The new NHS Long Term Plan set the stage for how the health service will remake itself with technology over the next 10 years. The Topol Review, released shortly after, had an even broader, and maybe more difficult, task: to understand what technologies can be of use to the NHS over the next 20 years – and how to reshape its workforce to take advantage of them.
According to the review a greater demand for healthcare, combined with younger staff in the industry looking for more flexible work patterns, will bring significant change to the NHS workforce, with digital technologies offering a way to tackle both trends. "Digital healthcare technologies, defined here as genomics, digital medicine, artificial intelligence (AI) and robotics, should not just be seen as increasing costs, but rather as a new means of addressing the big healthcare challenges of the 21st century," the report says.
Of the technologies that the Topol Review mentions, most are already in use in some from within the NHS today. Genomics, for example, is currently used to detect inherited diseases or identify which drugs certain cancers might respond to. As the costs and speed of genome sequencing continue to come down, genomics could be used in a number of new ways, such as more accurately predicting an individual's predisposition to particular disease or better understand the genetic and lifestyle factors that lead to disease.
Genomics should be added into curriculum for healthcare degrees, it adds, and career pathways for bioinformaticians should be developed.
More broadly the report also details the greater use of 'digital technologies', used to help manage long-term conditions, diagnose infection, and promote better health. Its broad-brush categorisation of digital medicine includes remote healthcare, apps, wearables, e-prescribing, IoT, sensors, VR, and AR.
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In order to create a health service ready to take on these technologies, the report says the NHS needs to undertake more R&D around emerging tech. This could go some way to creating an evidence base that will persuade clinicians as to the benefits of such technologies.
Clinicians in the NHS are trained to make decisions in the tradition of evidence-based medicine: implement a change, monitor it, analyse the results, and use that to inform future decisions. Due to the relative novelty of using some of the technologies included in the review within healthcare, that evidence base is not there yet – making it hard to persuade sceptical clinicians about their value.
"Bringing people with you is really important, and the Topol Review still has a lot of people to convince. A lot of staff need to be convinced that these [technologies] are the right things, and often on very scant evidence, which clinicians put off automatically," says Harry Evans, a researcher in the policy team at healthcare charity and think tank the King's Fund.
The Topol Review specifically references AI and robotics as technologies that the NHS needs to be on top of, using AI to analyse reams of data that healthcare creates, using robotics to aid with surgery, and using both to automate mundane tasks normally done by healthcare professionals.
Elsewhere, the report suggests getting health workers more involved in the development of digital tech in private companies, and also encourage workers to improve their digital skills, including being able to assess and buy new technologies. "Time and opportunity to increase the digital skills of the current workforce will be required, as will the ability to attract much needed up-to-date digital expertise," the report says.
But attracting that talent may come down to the simple questions of cost: in order to add new roles such as bioinformaticians and hire top technology talent, the NHS will be competing with IT companies with far bigger pockets. "It's important to bear in mind the wider challenges we have with the NHS workforce as well – we have challenges with recruiting and retaining the workforce that we need," says Rachel Hutchings, a policy researcher at health think tank the Nuffield Trust.
"I think it's also important to look beyond clinical staff as well and look more comprehensively at the workforce that's required to make that shift to a digital NHS. The NHS is competing with the private sector for a lot of those skills," she warns.
Overall, the review hopes to use technology to increase workforce productivity, but it will also mean a workforce that is more fluid, where roles and responsibilities blur. It will also require all staff to learn about various technologies: while the report does mention secondments and sabbaticals for this purpose, as well as continuing professional development (CPD), which nurses and doctors must do every year in order to continue to practice.
"We need to realise that there are not enough hours in the day for staff to be doing all the things that they're currently doing and also all of these other things," says the King's Fund's Evans.
"If you're not able to give your clinicians the tools, the passion and the responsibility over some of these kinds of really new, really emerging technology, then they're not going to use it and they're not going to take advantage of it."
Creating a new, tech-savvy workforce may also require revisions to the curriculums of nursing and medical degrees – and even then it will be years before the first nurses and doctors that are taught tech skills graduate and join the workforce. Medical and nursing degrees are already full to bursting with skills and knowledge that tomorrow's medical professionals are expected to know; fitting in even more IT capabilities may be a struggle.
The review takes the optimistic stance that "these technologies will not replace healthcare professionals, but will enhance them ('augment them'), giving them more time to care for patients".
Perhaps ultimately that will be the case, but staffing is one of the biggest challenges for the NHS.
Currently, there are thousands of unfilled nurse, doctor, and other healthcare-worker positions, leaving those currently in the NHS overstretched and working hard just to fill the gaps.
"As with any other plan or strategy that's coming out over the last few years, if we don't sort some of those workforce issues, it's going to be very difficult to deliver some of the changes that we need to see," warns Hutchings.
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