Imagining futures for the NHS

Familiar institutions might be revamped and strong

The future is unknowable. “Nothing in the world can one imagine beforehand, not the least thing,” said Rainer Maria Rilke: “Everything is made up of so many unique particulars that cannot be foreseen.” Nobody predicted the explosion of the internet, the faltering of the Far East economies, or the outlawing of the communist party in the former Soviet Union. But many people have predicted the paperless office, the leisure society, and the death of the book—none of which have happened. Yet paradoxically those who look to the future flourish, and the world's biggest and most successful organisations devote resources to imagining futures. The trick is not to predict (although the first box includes some predictions) but rather to gather data on recent trends, talk to lots of smart people to identify drivers of change, and then to relax and imagine scenarios of the future. You then use the scenarios to stretch current thinking and as a “wind tunnel” to test current practices and plans: will they still work in the new world?

The NHS Confederation, Institute of Health Service Management, and International Hospital Federation have been busy imagining future scenarios for the NHS, and the scenarios are due to be acted out at the confederation's conference to celebrate 50 years of the NHS. The team creating the scenarios* identified four drivers of …