Setting the Direction for Public Investment in Research, Science and Technology from 2000

• Introduction
  • What is the Foresight Project?
  • Why ’Foresight’
• Challenges for the Health Sector
  • Definition of the Sector
  • Linkages Between Researchers, Funders and Providers of Services
  • Impact of New Knowledge on Service Delivery
  • Ethical Issues
• Towards Implementation – The Development of a Health Sector Strategy

Introduction

What is the Foresight Project?
The Foresight Project has been initiated and led by the Ministry of Research, Science and Technology (MoRST). Ultimately the project will guide public investment in research, science and technology from the year 2000.

Foresight deliberately focusses on the future – it is a process for discovering the paths to a desirable future. By providing an overview of trends, drivers, and uncertainties, Foresight determines a desirable position in the future. This provides a conceptual framework for plotting paths to achieve the desirable future and for determining the competencies needed to achieve that future. Foresight is built on a concern for the future and depends on the involvement of the whole range of stakeholders.

Traditionally health sector strategic thinking has not included ’Foresight’ and has not developed a strategic view of the long-term future. There has been a tendency, rather, to project the assumptions of the past into the short-term future. Many of the issues facing the health service today are a result of the short-term strategic planning commonly used. The future is too important to be caught up in the current grind of coping with the many initiatives, changes, and problems of today.

It is vital that the Ministry of Health (MoH) and the Health Funding Authority (HFA) invest significant effort and resources into a ‘Foresight’ approach to their planning. Without an idea of the future shape of the health sector, we will simply remake the problems of the past; and future health administrators will consequently repeat the existing cycle, with the same resulting frustration for the general public.

The aim of ’Foresight’ is to think beyond the “here and now” and not have planning constrained by the problems of today. This is not a novel or new idea – Einstein said, “The problems we face cannot be solved at the same level of thinking we were at when we created them”.

Why ’Foresight’
There has been much written and spoken about the “knowledge revolution” and the effect it will have on people, as individuals and as members of society. New Zealand needs to respond to the challenge presented by the knowledge age with a developmental plan that enables the formation of a society that operates effectively in the knowledge age in which knowledge underpins economic, social and environmental well-being. The Foresight Project is an opportunity to develop that plan across sectors and link the Government’s investment in Public Good Science and technology to the establishment of New Zealand as a knowledge-based society.

Challenges for the Health Sector

Definition of the Sector
At MoRST’s Midsight Conference in July 1997, it seemed increasingly likely that the future, 2010, might see a sector defined as a “wellness” sector rather than as a health sector. This challenges existing paradigms, which see health as a single element without links to other sectors.

There is an opportunity to see health differently – linked to wellness – where there is more emphasis on those areas that contribute to the total well-being of an individual or community. Service delivery and research can be focussed on the broader scope of wellness and contribute positively to the economic prosperity and well-being of the nation.

There is, however, a risk in redefining the health sector too broadly. Resources may well be diverted away from those with very real needs in the “sickness” area to promote further “wellness” in those already well. Those groups that do not have sufficient resources or ability to control the system may quickly become an underclass in health terms. The health sector has a responsibility to bring these groups to the fore and ensure equity issues are constantly considered. Resource must be directed to the areas of maximum health gain.

Linkages Between Researchers, Funders and Providers of Services
To date New Zealand has been actively involved in biomedical, clinical and public health research but there has been almost no investment in health services research itself.

New Zealand is grappling with the problem of constantly increasing demand on its limited health care resources. There is a need to invest in processes that have been explicitly proved to be effective. An evidence-based approach to health care involves the integration of the best evidence of benefits, risks and costs into health care practice decision making at all levels of the decision-making process.

In striving for an evidence-based approach to health delivery it is important the linkages are made across the different groups within the sector with strong research capacity in all areas. There are some examples of partnership relationships developing already, eg, The Mental Health R&D project with funding from both the Health Research Council (HRC) and the Health Funding Authority (HFA), and also the Rheumatic Fever Study in South Auckland funded by the HRC, the HFA and the Heart Foundation.

The knowledge gained through solid research linked with strong economic data will enable a better quality, more effective service to be provided. Using ’Foresight’ thinking we will be able to develop a managed portfolio approach and ensure that the whole range of health research is covered.

Impact of New Knowledge on Service Delivery
Levels of knowledge and knowledge generation in the current era are unprecedented. The impact of recognised knowledge has the potential to completely change the way health issues are handled in the future. An example is gene technology. It is expected that within two years the entire human genome will be known – the challenge will then lie in the application of this knowledge.

Current practice is to treat the symptoms of disease – in the future the focus will be to look at the origin of a disease and target treatment and lifestyle choices to prevent the onset of the symptoms treated today. For instance, susceptibility to heart disease will be identified before significant disease progression through lifestyle choices and early treatment. Questions surround the effects that these changes will have on service delivery, such as their potential to eliminate the need for many current practices.

These new approaches to disease management may also have an immense effect on the pharmaceutical industry. The use of antibiotics, for example, impacts on a broad range of disease areas. With the knowledge gained from gene technology, drug companies will be able to produce drugs that target diseases far more specifically and effectively than at present.

The rapidly changing current knowledge base demands that the present style of health service delivery be reconsidered. Foresight provides an opportunity to explore where knowledge and research are going to be used in the health services, the issues relating to the delivery of health services, and the shape of health services for the future. It is important to understand the likely impacts now so that planning for the future can take place.

The implications that new technology has for workforce development must also be considered and planned for now. A strong research component in training of all health professionals is required to ensure that they can understand the implications of research undertaken both in New Zealand and overseas then adapt it to their own practice.

Ethical Issues
The impact of the new technologies available will need careful consideration. Technology makes possible, but not necessarily desirable, many new initiatives, eg, genetically modified food. There is a need for the ability to address the significant ethical issues involved and ensure that individuals remain in control of their own health care.

The development of a robust process of ethical review began after the Cartwright Report. Adopting a ’Foresight’ approach in planning for future ethical review enables continued development and allows considered ethical review of the significant issues ahead.

Towards Implementation – The Development of a Health Sector Strategy

The Foresight Project has been a labour-intensive process with considerable commitment from participants. The work behind the development of the final strategy has involved a variety of activities since the first sector workshop held in May 1997. Fifteen sub-sector groupings subsequently developed their contributions to the overall strategy. Input from sub-sector groups included:

• a description of their sub-sector
• the creation of the 2010 vision for their sub sector
• identification of future needs
• review of competencies.

The MoRST Midsight Conference outlined the Government’s five goals for science and technology: