce planning Descriptions of health workforce planning and forecasting approaches for Belgium, Finland, Germany, Hungary, Netherlands, Spain and the United Kingdom Qualitative methods 1 2 3
  36. 36. User guidelines –qualitative methods Published 27 November 2014 www.euhwforce.euwww.horizonscanning.org Use alongside quantitative methods to achieve integrated approaches across Europe Recommends taking into account the different useful approaches for different contexts Methods can be used to systematically investigate different workforce futures and deal with uncertainty 4 5 6 Qualitative methods
  37. 37. Future drivers and skills across Europe? Provide an estimation of the future needs of skills and competencies needed in the health workforce and their distribution. Drivers and trends Report on Future Skills and Competencies
  38. 38. Future drivers and skills across Europe? 54 Horizon scanning interviews 264 Drivers collected and grouped Megatrends under investigation Wellbeing skills
  39. 39. Visual key Van der Heijden (2005) Scenarios –the art of conversation Different environments of influence 7 indicative causal loop diagrams These guide the identification of megatrends. Focal Skills and competence of the health workforce in 2035.
  40. 40. 1. Connecting and enabling technology Enable. Effective engagement with engaged ‘consumers’. Patient engagement/partnership/ empowerment. Interpretation of data/statistics. Interpersonal and communication skills. Availability of health information System performance data Patient empowerment Policy and regulation Professional interpretation Remote consultations Connectivity between patients and professionals Health and care data Remote monitoring ICT Population health literacy ‘Big Data’ + + + + + + + + + + + + + + Working Transactional Contextual Focal
  41. 41. 2. Demographic demand Relieve. Enable. Link. Chronic disease management/supported self-management. Coordination/linking skills. Multidisciplinary coordination and team working allied with generalist skills. Long-term care skills. Challenge to single disease framework. Communication skills. Working Transactional Contextual Focal Multi-morbidity Chronic conditions EU fertility rate Healthy cohort of older people Prevention EU life expectancy + = + + ‘Age’ of the population + = + - Economic and social inequality +
  42. 42. 2. Demographic demand Working Transactional Contextual Focal Multi-morbidity Chronic conditions EU fertility rate Healthy cohort of older people Prevention EU life expectancy + + = + ‘Age’ of the population + = + - Economic and social inequality + Attach indicators which describe the current state or trend
  43. 43. 2. Demographic demand Working Transactional Contextual Focal Multi-morbidity Chronic conditions EU fertility rate Healthy cohort of older people Prevention EU life expectancy + ‘Age’ of the population + + Economic and social inequality + < 5 10 - 14 20 - 24 30 - 34 40 - 44 50 - 54 60 - 64 70 - 74 80 - 84 2035 2010 Source: Eurostat Source: Barnett et al, 2012
  44. 44. 3. Mobility Education, registration, licensing and regulation of skills. Workforce planning skills. Health system and workforce system incentives. Working Transactional Contextual Focal Mobile health professionals National skills distribution European skills distribution Health outcomes National skills requirements Mobile patient ‘consumers’ + + + European health market for skills + Freedom of movement +
  45. 45. 4. Productivity Enable. Self-care and self-management. Task allocation. Leadership skills. Productive teams. Working Transactional Contextual Focal Location of care GDP allocated to ‘healthcare’ Skill mix Resistanceto change Complex comorbidities Public health expenditure Health system efficiency Patient/public expectations Gross Domestic Product Access to care Quality of care + - -
  46. 46. 5. Personalisation Assess. Enable. Treat. Communication of risk. Shared decision making. Translation of research developments. Task allocation. Working Transactional Contextual Focal Workforce productivity Behavioural sciences Population health literacy Personalised care Innovation genomics, Pharmaco- genetics Diagnostics Decision aids Industrialinnovation Risk stratification + + Therapeutics + + + + + + + + Data collected by individuals +
  47. 47. 6. Future patients Assess. Enable. Prevent. Communication skills. Coaching skills. Broader skill base and competence of healthcare in the population. Mobility. Role changes or partnerships. Defensive medicine. Working Transactional Contextual Focal Proportion of types of care Ageing populations Complex demand Diverse populations Proportion of generalists to specialists Climate change + + + Disease profiles + + Patient empowerment Informed patients + +
  48. 48. 7. Supply Link. Cooperation. Task allocation. Supply of skills and competences. Workforce planning skills. Leadership skills. Multidisciplinary teams/integration. Workforce flexibility. Skill mix. Task shifting. Working Transactional Contextual Focal Mobile healthprofessionals Workforce roles Health workforce headcount Attractiveness of career Labour force Work-life balance expectations Age of the population - - Induced demand - Workforceinteraction Quality of care
  49. 49. 7. Supply Working Transactional Contextual Focal Mobile healthprofessionals Workforce roles Health workforce headcount Attractiveness of career Labour force Work-life balance expectations Age of the population - - Induced demand - Workforceinteraction Quality of care
  50. 50. Demand is increasing and accelerating (World Bank) Global population Global and national imbalances of workforces 6.9Bn 9.5Bn 20102050
  51. 51. World population by 2100 UN Population Division (UNPD) projects an 80 percent probability that the world’s population will be between 9.6 and 12.3 billion by 2100. www.sciencemag.org/content/ 346/6206/234.abstract http://www.newsecuritybeat.org/2014/10/refines- population-projections-80-percent-probability-10-12- billion-people-2100/ World population (Billions) 2010202020302040205020602070208020902100 13 12 11 10 9 8 7 6 UNPD and IIASA Projections, 2010-2100 IIASA SSP2 medium variant UN medium variant UN 80% upper probability UN 80% lower probability
  52. 52. Key shifts and possible solutions? Integrated care 24/7 and tech enabled working 24/7 Care model shifts Secondary Care Patient and service user empowerment / self- management
  53. 53. New workforce roles and prototyping Prototyping and discovering New roles and skills
  54. 54. Key points What if the future is not what we expect? Consider many futures Transparent and participatory approach
  55. 55. Scaling skills analysis to new levels? Country Continent Global
  56. 56. Acknowledgements Thanks to Jim Campbell, the WHO and GHWA for the invitation and hosting of this session. Dr DelanyoDovlofor chairing. Also to acknowledge the continued support from the EU Commission, EU Joint Action, the Department of Health, UK and our national and international partners and advisors for participating in our research.
  57. 57. Contact details Dr Graham WillisHead of Research and DevelopmentCfWI, England @ +44(0)7812 340 405 graham.willis@cfwi.org.uk www.cfwi.org.uk| www.horizonscanning.org.uk Matt EdwardsHead of Horizon Scanning & InternationalCfWI, England +44(0)7834 800 393 matt.edwards@cfwi.org.uk Questions welcomed…

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