Dr Duncan Nicholson,
Cambridge Health Futures.

Values

Are there essential values that will shape the health service we want for Britain next century? Are there constant characteristics that describe good health care - underlying characteristics that we assume and that do not quite grab our attention as readily as the organisational change and technological developments that fill our thinking? And can we identify those values and characteristics, and recognise them as the foundations on which we need to build our health service for the future?

The Future Issues Project Team has set out to capture the essence of today's "ideal" health service. We wonder if it is any different to the vision of those who set up the National Health Service fifty years ago. We wonder too, how today's NHS matches up. If we can agree on our values, we can start to consider what there is about the NHS we want to preserve, what we might wish to enhance and where we feel times have moved things on.

We are conducting three separate but overlapping exercises to consider these fundamental questions:

• Firstly, we are conducting a Delphi consultation with around 500 professionals in and around the UK National Health Service.

• Secondly we are asking everyone attending the Conference for their thoughts through the "Conference Voices" questionnaire. Hopefully, you have already received and returned these papers.

• Thirdly, through the "International Perspectives" initiative, we are seeking to discover whether colleagues from overseas share our thinking, or if there are other angles we should take into account.

These investigations should prove interesting in themselves, but are designed to feed the Future Issues Debate that runs through the three days of the Conference. There we will see how the values and characteristics we have identified survive in two very different views of the future. Some will find a natural place in whatever society we have twenty-five years from now; others will undoubtedly come under pressure. With these project elements to guide us, the Debate can focus on what we should be doing today to protect and enhance these values and characteristics for the health service of tomorrow.

This is an active series of investigations capturing the thinking of people working in and around health care today. They will be running right up to the week of the Conference. (The citizens' and users' perspectives enter the debate through the Deliberative Group work described elsewhere in this briefing pack) In this paper we can only tell you what we are doing, give you some very early indications of what might be emerging and perhaps whet your appetite to engage in the Future Issues Debate at Earls Court in July.

The 50th Anniversary Delphi

Delphi is a formal and systematic way method of consultation that can be used to tap expert knowledge and judgement in thinking about the future and developing strategy. It is based on cycles of pen and paper questions, each round dependent on the responses to the last. It is at its most powerful where no formal evidence exists, but there is a large number of experienced and informed people whose thinking should be engaged in any consideration of future directions.

In the 50th Anniversary Delphi, we invited around 500 professionals (managers, clinicians, and partners-in-health from social services, and voluntary and commercial sectors) to list the characteristics of their ideal health service. We also asked them to consider the main changes that would face health services over the next twenty-five years or so, and to identify the main opportunities and threats for the NHS. Answers to their "ideal health service" formed the basis of a second round sent out about a month later asking the panel members to list these in order of importance of and evaluate how the NHS was performing against these criteria. In the second round, we also asked the panel members to identify which characteristics that are so central to the idea of the NHS, that it would no longer be recognisable if they were abandoned.

Some early results

As I write, the results of the Round Two Delphi are just coming in, and Conferences Voices and the International Perspective have just gone out. Some clear pointers however are already emerging. Delphi panel members seem to be rating highly:

• Emergency Care available 24 hours a day

• Free at the point of delivery

• No difference in treatment dependent on race culture or creed

• Managed by consent and not pressure

• Funding arranged to relieve financial fear when illness strikes

• Complaints and comments taken seriously and acted on

• Driven by community rather than commercial values

• All staff well trained and continuing with in-service learning

• Planning that clinicians' priorities into account

• Well organised and administered

• Care centred around the needs of the patient

• Lack of domination by any one profession

• Primary health care oriented

Conference Voices

The work of the Delphi panel also feeds into the Conference Voices questionnaire that we hope will be completed by everybody coming to the conference - perhaps around 3000 people. This will mean that everyone coming will have had the opportunity to contribute to the conference preparations as well as participating in the event itself. The "values" input to the Future Issues debate itself will be entirely based on the views of those attending. The International Perspective

To ensure our approach is not too constrained by our own ways of thinking, we have also invited the views of some 300 health services professionals from around the world. We asked them to answer the same question as Round Two Delphi and Conference Voices. In addition, they have been asked to suggest aspects of the NHS they would like to see replicated in their own country, and which they would not. We also requested thoughts on whether the NHS is more cost effective than the health care provided in their own country. We look forward to some interesting returns.

The project team believes that understanding these values and characteristics is an essential part of planning the future of our NHS. We hope you share our beliefs, find the outcome of this work compelling and use it as you take your part in planning the future of your NHS.

Five successes and five challenges

An analysis of your early Conference Voices returns identifies some issues that you rate as important and believe the NHS delivers.

• Emergency Care available 24hours per day.

• Driven by community values rather than commercial values.

• All staff well trained for their role in-service training.

• Integrity and sound corporate governance.

• Funding arranged to relieve financial fear when illness strikes

It may be that these are some of the strengths of the NHS we must nurture.

In contrast, there are some issues you see as having a high priority, yet feel the NHS still has some way to go before it meets your aspirations.

• Equivalent facilities across the country.

• Emphasises individuals responsibility for their own health.

• Encouraging evidence-based medicine.

• Well integrated with social and voluntary sectors

• Short waiting times

It may be that the conference identifies these issues as requiring greater attention in the future. By the time of the conference itself, there will be more returned papers to consider so we will be able to tell you much more.

Join the debate

A longer article will be available on this website on the 26th June