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 Horizon scanning  Big picture challenges  Ideas
 Drivers  TEEPSE  Scenarios
 Trends and megatrends  Wild cards  Weak signals



Horizon scanning

Horizon scanning is the exploration of the potential challenges, opportunities, and likely future developments. The CfWI uses horizon scanning to think about, and help plan for the long-term future.

Horizon scanning is the first stage of the CfWI’s robust workforce planning framework. The output from horizon scanning is used to inform the scenario generation stage, where plausible future scenarios are created to inform strategic planning.

Big picture challenges

For the CfWI, each big picture challenge is a fundamental problem facing workforce planners and policy makers across health and social care system. Management of a big picture challenge requires focused action at the highest level across the health and social care sector, politics, industry, research, etc. and requires multi stakeholder action.

The CfWI big picture challenges fall under four categories: demographics and social, health and social care system design, quality and productivity and financial and economic.

See big picture challenges section.


An idea, as identified through CfWI horizon scanning, is a narrative that describes a possible future situation that would have an impact on the health and/or social care workforce. Ideas may include information about historic and possible future trends, drivers, wildcards and weak signals.

The narrative may describe impacts on the system that are detrimental (risks) or beneficial (opportunities), or combination of both. Whether the impact is viewed as beneficial or detrimental will be dependent on the perspective of the stakeholder group.

See ideas bank.


A driver or a driving force when applied to one or more system factors brings about a change or movement in trends that we identify within our system of interest.

In the context of horizon scanning at the CfWI, driving forces are considered as factors that are significant to the question of concern, and generally not within an organisation’s control, although they may be within an organisation’s sphere of influence.

Example: UK economic conditions impacting on migration rates of UK health professionals to other eurozone countries.

The identification of drivers is a key part of the scenario generation process.


TEEPSE is a framework which categorises ideas as technological, economic, environmental, political, social and ethical factors. This can help in understanding and exploring the interplay between ideas.


  • technological factors cover developments such as minimally invasive surgery, genomics, new diagnostic techniques, etc.
  • economic factors cover financial and budgetary constraints, such as budgetary deficit
  • environmental factors cover changes such as minimising the carbon footprint, climate change, etc.
  • political factors cover political and policy changes such as the European Working Time Directive
  • social factors cover developments such as ageing, co-morbidity, atomisation of the extended family, etc.
  • ethical factors cover considerations such as the acceptability of genetic screening, euthanasia, etc.


A scenario is a description of a possible future situation including the paths of development that may lead to that future situation. Scenarios can be qualitative (a narrative or pictorial story) or quantitative.

Scenario generation is one of the stages of the CfWI’s robust workforce planning framework. During scenario generation, the potential futures are generated based on the future developments identified during horizon scanning.

A scenario is a set of particular workforce ideas that contain a consistent and plausible underlying causal structure.

Trends and megatrends

A trend is an observed historic change over time. A trend is measured using system indicators. Indicators define how system factors can be measured. A trend may be quantitative or qualitative.

A megatrend is a significant trend that has a high impact on the system and will have a large momentum or inertia. Megatrends are created from the cumulative impact of multiple system factors. For example, the ageing population megatrend is composed of trends in birth rate, death rate, quality of healthcare, lifestyle, etc.

Wild cards

A wild card is a situation or event with a low probability of occurrence but with very high impact. In the context of horizon scanning at the CfWI, if a wild card were to occur, it would seriously impact the health and social care workforce. Wild cards may change, or even reverse, the direction of a trend or megatrend, or produce a solution to a big picture challenge.

Weak signals

Weak signals (sometimes referred to as early signals) are barely observable trends or events indicating that an idea, risk or opportunity may arise. As weak signals are barely observable we need to look at the right indicators or event .

Weak signals are subjective in nature, since they are based on limited information and are dependent on a stakeholder’s interpretation.

Signals become stronger as the potential risk /opportunity is closer to manifesting itself.