Andrew Eborn Back To the Futurist – How Robotics and AI can save the NHS
Sajid Javid , former health secretary, points out in The Times that we need to agree a new NHS future or 1948 dream dies.
Sajid Javid is right that the 75 year old model of NHS is unsustainable but charging patients for GP and A&E visits would threaten the fundamental principle of NHS and be wrong.
Instead the seismic advances in technology in particular in the areas of robotics and Artificial Intelligence (AI) must be embraced.
NHS was founded on 5th July 1948 and was what Nye Bevan called a great and novel innovation.
The NHS must remain free for everyone at the point of need.
It is true, however, that services are under extreme pressure with waiting lists growing and widespread dissatisfaction both from outside and within the medical profession.
NHS strike on February 6 will be the biggest ever as nurses and paramedics will walk out on same day. Nurses and ambulance staff are at breaking point.
All medical professionals deserve our respect and support and should be empowered to do their jobs. Job satisfaction is not just about money but also the ability to provide a service of which we can be proud.
10 million avoided care during pandemic
It is estimated that during the pandemic approximately ten million people stayed away from seeking care and treatment. Illnesses went undetected and untreated.
Change in conditions since 1948
Since the NHS was founded in 1948 there has been a massive change in life expectancy and the medical conditions.
In 1948 approximately half a million people lived over the age of 80. Today that figure is more than three million and rising.
There has also been a change in the medical conditions from polio and diphtheria in 1948 to cancer, obesity, cardiovascular disease and degenerative diseases today.
As Savid Javid points out “to overcome these challenges, radical reform is required. However, part of the problem, and the reason why the NHS is under so much pressure, is that political debate about the NHS’s future has become so constrained. This self-imposed caution extends to both voters and politicians, and it is letting patients as well as NHS staff down.
In one of my first meetings as health secretary, I remember being told how strongly the public felt about the state of the NHS and its dysfunction — but also how their proud support for the institution meant they were resistant to anyone meddling with it. “Fix it, without touching it” was the message. To a large extent, this is understandable. We know how much people care about the health service because of what it has provided them and their families for generations. We rightly appreciate the incredible work of NHS staff, who labour tirelessly in challenging circumstances, but too often the appreciation for the NHS has become a religious fervour and a barrier to reform….It seems every time a politician opens their mouth to talk about NHS failings or a new way of providing healthcare, they are pilloried. This happened recently in Scotland, where reports of discussions around asking the wealthy to pay for treatment provoked a furious backlash and were shut down before they’d even begun.”
In 2000 the UK health budget accounted for 27 per cent of day-to-day public spending. In 2024 it will hit 44 per cent. On this trajectory it will be more than 50 per cent by the end of the decade.
This level of spending and its rate of increase is unsustainable, particularly with the tax burden already at a 70-year high.
Supply
According to YouGov and Eurostat, in the past year one in six adults has been unable to access a medical appointment they needed. This was the highest out of 36 European countries and almost triple the EU average.
UK health spending is above the OECD average. The issue is about how the system operates. For the NHS, when faced with excess demand, the only rationing mechanism is to make people wait.
Contributions Savid Javid points out that across Europe there are different versions of a contributory principle to complement public financing. This helps manage demand and leads to more efficient methods of supply.
In Ireland some people are entitled to free healthcare through the public system based on household income. Others must pay nominal fees such as a €75 charge for attending an injury unit without a referral from a GP. That fee is only payable if you do not have a referral. If you do the service is free.
Savid Javid argues that in this way people take active steps to assess whether their demand for frontline services is required. “Even a tiny fraction of patients reconsidering their visit to the GP (and perhaps visiting a community pharmacist instead), would save thousands of clinical hours.”
In Norway and Sweden a visit to the GP comes with a contribution of about £20.
Germany’s social health insurance model provides greater choice of providers, including non-profit community hospitals, and therefore less pressure on the public system.
Reducing the level of demand
Savid Javid points out that “for too long the NHS has been viewed as a “National Hospital Service” — treating people when they get sick rather than preventing them from becoming ill. By some estimates 40 per cent of NHS spending goes on treating preventable conditions. We need to get better at taking a long view — and this is where the structures and incentives of politics often fall down…My attempts to address this led to something of a reputation for announcing ten-year plans. Reviews, investigations and consultations are viewed with scepticism — but these are critical to building consensus. Whether it is cancer, dementia, mental health, or suicide prevention, we need to get ahead of the curve and quickly.”
Long-term plan on staffing requirements
There needs to be a long-term plan on staffing requirements for the next 10 -15 years. This is a workforce of more than one million people, and it is constantly changing.
Pharmacy First
Adopting a “Pharmacy First” approach would also relieve pressure and help to support patients.
Digitisation and data are critical.
Digital innovation in hospitals is crucial.
Milton Keynes University Hospital was the first in Europe to use surgical robots for big operations leading to a lower risk of infection and faster recovery times.
It is this area that should be embraced rather than Sajid Javid suggestion to extend “the contributory principle” as part of radical reforms to tackle waiting times.
I agree we need a “grown-up, hard-headed conversation about alternatives” and that “too often the appreciation for the NHS has become a religious fervour and a barrier to reform.”
The fact is that people are already paying for GP appointments and A&E visits through tax and National Insurance contributions. The NHS must remain free for everyone at the point of need.
Dr Nick Mann, GP and member of Keep Our NHS Public, a non-party-political organisation campaigning against the privatisation and underfunding of the NHS, pointed out: “In practical terms, charging patients to access their GP or for an A&E visit is a zombie idea which is expensive to operate and acts as a deterrent to the patient groups most in need of healthcare…. The idea of charging patients extra to access essential medical care is a slippery slope – just look at dentistry.”
Professor Philip Banfield, chair of the British Medical Association Council, said: “Charging patients for using the health service would threaten the fundamental principle of the NHS that must be protected – free care for all at the point of need.
“Between 2010 and 2019, average day-to-day health spending in the UK was £3,005 per person – 18 per cent below the EU14 average of £3,655. “The country is now paying the price for this lack of long-term investment through increasingly poorer health.”
He added: “It is a false economy to suggest that charging patients for GP appointments will reduce demand on the health service. While it may result in less demand in the short-term, people who do need treatment but struggle to pay for a GP appointment, may decide to not see a doctor when they need to or turn up at hospitals with a later stage of illness which is more costly to treat. This risks worsening the health outcomes of our poorest patients.
“We have lost the equivalent of 1,973 fully qualified full-time GPs since September 2015. The solution that is staring the Government in the face is to staff and resource general practice and the NHS appropriately so that it is able to meet the needs of its patients.”
“Charging patients is not the answer – giving the NHS what it needs to function properly is.
“It isn’t fair, or ethical, to expect patients to pay for mistakes they didn’t make.”
MKUH first in Europe to use surgical robot for gynae procedures
Milton Keynes University Hospital has become the first in Europe to use the Versius Surgical Robotic System for major gynaecological surgery, including complex cancer cases.
Since its introduction at MKUH in 2019, CMR Surgical’s Versius Robot has performed over 100 complex surgeries across colorectal, gynaecological, and general surgery.
Now Versius is being used to conduct major gynaecological procedures at MKUH, offering women needing gynaecological procedures, including hysterectomies, greater access to keyhole surgery.
Surgical robots can enable a much wider uptake of keyhole surgery, with faster recovery times, less time in hospital and reduced risk of infection.
Nidhi Singh, Consultant in Obstetrics and Gynaecology at MKUH, said: “Versius represents a massive step forward in making minimal access surgery (MAS) accessible to many more patients. A hysterectomy is a major and complex surgical procedure. When performed openly, it traditionally requires around five days’ stay in hospital and many weeks to fully recover. We aim to change this for the hundreds of women who undergo these types of surgeries at our hospital every year.”
Mark Slack, Chief Medical Officer at CMR Surgical, said: “We are delighted that the team at Milton Keynes are the first in Europe to be using Versius to perform gynaecological procedures. Where surgical robotics were previously focused on Urology, with Versius we are opening up the opportunity for gynaecological cases to be conducted robotically giving patients the benefits of MAS. In designing Versius our goal was to provide a versatile and portable surgical robotic system that could transform the field of minimal access surgery – allowing more patients to benefit than currently do.”
HELPER BOT
Milton Keynes University Hospital NHS Foundation Trust (MKUH) is also trialing an innovative ‘Helper Bot’ in a bid to ease pressure on staff by expediting certain logistical activities.
The team at MKUH, who initially began the landmark trial late last November, is testing how effective the robot – eponymously dubbed Milton – is at delivering medicines, specimens, and clinical supplies on designated routes throughout the hospital.
By learning how to safely navigate through the area between the hospital’s pharmacy and a specific in-patient ward, Milton will inform clinicians about how similar robotic technology can be harnessed to support the delivery of other non-controlled substances throughout the health setting.
The robot was designed following a series of online and in-person workforce consultations, where staff members from departments like pharmacy, pathology, estates, and support services all attended.
Data collected from the study will help MKUH determine how Milton can be scaled up and used to take on even more responsibility and further unburden hospital staff.
MKUH Chief Executive, Professor Joe Harrison, said: “This trial is an opportunity to test the safety and efficacy of this technology and we will continue to work closely with all teams involved to understand how it can be most effectively utilised in the future.”
Milton is just the latest in a string of robotic and artificial intelligence advancements that are helping MKUH improve heath outcomes and enhance patient experience. This includes the introduction of an innovative robot that assists complex colorectal, gynaecology, and general surgeries, as well as integrating artificial intelligence across its imaging equipment.
Octopus TV video explanations
Octopus TV www.Octopus.TV is also working with a number of leading institutions producing videos for patients detailing the most common questions asked including about particular procedures.
These videos provide a power tool for the medical practitioners enhancing face to face appointments by assisting understanding.
Andrew Eborn, Lawyer, Broadcaster, Futurist & President of Octopus TV points out that we should embrace the sesismic advances in technology in particular in the areas of robotics and Artificial Intelligence (AI).
AI is already providing efficiencies across several industries. Byway of example, AI can process a mortgage application in 3 minutes a process that would have taken 30 days.
Imagine a world where every doctor had access to the best research in the world and could input your data to ensure you received the best possible care. Prevention is better than cure. Early diagnosis can save lives.
Automating clinical escalation including 1st tier diagnosis would reduce waiting times massively.
As AI improves the profession will also improve.
Embracing the thrilling opportunities technology offers is key.
About Andrew Eborn
Andrew Eborn, President Octopus TV Ltd, is an international lawyer, strategic business adviser, broadcaster, author and futurist. For many years Andrew has empowered companies to face the challenges of changing markets, maximise the return on their rights as well as assisting with the strategic development of their businesses. Andrew Eborn appears regularly on various channels around the world as a presenter / contributor on a wide range of topics as well as a speaker / host at live events including major festivals.
Andrew Eborn presents and chairs various events and podcasts for a number of leading organisations including the Royal Television Society.
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