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Four futures for health and social care integration

Over the next few years, the (potential) integration of health and social care is perhaps the greatest system leadership challenge we face in the UK. The associated complexities of this integration create what we (inspired by the doyen of systems thinking, Peter Senge) have dubbed an ‘uber wicked’ problem.

In 'Four futures for health and social care integration' we have applied scenario analysis to the future of health and social care, a technique frequently used to help structure complex situations by considering alternative possible outcomes. The scenario analysis process is not an attempt to predict the future, or to describe what we would want to happen – it is a process for articulating uncertainty and for following the potential ‘futures’ to a conclusion.

In this paper we:

  • Consider two dimensions of uncertainty about what the future may bring over a ten year time frame. We think there are two here:

1. Whether health and social care will be highly centrally directed or whether they will be directed locally.

2. Whether provision will occur along service or professional lines, or whether it will be user-centred.

  • Use these as uncertainties as axes for a chart that maps a landscape for the future, following each area of uncertainty from one end to the other.
  • Put these dimensions into a grid and we get four, albeit extreme, futures to consider. We tell a ‘plausible story’ about how we could (in principle) end up at these extremes – there might be other ways of getting there, and you may think it is unlikely, but a story helps to make the scenario ‘real’.
  • Think about what these future stories would mean.
  • Have named these futures ‘Care as Benefit’, ‘Regulated Consumerism’, ‘Local Drift’ and ‘Me in My Place’.

Our four futures - for full descriptions of each, download ‘Four futures for health and social care integration’(pdf):

Landscape for four possible futures of integrated health and social care

In reality, none of these futures is likely to play out to the deliberately extreme extent to which they are described, but we may find a blend of these futures emerging – and this thinking helps us to get ready.

The purpose of this paper is to provide a framework for discussion, and for relevant leaders – whether they be commissioners, providers, regulators, local or national politicians – to consider how the world in which they must lead may change over the next ten years.

Will they agree about means to achieve desirable outcomes? What will happen if they don’t?  This note aims to provoke that discussion.

This paper was written by Jonathan Flowers, local government market director, Capita, with grateful thanks to Debbie Sorkin and Tony Hunter for input and ideas.

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