The NHS at 70 and beyond: a vision of the future

Mark Kroese

5 July 2018

As we celebrate 70 years since the launch of the National Health Service, it is an opportunity for many of us to reflect. Since we began in 1997, a significant part of the work of the PHG Foundation has always related to developing policy to support NHS use of new scientific knowledge and applications for better health.

The driving force for change

NHS clinicians, researchers, managers and policy makers have played a vital role in this endeavour, driven by a shared vision of improving outcomes and experience for patients and populations. This enthusiasm and dedication typifies the passion that drives the whole NHS – not only in clinics and GP surgeries, but also in multiple laboratories, offices and community outposts. As an organisation, we have been privileged to work with you all over the last 21 years in pursuit of shared goals.

The path from bench to bedside

The NHS has come a very long way in 70 years, and has a proud history in championing the uptake of scientific innovations. In recent times, as well as grappling with increasing demand, financial restrictions, demographic changes and new social pressures, we have also seen a marked acceleration in the pace of development of science and technology, and potential applications within healthcare. Genomics is a prime example. In 2003, the year the Human Genome Project reached completion, it was the subject of a landmark Government White Paper, Our Inheritance, Our Future – realising the potential of genetics in the NHS, which set out a vision for the NHS to lead the world in harnessing genetics for healthcare. Fifteen years on, we are about to see the launch of a new NHS National Genomic Medicine Service embedded in England, offering as routine genetic tests that were not so long ago hardly imaginable. This is a momentous achievement, built on world-class scientific endeavour, extraordinary NHS clinical commitment and development - and policy effort.

Dealing with disruption

Whilst the ultimate vision of genomic research – a comprehensive understanding of the roots of disease and a fully personalised effort to prevent and treat it – is not yet fully realised, a host of other innovations are set to have similar, or perhaps even greater, transformative effects on the NHS. In addition to the advent of revolutionary therapeutics that are changing whole specialty areas of medicine (for example, regenerative medicine and immunotherapy), other innovations are set to change how the NHS itself operates. The potential impact of some of these technologies, such as machine learning and AI to process and handle health-linked data of all kinds, and remote monitors and sensors to enable real-time, continuous and remote patient monitoring, is profound. Necessarily, it will be disruptive to current practice.

The question as we look ahead is, can the NHS adapt and appropriately implement these in a timely manner to ensure patients benefit promptly? This is an issue for systems and policies as much as for staff and resources. Major health system change requirements include planning, testing, engagement, leadership, coordination and implementation capacity.

The NHS will continue to try to make the most of the health innovations that become available. What it will look like seventy years from now is not easily imagined, but undoubtedly we need to maintain a visionary, long-term view alongside dealing with the here and now if we are to move smoothly towards a better, technology-enabled future. There are promising signs that the Government is taking this agenda seriously, increasing investment in all types of biomedical and healthcare research and trying to stimulate both innovation and translation through initiatives such as the NHS Innovation Accelerator, the Academic Health Science Networks and selected Catapults. NHS England is committed to moving beyond the transformation of genomic medicine to a future of increasingly personalised and person-centred healthcare.

Bridging the gap

There are two major hurdles for the NHS to leap whilst simultaneously delivering safe, equitable and high quality healthcare for its population. The first is maintaining the agility to respond appropriately in a timely fashion to rapid scientific developments; this is a perennial issue, but the imperative to improve is stronger than ever as the pace of change continues to accelerate. Our Healthcare Futures series outlines just some of these new technologies, with more emerging all the time. We are already seeing moves towards a more streamlined and responsive regulatory system, but resources, training and direction will continue to be needed to deliver widespread NHS uptake.

The second is the very considerable difficulty in seeing the ‘bigger picture’ that lies 20 years or more ahead, and driving transformational changes to get there. Our My Healthy Future initiative is working with some of the country’s foremost experts in a host of areas to get a vision of a better, science-enabled and more personalised future for disease prevention, detection and treatment, in order to inform NHS longer term development.

Making science work for health has never been more important, more exciting - or more of a challenge. But as we look at the NHS on its 70th birthday, we have to say: you’re worth it.