NHS Case Study

Department of Health

Scenarios exploring the future of healthcare provision

Driving options and priorities

Department of Health, London Head Office

Need to identify the scale and impact of the elderly English/Welsh population, to project up to twenty years ahead, the balance between publicly and privately funded health care for the elderly
Key question: how much personal/family funds could hold in check the need for government spending?
How to understand the future impacts of relevant economic, social and medical conditions for populations between ages 60-80. (Over 80 to required separate study)
How to use scenarios to define alternative policy pathways to be presented to senior officials and eventually to the Secretary of State

Facilitated small groups of officials to debate and clarify alternative scenarios to estimate sources of financial support for health care of the elderly
Employed a methodical, strongly structured, step-by-step use of scenario analysis, ensuring consensus over the process
Developed alternative scenarios to surface controversial assumptions and upside benefits and downside risks of policies weighted either to more personal or public financing
Prepared and submitted a finished report for the Department explaining the scenarios and the policy choices which they generate

Achieved agreement in reducing the 20-years ahead to two main scenarios when applied to the same growth-of-demand projections of the "market".
Two scenarios were named "Robust Finance" and "Financing Crisis" each with their own set of assumptions and conditions such as:
- "Robust Finance" - good economic growth; early retirement and positive unemployment trends, modest growth of family-based financing of care, lower income groups supported by public finance etc.
- "Financing Crisis" – slow growth economy, high unemployment, a growing underclass, an overburdened government budget, fewer elderly living with their children, higher divorce/separation with fewer women caring for the elderly of spouse/ex-spouse/absent partner etc
Key government assumptions or hopes of more privately provided and financed care of the aged challenged through the "Financial Crisis" scenario, and the scale of publicly financed care re-examined.
The two scenarios were understood not to provide sharp "either/or" choices but were agreed to provide signs ahead for encouraging one future more than another or more warnings against another
The scenarios provided the platform for different action and resource plans aligned with each. They would not resolve uncertainty but rather drive confrontation with choices, priorities and trade-offs