validus management consultancy UK

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