To mark the BBC's coverage of the NHS's 70th birthday in July 2018, researchers from the Health Foundation, the Institute for Fiscal Studies, The King’s Fund and the Nuffield Trust have joined forces for the first time, using combined expertise to shed light on some of the big questions on the NHS.
The four organisations have been asked by the BBC to look at five key topics, covering the relative strengths and weaknesses of the health service, the state of social care, NHS funding, the public’s expectations of the NHS and the potential of technology to change things in future. This project and the reports we have produced are intended to inform the national conversation about the past, present and future of the NHS.
It is notoriously difficult to predict how technological advances will interact with health services and the policy landscape to shape the future of health care.
This report provides numerous examples of developments that were anticipated to transform health care, but that failed to deliver – at least in the short term. Meanwhile, other key advances have been made with little fanfare or prior expectation. For these reasons, we do not attempt to predict what the ‘next big thing’ will be. Instead, we look at four current trends and what they might mean for health care over the next 5–10 years if they continue to progress.
All of these have the potential to improve health care:
Genomics and precision medicine can target treatment interventions at specific sub-groups of patients, potentially making them more effective and opening up new therapeutic possibilities.
Remote care can improve access to health care services, enabling patient needs to be addressed as early as possible and potentially making systems more efficient.
Technology-supported self-management can help to empower patients to better manage and understand their condition, supporting improved behavioural and clinical outcomes.
Data can provide new ways for the NHS to learn, improve and generate new research – alongside artificial intelligence (AI), which is providing new analytical capacity for diagnosing patients, effective triage and logistics.
While all of these offer benefits, they offer different degrees of transformative change. Remote care, for example, does not challenge the fundamental principle of health care professionals delivering care to patients – it only changes the means through which this is offered. Genomics, on the other hand, may enable entirely new treatment options and, if health care technology becomes ever-more available to consumers, our traditional understanding of ‘patient’ and ‘professional’ may be challenged.
Each of these technologies also comes with challenges and opportunity costs. In each area we ask questions about how the NHS should prepare for these technological advances. Some of the biggest relate to ethics; what we can reasonably expect technology to do; and how we can make decisions about what to prioritise in a resource-constrained system where new developments may add value but cost more.
Technological advances offer significant opportunities to improve health care but are not a silver bullet for the pressures facing the NHS. While there are really exciting developments in areas like genomics and precision medicine, we are a long way from being able to realise their full potential.
Technology has the potential to deliver significant savings for the NHS but the service does not have a strong track record in implementing it at scale and needs to get better at assessing the benefits, feasibility and challenges of implementing new technology.
Patients are embracing new technology and increasingly expect their care to be supported by it. For example, the majority of people say they would use video consultations to consult their GP about minor ailments and ongoing conditions.
New technology could fundamentally change the way that NHS staff work – in some cases requiring entirely new roles to be created. The impact of these changes should not be underestimated.
People generally have relatively little knowledge about how the NHS and commercial organisations use data for health research, which may be responsible for mistrust in some cases. Transparent public dialogue is needed about how data is currently used; what the opportunities are for the future; and how risks can be mitigated. While it is vital to balance the benefits of sharing data with concerns about security and confidentiality, these concerns should not be used as a barrier to progress.