This document summarizes a presentation on the future of European healthcare. It notes that current healthcare systems are unsustainable even in the medium term due to rising costs from an aging population and new technologies. However, there is significant resistance to change from stakeholders with vested interests in the status quo. The document suggests that disruptive innovation from outside the existing system may be needed to drive the transformative changes required to address these challenges in a sustainable way.

1. European Health Futures Forum
57th EOQ Congress, Estonia 18/19 June 2013
David Somekh, Network Director, EHFF
1

2. 2
What
will
her
healthcare
future
be?

3. Health systems represent complex organisations
that have more or less the same characteristics as
business organisations, although they are unusual
in being usually very manpower intensive and quite
complicated. Some of them are extremely, if not
unmanageably, large e.g. the NHS in the UK.
Given the modern day application of complexity
ideas in the turbulent modern social and business
environment, how is current strategic thinking
about European health configured?
3

4. 4
Adapted
from
Kees
van
der
Heijden
Scenarios:
the
art
of
strategic
conversaBon:
2004

5. Source: Hans Kluge. Director Division of Health Systems and PH, WHO Europe 5

6.
6

7. 7

8. Comment: note the ‘solutions’ in the previous
two slides. The whole presentation is a
convincing over view of current threats to EU
health systems.
What is not convincing however is the proposal
to do what EU health systems have signally
failed to over the last 20 years (make significant
inroads into the estimated annual 25% wastage
of resources across the board). Systems are to
be ‘strengthened’, not changed. The proposal is
simply not credible, particularly in the context of
a hyper-connected rapidly changing external
environment.
8

9. ‘The Singularity is Near: When Humans Transcend
Biology’ Raymond Kurzweil (2005)*
On the one hand we have the public health data
and predictions from WHO-Europe, on the other
hand we have the largely US-based predictions of
rapid technological growth and its impact on health
systems
*Kurzweil argues that the inevitability of a technological singularity is implied by a long-
term pattern of accelerating change that generalises Moore’s Law to technologies
predating the integrated circuit, and which, he argues, will continue to other technologies
not yet invented. According to him, artificial intelligence should be able to pass the Turing
Test (a test for the presence of intelligence in putatively-minded entities) by 2029, and the
technological singularity should occur by 2045.
9

10. Smart
Living
• Smart
clothes
– Sense
body
funcBons
• Smart
bathroom
– Evaluate
body
fluids
• Smart
kitchen
– Prepare
body
nutrients
• Smart
house
– Elderly
can
live
at
home

11. GeneBcs
• HapMap
ê
£/€/$
of
human
geneBc
variaBon
(disease
diagnosis)
• “Gene
Chip”–
mul$ple
gene
examinaBon
• Personal
genome
sequencing
direct-­‐to-­‐
consumer
(DTC)
• IdenBfied
origins
and
causal
rela$onships
of
complex
diseases
• “Epigene$c"
factors
linked
to
diseases,
heritability
across
generaBons
• Stem
cell
transplants
• Human
reproducBve
cloning

12. The
Nanomedical
Universe
• Nanomedicine
• Nanobots
• NanoroboBc
therapy
• Nubots
• Nanosensors
• Bionanobots
• Nanotechnology

13. The problem with the ‘future is techno.’ approach
such as Mike Jackson’s presentation on his site
Shapingtomorrow, which skillfully scans potential
technological advances and their impact, because
of the audience it was aimed at it doesn’t tackle the
‘elephant in the room’ issue that unlike airlines or
production lines, present day health is manpower
intensive and complex and especially vulnerable to
the vagaries of the human psyche.
The same argument applies to Luis Cordeiro’s
presentation of a future world of enhanced human/
human-robot synthesis, in his role as futurist and
ambassador of the Singularity University, CA
13

14. There are two elephants in fact crowding the room:
human nature (a real problem when we come to
the value systems employed by the techno-
enthusiasts who promote the advent of AI as the
solution to our problems) and the sheer size and
complexity of current health systems. Their abiding
characteristic is the second elephant: that if you
concentrate your resources on improving one
element in the system, the effects are almost
always neutralised by compensating movements
elsewhere in the system.
14

15. 15
The future of European healthcare – a possible scenario

16. To summarise:
‘Sickness care’ in its present form is notoriously wasteful and
significant savings are likely to be achieved only by substantial
change in the form of care delivery. There are many barriers, both
institutional and political which hamper this transformation
Increasing life expectancy results in an increased burden of
potential healthcare costs which ironically may be exacerbated by
increasing expectations from the public for care, potential costs of new
technology (it could go either way), the effects of greater health
inequalities and of other factors such as migration, climate change etc.
In the present setting, financial forecasts suggest that the
envelope for healthcare spending has limited capacity for
expansion. Equally there is gross underinvestment in prevention and
health education.
Chronic mismanagement of workforce planning makes it likely that
serious shortfalls will impact on quality of care
16

17. 17

18. 18

19. Health effects of the financial crisis: omens
of a Greek tragedy
In a review of public health capacity in the EU, Prof
Brand from Maastricht recently gave the example
of the impact of the demands of the Troika on the
health of the Greek population, as will be seen in
the next slide. However, he was also making a
crucial point about the availability of what is called
‘cockpit data’. The effects during 2007-9 were only
available in 2011.
I have my own example of the same phenomenon
based on the local effects of the Spanish crisis….
19

20. 20

21. 21
There
is
indisputable
evidence
that
European
healthcare
systems
are
simply
not
sustainable
–
even
in
the
medium
term
future,
but
percep$on
of
threat
cannot
in
itself
bring
about
societal
change.
If
the
possibility
of
a
potenBal
collapse
of
the
system
can’t
be
contemplated,
people
will
behave
as
if
it
isn’t
there.
Just
like
they
did
in
the
banking
crisis.
Analysis
over
a
number
of
years
of
the
barriers
to
fundamental
change
in
health
delivery
systems
leads
to
the
inevitable
conclusion
that
there
is,
on
the
part
of
most
stakeholders
huge
vested
interest
in
maintaining
the
status
quo

22. 22
Even
though
the
model
of
healthcare
delivery
we
are
using
is
currently
by
and
large
a
nineteenth
century
one,
bringing
about
radical
change
is
seen
as
far
too
difficult
and
threatening
Its
like
a
raBonal,
progressive,
energy
policy:
the
means
are
there,
but
the
resistance
to
change,
from
so
many
sources,
is
just
too
great.

23. 23
Complexity
science
teaches
us
that
condiBons
of
turbulence,
of
high
levels
of
interacBon
between
diverse
actors
fosters
the
emergence
of
new
configuraBons.
Conversely,
excessively
rigid
and
unchanging
systems
are
unlikely
to
generate
sustainable
new
forms.
StarBng
from
the
applicaBon
of
the
principle
to
financial
systems,
this
Harvard
Business
School
team
argue
that
the
only
way
to
generate
real
change
in
such
circumstances
for
healthcare
is
from
the
outside.
DisrupBve
innovaBon
implies
demonstraBng
the
effecBveness
of
innovaBve
transformaBonal
change
by
implemenBng
it
outside
the
city
walls,
and
creaBng
a
criBcal
mass
for
the
alternaBve
paradigm
which
will
gradually
erode
the
status
quo.

24. An
interes$ng
idea
Several
years
ago
(at
the
end
of
2006
to
be
precise)
a
group
of
us
found
ourselves
in
a
very
unusual
situaBon
.....we
were
drinking
in
the
bar
of
a
hotel
in
a
European
capital
city,
late
at
night.
We
had
by
then
spent
many
years
working
on
improving
healthcare
quality,
but
recognised
that
the
results
of
the
labours,
not
just
our
own,
but
those
of
other
prac$$oners
in
the
field,
represented
a
very
poor
return
on
investment.
We
concluded
that
what
was
required
was
a
radical
transformaBon
in
the
way
that
healthcare
was
delivered;
an
ac$ve
collabora$on
between
representa$ves
from
Industry,
Educa$on
and
Healthcare,
crossing
tradi$onal
boundaries.
This
we
called
our
BIG
IDEA.
However,
it
took
several
years
to
find
a
means
to
put
the
idea
into
pracBce…
24

25. In addition to our existing expert knowledge, we started to
look at futures methods, such as scenario planning, horizon
scanning and wild cards and weak signals methodology, to
see to what extent these techniques had successfully been
applied in the health field.
We discovered William Gibson (author of ‘Neuromancer’)…
“The
Future
is
already
here
–
it
is
just
not
evenly
distributed”
We decided to use what small inroads we had achieved
thus far within the health policy field in Europe to establish
quite a different enterprise…
25

26. ESQH was set up as a European NGO in
1998. It is registered as a charity in Ireland
and the idea was to create a society of
national healthcare quality societies, to
represent the grass-roots staff across
Europe and whose mission statement was:
• to
promote
communicaBon
between
the
stakeholders
in
European
health
quality
• to
champion
quality
in
healthcare
in
Europe
• to
sBmulate
innovaBon
in
healthcare
quality
in
Europe
Both
the
founders
of
EHFF
have
formerly
served
as
Presidents
of
ESQH
(and
collaborated
with
EOQ!)
26

27. Networks
of
networks
SocieBes
Offices
EU
agencies
and
Associates
27

28. In summary, there are several reasons that ESQH
is well placed to provide a springboard for a new
European NGO which concentrates on health
futures. Among these are:
It has a well established network involving 20 countries and
contacts within several stakeholder groups in each
Experienced at becoming involved with policy issues at a
significant level, starting from scratch and building a brand
Run as a lightweight, flexible but effective organisation that
is more or less virtual but has appropriate governance
Will build on ESQH’s work but will create its own brand and
intends to operate faster, smarter and more effectively
28

29. What are the USPs that EHFF offers, that merit
participating in its development?
• Supporting disruptive innovation with a cross-sectoral
focus using a network structure
• Offering an approach to health scenarios which fosters
on-going multi-stakeholder dialogue
• Aiming to collect data that identifies potential threats to
health systems in a more realistic timescale
• Operating in a 21st century organisational mode, with an
effective but fluid, inclusive and open-source orientation
• Cognisant of current policy but side-stepping political
pressures and the constraints of traditional institutions
29

30. 30
Consistency of EHFF principles with Foresight
concept

31. Brief
summary
of
what
EHFF
will
aIempt
to
do
Create
an
open
interac$ve
forum,
whose
members
will
seek
out,
process
and
exchange
knowledge
and
informa$on
in
real
$me
that
may
either
influence
the
future
of
health
and
healthcare
in
Europe
and/or
provide
a
beIer
understanding
of
future
possibili$es
and
risks
in
this
area.
We
aim
to
facilitate
beIer
ques$ons,
not
offer
solu$ons.
The
business
model
involves
establishing
a
diversely
populated
not
for
profit
legal
enBty
and
incrementally
building
web
presence,
funding
streams,
eclecBc
network
of
expert
associates
linked
to
current
network,
involvement
in
relevant
European
acBviBes,
iniBaBng
own
projects,
on-­‐going
horizon
scanning
and
promoBon
of
values.
31

32. Global
to
local.
Lessons
from
global
ac$on
networks
(GANs)
Steve Waddell* is fascinated with networks. He says GANs tend to
have most of 7 characteristics: they are multi-level, ‘diversity-
embracing boundary spanners’, inter-organisational networks,
systemic change agents, entrepreneurial action learners, voluntary
leaders and global public good producers. EHFF could aspire to
most of these, eventually, on a smaller scale than global, but notice
how much growth of networks figures in the three work streams
discussed below. Steve also stresses that GANs cannot simply float
in the clouds as it were; their interest needs to be in ‘where the
rubber hits the road’ and on the ground action, because that’s one
important area where their influence can be assessed.
32

33. A
new
context
–
the
new
paradigm
for
how
the
world
works
• from addressing issues in parts to whole systems thinking
• from inter-national structures to multi-stakeholder ones in order
to address the issues
• from assuming the environment to nurturing it
• from linear approaches to change to complex systems
strategies
• from negotiating our way to solutions to envisioning futures
• from a conformance focus to a collective values focus
Considering that we developed our concept piecemeal over time
and intuitively, not having read Waddell’s work, the closeness of fit
is pretty spooky!
33

34. The
three
ini$al
work
streams
(project
categories)
• A
Europe-­‐wide
innovaBon
laboratory
for
improving
health:
its
first
projects
would
be
a)
involvement
in
EC
projects
on
paBent
self-­‐management
b)
the
young
health
innovators
project:
EVY
(a
network
project)
c)
a
community
of
pracBce
for
those
at
the
leading
edge
of
health
professional
educaBon
d)
seeking
partnerships
with
business
and
educaBon
to
create
Health
based
Knowledge
and
InnovaBon
Centres
(KICs)
as
promoted
by
EITT
• The
first
ever
Europe
wide
scenarios
exercise
for
health
that
includes
all
the
stakeholders
• Linked
to
web-­‐portal,
begin
a
scanning
exercise
on
emerging
health
trends
using
sophisBcated
techniques
imported
from
other
fields
34

35. MagriIe:
the
schoolmaster
(1954)
In
a
leser
to
a
friend
Magrise
says:
“
I
had
a
magnificent
idea
without
realizing
this,
nor
did
you,
when
I
pointed
out
to
you
a
year
or
two
ago,
that
the
moon
in
certain
posiBons
was
exactly
above
a
chimney-­‐stack
or
a
tree.
At
the
Bme,
we
thought
this
'droll',
'amusing'
but
of
lisle
interest.
Thanks
to
the
new
pictures:
The
girls
of
the
sky,
The
evening
gown,
The
schoolmaster
and
The
masterpiece,
we
can
now
display
genius,
if
we
realize
that
the
'droll'
idea
is
in
fact
magnificent...
genius
is
not
about
having
magnificent
ideas,
but
about
recognizing
them.”
35

36. Thank
you
for
your
Bme.
Now,
how
might
we
work
together?
EHFF became a legal entity in March 2013, after two years
of planning. The prototype portal address is www.ehff.eu
36