Editorial

 A word from our director Dr David Somekh

Dr David Somekh

It’s seven and a half years since we formally set up EHFF although it had been in waiting for three years before that. Although we had an agreed mission, to support transformational change in society, beginning with health but looking at health in a holistic way, we didn’t have a clear cut understanding about how we would do that. We participated in joint EU projects, we developed a method of interaction with other players and as a result, some sort of profile in the narrow policy circles around the work of the European Commission. However, we retained the concept that we wanted to work more intensively outside of the box, and we wanted to use futures methods, e.g. Foresight, to help support innovation.

This year appears to represent a step-change period in our activities. We had talked about, but not really succeeded in, harvesting the expertise of our Community, in walking the talk as a futures group, in being engaged in the external holistic view of health but not ignoring technological change-levers. The items in this edition of the Newsletter represent all four of these elements.

Our trawl from the Community this edition brings up Lois Macklin, who lives in Alberta, Canada. She and I met some 5/6 years go when she was visiting London to lecture on the future of health. Our recent conversation, recorded here, reveals her continued interest in future thinking, but again, her perspective is wider than health.

Our European health futures exercise, initiated early this summer, has gathered speed. We reported in September, but things are moving forward quickly, so here is the update promised last time.

Digital is a central theme in the current German Presidency of the European Council and one that the Commission has been homing in on, for commercial and other reasons for several years. We recognise the potential for digital technology transforming health and healthcare despite major adoption issues but struggle to define a direction for EHFF to focus on. In a reflection piece I seek to define what the problem might be.

Finally, a further update to our previously reported engagement in the wellbeing economy area. This is a good example of future thinking applied to emerging attitudes in a holistic context. The wellbeing economy philosophy, apart from challenging the prevailing ‘greed is good’ culture of many businesses and governments, pulls together the needs of society as a guiding principle for economic planning; linking health, education, social cohesion and tackling inequality and environmental sustainability. We describe recent activity with others in setting up the core of a Well Being Economy Alliance hub in Ireland.

Interview with Lois Macklin on 9th September, 2020.

Future Thinking – Canada After the Pandemic

Lois described the project that she and two colleagues (Dr Ruth Collins-Nakai and Dr Axel Meisen) are currently undertaking to think about the future of Canada following the Covid 19 pandemic.

Lois Macklin

They have been meeting weekly since early June, undertaking a Foresight exercise, something Lois and her colleagues have considerable experience with.  Their goal is to develop new perspectives on how Canada should proceed given the severe economic and social consequences of the Covid 19 pandemic and present these perspectives to the political and community leaders whose job it will be to lead the recovery.

A major challenge for Canada is how to balance the delivery of social programs such as public healthcare (which consumes over forty percent of the budgets in most Canadian provinces) against the huge financial consequences of the pandemic. Delving into how the Government might manage this, has raised real questions about the relationship between a strong economy and a strong democracy.

The concepts of a strong economy and a strong democracy are not as straight forward as they might seem, but they are intimately linked. There is a growing perception (e.g. led by the OECD but also implicit in the UN SDGs) that an economy simply based on accumulating greater wealth is not one that genuinely addresses the needs of a society. Holistic measures of wellbeing must be integrated into economic policy, covering key areas such as opportunity and education, social inequality and social cohesion, health, and the environment. Attempts to reform economic planning are challenged by the global trend towards greater individualism and personal interests, which can prevail above a sense of responsibility for long-term consequences.  These same trends also threaten the traditional democratic processes which have underpinned and supported Canada’s social programs, such as public healthcare.

Read the rest of the interview here Interview with Lois Macklin on 9th September, 2020

Future of Healthcare: An update on our 3 Horizon exercise

Work in Progress!

This is a snapshot of the tool we’re using to analyse the questionnaire results from 30 of our Community members. That’s 30×8 questions which generated over 600 statements (any resemblance to a corona virus on the diagram is coincidental!). What the snapshot shows is statements clustered round an identified theme. The different questions are colour coded  and you see them aligned to the three horizons: so the pinkish line is here and now, Horizon 1, which is portrayed as gradually in decline, the light green is H3, the future we aspire to, which is developing and the light blue line is H2, the pathway to transition.

The next stage was to cluster the themes further and we’ve been left with 35 key statements which we use to construct a narrative. This first stage narrative is appended here, and is like a position statement describing the overall content of the questionnaires linked to the 3 horizons and their 8 questions. The next step and perhaps the most challenging (but potentially most rewarding) will be to then look with a systems perspective. In other words, to try and identify causal loops, seeing what drives what in the configuration, e.g. what factor may increase or decrease the effect of another.

This phase of the exercise would then allow a potential strategy to support changes that seem to be emerging. This would have both general significance (i.e. be of interest to a wide audience, depending on which aspect of the findings we promote) but also should help EHFF better define its own strategic  trajectory. The other issue is the human factor; what strategies might be used to persuade players who are determined to defend the status quo to recognise value in proposed changes and shift their position.

The first stage narrative is here.The future of health in Europe – main outcomes 

Reflections on the Digital Space

The digital data market has been a key area of interest for the European Commission since 2018 and an update of the strategy has recently been published (https://ec.europa.eu/digital-single-market/en/policies/building-european-data-economy). Currently with the German Presidency of the Council, the interest is intensified. Here is an example of the kind of thing being discussed: https://www.biometricupdate.com/202009/european-digital-identity-vision-outlined-by-ec

For EHFF the issue is slightly different. How do we fill the space in our strategy which is labelled ‘digital’? Digital is one of the key levers for transformational change that we identified seven years ago, and there is no reason to alter this view. Our problem is, what aspect to focus on, that fits with the context of our mission and current perspective on the health and healthcare ecosystem?

Over the years we have identified five themes which seemed to us significant in the enterprise to harvest the most benefit from technological advances:

1. Improvement versus innovation: the problem of ‘shiny toy syndrome’. We examined this while working on the nature of innovation during a big project on self-management in chronic disease (PROSTEP). Most innovation comes within the category of incremental improvement – nothing wrong with that, but rarely does technology make the kind of societal impact that the iPhone did, or medical equivalents, such as fibre-optic telescopes combined with key-hole surgery (revolutionising day-surgery with attendant cost-savings and related changes in service provision). Usually, even when they are as transformative, there may be a significant lag before institutional systems are able to embrace them because they’re endemically resistant to innovation.

2. The value of user led design: we held a two day multi-stakeholder workshop on this subject a few years back. The benefits of co-production are well-established: the evidence is that tools developed on the basis of business-driven technology  are much less effective than tools designed on the basis of agreed need on the part of end-users. Involving end-users directly at all stages, not as late as the beta-stage of design is much more likely to be a) effective and b) achieve good levels of adoption. Unfortunately, engrained old habits mean that many companies  continue to follow out of date design practices.

3. Barriers to implementation: fear of change and poor digital literacy, coupled with faulty design and institutional rigidity conspire to hold back the wholesale adoption of tools, even when they have a sufficient track-record, and commercial pressures and other vested interests may play a role here. The message, as with all necessary changes to complex systems like healthcare, is simply that we need to persevere, and that necessary change takes much longer than initially envisaged (integrated care is a classic example).

4. Human factors: Behaviour change is perhaps the most obvious area where we might see leverage. It’s interesting that while digital literacy seems to be an issue for older citizens and healthcare professionals now, and still a target for current health workforce strategies, we could imagine in a few years that it becomes a non-issue (watch your children or grand-children) apart from within some disadvantaged sections of society. The accelerated use of telemedicine prompted by COVID illustrates how unexpected events can be much more powerful in influencing behaviour than targeted programmes – sometimes.

5. Data:  Finally, data, data, data. There are people out there convinced that big data will transform our society and to some extent that’s probably true. The problem we foresee is that so often data driven systems are poorly designed in terms of the machine/human interface. It’s a really exciting prospect that sensible use of data could mean that each of us has a personal data profile that allows professionals to immediately see where risk areas are when we start to get ill (or before, in terms preventative measures) but the risks are obvious. Firstly, the interface design (why so many health portals give poor return on investment), and secondly because of moral/ethical issues which have not been examined by those creating the technology because, well, their brief is the technology (and they don’t always ‘get’ human factors). Who has control of the decisions that arise from this amazing information? What’s their moral compass? Similarly, who owns ‘your’ data? GDPR was meant to give us some reassurance about this, but does it really address the problem? In relation to moral compass, who can we trust in this day and age?

Irish WEAll hub: what does this mean?

In the September newsletter we described the concept of a Wellbeing Economy and how we ended up chairing the Wellbeing Economy Working Group of the All Policies for a Healthy Europe (AP4HE) consortium. We also explained how this led to our joining the Wellbeing Economy Alliance (WEAll) network.

There are developments on both of these fronts. For the wellbeing economy Working Group of AP4HE early next month we will participate in a roundtable co-hosted with the European Policy Centre (EPC)* , on ‘achieving an economy of wellbeing in Europe’ where EHFF will present the AP4HE outline policy paper. Other panellists will be Katherine Trebeck, chief advocate for WEAll who helped set up the Scottish WEAll hub; a senior policy officer from EuroFound,** an EC funded agency which provides statistical data in the social and employment arena; and a senior member from the team of the Chief Economic Officer of the Netherlands. After the event we’ll post the short version of the policy paper in our News section.