What will the future of our health service look like over the next few decades?

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Derek Greene
Derek Greene

Influence of the Political System.

If the provision of health care services is not decoupled from political influence, vested interests will still play a huge part in the way our services will be managed, organised and delivered in the future, writes Derek Greene.

Vested interests’ decision making does not lend itself toward long term effective planning or service delivery. Just look back over the last 75 years and let’s hope we learn from the mistakes of the past. 

With the advent of social media and messaging platforms, access to commentary and criticism of our health service never ceases, 365 days per year. The court of public opinion, often aided and abetted by media commentators are now driving much of our health care priorities and standards. While listening to the public is important, our political system seems to be overly sensitised to the ebb and flow of media commentary and not wanting to be seen unpopular, often support issues or initiatives which in the long term do not support best healthcare outcomes or integrated service provision. 

Just look at the last 20 years and see how many times the health services have been restructured, reorganised and reengineered. Yet ,are we really better off? For the future we need to develop coherent short to medium and long-term strategies and objectives for our services, which can be measured objectively and reported on. Appropriate funding and resourcing need to underpin these priorities and we need to implement them effectively and within the timeframes necessary.

So, what will our Health Services of the future need and require.

  • Clearly defined split between service funders (commissioners of services) and providers.
  • Higher level local access to a whole range of integrated care and services delivered as close to the patient as possible. 
  • Care delivered through fully formed integrated and multidisciplinary care teams which are adequately resourced. 
  • Greater personal choices for care, with more timely access.
  • Greater personal responsibility and autonomy for self-care. 
  • Increased use of technology for remote access and patient monitoring.
  • Increased use of robotics for precision care e.g. precision surgery etc. 
  • Far greater automation across all our services. 
  • Increased use of immunotherapies and gene therapies. 
  • Far more flexible service delivery models. 
  • System Agility and responsiveness to needs as and when they arise.
  • Meeting rising public expectations through better education and information technology. 
  • Catering for increased life expectancy – people will live longer, die older, and there will be a greater burden of care for later life diseases and illnesses. 
  • Greater progression/finding cures/new treatments for cancer care, dementia, obesity, heart disease etc/greater investment in research.
  • Healthcare and wellness facilities for the public to assist with illness prevention rather than curative care. 
  • Medical, pharmaceutical, general nursing and therapeutic care being completely reshaped and re-engineered from what we know of it today.
  • Greater integration of care and management systems, both from a clinical and non-clinical perspective.
  • More effective overall system management of the in services from hospital to community and joined-up seamless care pathways underpinned with simple “big” system technology and capability. 
  • Greater healthcare cost in terms of GNP/GDP than at present.
  • Debate on whether our health service should be seen as a cost or an investment. If seen as a cost, it will continue to be underfunded, whereas an investment is more likely to garner appropriate funding in line with service needs. 

Our political system and the media must refrain from interfering with service delivery and our public representatives and media commentators must refrain from undermining the very important work that health service workers do

Even with all of the above we will still need highly trained, well-motivated people to manage and deliver health and social care services, going forward. To do this we must ensure our educational systems keep a pace with emerging new roles, increasing public expectations and new research outcomes. Most importantly the workers in our health services of the future must feel that they are highly valued, appropriately trained, adequately resourced, have more control i.e. properly paid and most importantly be allowed to make decisions without feeling constrained. In addition, they must feel and be fully supported and integrated by our Health & Social Care Services Management structures and service delivery systems in order to deliver more effective and timely care.

What we will need is a dynamic, agile health services free from political influence which has timely access to services for those in need on a timely accessible basis, with services provided/delivered by well-motivated, valued, properly paid staff. 

Finally, our political system and the media must refrain from interfering with service delivery and our public representatives and media commentators must refrain from undermining the very important work that health service workers do. They should be supporters and enablers of our work not detractors or underminers of what we do. 

Derek Greene, Chief Executive, National Rehabilitation Hospital.

HMI President 2013 – 2016