Healthcare in 2088 - how will research and innovation transform the NHS in the next 70 years?
One of the most exciting things about medicine is that it is constantly evolving. This evolution is being driven through research and by healthcare professionals, scientists and patients constantly seeking to improve health and wellbeing, identify opportunities for greater efficiencies, and to make services more accessible.
Looking back at improvements in healthcare and its impact is relatively easy. But predicting and preparing for the healthcare system of 10 to 20 years in the future, let alone 70 years ahead, is much more difficult. Yet, without this preparation, it will be hard for us to be ready for the next generation of healthcare provision. Being ready can range from how we regulate or approve new ways of healthcare to how we deliver it across the NHS.
It’s hard to believe that less than 100 years ago there was no established healthcare system in the UK. Since the introduction of the NHS in 1948, universal healthcare provision has transformed our lives. As the NHS celebrates its 70th birthday we are living nearly 20 years longer as the consequence of better hygiene, nutrition and more recently medicines.
Our role at the NIHR Innovation Observatory is to help people keep an eye on what the future holds. Helping the NHS and healthcare leaders to understand future medicines, devices and diagnostics helps to shape policy, regulation and approvals and stimulate research activity.
We could highlight many things that might influence the future of healthcare, but here are our top three to watch:
Our everyday lives have fundamentally changed as a result of digital ‘things’, from how we access information, such as Google; find our way, such as Sat Navs; or talk with friends, such as Facebook.
Digital healthcare is past its ‘hype’ and is starting to make itself known. 2018 saw the procurement of a national programme of digital programmes for type 2 diabetes, showing how seriously the NHS is taking it. The NHS even has its own app store!
Digital tools can open up access to services and help care teams make more efficient decisions, but there needs to be a new framework for how we evaluate digital health systems and keep them safe.
In the future, whether you access a GP through a video call, artificial intelligence is used to interpret your MRI scan, or your phone lets you know what dose of a drug to take – digital healthcare holds the potential to fundamentally change how we access and provide care.
Once the topic of movies and newspaper headlines, 2018 saw the advent of a new era of personalised medicine unfold – at the centre of it is genetics. The ability to alter genetic coding was established in 2012, a technology called Clustered Regularly Interspaced Short Palindromic Repeats - CRISPR. But scientists and care teams have translated this into ways to tailor immune therapies to attack cancers or cut out mutations that cause disease.
Research taking place in this area right now provides a glimpse of how gene editing might affect future care. For example, researchers funded by the NIHR’s Efficacy and Mechanism Evaluation (EME) Programme are conducting a clinical trial looking at using gene therapy to replace the faulty gene that causes the incurable eye disease choroideremia with a healthy one.
The ability to modify genes will have deep implications for the management and prevention of some diseases, but it will also have deep societal and ethical implications.
Looking after ourselves
This area is not an innovation by definition, but it will have important implications for us all. 70 years ago the NHS was formed as a consequence of a report from Sir William Beveridge in 1942. The report detailed how Britain should put in place national systems to prosper after the war. There were several recommendations that were truly revolutionary at the time, but from a health perspective they can be summarised in two points:
- Free access to support for the management of disease - an “illness management system”
- Access to support for keeping people well - a “wellbeing management system”
This was a defining time for the UK: the NHS was formed. But, at the time resources weren’t available to create a wellbeing management system. It was suggested that this was the responsibility of the employer and community.
Fast forward to today, and the NHS has developed into a world leading health care provision service, but is being challenged by the pressures being put upon it. Obesity rates continue to rise and physical activity levels falling. Although the NHS is keeping us alive longer, it comes at a very real financial and individual cost (are the extra years actually of a quality we would like?).
We are moving from an era of biomedical enlightenment into a realisation of its limitations. The future will involve a greater balance of disease prevention and public health as well as disease management – we need to revisit the original remit of the NHS and create a “wellbeing culture”.
For example the Football Fans in Training follow up study funded by the NIHR’s Public Health Research (PHR) Programme found that a football club based weight management programme that encouraged men to make small, incremental physical activity and dietary changes led to nearly 3kg weight loss after 3.5 years.
Creating a “wellbeing culture” will involve empowering people. Whilst we can edit genes and create digital tools that will change the fabric of care, understanding and supporting positive behaviour is nowhere near as simple, but even more important.
A pivotal time
It’s interesting to let your mind wander: in the future, will we look back at today’s care and say how old fashioned it was? Will our children smile when we talk about going to our GP to meet them in person, wonder why we did not have our health record on our phone, or be looked after by a virtual wellbeing assistant? I don’t know, but it’s interesting to imagine what our NHS could look like in 70 years time.
What I do think is that we will look at the 70 year anniversary of the NHS as a pivotal time in the evolution of healthcare, one I am proud and excited to be a part of as I hope you are too.
The NIHR’s I Am Research campaign gives patients, the public and health and social care research professionals a chance to shout about how fantastic research is. We aim to raise awareness of the benefits of research and the positive impact it has on people's lives.
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.