‘The patient’s perspective is at the heart of any discussion about integrated care. Achieving integrated care requires those involved with planning and providing services to impose the patient’s perspective as the organising principle of service delivery’ (Shaw et al 2011, after Lloyd and Wait 2005)
Over the last seventeen years there has been more technological and scientific advancement than that which occurred since mankind began which, when you think about it, is a staggering amount of progress. I think it’s fair to say that we now have at our fingertips the greatest opportunities with which to control and repair our health, by way of science and the digital revolution.
What I find particularly fascinating is the role that technology plays in both proactive and reactive healthcare. At one end of the scale we are a multi demographic community of health conscious technophiles, citing Apple’s Health app and wearable technology like Fitbits among our favourite, and at the other, there are those who have fallen prey to the many internal and external factors that increase the chance of conditions like cancer and heart disease, finding themselves beholden to technology by way of communications, diagnostics and medical devices for treatment.
An ageing population and an increase in long term conditions, for example, diabetes, heart failure, pulmonary hypertension, affecting 15 million people at present, have a huge impact on the health system with a need for an extra £5 billion expenditure predicted by 2018, according to a Department of Health report.
One thing for certain is that technology will play a key role in our health, from both a preventative and a cure standpoint. Long term conditions in the UK account for 70% of health and social care spending, and one of the NHS’s long standing strategies is cost reduction through the use of technology and an out of hospital care strategy.
The aforementioned report also states that the use of technology has reduced:
- Death rates by 45%
- Visits to Accident and Emergency departments by 15%
- Emergency admissions to hospitals by 20%
The current UK healthcare system, designed during the post World War 2 era, was set up to focus on the diagnosis and treatment of illness and to, therefore, be reactive. This acute care model is embedded, not only in our healthcare system but within our society.
As a child of the seventies, we put our trust in family doctors and I can invariably remember the sense of relief felt by both parents and grandparents after a visit confirmed there was nothing to worry about, usually accompanied by a prescription of sorts but never with an educational briefing as to what we could do to improve our own health. That’s not to cast aspersions in any way, it was simply a part of healthcare’s journey before shifting into a new paradigm.
Over the last forty or so years, a new era has emerged. The 1980’s bore witness to a new wave of gurus who brought health and fitness into the mainstream via the popular medium of the day, television. Our family practitioners, nurses and consultants alike became increasingly keen to promote holistic alternatives as opposed to a reliance on treatment, a trend that has risen dramatically in recent years and one that has evolved to new technological mediums.
A key area of focus for proactive care is to classify individuals based on four key risk factors that lead directly to over 90% of chronic disease:
- Tobacco use
- Alcohol consumption
- Physical inactivity
- Unhealthy eating
As seen in the recent Public Health England sugar tax campaigns, the focus is very much about taking control of one’s own destiny, in this instance by diet and the reduction of sugar consumption to prevent future diseases like diabetes. I mean when all said and done, it’s one thing that it will ease pressure on the NHS but let’s face it, the quality of our lives will be improved, not to mention longevity, and that is clearly more important than money to us and our families.
So what does the future of healthcare look like?
A return to that old adage of ‘an apple a day keeps the doctor away’, which in essence is the very heart of proactive healthcare, seems imminent. Millennials could herald a new era of healthcare; technologically savvy and passionate about personal fulfilment and good health, new generations are already taking responsibility for their own wellbeing.
It would appear that those ‘bought in’ to technology will soon revel in virtual reality fitness studios and healthcare programmes, and those who are part of the chronic and acute healthcare systems will see the continued roll out of virtual wards and all manner of high technology devices, such as palliative care and pain management systems, all fully portable and with the capabilities for external monitoring. Meanwhile the likes of Verily, formerly Google Life Sciences, has ambitious projects lined up such as its glucose detecting contact lens.
And let me skip briefly to Big Data, the encouraging link between proactive and reactive healthcare whereby our health records (every minute detail of our physical and mental health) could be stored in one digital location, accessible by anyone who can have a tangible impact on our health, including us! Such a wealth of data could be used to not only develop care plans that suit us most efficiently but, as the holy grail of healthcare transformation and sustainability, will enable analytics algorithms to predict and help prevent sickness.
With a combined top down (technological innovations), bottom up (citizens taking responsibility for their own healthcare) approach, and despite the constant political bickering about the NHS, my experience of which has always been first class just to interject, it would appear that the future is extremely bright for healthcare in the UK and, what’s most encouraging, is that we each have the power to play our part in a combined effort to positively influence our future.
By Rachel McClelland