1. The next 15 years start here…
Professor Ian Cumming, Chief Executive

2. Our purpose
‘Health is all about people. Beyond the glittering surface of modern technology, the core space of every health care system is occupied by the unique encounter between one set of people who need services and another who have been entrusted to deliver them.’
Health professionals for a new century [first published in the Lancet], 2010

3. Some NHS facts and figures
1.3 million staff – one of largest employers in world
£115 billion annual budget - £2k annually for every citizen
Over one million patients treated every 36 hours
15 million hospital admissions per year
88 million outpatient attendances
£12 billion spent on medicines
1000+ different employers across public, private, voluntary sector
350 different roles – nurses largest, circa 30%

4. Looking to the future
‘Computers in the future will weigh no more than 1.5 tons’ (popular mechanics 1949)
‘We don’t like their sound and guitar music is on the way out’ (Decca recording company re: The Beatles 1962)
‘Heavier than air flying machines are impossible’ (Lord Kelvin 1895)
‘Louis Pasteur’s theory of germs is ridiculous fiction’ (Prof Pierre Pachet, Prof of Physiology 1872)
Brexit? 4

5. Planning for an uncertain future
Many predictions, e.g. Nuffield in 1999 have only partially come to pass:
Greater concentration of specialist expertise and equipment
Growing importance of self-diagnosis & treatment
More common conditions treated by telemedicine
Capacity for screening widespread
Reductions in length of stay

6. Why a 15 year strategic framework?
Circa 13 years to train a consultant / 3 years for a nurse
We invest £4.8b in education and training, making expensive assumptions about future health care models
If we are wrong, under-supply could result in unmet need; over-supply means an unemployed workforce & wasted resources
If we make wrong decisions we risk locking the service into outdated models of care
We need a strategic framework to guide our investments in the future

7. The best predictor of the future is the past…

8. Changes in projected demand
Consultants
Adult acute nursing
In 2015/16 trusts reported increased demand for nurses for the fourth consecutive year. The cumulative total increase in established posts is 25,131fte in adult hospital settings alone (14.3%)
Staff in post has increased significantly since trusts started trying to expand in 2012 by 12,199fte
The outpacing of demand v supply growth was forecast to result in over 12,000 additional vacancies
Consultant vacancies appear to have been historically stable at 3.0% to 3.5%
Only excess vacancies pre 2014 were 2008/9 which appears to have been due to higher level of posts created that year (2, %)
2013/14 and 2014/15 both appear to have been periods of very high establishment of new posts, 5, % in two years (as reported by trusts)
Supply did increase above the ‘norm’ in response but not enough to match increased demand
Excess vacancies of a level previously unseen have therefore been created
Unclear if extra posts are sustainably funded
Concern that historically vacancies have been hidden if no prospect of filling them

9. How can state funded healthcare respond to economic challenges?

10. Demographics

11. Informatics 43% using internet to access health information
New ways of predicting, preventing, diagnosing and treating some conditions
How can we ensure our staff have the skills to respond to and adopt new research, technology and innovation, so that patients can reap the benefits?

12. Patients will be more informed, active and engaged, and with higher expectations
Health app downloads predicted to triple to 142m in 2016
One of the main topics of google searches is health
Patients are likely to become members of communities of health
91% of cancer patients want to be involved in care decisions
But the capacity to be engaged is not distributed equally across society
Expectations of quality are increasing all the time
How can we educate and train our staff so that they can respond to the full spectrum of needs in society, able to treat the whole person and not just one disease or specialty?

13. Genomics

14. The Genomic Revolution
Improving diagnosis of infectious disease, cancer, and rare diseases
Individualising clinical care: ‘Precision Medicine’
Better predicting drug effects
Understanding disease and tracking epidemics
Developing novel therapies
Refine diagnoses and understand disease (eg Deciphering Developmental Disorders project)
Individualise clinical care (eg cancers)
Better predict drug effects
Diagnose infections and track epidemics (eg MRSA outbreaks)
Develop new therapies (eg Cystic Fibrosis)

15. Five Year Forward View Health gap Quality gap Finance gap
Three areas of action
Health gap
Quality gap
Finance gap
*They will know about the FYFV, our issue is what workforce is doing to support it – i.e. WAB* so I wouldn’t really talk about this slide beyond saying:
Workforce, our people, is where the majority of our spend is, around 70%. To meet the health gap, the quality gap and the finance gap our workforce needs to be at the centre of the discussions and the answers. It can’t just be about more pay restraint and fewer people, it has be to about working differently in different settings and that means changing the workforce of the future through the education and training we commission, but it also means making change now and supporting staff through that change.

16. The future workforce
So what kind of workforce will be required if we are to respond to the drivers of change and meet the predicted need of future patients?

17. Mind the (generational) gap
‘Baby Boomers’
‘Generation X’
‘Generation Y’
‘Generation Z’
Motivated and hard working; define self-worth by work and accomplishments.
Practical self-starters, but work-life balance important.
Ambitious, with high career expectations; need mentorship and reassurance.
Highly innovative, but will expect to be informed. Personal freedom is essential.
25% of the NHS workforce
40% of the NHS workforce
35% of the NHS workforce
<5% of the NHS workforce
Jones K, Warren A, Davies A Mind the Gap: Exploring the needs of early career nurses and midwives in the workplace. Summary report from Birmingham and Solihull Local Education and Training Council.

18. We must be bold and brave…
“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be pulled into inaction.”
Bill Gates