Horizon scanning: potential research priorities arising from proposals for NHS reforms in England

The current policy debate on health care reform in England revolves around longer-term demographic, social, econonic and technological trends, and is underpinned by a need to increase the efficiency and integration of health and social care services. New approaches to the organisation and funding of health care are shaped by these broad trends as well as by the ideological nuances of the government of the day. Many of these approaches are innovative, not having been previously used in the English health system (or perhaps anywhere else) before. Under an evidence-informed policy model, the extent to which there is existing evidence for the benefits and costs of a potential new intervention will influence the need for new research to provide backing for its introduction.

The aim of this horizon scanning exercise was to anticipate and analyse emerging new challenges facing the health care system in England over the next five years in order to provide early awareness of priority areas for effective policy intervention. The exercise also provided guidance on areas where the existing evidence base needed strengthening through research. The project focused in particular on the specific health care issues and possible policy interventions that were expressed in the Health and Social Care Bill, and subsequent responses to it, during 2011.

The horizon scanning activities were undertaken between January and August 2011. It involved both formal and informal literature search strategies. The formal strategy relied on a keyword-based reviewing process to identify documents making a core contribution, either conceptually or empirically, to current policy. The informal approaches involved browsing the website information of different health care organisations and being alert to ongoing political debates on UK health care reform.

PIRU's horizon scanning exercise identified a number of areas where there was emerging policy interest, but where the evidence suggested new research might be merited. Five extensive tables covered major areas of potential future policy intervention: 

1. Improving health outcomes and quality of care in a context of cost constraints;
2. Changes in patient expectations and attitudes; 
3. Self-management approaches/increased personal responsibility for health;
4. Placing patients at the centre of services and increasing accountability to patients; and
5. Market-based approaches for generating competition, reducing costs and improving performance.