No room for risk aversion in healthcare innovation

Leila Luheshi

18 May 2016

I’ve been trying to reconcile my many contradictory thoughts and feelings following the medtech / big data / biomedicine whirlwind that was Wired Health 2016.

The event didn’t so much leave me tearing my hair out as searching my soul. From a purely scientific perspective the meeting was jaw dropping. Personalised drug testing using microfluidic organs-on-a-chip, personalised mental health support using the ‘Big White Wall’ app, unique brain-computer interfaces to overcome paralysis: the ingenuity of scientists and technologists on display was astounding. My inner ‘geek’ brain was in heaven, but the rest was more troubled.

Where techno-futurism butts up against the grittier reality of the NHS

Listening to inspiring narratives of data- and technology-enabled healthcare futures, a question – often posed to the speakers in Q and A – kept nagging away: “How can we deliver this in the UK through our existing health system?” Mahiben Maruthappu from the NHS Innovation Accelerator spoke about making the NHS ‘more disruptable’, but is this a realistic aim for a system that is first and foremost striving (and struggling) to improve the efficiency with which it delivers its existing healthcare offering, whilst remaining free at the point of access and available to all? Some speakers argued that the technologies on display could, if deployed effectively, deliver those desperately needed efficiencies to our health system, but the problem is that this typically comes at an upfront cost often deemed impossible to bear.

Was I the only person in the room uncomfortable with the juxtaposition of the excitement, risk taking and radicalism of the technology developers with what I know of the risk-averse and cost-constrained realities of our health system? This is not to say that health professionals within that system are not capable of, or willing to develop, deliver and embrace radical innovations - many of the most astonishing ideas on show came from just such people - but institutional barriers are preventing them from doing so at the pace and scale that will bring benefits to us all.

Appetite for change

Try as I might I cannot envisage how our health system (both our health services and the individuals that use them) can benefit from the innovations described by the speakers, without radical transformation. In the UK, we know that our health system is notoriously slow to adopt new innovations. We know there are sound, socially accepted reasons for this: ensuring patient safety, realising value for our money, the need to prioritise fairly the scarce resources available to maintain universal provision free at the point of access. Listening to the speakers at Wired Health, however, I was unable to escape the politically and philosophically uncomfortable (for me at least) conclusion that these principles are incompatible with achieving rapid access to the benefits that digital and biomedical technologies have to offer efforts to improve our population’s health. We cannot have our cake and eat it.

Try as I might I cannot envisage how our health system can benefit from the innovations described by the speakers without radical transformation

So what to do? Are we in the UK prepared to sit behind the curve in exchange for maintaining our current approach to healthcare? If the increasing multitudes of patient voices advocating for access to the latest tests, drugs and other healthcare interventions is anything to go by, I’d guess we’re not.

The uncomfortable truth

Technological disruption occurs when entrepreneurs invest in ventures with highly uncertain returns; and when consumers are prepared to invest in the relatively untested outcomes of these ventures. We take risks.

In the face of a diverse range of approaches for improving aspects of our daily lives, we make choices as to which of these will fit our ‘new world’. When left dissatisfied we can simply shop around for a desirable alternative– we vote with our wallets. In exchange for these collective (but not equally distributed) acts of risk taking, society as whole is deemed to reap rewards, albeit accepting (often tacitly) that these are far from equally distributed.

Here’s the challenge: healthcare is not like other services that are benefiting from digital technologies. In the UK at least, we do not consume healthcare in the same way that we consume, for example, telecommunications - changing provider and device in response to cost, functionality and satisfaction. Our appetite for risk and our attitude towards diversity and choice are fundamentally different when we think about consumer goods from when we think about our health and wellbeing.

Changing our attitude to risk

Are we prepared to change our behaviour, as individuals and as a society, and engage in similar collective acts of risk taking with our healthcare? Are we prepared to try different products and providers and to move beyond the expectation (or hope) that one organisation can best provide for all our healthcare needs? Are we prepared to share our experiences with others (through sharing our health information) so that collectively we can learn from them and improve our health together? Are we prepared to accept inequality in the distribution of risk and reward?

And what of our healthcare services? Are they prepared to embrace the diverse approaches to delivering care that will enable them to meet the disparate and varying needs of their populations? Are they prepared to provide an open and ‘disruptable’ environment in which innovators, such as those on show at Wired Health, can develop their services and compete to provide them as valid choices to us as individuals? Are they prepared to do more than create new schemes to ‘bolt on’ innovations (e.g. the Cancer Drugs Fund) to the seemingly impenetrable fortress walls that are built around our existing models of healthcare provision?

Taking control of our own health

I freely admit that this brief analysis side steps the vast complexity and diversity of demands on our health services, but in a way that is the point. Attempting to carefully analyse and deconstruct the complexity of our healthcare model and then incrementally reengineering it to be more open to innovation - as I believe the Accelerated Access Review aims to do – seem futile pursuits to me.

Many of the digital and biomedical technologies being developed to address our healthcare needs are intrinsically incompatible with delivery through monolithic, one-size-fits-some, institution-centred models of healthcare delivery. They are more naturally oriented towards delivering impact as part of a health system that is built from the bottom up by us as individuals, that enables us to understand the personal determinants of our health and empowers us to take personal decisions about how to maintain or improve it based on our personal appetite for risk.

It is not yet clear if the uncertain rewards of combined biomedical and digital innovation in healthcare will outweigh the financial, societal and ethical risks inherent in radical transformation. 

What is clear is that these are choices our society can no longer avoid making.