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6 November 2019updated 30 Jul 2021 9:14am

How we can create a 21st century health service

The Chair of the Royal College of Surgeons’ Commission on the Future of Surgery looks at how data, genomics and robotics can transform the National Health Service

Technological innovation within the NHS has not always been easy. Many will remember that the introduction of aimed to bring together patient records in a central database, to enable practitioners across the NHS to instantly call up relevant information about a person in their care. The dataset would have been the largest of its kind in the world, with the potential to produce population-level information about trends in public health.

However, because of concerns about data security, more than a million people opted out before a single piece of patient data was transferred into the system. It is critical that we learn the right lessons from that episode – not that data sharing is inherently wrong or unduly risky, but that such a new system must be rolled out with far greater understanding and emphasis on the benefits to patient care and, crucially, with visible safeguards in place to protect privacy. 

The Department for Health and Social Care has already set out some welcome guiding principles but these now need to be put to work on the ground. Where data sharing is transparent, properly secure and arises from consent, it will be a crucial and powerful tool in feeding the next revolution in healthcare: genomics. That development is a critical foundation stone for transforming the NHS from largely a sickness service – treating those who are unwell – to an illness prevention and health promotion service.

Detecting disease early – particularly cancers – could make the single biggest contribution to saving lives in the future. We will not just be able to flag who is most at risk, but will have the ability to track which treatments are most effective for individuals. Methods of diagnosis are likely to become quicker and less invasive. Liquid biopsies may be able to identify the DNA of certain cancers in bodily fluids; microscopic nanorobots are being developed, which could be sent into the body, remotely controlled, to retrieve tissue samples; and Artificial Intelligence (AI) will be able to examine 3D images of our organs for signs of disease. The days of clinicians squinting at x-rays are fast entering the rear-view mirror.

These rapid developments in technology could also potentially have a positive effect on the workforce. Last year’s Future of Surgery commission, sponsored by the Royal College of Surgeons of England, found that clinicians’ expectations around work-life balance are shifting, with recognition of the important impact this may have on the wellbeing of healthcare professionals, and thus of their patients. We shared the analysis of the Topol Review into Preparing the healthcare workforce to deliver the digital future, which said that technology has the capacity to reduce workloads, augment healthcare workers, and thus provide more time to care even as demand for our services inexorably increases.

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The NHS must reform and improve the working conditions of its staff, and in turn healthcare professionals will need to take a more flexible approach to their own careers. Alvin Toffler, in his book Future Shock, predicted that “the illiterate of the 21st century will not be those who cannot read or write but those who cannot learn, unlearn and relearn.” This applies to all those delivering healthcare, who will need to keep up with the pace of change, and keep an open mind about which professionals undertake which tasks. 

In my own field of surgery, the old-fashioned style of ‘surgeon master ’ is long gone. We are now leaders not dictators, facilitators in the delivery of team-based competencies, increasingly likely to find ourselves working with the assistance of surgical robots. The potential for this technology to reduce open surgery and increase the volume of minimally invasive ‘keyhole’ surgery is significant. But, more than that, it heralds the potential for much wider change with the digitisation of theatre activity.

Contrary to the popular media imagination, robots are not set to replace healthcare professionals. The idea that humanoid robots will suddenly do everything from changing sheets to complex neurosurgery is false. Instead, robots are a precision tool for surgeons to use in operations – their arms more slender than those of their human counterparts and free from fatigue and tremor. In addition, robots are usually controlled from a seated position, reducing the ergonomic strain surgeons experience leaning awkwardly over operating tables.

However, there is a concern that such technology is leading NHS Trusts to rush ahead with procurement without proper planning and training. A tragic case in Newcastle, where robotic heart surgery ended in a fatality sadly illustrated how serious the problems can be if robots are used by the uninitiated. 

There is therefore an urgent need for the NHS to map where robots already are, and to plan methodically for their deployment around the country, ensuring the technology redresses existing health inequalities rather than reinforcing them. Such an exercise would identify not just the potential capital funding for buying more robotic equipment, but also enable development of high quality training programmes to ensure they are safely used.

Robots are developing so rapidly that in most cases manufacturers will be best placed to provide training in their use. The Royal College of Surgeons of England is now discussing with industry how it can accredit that training to ensure it meets rigorous standards. We also consider a national registry crucial for documenting all robotic procedures and for building basic critical data to inform research on the procedures in which robotics can make the most difference. 

As we approach the 2020s, there is an opportunity for the UK to lead the world in putting medical technologies to work for the common good. While the NHS is much maligned for its centralisation, the existence of a relatively cohesive system across the country means we have the opportunity to ensure sophisticated data analysis, preventative healthcare and cutting-edge, minimally invasive surgical techniques are not the preserve of a wealthy few, but available for all.

Mr Richard Kerr is a consultant neurosurgeon and Chair of the Royal College of Surgeons’ Commission on the Future of Surgery

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