Life on Marsland on the shape of things to come

In the second of his columns reflecting on the health service and IT as the NHS turns 60, Iain Marsland gets out his time machine to explore what the next 60 years might bring.

Last month, I reflected on the parallel advances in information technology and healthcare during the first 60 years of the NHS, whose anniversary we celebrated on 5 July. This month, I want to look ahead (with apologies to HG Wells) to the possibilities that another 60 years will bring.

Serious pundits always avoid long term predictions. Luckily, I am not a serious pundit. However, I will still try to avoid the fantastic, such as tri-corders, personal air speedsters, time travel and moon colonies.

Old needs, new solutions

It is already evident that our healthcare needs derive from:

• our postcode, reflecting our housing, wealth, education and access to services
• our lifestyle, including our use of drugs and alcohol, and factors such as obesity and exercise
• our genetic makeup and predisposition towards diabetes, cancer, heart disease and so on
• our luck; as accidents do happen!

In 60 years time, even if society hasn’t reduced the causes of ill health, we can expect the NHS to have developed new capabilities to deal with those needs. These could include utilising genomics, the rapid development and deployment of new drugs, frequent broad spectrum screening and universal non-invasive surgery.

Hopefully, cancer, the common cold, Alzheimer’s and HIV will be consigned to the history books and ways will have been found to make our own hips and knees last a little longer. These capabilities will need to be matched by greater personal responsibility for our health, probably linked to individual payments for some elements of care.

Rising costs but better information

Costs will, of course, continue to rise. In 1948, the NHS consumed 3.5 per cent of GDP at £328,000 or 32 million Mars bars. In 2008, the NHS takes 8.2 per cent of GDP and cost £110 billion or 320 billion Mars bars; a real increase of 1 million per cent. Economists predict continued higher funding, rising to between 11 per cent and 14 per cent of GDP by mid-2050.

Supporting this will be mature and comprehensive healthcare intelligence. Gone will be the days of depending on clinicians’ individual knowledge. The information age that will result from current IM&T investments will be eclipsed by the age of intelligence, in which a neural network of global, evidenced-based care will provide advice and guidance to clinicians and patients throughout the care continuum.

In the process, patients will be able to move from being the grateful recipients of services, as they were in 1948, to consumers with choice, as they are today in 2008, to being the managers of / partners in their care by 2068.

No more cables, no more keyboards

The technology to deliver these services will be different from anything we use or understand today. The next step change in technology is already overdue and there may well be two or three evolutions before 2068. However, if sense prevails we can expect some of the perversities of our current IT to become museum pieces over this period.

Top of my museum list would be computer cables. Whether DVI, SCART, SCSI, RJ45, RJ11, USB 2, Mini B USB, Cat5, Cat 6, parallel or serial; the list of incompatible data transfer wires is endless. Can someone please develop a global wireless network that can be used for all commercial and domestic data? Then, why do applications reside on a mechanical device that needs to spin at 7,200 rpm to deliver the application into memory? Perhaps, by 2068, we will have memory-resident applications with embedded device handlers.

Next on my replacement list would be the keyboard and mouse. Today’s Wii and touch-screens can be seen as way markers towards more ergonomic human interfaces. I feel myself heading rapidly towards the land of tri-corders and time travel, but perhaps holographic devices will be the way forward.

On a more mundane level, I predict that cooler technology will result in 2068 being much quieter; without the millions of fans running on today’s equipment.

The politics of change

What is the political equivalent of replacing the technology wires? It will take some seismic event for the public to lose faith in the NHS. However, the shape of care provided under the NHS badge can be expected to develop and change.

Government management of the NHS cycles from close stewardship to benign overseer and back again. However, if the NHS is to remain publicly funded then the Treasury will maintain its close interest.

Increasing public awareness of their healthcare and options, along with increasing wealth and an increasing expectation of service will drive demand. Healthcare is already becoming commoditised, with choice, tariffs and provider diversity. Therefore, a mixed economy of public / privately funded care would seem likely, together with an increasingly diverse range of care providers, at some stage in the next 60 years.

The challenge for healthcare IT will be to develop global standards for information to provide benchmarks for quality and cost of care. Who knows, we may look back on the National Programme for IT as the point where modern models of healthcare began.

Read Iain’s last column - 60 years of learning to love the computer
About the author: Iain Marsland has been in the NHS for 34 years, most recently as chief information officer for Essex Strategic Health Authority and previously as director of IM&T for acute trusts in Brighton, Sussex and Bristol. He is now an independent consultant.