The future is not a place, like the Isle of Wight, awaiting our arrival; it is more like the Great Western Railway, something that we have to imagine, design, and build. If we do not build it, other people will.

Designing the future does not require vision, because, in the words of the science fiction writer William Gibson, “the future is already here, it’s just not evenly distributed.” By looking about we can see many examples of leading edge work that just needs to be generalised. We do not need vision or dreams, although Pharoah’s dream is probably a perfectly apt theme for health care after the credit crunch: we have had seven or so years of plenty, and we all know what comes after that. Furthermore, post-crunch health care also arises at the appropriate moment for low carbon health care, for health care in an era of sustainability. Even if money were to flow, health services would need to focus on the carbon footprint consequences of their development and achieve a reduction in the amount of energy used. One hospital I know is planning to double its …