Kill or cure? Why keeping pace with science and technology may be the death of the NHS
Breakthroughs can save lives – but they can also stretch the service past breaking point. Jeremy Laurance on the debate that divides doctors
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Wednesday 03 October 2012
They could save the NHS – or bankrupt it. New technological advances that are transforming care of patients also risk crippling the health service responsible for delivering them.
At a conference today, sponsored by The Independent, experts will describe advances in healthcare, on or just over the horizon, and consider whether they are the route to salvation for the cash-strapped service – or a fast track to its demise.
With new cancer drugs costing hundreds of thousands of pounds per patient and robotic surgery devices requiring investment of millions of pounds by deficit-burdened NHS trusts, innovations are urgently needed that will save money for the NHS and provide it with a way out of the present impasse.
As an example of how technological innovation can transform the care of patients, the project run by the Wellcome Trust Sanger Institute for children with rare developmental disorders stands as a beacon.
Doctors treating these children worked largely in the dark because of the rarity of the conditions and the paucity of evidence on what treatment was effective.
But using sophisticated techniques, researchers have catalogued the genetic abnormalities in the children and linked them with details of their medical management to show what works.
Called Decipher, the project was initially based on a network of 23 clinical genetic centres in the UK but has since expanded to include 200 centres worldwide, feeding in data about their patients and providing doctors with essential details to enable them to provide the best treatment.
"It is an example of how sophisticated genetics and sophisticated informatics can together improve care," said Richard Seabrook, head of business development – technology transfer, at the Wellcome Trust.
In a second example, Dr Seabrook cites a US health insurance organisation which has arranged with an IT company to collect details of patients' waist size, blood pressure, cholesterol level and other measures each time they are issued with a prescription, to provide early warning of future illness. Asked if that would increase or reduce healthcare costs, he said: "I think it has the potential to do both. It can remove the element of trial and error so patients get the correct care sooner which should save costs. But you have got to invest in the infrastructure."
One of the biggest challenges that faces the health service is the increasing burden of dementia, driven by an ageing population, with no early prospect of new treatments as drug companies cut funding for neuroscience departments, as reported in The Independent last month. Simon Lovestone, professor of Old Age Psychiatry at Kings College, London, said suggestions that dementia research was in the doldrums were premature and the failure of recent drug trials was likely to be due to the drugs being given too late in the development of the illness.
Biomarkers, including blood tests and new brain scanning techniques allowing early detection of Alzheimer's disease, could transform the outlook.
"We nearly have biomarkers [for Alzheimer's disease] now and they will improve steadily over the next five to ten years," he said.
Despite a long and unhappy history, the relation between the NHS and the computer industry has a brighter future, according to Derek Wyatt, digital consultant and former MP.
Patients will in the future be able to access their medical notes, make appointments, check referrals, order prescriptions and collect test results via mobile phone apps, he said.
Attempts to computerise the NHS over the past three decades have ended in failure because of the need for compatibility and the failure to agree on a common system.
"It has been chaotic with different hospitals having different systems. With apps you don't need compatibility, you just need the system design to be the same.
"Public sector apps in health and education will be the big breakthroughs over the next 18 months," he said.
Biomarkers for dementia could allow early detection of the disease with blood tests or brain scans and the potential development of effective drugs that could slow or halt its course. Available in five to 10 years.
Medical apps for mobile phones will allow patients to access their medical records, make appointments, check referrals, order prescriptions and collect their test results. Available in around 18 months.
Linking DNA databases would enable the genetic details of children with various developmental disorders to be shared across 200 centres worldwide to allow doctors to devise the best care. Already available.
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