The London Health Mission is a 10 year commitment to tackle health inequalities resulting from digital exclusion. Led by the Greater London Authority (GLA), it brings together the NHS, London Councils, the boroughs, VCS (Voluntary and Community Sector) organisations and other partners. We’re now moving from discovery into design.

In my view, the tension with this ambitious timeline is that we’re designing for outcomes in 2035, based on the problems, technologies and tools of 2026. 

The problems we see today may not be the problems of 2035. Technology will have undoubtedly moved on, solving some issues and creating others. 

It is well known that digital exclusion is one of many barriers to accessing health services. Just from our digital inclusion work here in London, we know that devices, connectivity, skills, affordability, and security concerns make it impossible for some to get online. Our digital inclusion community has told us that motivation, language, and cultural aspects also pose additional barriers for many Londoners today. 

This is just how the world is right now – a snapshot in time. These barriers might look completely different in five or ten years, we just don’t yet know how. 

Our human instinct is to jump in right away and start solving. Testing, learning, iterating. In most contexts that would be exactly right. But over a 10 year horizon, designing and building only for the conditions we see now risks designing services that are obsolete before they even have time to scale.

Wouldn’t it be better to start with a range of hypotheses, like the ones below, that explore different futures – probable, possible, and improbable? For all we know, what feels improbable now might be a common reality in 10 years time. 

What if:

• AI triages every GP and hospital appointment by 2030, even A&E?
• Community pharmacies become the front door to mental health support? 
• Agentic AI does the booking, the chasing and the advocating for most Londoners (and the excluded are those without a capable assistant of their own)? 
• The NHS stops building and using physical clinics entirely? 

We’re not trying to predict which of these will come true. We’re trying to read signals from today to imagine what they tell us about our world in a few years time. Of course, there are no guarantees, but we should ask ourselves now, whether a service built for the Londoner of 2026 still works for them in 2030 and 2035. 

It’s for this reason, we’re working with  the Royal College of Arts (RCA), with a  track record of designing solutions by combining scientific rigour with the creativity of the arts, their speculative design methodology is based on turning a range of signals (socio-economic, political, technological etc.) from today into scenarios that explore the probable, possible and improbable futures across three time horizons: now, 2030 and 2035.

You might be thinking – yes it’s great to have some more scenarios, but so what?

It’s easy to get lost in creating endless personas, but if we don’t stress-test our solutions against future realities, we ultimately risk failing to achieve the desired outcomes for Londoners.

This also matters because the real test isn’t whether these scenarios are clever on paper. It’s whether a borough commissioner, an ICB (Integrated Care Board) leader or a frontline practitioner can recognise their world in it, and start to see what they’d do differently straight away.

This is only the start. Later this year we’re bringing all of this together in an in-person event. Practitioners from across the public sector will spend a day exploring the three immersive futures alongside academics and innovators, and leave with defined ideas for solutions to take forward. Get in touch if you have any feedback, suggestions or recommendations.