Such caution in forecasting the future is sensible, particularly when it comes to how scientific breakthroughs are going to change our lives. Here, predictions have often been wide of the mark. In 1937, the American Academy of Science predicted what the future could look like, but it is now mostly remembered for what it failed to anticipate: computers, the jet engine, rocket science, nuclear power – and World War 2.

In healthcare, too, there has been both over- and under-selling of the impact of science and technology. A prime example of the former is what followed the mapping of the human genome in 2003, with extravagant predictions about a new era of personalised medicine. While this age is ‘belatedly’ on its way and will, as we illustrate, transform many care pathways, it will take place over a much longer timescale than the euphoric enthusiasts of the early 2000s envisaged.

So, should we take Steven Pinker’s advice to social scientists and avoid forecasting the future or is there a constructive way to anticipate how – and when – science and technology will influence care pathways so that we can plan systems, workforce and facilities accordingly? In this presentation, it will be argued that the latter is not only possible but essential if we are to optimise the health gain return on investment.

A model healthcare system will be used to illustrate the combined, disruptive impact of a range of developments, including personalised medicine, self-management via crowdsourcing, remote monitoring, automation, hybridisation, and logistics. This will be considered alongside inhibitors of change to demonstrate that there is a range of possible futures, and that we have opportunities to shape one that is preferable. As Humphrey Lyttleton might have put it, the future is trumpet-shaped.