Foresight and futures – an approach to support hospice and palliative care development?

I have recently had the privilege of attending a two day workshop on foresights and futures by thoughtengine as part of the Clore Social Leadership Programme. When I entered the room I was an interested skeptic, and after some resistance, I left the room a convert.

Futures and foresight is not about predicting the future. It accepts the uncertainty and complexity of the world we live in and helps us generate insights and look at trends and drivers to consider the future possibilities. This can then be used to influence planning and innovation to be better prepared for what could happen.

Key drivers and palliative care

The development of hospice and palliative care has been – and will continue to be – influenced in both a positive and negative way by multiple external drivers and trends. These can be positively harnessed and planned for or they can be huge risks.

But what are these trends and drivers? thoughtengine are working on a project called Future Agenda which is the world’s leading open foresight project. Throughout 2015 it is bringing together multiple experts around the world to share and discuss different perspectives of the world in 2025. The aim is to build a rich, multi-regional and cross-sectoral view of the next decade for all that encompasses a range of different topics – a shared view for all to use. The future of healthcare is part of this.

Progress so far on the identified drivers was shared with us at the workshop (they will ultimately be available freely to all). Many of the drivers I have heard raised regularly in palliative care were discussed, such as the aging population, the rise of technology, the inequality gap, funding challenges, the rise of chronic diseases and the need for healthcare for all.

Others key drivers discussed are potentially very significant but may be considered less in palliative care discourse, if at all. These include the climate, the rise in societal activism, business solutions to societal problems, readiness for water scarcity, the role of corporations in society, the role of the state, the rise of China and society’s understanding of what success or growth looks like. It is easy to see that some of these drivers could have a major impact on palliative care development.

Practical application

Part of the foresight process can include developing scenarios where you look at how two uncertain key drivers collide with each other and what the impact is. This can really open up your mind to new possibilities and challenges.

The whole process of looking realistically at how the world may be in the future, rather than how we want it to look is quite a mindset shift. In addition, looking at the influence of drivers which may seem uncertain or may not seem to be directly in our sphere broadens your perspective to more possibilities.

So, yes we want affordable, quality palliative care for all but given the key drivers what do we think the world will look like in 2025 and what impact does that have on what we are doing now? There are many practical tools to support this work including the UK government futures toolkit for policy makers and analysts.

Foresight and futures work in action in palliative care

Some organisations with an interest in hospice and palliative care have touched on futures and foresight work. From the UK perspective, Hospice UK undertook a ‘commission into the future of hospice care’ which brought important insights on how things may look in the UK. This was following on from Charles Leadbeater’s pamphlet ‘dying for change’ by Demos.

The University of Glasgow has stressed the importance of foresight in their blog as part of their project on the ‘Global Interventions at the End of Life’. The UK government has foresights projects including one on aging. Marie Curie’s recent shift to covering end of life care for all conditions and not just cancer could have been driven by foresight. And many more hospice and palliative care organisations around the world may be doing elements of this work, albeit perhaps without calling it by this name.

Challenges

Of course there are challenges. Firstly, as a relatively new approach, the science and evidence behind it is just emerging. Secondly, it is harder than you may think to change your thought processes and your mindset. The exercise is not initially about visioning or finding solutions, or to look at how we want or hope the world to be but to look at how we think the world will be. And, as I discovered, it can be really quite sobering. Thirdly, monitoring and evaluation. If you are going to put resources behind this you would want to see the evidence of impact and that may be hard to measure. Fourthly, it does take some resources, although this can be controlled.

Conclusion

From my brief insight into this area, foresights and futures techniques could benefit hospice and palliative care development. It could help organisations to prepare in order to maximise possible opportunities and mitigate possible risks.

I would like to know which hospice and palliative care organisations, or broader health and social care organisations, are already doing this and what have they learned? How wide and deep are people thinking in their foresight and futures work or are they working to narrow frameworks which may limit the benefits?

How could it change our thinking around planning in all areas of development, from service delivery to advocacy to education if we looked further afield and broadened the framework of how we plan? How can we feed into the Future Agenda work and other foresight projects on health and broader and where does palliative care currently feature in those discussions?

In an interconnected and complex world, it is neither sufficient nor effective to prepare and plan looking only at our sector. The foresights and futures approach could be the tool that really pushes boundaries to help organisations involved in palliative care seize and maximise future opportunities.