2020 Future: Health and wellbeing

In this ongoing series in Leader, Robert Hill introduces the third of eight dimensions - health and wellbeing - in the ASCL 2020 Futures project, which is plotting the trends that will impact on school and college leaders in 2020.

A baby born today can expect to live longer than ever before. Life expectancy at birth continues to increase for both males and females. Deaths from the main killers - circulatory diseases and cancer - are down significantly and the NHS has improved its performance on waiting times out of all recognition compared with ten years ago.

But society faces a range of pressing health challenges. Smoking may be down but diabetes, drinking and Chlamydia are up. Rates of teenage pregnancy are still relatively high. One in ten children has a mental disorder and the health inequalities gap is not closing.

Looking ahead to 2020 two issues loom large. First, the number of the very elderly who will need care and treatment is growing fast. Currently 700,000 are estimated to have dementia and that figure is set to double within a generation. And other disorders related to old age such as asthma and osteoarthritis will rise.

The other big issue is obesity. Most adults are already overweight. A combination of poor diet and a lack of exercise means that by 2020 up to 40 per cent of the population are projected to be obese - and this is likely to cause to obesity-related diseases such as Type 2 diabetes to spiral.

The next decade will herald positive developments - better screening and new drugs driven by our understanding of genomics, the advance of stem cell and gene therapy, and increasing use of nanotechnology and non-invasive surgery (for example, using lasers).

The affordability of healthcare will continue to be a topic of debate as spending rises to meet the costs of treating the over 85s. However, the NHS is likely to remain a predominantly tax-funded service with government managing the affordability agenda through increased emphasis on prevention and healthier living, greater use of co-payment, increased competition between health providers and a move to personal budgets.

GPs will work more in clusters and in local health centres - possibly on a franchised basis. New drugs will both advance health care and reduce costs while adding to the size of the drugs bill. And there will be a big increase in the use of technology.

In terms of trends which are possible but cannot be foreseen, the recent outbreak of Swine Flu reminds us that a world-wide flu pandemic has the potential to cause between 50,000 to 75,000 deaths in the UK. A new superbug could prove resistant to antibiotics or a new virus could emerge, as with HIV AIDS in the 1980s.

What will this mean for school and college leaders?

The vast majority of schools are already involved in the National Healthy Schools Programme but are being asked to play a greater role in children's health and wellbeing.

Some see this as 'not their job' but of the range of indicators that the government uses to measure health inequalities, schools and colleges have the potential to have a high impact on at least half of them.

Of course, schools need the support and engagement of other agencies to tackle this agenda. This is the area where we are likely to see the greatest scale of change over the next ten years.

Already we are seeing schools working with or running children centres, locating primary care services on their premises and using extended schools to team up with statutory and voluntary organisations to provide access to sporting, health, counselling, drop-in and mentoring services.

In the future, groups of primary, secondary and special schools and FE colleges - based perhaps on school behaviour partnerships - might take on functions now exercised by other agencies. Children's trusts, which are being given statutory status, could evolve to being based around a cluster of local educational institutions, rather than local authorities.

A school partnership would directly employ or commission educational psychologists, educational welfare staff, children's social workers, parenting support, community learning, specialist psychiatric staff and youth workers. It would have full responsibility for pupil referral services facilities. It could even be that a school/ college-based children's trust has a franchise for delivering local primary care health services.

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2020 vision

For each of the eight dimensions, a paper will be published on the ASCL website, outlining the main issues, and ASCL members are invited to comment on the content.

To read and contribute to the full position paper on changes in health and wellbeing go to www.ascl.org.uk/2020future You will also find the previous two position papers, dealing with population change and climate change.