How do you see the world evolving by 2020? Will we find ourselves in a fragmented society in which we have to find our own way and science is just one voice among competing world views. Or will the nation state reassert itself, and with it individual reliance on those speaking with the voice of authority?

In the first scenario, it is increasingly difficult for people to know whether they can rely on the information available to them;

politics, business and community life are characterised by transient networks and shifting partnerships; but elderly people may be viewed as a resource.

In the second, new technologies will have assisted national institutions to revamp themselves, and to achieve greater control over information; national government remains the focus of politics; government institutions underwrite family life through childcare support. Yet elderly people are seen as a burden.

The two scenarios are set out in rather more detail in anticipation of next week's big Institute of Health Services Management/ NHS Confederation conference as the basis for debate about where the health service could and should go in the next half-century of its existence.

Contributions to the NHS future issues debate can now be made through the official NHS 50 web site, and will be fed into a discussion forum at the conference, where delegates attending in person will also be asked to list the characteristics of their ideal health service.

It is a good way of getting people involved with the conference, allowing them to contribute to the debate even if they cannot attend, and shows that the Department of Health can run an interesting and attractive web site when it puts its mind to it.

You can even send a nice 'virtual postcard', selecting a picture from the online photographic exhibition, with a 'stamp' of your choice.

This and other sites of interest can be reached via HSJ 's website at