How can scenario planning help NHS organisations and integrated care systems to succeed?

by Mike Farrar PwC NHS NEDs programme chair

Email +44 (0)20 7804 4019

The Five Year Forward View, the NHS Long Term Plan and, more recently, the 2020/21 Planning and Priorities Guidance, have set out a clear direction of travel for the NHS towards the establishment of ‘integrated care.’

This runs strongly in parallel with other health systems across the world that are migrating away from quasi market mechanisms towards provider collaboration and population health as a means to square flatlining human and financial resources with increasing, seemingly exponential, demand.

This move has been welcomed in broad terms by many in the NHS and care system. But whilst the ‘why change is needed?’ question is fully understood, there is still considerable policy ambiguity and front line confusion regarding specifically ‘what does integrated care mean in practice?’ and ‘how will we make this change safely and deliver the benefits?’ Forthcoming legislation may be helpful on clarifying some aspects, but there are still questions in the minds of many leaders as to the future state and structure of the NHS at local level.

Our approach

As a result, we have developed an approach that tries to capture the current journeys that Sustainability and Transformation Partnerships (STPs) and integrated care systems in the NHS appear to be pursuing and we have used our NHS experience and international evidence to help map out the potential future scenarios that we can see are likely to emerge.

It is not a definitive prediction of the outcomes of their work, nor a statement of the only destinations they might arrive at, but rather it is designed to help NHS leaders in these systems in their thinking and planning processes to understand where they might be headed and what it might take to achieve the benefits they perceive might follow.

By using some simple scenarios as a guide we are able to paint a picture of the potential ‘end states’ to help people to test out their understanding and alignment. We have learnt from other sectors that when dealing with ambiguity or the need to secure complex, system wide, organisational alignment of purpose and vision, working in this scenario planning way, is an extremely effective methodology.

For the development of systems in the NHS this is an valuable way of helping hard pressed leadership teams think through the consequences of their actions. Crucially, it can also help reveal the huge contribution that integrated care reform and place based working can make towards solving their immediate operational issues such as delivering financial balance and constitutional standards.  In short, it connects their ability to see how ‘designing and in some cases accelerating tomorrow helps them deliver today.’

The scenarios are not mutually exclusive and for some systems they may be stepping stones towards a more developed destination but for others they might represent an end state in their own right. 

Over the coming weeks we will be looking more closely at some of these issues - look out for more blogs in this series. In the meantime please get in touch if you are interested to hear more about our approach.

by Mike Farrar PwC NHS NEDs programme chair

Email +44 (0)20 7804 4019

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