Our healthy future is a new foresight report launched this week by the PHG Foundation. In contrast to other reports considering how science and technology may affect future healthcare, Our healthy future focuses on the bigger picture for policy-makers. How can they prepare for a future underpinned by science and technology, much of it as yet unknown? The accelerating pace of innovation means that, though we may extrapolate current trends, we simply can’t know for sure what may emerge.
The big picture
Policy-makers are certainly well aware of the need to prepare for change; the NHS Long Term Plan is a specific attempt to take a longer-term view for the UK health service, and includes clear commitments to using technology to meet sustainability and care challenges. Similarly, the recent Topol Review considers not only the technologies expected to have an increasing role in healthcare, but also the implications for health professionals.
Our healthy future takes a step back to consider the bigger picture for policy. It is the end result of a wealth of background research and contributory reports, briefings and other materials, covering both a range of human life-stages (reproduction, youth, middle age and healthy ageing) and in-depth consideration of selected key themes: person centred care, overdiagnosis, privacy and autonomy, social impacts.
Future focus
Future healthcare will be increasingly personalised, supported by a whole range of technologies to underpin prevention, diagnosis and management. Science will not only enable precision through data collection and analysis (within and far beyond traditional health systems) but also shape people-centred care – ensuring that individual preferences and needs feed into decision-making and interventions.
This will need a health system built on strong data foundations – in terms of systems, standards and sources, including appropriate diversity – and that maintains human contact at critical points. Ensuring that individuals can understand and make decisions based on increasingly complex data will require human support, and some current roles of health professionals will undoubtedly evolve to embrace new specialisms and skills in achieving this. A changing view of health and disease as a continuum will probably also affect this, with new health professionals (as well as technologies) supporting prevention of disease as well as different forms of care and management.
A question of balance
This all sounds good, and it indeed could be very good – if we get the balance right. For all the promise of technology to improve health and solve current limitations and pressures on health systems, there are risks to be addressed. In most cases, the issues are not black and white, but a question of where societies wish to strike a balance. For example, how will we cope with differing views on what ‘good health’ means, and relative responsibilities for pursuing it? Who makes health decisions in differing circumstances? How will we maximise the research and care benefits from data whilst maintaining public trust? There are also many questions around balancing citizen and patient safety against individual autonomy and agency; costs against preferences; personal choice and equity of access.
Laying the foundations
Policy-makers can help to shape the debate around these issues, and start developing systems equipped to meet the challenges of the future – which boil down to reaping the benefits of technology for health, whilst hanging on to those elements of human interaction that really matter to people: communication, choice and care. This will not just happen automatically – but we can greatly strengthen structures and systems to make it more likely, and build a framework for future decision-making.
The key take-home message of Our healthy future is that policy-makers will need help –existing stakeholders in the development and uptake of health innovations should be joined by new contributors to oversee and participate in their design, development and delivery. This includes members of the public as well as patients; people from different health professions and communities; an expanding range of commercial participants (for example, with expertise in user-centred design as well as technology); and researchers from many different disciplines. New incentives will be needed to achieve this new diversity, but ultimately will secure robust, user-centric, practical innovation whilst minimising the risks of inequity.
Similarly, data from a diverse sources will be needed to underpin research and care that meets the needs of very different people. This will necessitate flexible systems and shared standards for data collection and integration, as well as interpretation – allowing a learning health system that will reflect wider population needs and situations, whilst supporting public confidence in data sharing. Public trust will only be maintained with responsive systems for regulation to keep pace with fast moving technologies that cut across traditional categories of innovation and health application.
Changing times
We anticipate enormous change ahead – driven both by population need and scientific potential. To see the benefits, we will all have to adapt to new systems, approaches, roles and responsibilities in relation to health and care, health professionals, scientists, policy-makers, patients and public alike.
Operating outside our current comfort zones is not an easy thing to contemplate, and this could further add to concerns about potentially harmful consequences of embracing technology for health. However, by working together as people, patients and professionals, and as members of society, we can agree on those things we don’t want to change – our shared values – and use these as the guide for when and where to use technological solutions and tools. Anticipating, understanding and discussing potential problems as they arise via meaningful public dialogue will be essential; and will require promoting both scientific and health literacy.
Embracing emerging science and technology can offer a healthier future for us all, but we must also take appropriate steps to ensure it is the servant and not the master by centring shared human needs and societal priorities.