The Future Delivery of Medicine: 2020 – The policy implications

UCL Provost Malcolm Grant addressing the conference.

Healthcare systems need to be re-engineered to create an environment where technology is encouraged and enhanced in ways it has not been before, said Niall Dickson of the King’s Fund, a UK healthcare policy think tank.

“The uptake of technology in our healthcare systems is very slow,” he told delegates at the University College London/Science|Business conference on the Future Delivery of Medicine: 2020, held earlier this month.

But there is evidence that technology can force systems to change. Delivery of psychiatric care has been transformed in the past two decades as mental institutions have been closed down. That reform was made possible by new drug treatments. Similarly, antibiotics led to the closure of tuberculosis (TB) isolation units.

From this perspective we have got to be “fantastically enthusiastic” about technology, said John Martin, Director of the Centre for Cardiovascular Biology and Medicine at UCL. “I would argue that the organisation should follow technology, otherwise you have TB hospitals when TB has been wiped out.”

Psychiatry and TB are examples of the system responding, over time, to individual technologies. What is unprecedented now is the “collision” of an array of industries and technologies around healthcare. “How do you make all that available?” asked Rakesh Mahajan, Director of Mobile Services at the telecoms company BT Global Services. “There is no equity of access to the most advanced technology: it takes a huge amount of time to get technology applied.”

‘Immense opportunity’

There is no doubt the opportunity afforded by technology is immense, said Graham Spittle, chair of the UK Technology Strategy Board and Vice President of Software at IBM, who asked delegates to consider the way that the Internet has fomented a revolution across industry in the past ten years. Meanwhile the UK’s National Health Service does not even use email.

The critical issue in healthcare is not the rate and pace of technology; it is a “fundamental societal fear based around cost,” said Spittle. It seems self-evident that the route to bringing technologies together and making them affordable and manageable is for each individual to control their own health data. “No other model works [when technology means that] we can tune our bodies, time our death, choose out children.”

Given this perspective, it is necessary to engage with the public and explain this potential. “Otherwise we won’t get take-up,” said Spittle.

Check first what technology can do

Nicolaus Henke, Global Health Practice Leader at the management consultants McKinsey and Company, suggested that rather than pushing for faster (and expensive) technology adoption across the board, it would make sense to identify particular problems that technology could solve.

His candidate for the technology treatment is chronic diseases, where there is currently a global annual spend of $3.5 trillion, a figure, which as Henke wryly observed puts the $700 billion US banking bailout into context. “We kind of know how to solve this by better managing chronic diseases,” he said. Patients with the same disease should be grouped together and get regular care from a dedicated, specialist team.

This approach is about changing the way care is organised, and technology can contribute by providing information to carers, and new, targeted interventions can be introduced more rapidly, at a scale that reduces costs and provides relevant, concentrated clinical feedback, Henke said.

With ageing populations, chronic diseases are one of the most pressing issues, both in terms of their cost and the impact on quality of life, yet the whole healthcare system is based around acute, episodic care, said David Colin-Thomé, National Director for Primary Care and Medical Advisor at the UK Department of Health.

“We are spending millions on ineffective methods. Outpatients, for example, is a relic of 19th century care.” What is needed said Colin-Thomé, are “new and integrated care models.” One way that technology could help to overcome the vested interests that stand in the way of such models is by supporting self-care.

Another specialist in healthcare policy, Juha Teperi, Programme Director at the Finnish Ministry of Social Affairs and Health, agreed the current systems are irrational, “We pay for activity not outcomes.” He suggested one way to create demand, and encourage healthcare systems to develop the same appetite for innovation as other sectors, would be a model in which reimbursement is based on a whole cycle of care.

“Can you imagine any other industry where you measure so little of your primary output as health? We hardly even look at outcomes and use that [data] to improve outcomes,” said Teperi, adding, “There are some initiatives, but they are nothing compared to the challenge.”