When it comes to predicting the future of primary healthcare, futurologists tend to fall frequently into a trap of blind faith and optimism about the prospects of technology and forget about the people.
An exception was a report written in 2018 by Andy Wilkins and Richard Gold which was commissioned by the Royal Free Charity in Hampstead, London. Wilkins and Gold penned an illuminating and sensible vision about the potential trajectory of healthcare, the ‘megatrends’ underpinning them, and the potential for a far more personalised and sensitive primary healthcare system. It’s a piece of work of interest to all GPs.
The underlying thesis of the report is that the NHS as constituted in 1948, was designed for a fundamentally different approach to healthcare, in line with a very different society. The traditional symptom-led clinical care was geared towards acutely ill patients, while today, chronic conditions are more common. In combination with the way in which healthcare is better understood as heavily linked to lifestyle and environmental issues, there’s a need for a greater focus on wellbeing and lifelong care. As discussed in Matthew Gwyther’s chapter about the Peckham Experiment, there has been precedent for this school of thinking, but Wilkins and Gold have examined how this can be realised through the use of emerging 21st century technology.
The key rubric of the report is the identification of ‘megatrends’ – that of long-term shifts in society that shift the purpose and capacity of healthcare provision. Health technology is an emerging field – from AI assistants to digital sensors. Other industries, from social media to banking, already utilise technology to provide more personalised services which may create expectations for similar development in healthcare.
On a personal level, people can be provided with the capacity to understand their health, between or instead of consultations with medical professionals. Technologies such as genome sequencing can also provide early warning of genetic diseases, while AI can analyse data efficiently and provide psychological ‘nudges’ to encourage healthier lifestyles.
The central through line of the whole report is that healthcare encompasses far more than visits to clinicians and that technology should be used to facilitate a shift to preventative care. According to the report, even patients with chronic disease spend less than 0.1% of their time with a medical professional, and virtual assistance can be used to create a holistic ‘health ecosystem.’ Such a system would use ‘always on’ health technology in combination with an integrated health system, across the whole NHS and care system. Building upon the values of wellbeing, early detection, management of conditions, and assisted independent living, the digital healthcare ecosystem would have the aim of providing lifelong care that improves the quality of life as well as reducing the need for medical interventions.
At the same time, the collection of data, on a population scale, can also be utilised to provide health benefits. Analysing links between environmental or genetic factors and health can be used to identify at-risk groups or further medical research. In order to realise this broad vision, it is key to centre prevention and population health, over the treatment of individual symptoms, and ensure that there is an integrated healthcare model that can provide holistic support.
People must be encouraged to take control of their health, through technology and AI digital coaches, while a consensus must be built for the appropriate sharing of data and use of sensors to collect intimate data. Data protection and security must also be key to realising this vision, as well as new clinical organisational structures to decentralise healthcare, into community care with the support of AI health technology.
Crucially the report provides hypothetical ‘case studies’ to demonstrate how a technologically adept and community-focused healthcare system could function. For example, a 26-year-old with an ‘NHS dot’ device, and a family history of high cholesterol could be provided with their weekly report of sleep, stress, energy, and exercising levels. This could then link to suggested local exercise activities and diet recommendations. It is vital that the advice is provided in a natural way, rather than dictated paternalistically, as the technology is designed to empower patients to take active choices. Alternatively, a 68-year-old with a chronic condition such as COPD could be provided with live pollution data and specialised exercises; at the same time, the sensor collects data on Oxygen levels and can automatically prescribe emergency medication when it detects an issue – preventing hospitalisation.
The data collected can also be used in consultations at community ‘polycentres’ where medical professionals can provide general lifestyle advice, as well as targeted healthcare interventions. The goal is to prevent illness before it occurs, promote wellbeing, and integrate health into everyday activities. A stern critic might point out some shortfalls in this vision. In this Brave New World, take up among Fitbit fanatics can be assumed. They are frequently The Worried Well. However, those less engaged and committed, those who doubt, might be left by the wayside. How are those who might still wish to be passively carried from the cradle to the grave by the NHS to be persuaded to engage with their own long-term wellbeing?
What tech would do in an ideal world is challenge the individual in real time and regularly when they are engaging in activities that are to the detriment of their health – alcohol and cigarettes, for example – and make them accept that a visit to the GP in the hope that they can sort it out when they’ve developed a chronic disease will not suffice. Because it doesn’t. That’s why a transfer of power is important.
There remains an undeniable link between poverty and poor health. If you’re not well off, you are far more likely to get to breathe more lousy air in cities. You are also more likely to resist having a COVID-19 vaccination.
Big and small Tech has its sights on healthcare, and it won’t go away. If one thinks about what Facebook/Google know about us already, they know what more data they might scrape together if they had loads of tiny probes all over us and what the data derived from those probes would be worth.