By Karen Taylor, Director, Centre for Health Solutions
Last month saw the publication of the independent report on The Topol review: Preparing the healthcare workforce to deliver the digital future.1 This review complements a number of initiatives aimed at informing the Department of Health and Social Care (the Department) on the workforce strategy required to deliver the NHS Long-Term Plan.2 The Topol review recognises that the NHS is at a tipping point with regard to the adoption of digital technologies and presents a compelling vision of the potential for technology to transform healthcare and the need to equip the workforce to adopt technologies in the most efficient and effective way. This week’s blog provides an overview of the Topol review and the challenges that will need to be overcome if its ambitions are to be realised.
About the Topol review
In April 2018, the Secretary of State For Health and Social Care appointed Dr Eric Topol, an expert in cardiology, genetics and digital medicine, to lead an independent review to determine:
- how technological innovations are likely to change the roles and functions of clinical staff across all professions over the next two decades
- what the implications of these changes are for the workforce skills required, identifying those staff for whom the changes may be particularly significant
- the consequences for the selection, curricula, education, training, development and lifelong learning of current and future NHS staff.3
Dr Topol appointed an eminent Review Board and three Expert Advisory Panels on genomics, digital medicine and AI and robotics to explore evidence and insights from a diverse range of sources.4 The Review Board published an interim report in July 20185 accompanied by a call for evidence from all interested stakeholders.
The Topol review established three principles to govern the deployment of digital healthcare technologies:
- people first – technology provides an opportunity to empower people who are willing and able to become partners in their own care
- evidence-led – the introduction of new technologies needs to be grounded in compelling real-world evidence of clinical efficacy and cost-effectiveness, underpinned by a legal and ethical governance framework that engenders trust in the technology
- giving the gift of time – whenever possible, the adoption of technology should provide clinical staff with more time to care and interact with patients.
The enablers and opportunities for change
The Topol review notes that some 90 per cent of all jobs will require some element of digital skills within 20 years. Moreover, if the benefits of technology deployment are to be realised, the NHS will need to ensure that the workforce and patients are consulted and involved in the design and deployment. While it recognises that investment in an interoperable IT infrastructure across the NHS is a critical enabler of the NHS’s vison for a digital future, it falls short of addressing how this critical enabler can be achieved. Other key requirements include investment in the development of collaborative working, in leadership skills and in approaches that will speed up the adoption and implementation of technology-enabled practices. Requirements that other reviews have highlighted but have proved elusive.
Developing a digitally health literate workforce
The review in its specific focus on building a digitally literate workforce recognises that:
- embracing technological innovation will require the NHS to provide enhanced development opportunities for selected clinical staff to become ‘digital champions’
- the NHS should foster a culture of inter-professional lifelong learning, based on collaboration and multi-disciplinary problem solving
- collaboration with academia and industry is needed, as is attracting global technical talent (robotic engineers, data scientists and other technical specialists) through new apprenticeships, Masters schemes and industry exchange networks
- there is a need to create an environment that encourages innovation and life-long learning and opportunities to learn and reflect away from the workplace.
Wide-scale adoption of digital medicine
The review recognises that digital medicine (digital technologies and products that directly impact the diagnosis, prevention, monitoring and treatment of a disease, condition or syndrome) is already having a positive, albeit uneven, impact on healthcare. It highlights the potential of telemedicine, telephone triage, video consultations, and smart phone apps and wearables and emphasise that the patient-clinician relationship is important for adoption and that technologies need to be intuitive to use. Furthermore, that clinical staff need to understand, and be able to convey to patients, the benefits that digital technologies can bring while being confident that the technology meets the requisite regulatory and data protection standards.
Providing a grounding in genomics
Most stakeholders agree that the completion of the landmark 100,000 Genomes Project and the launch of the NHS Genomic Medicine Service has placed the UK at the forefront of efforts to introduce genomics into healthcare and improve outcomes for patients. The review acknowledges that if the NHS is to capitalise on the insights and associated technologies, clinical staff will need to have an understanding of the broad principles of genomics. There will also be a need for a clear framework for staff to use genomic data in a way that safeguards patient confidentiality and inspires the support and confidence of citizens. While there will be elements of healthcare that will remain the domain of specialists (such as the management of rare genetic diseases), many genomic applications will become embedded in daily healthcare (for example the targeted prevention of common diseases). However, the expansion of genomics into medical care will be incremental as whole genome sequencing is still a little way off and expensive.
Embracing AI –based technologies
The review highlights how advances in AI-based technologies is accelerating analysis and decision making, and automating or augmenting many working practices and improving the quality of people’s lives. Indeed, computer algorithms are already more accurate in interpreting a range of digital images that clinicians. Moreover, AI will also transform patient generated data into clinically useful information and empower patients to self-manage their own health or seek appropriate support. However, the review notes that there is currently ’an evidence and skills gap’ in the current NHS workforce’s ability to realise the potential for AI in healthcare and that addressing this gap requires the NHS to develop education and training collaborations. It recommends that if the NHS is to optimise the opportunities presented by AI technologies, the workforce needs to be trained in understanding:
- how AI can augment clinical practice
- how to manage and curate AI generated health data
- the associated ethics and clinical governance issues.
The review provides a total of 43 recommendations with separate recommendations from the Review Board (3), the Organisational Development Group (9) and the three Expert Panels (Genomics (8), Digital Medicine (4) and AI and Robotics (4)). There is a joint one from the Digital Medicine, and AI and Robotics Panels regarding the need to increase the number of clinician, scientist, technologist and knowledge specialist posts. There are also 14 educational recommendations, emphasising the need to establish a culture of learning and a cadre of educators and trainers who can lead education programmes. For the future workforce the expectation is that genomics, data analytics and AI s, and understanding the possibilities for digital health care technologies, should be prominent in undergraduate curricula.
The review presents an exciting and optimistic vision of the future possibilities for healthcare that new technologies could deliver over the next 10-20 years. However, the cultural changes and service transformation required are immense. The scale and speed of adoption will depend on the extent of implementation of the reviews’ recommendations and the willingness of stakeholders to embrace a culture of innovation and be prepared, or indeed able, to shift priorities and funding to initiatives that will deliver a digital future for patients healthcare providers alike.
As our current research on ‘Shaping the future of digital healthcare in the UK’ is finding, the reality today, in terms of technology adoption in many hospitals, GPs and community settings, is far removed from the future envisaged by the review. This presents an important conundrum. While it is hard to argue with the optimism and ambition in the report, many of the recommendations lack specificity and none are costed. A key challenge therefore is how the implementation will be resourced given the significant financial challenges faced by the NHS, and importantly, how the much beleaguered workforce will be afforded the time to develop their skills in the ways envisaged. Given the need to develop a sustainable and affordable NHS, resolving this conundrum needs to be given the highest priority in the upcoming spending review and in the workforce implementation plan required to support the LTP. It also needs to be a priority in for the new NHSX unit.6
1 The Topol review: Preparing the healthcare workforce to deliver the digital future. February 2019. See also: https://topol.hee.nhs.uk/wp-content/uploads/HEE-Topol-Review-2019.pdf
2 Developing the long term plan for the NHS Briefing from the Long Term Plan Engagement Team –August 2018. See also https://www.engage.england.nhs.uk/consultation/developing-the-long-term-plan-for-the-nhs/user_uploads/easy-read-nhs-10-year-plan-discussion-guide-v3.pdf
6 NHSX: new joint organisation for digital, data and technology, Department of Health and Social Care, February 2019. See also: https://www.gov.uk/government/news/nhsx-new-joint-organisation-for-digital-data-and-technology