BeyondtheFog Mainreport V1.0complete 01-02-18

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10-15 Y a V F P b cH a ca a c ab d
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Re ea ch J 2019
DOI: 10.13140/RG.2.2.19415.73123
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FUTURE OF HEALTH
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1
Executive Introduction & Mega Trends 10-15 Year Future Healthcare Transformation
summary Scene Setting Impacting Health Vision Stories Journey Next Steps
Contents Report Authors
Andy Wilkins
1. Executive summary 4 Andy has extensive experience in strategy, innovation
and systems thinking across both the private sector and
healthcare. He has a BSc in Human Physiology and his
2. Introduction and scene setting 10 deep interest in ps cholog brings a human-centred
approach to thinking about healthcare futures.
3. Mega trends impacting health 21
linkedin.com/in/andywilkins
4. Vision and assumptions 49 Richard Gold
5. Future healthcare stories 84 Richard has a broad experience in strategy,
communication and digital transformation in both the
private and public sector. His deep interest in
6. The transformation journey 91 emergent strategy and approaches to breaking down
siloed thinking brings a new perspective to integrated
healthcare futures.
7. Next steps 100
linkedin.com/in/richardgold
This report was commissioned by
Appendix 1 Glossary 106 the Royal Free Charity from Transform
February 2018
Appendix 2 Healthcare story boards 113
For further information please contact:
Appendix 3 Reasons to believe 142 info@beyondthefog.org
©2018 Royal Free Charity. All rights reserved
Appendix 4 References 158
2
Foreword
As part of its strategy process, The Royal Free Charity We hope that the report will stimulate wide ranging
commissioned Transform* to develop a 10year vision debates and consultations in that vein.
of a patient-centred, technology-enabled distributed
clinical Outpatients network. Its purpose was to help Chris Burghes, CEO, Royal Free Charity
the Charity focus its investments supporting the NHS in
the most appropriate areas where there could be
long-term, patient-focused benefit.
Early on, it became clear that thinking about
Outpatients as a silo made no sense given the ambition
to move towards new models of integrated care and
holistic population health. So the team started to think
about what a future person-centred system might look
like if the major trends impacting healthcare were to
be rolled forward.
2018 is the 70th anniversary of the founding of the
NHS. It was founded based on the idea that good
healthcare should be available to all regardless of
wealth. At that time, the major challenge of the time
was acute illness; and the way the NHS was structured
was appropriate and successful in addressing it.
Today, the biggest challenge is chronic long-term
conditions; the structure of the healthcare system
including the NHS is struggling to cope; and the
debate is currently focused on how to make the current
system more efficient.
Our ambition as a hospital charity is to provide a * Transform is a management consultancy specialising
contribution to the debate. The contents of this report in digital transformation. Transform authored the
Martha Lane Fox report, Digital by Default, that laid
are intended as a provocation to encourage debate the foundations for GDS and Gov.uk; it also delivered
and potentially re-frame it so it s less about how do D H D D ,
we fix the current s stem and more about how do we Digital First; and it worked with the Royal Free Charity
solve the problems to get to a future sustainable to build a outpatients experience improvement plan
s stem . built on a deep understanding of patient needs.
3
1. Executive summary
In this section we provide a high level summary of the report
and the provocation for a national debate it is calling for. This
covers the case for transformative change, the mega trends
that will impact healthcare, a new person-centred vision for
healthcare, the journey to get there and the key questions for
policy makers, system leaders and the public that arise from
having a long term vision for healthcare in a technology
enabled 21st century.
Executive Summary
Introduction on rolling forward existing trends. Where there is Six megatrends that define the future of healthcare
difference of opinion, it is generally on how to get
• The health and wellbeing of the UK s citi ens is there. • We have taken a whole s stem approach to integrating
fundamental to the future prosperity of the nation the potential impact of the six megatrends to develop
and shapes the quality of life and opportunities of • While the Vision describes the art of the possible, a coherent model that takes advantage of the current
its people a bold approach with a strength and clarity of trajectory of each to offer the potential to radically
ambition on the scale of 1948 will be required to re-think the delivery of prevention, diagnostics, treatment
• The NHS since its inception has been held up as an achieve it. Gradual evolution starting from here and disease management, while also reducing overall
exemplar for the world as to what is possible when with planning going no further than the political healthcare system costs.
a country chooses to invest in the health of all its business horizon will not deliver it.
citizens • Each of the megatrends represents a huge and expanding
• There is an enormous amount of starting from here area of specialist knowledge. What is new here is that we
• The UK health system, organised as it is to meet the going on in many parts of the system at present have brought them together into a single, coherent model.
acute care challenges of the past, is however most of it headed in broadly the right direction The six megatrends are:
heading rapidly towards unsustainability in the from major initiatives such as the emerging STPs
and ACSs to the vast number of health apps that 1. Socio-technological advances. The explosion of digital
face of the rising cost of caring for chronic long-
are launched pretty much every day. services is likely to accelerate as sensors, artificial
term conditions.
intelligence, voice controlled virtual assistants become
• This report aims to shine a light on what the future entwined in our daily lives changing our relationship with
• In the 70th anniversary year of the founding of the
could look like to act as a provocation a stimulus the services we depend on as we expect them to come to
NHS, this report has been commissioned by the
for discussion and debate at a system level with the us in an increasingly personalised way. This will have a
Royal Free Charity (itself celebrating the 190 th
long view and (as was the case when the Royal profound impact on health and wellbeing as a target for
year of its founding) to provoke an optimistic but
Free was founded 190 years ago) with the patient industry not just technology, but pharma, retail, food
rigorous debate about the future of the UK health
or person at the forefront. and lifestyle too as they seek to surveil and monetise our
and care system independently of NHS planning
personal health data. It will be vital for the public health
processes and the political business cycle.
• The path towards this vision will not be easy and system to have a seat at this table to avoid being locked
many challenges lie ahead but the prize that out from the data that will drive the future of healthcare.
• This report describes how, if six megatrends
affecting healthcare are rolled forward 10-15 awaits will be a sustainable healthcare system, a 2. Systems biology and medicine. Our understanding of
years, a vision for a new person-centred, country where people are able to flourish and the the determinants of health are extending downwards in
technology enabled healthcare system emerges old and sick can live in dignity, and a more scale from organs to genes and upwards to encompass
which is capable of meeting the growing prosperous nation able to capitalise on its health behavioural, social and environmental levels. The
challenges. leadership to succeed in the largest international combination of genomic medicine and the data that will
market sector in the world. be pouring out of sensors within and around us, means
• In our consultations, we have found remarkable that we are moving towards an era of Systems Biology
agreement on the key elements of the vision based
5
and Medicine (see graphic below), where 5. Data and AI. Even patients with chronic disease A 10-15 year vision for person centred healthcare
medicine moves beyond being symptomatic and spend less than 0.1% of the time with a medical
reactive towards being predictive and proactive. professional. Advances in Data and AI-powered • A person-centred healthcare system would be
support will enable expert, personalised advice fundamentally different from the current system along a
3. Personalised medicine. Fundamental to the and coaching to be delivered in the 99.9% where number of axes:
systems medicine approach is its person- the myriad behavioural choices that drive
centredness. Data will be collected about each outcomes are made. In this context, the dynamic • System focus: from sickness to prevention
individual, stored, analysed and progressively health record will fundamentally change the role • Scope of Care: from medical and reactive to
added to. This personal dynamic data cloud will of healthcare professionals from a reactive to a
be able to combine information about the proactive model and require skills with new data
holistic and predictive
individual and their context to provide continuous, sets and analytical tools. At a population level, • Point of care: from hospitals clinics and labs to
holistic and actionable insights moving away the application of machine learning has the a setting closer to the person
from standard treatments towards an era of potential to spark a revolution in academic and
Personalised Medicine. scientific research, accelerating advances in R&D • Delivery of care: from standardised transactional
on disease and providing a significant opportunity care to personalised always on care
4. Progressive Innovation in Medical Technology for the UK life sciences industry.
will lead to point of care diagnostics and medical • Engagement model: from paternalistic to
devices becoming more portable, allowing 6. Psychology of Health. Finally, the emerging coaching and guiding
procedures to be carried out within a community understanding of the Psychology of Health how
setting and by less specialised professionals. people experience, frame and engage with their • Knowledge base: from scientifically determined
Innovation in sensors in and around the body will own health, and what drives behaviour change to revealed and emergent
provide the opportunity to embed healthier will inform the design of new services that help
and encourage the public to embrace the new • Data and ownership: from provider-owned to
behaviours into daily life. person-owned
responsibilities and opportunities for improving
personal health and wellbeing.
• Underpinning these principles of the new system is the
shift from symptomatic medicine to always-on care
driven by the availability of real-time data combined
with increasingly sophisticated AI trained inleading edge
scientific knowledge. The implication is that management
of individual health will move out of the clinic and
towards the person.
• New engagement models will be need to be adapted to
how individuals do or do not accept a more active role
in the management of their health. Coaching
conversations will need to adapt based on factors such
as life stage and comfort with self-management; and
strike the right balance between digital health coach
and healthcare professional interactions.
6
• Rolling forward the megatrends described above,
we believe that the healthcare system of the future
has three core elements (see graphic, right):
• The individual
The individual and their biological, social and
environmental system increasingly aware of their
own body and behaviours, options and the
consequences. Empowered with passively collected
information, coaching and nudges to make
informed choices to maximise wellbeing and gain
early detection of disease onset and holistic
support to manage disease.
• The digital health coach
A personal, AI-powered real-time health coaching
function powered by self learning algorithms
combined with a real time personalised data cloud
enabling a dynamic holistic health and wellbeing
data model. Providing direct support and
mediating and optimising care in support of
health care professionals within the future health
and care system.
• A new health ecosystem
An integrated system designed around the delivery
of person-centred, coaching-oriented, holistic
healthcare. Relevant specialists will use the AI
coach as a resource, responding when alerted to Four value drivers: • The overall impact will be to increase the proportion of
triage medical support as needed. A wider life spent disease free and reduce the overall cost of
ecosystem of community, research and industry 1. Wellbeing and prevention activities to reduce the providing healthcare to the population.
players would also be likely to be involved. onset of disease
Population-level data and analytics would inform • The combined impacts of greater levels of prevention,
2. Early detection of disease
individual-level coaching and treatment. disease detection and superior disease management
3. Management of disease through continued (often offer the potential to radically change the balance and
• We believe that this system will also deliver value machine driven) innovation, reduction in incidence of disease in the 21st Century opening the
against the NHS Triple Bottom Line of better unwarranted variation , personalised treatment door to a healthier nation and a more sustainable and
health outcomes, higher quality care delivery and better self-management effective health and care system
and sustainable finance. In particular, substantial
improvements will flow from four key value drivers. 4. Assisted independent living
7
The transformation journey building blocks, Public engagement • Transformational funding
phasing and management of the process How will the radical transformation needed over the
• Making the case for self-management of health and next 10-15 years be funded and resourced while trying
• For this radically different health and care system wellbeing to manage overstretched services?
to emerge, we have identified 15 building blocks Will the public engage with the new responsibility
that will need to be in place. Some are so and how do we ensure that the hard to reach • New clinical care models
fundamental the ll need new legislation, a new communities are included so as not to increase How will these new alwa s-on clinical engagement
contract with individuals, perhaps even a new health inequalities? models work and how will a future care system transform
constitution for the NHS and wider health and care itself to support these new always-on models? How do
system. We have divided them into three types: • Acceptance of sensors we prevent an explosion of the worried well armed
System Framing; Public Engagement; and Even though many sensors are likely to be invisible with new information, from swamping the system?
healthcare ecosystem enablers and described and passively transmitting data, how are people
the key challenge for each. likely to react to the idea of using sensors that will • New funding and governance models
surveil the most intimate parts of their lives? What will be the new governance structures, incentives
System framing and target structures to create the incentives for
• Acceptance of sharing of data innovation and transformation towards the holistic
• Making prevention and population health a priority If the assumption is that people will own their data, person-centred service vision of the future?
How do we create a clarity of purpose across the what are the privacy concerns, mechanisms for
entire healthcare system to shift from a reactive sharing and how will data sharing be managed, • New clinical organisational structures
symptomatic care orientation, to a proactive policed and supported for those who need help? How will the rebalancing of capacity and care towards
preventive one? community-based provision be undertaken in an
• Acceptance of an AI powered digital health coach economic manner and in a way that gains acceptance
• Integrating prevention, healthcare and social care into How people will embrace this as a trusted presence and support from the public?
a unified care system and how will it need to function to truly be
The system is already on this journey with STP and perceived as both dispensing trusted expert health • Person-centred data strategy
ACS initiatives how can this process be advice while also remaining sensitive to personal How will the expanded set of real-time holistic personal
strengthened and accelerated? preferences data be given a taxonomy and securely shared by all
parties, systems and apps in a way that enables all data
• Taking a longer term investment perspective New healthcare ecosystem pertaining to an individual to be uniquely identified and
Should there be an independent non political body made usable for real time health decisions?
to protect from shorter term budget pressures and • New data skills and capabilities
provide independent guidance on strategic When and how will new data skills become • Radical new innovation
transformation? integrated into the curriculum for healthcare How can the new capabilities, skills and centre of
professionals? innovation expertise emerging from the intersection of
advances in medicine, sensors and AI be brought into the
• New medical and wellbeing skills heart of a new system? How do we create a silicon
How is genomic and molecular medicine and valley of digital and life sciences to support the future
broader systems medicine knowledge to be care system and UK plc for the future?
included in medical training for both new doctors
and CPD for existing HCPs already serving in the
healthcare system?
8
Next steps 2. Further research and thinking to make the vision Camden 2033: a platform for creating and telling stories
more rich, deepen the value case and work on about the future experience of healthcare
• This report, and the Vision that it describes, began each building block:
as a small project to help the Royal Free Charity
to think through how it could best support the • Prioritise areas for further research and
Trust with patient-centred initiatives that would thinking
make sense with a 10-15 year timeframe.
In researching the future, we found that an • Further development of the value creation lens
integrated vision such as the one we have on the Vision as this will be key to developing
created did not exist and this was seen by all consensus
as a major gap.
• Public Engagement on the Vision using the
• As a result, the report has developed into a wider Future Health Stories we have developed
provocation for the industry which seems to have to bring to life the experience of healthcare The stor platform consists of a conceptual map of
the potential to have an impact on the debate and wellbeing if the Vision is realised (see Camden (home of the Royal Free Hospital) in 2033. The
around the future of healthcare in the UK. box, right) map is overlaid with a number of stories of individuals and
groups who live in the area.
• We are now actively and keenly looking to extend 3. Recommendations for the Royal Free Charity for
the project to develop further debates in key its support of the Trust s activit in line with the
areas; to do more work on the details of, for vision
example, the economic case for the Vision; to build
richness into the person-centred stories as a tool for • Specific opportunities emerging from
engaging with the public on some of the big issues stakeholder consultation including innovation
that will need to be addressed. hub, patient portal and a drop-in counselling
unit for those diagnosed with chronic disease
• We have identified potential next steps in three
areas: • Develop a set of investment criteria based on
whether proposals support the attainment of the
1. Building the debate around the Vision to ensure Vision such as putting the patient in control; a
it has impact: digital or technology element; interoperability
embedded in the solution To date, we have developed four stories which represent
• Create a Steering Group to contribute to the different kinds of interaction that each person has with the
thinking, provoke wider debate and make the • Use the vision to provide a positive context for system. The stories were developed with the help of a
most of the opportunity presented by the work wider Trust strateg b providing a pull to a group of Junior Doctors to ensure clinical credibility.
done shared Vision which could support development
and communication of strategy at Trust and STP The stories are described briefly in the full report and can
• Develop a series of sponsored events in the run level and to help staff explore and understand be explored in the Appendix.
up to NHS70 the skills they will need to develop in coming
years.
• Seek funding for the above
9
2. Introduction & scene setting
In this section we set out the background, objectives and scope We make the case that incremental tactical innovations to
for this report. We summarise the founding rationale and existing provider models are unlikely to yield the emergence of
assumptions of the NHS and make the case that after 70 years a new integrated system and that a 10-15 year vision is
it is now time for a inspirational new vision for health and care essential to act as a north star to inform the transformational
system. One that embraces the transformational innovations in journey over the next decade.
medicine and technology now appearing and that fully align
these with the health and wellbeing needs of the nation in the The vision outline in this report represents describe what is
21st Century. possible in a 10-15 year timeframe based on extrapolating
current trends. We outline the scope, audience and the debate
Using the current population health status for North Central we seek to provoke within the wider health and care ecosystem
London (NCL) we make the case that the rise of chronic disease around what health and wellbeing system we want as a nation
and an aging population requires a radical new approach that for the future.
puts a person centred focus at the heart of this new system.
NHS 70th anniversary Chronic Disease needs new answers A new vision for a new health system Scope & purpose of report
Setting the Scene - The case for a new vision of health
and wellbeing delivery in the 21st Century
Health is: a state of complete
The health and wellbeing of the UK s citi ens is
Introduction - a provocation
fundamental to the future prosperity of the nation and
physical, mental and social well-
As the NHS celebrates its 70th anniversary in 2018 will shape the quality of life and opportunities of its being and not merely the absence
we stand at the dawn of a new age, one that is set to people. In a world characterised by increasing levels
usher in the greatest changes in technology and of anxiety and insecurity the NHS is seen as a bedrock of disease or infirmity
medicine in human history. of British life and values and therefore remains by far
and awa the UK public s most cherished institution. World Health Organisation (WHO)
Accelerating breakthroughs in science are revealing
the underlying nature of disease, psychology, human It is clear however, that the health and wellbeing of
flourishing and the broader social and environmental the nation cannot be viewed only through a medical
determinants that give rise to them. This brings lens. Our personal and societal health is shaped by a
profound new opportunities to rethink and reimagine broader set of public, private, community and 3rd
health and care delivery in the 21st Century, if we sector actors operating outside of traditional health
have the vision and ambition to do so. and care system. Here lies the core of our challenge,
for it is only through widening our frame of action to
It is not only technology and the new tools it provides include the full landscape of health determinants that
us that is changing however. The nature of work, social we will truly have an answer to the challenge of
life and individual expectations are also changing. improving health in the 21st Century
The public are becoming more knowledgeable and
more demanding of the institutions that serve them. The decisions we make on the long term future of
health and care are therefore not just technical,
Modernity is bringing many new possibilities but is administrative or financial, but will be core to Politics,
also bringing new challenges to health in the form the Economy and in redefining a new social contract
rising levels of lifelong chronic disease, mental illness between the State and the public in a technology
and increasing demand for social care and welfare enabled 21st Century.
support. These are further exacerbated by growing
levels of automation, work and financial insecurity,
poverty, loneliness and social inequality.
11
The founding of the NHS and the Welfare 190th anniversary of the Royal Free
State Hospital The aim of medicine is to prevent
The Great depression and the 2nd World war brought
disease and prolong life, the ideal of
a new social awareness of the widespread poverty 2018 is the 190th anniversary of the founding of the medicine is to eliminate the need of
and suffering that existed across the nation. Royal Free hospital in 1828 by the surgeon William
Beveridge, in his famous report of 1942 proposed Marsden. The founding story precedes the formation a physician
sweeping reforms reflecting a growing belief that a of the NHS by over a century but gave rise to many of
civilised society was capable of something more. These the values that would eventually lead to the William J. Mayo, founder of the Mayo Clinic
reforms represented nothing less than an expansion of modern NHS.
the social contract to provide rights of free healthcare,
education and a welfare safety net to all. William Marsden, living in London during the industrial
revolution was moved to act by witnessing the hardship
The creation of the Welfare state was visionary for its faced by working families and the difficulty that the 70th Anniversary of the NHS
time and lifted thousands out of abject poverty, poor had at receiving medical treatment. This led him The UK s most cherished institution founded in 1948 on the
provided many more of us with decent homes, a good to create the Free hospital in London for which principles of:
education and a sense of security. The NHS was "povert and sickness are the onl passports . In 1837
formed in 1948 in a post war era and represented a the hospital was granted the title Ro al b Queen 1. that it meet the needs of everyone
new covenant between the British state and its people Victoria in recognition of his work with cholera 2. that it be free at the point of delivery
in recognition that health is foundational to human patients. The Royal Free Hospital moved to its current 3. that it be based on clinical need, not ability to pay
flourishing and dignity. The NHS is admired around the site in the mid 1970s and became a Foundation Trust
world as the leading exemplar of an efficient and in 2012 which has now expanded to include Barnet
effective Public Health system. and Chase Farm hospitals
Rising costs due to an aging population, rising chronic
disease and new treatments are now threatening the
sustainability of the NHS and social care system in
their current form. A new vision for health and care in
the 21st Century is now urgently needed. 190th Anniversary of the Royal
Free
In 1828 William Marsden founded
what became the Royal Free which has
now become a Foundation Trust
12
There is much work already being done at national
A vision based approach to strategy
and regional levels looking at structural initiatives
An emergent strategy approach
geared around integration (Integrated Care Systems);
Our approach is based on the idea of emergent
Since 1948, the rise in chronic disease has brought strengthening community based care, behavioural
escalating levels of demand that increasingly threaten strategy1. In a complex and rapidly changing world,
change initiatives to drive prevention; and increasing
the long term sustainability of overstretched health and we can t know what will happen, but we can create a
digital access to the health system to drive efficiencies
care s stems. It is widel recognised that esterda s beacon to work towards so that we are aligned in our
and improve the experience of care. Much of this work
siloed models of speciality based care need to be thinking and know how to respond to the inevitable
brought together and redesigned around the needs of however has a shorter term focus framed around
challenges we will face to stay on track
individuals and communities to enable the public to augmenting and extending legacy approaches to
play a greater role in managing their own health. care.
There is much work already being done at national This project, commissioned by the Royal Free Charity,, The foggy beachhead analogy
and regional levels looking at structural initiatives takes a different starting point. Rather than working
geared around integration (Integrated Care Systems); forward from here to fix the current s stem, dealing
strengthening community based care, behavioural with the difficulties of reconfiguring what exists today
change initiatives to drive prevention; and increasing
and the uncertainties and risks inherent in change, this
digital access to the health system to drive efficiencies
and improve the experience of care. Much of this work report paints a picture of the potential destination,
is necessarily framed around augmenting and based on extending forward the transformative trends
extending legacy approaches to care. It is not being in personalised medicine, prevention, AI & digital
designed from any common understanding or health and setting out a 10-15 year future vision for
agreement of an overall shared vision of the future. person centred healthcare.
Outside the public health and care system, a wider set This report therefore is an attempt to shine a light on
of industries and organisations will also play an these future trends and the possibilities they create,
increasing role as part of a wider health and care
and in doing so provoke a much needed debate about
ecosystem. Technology, Life Sciences and Research
organisations hold the keys to the new capabilities that what a future vision could look like. We invite you to
will transform health while the food, drinks and wider read this with an open and curious mind and welcome
We are on a foggy beachhead; a lighthouse
wellbeing industries will play a growing role in your thoughts and feedback as we look to develop the
illuminates our destination. We can see the light, but
shaping the health choices we make in day to day life. thinking in future iterations of this report. Let the
the detail is hard to make out. There could be all kinds
journe begin
of hazards and detours in the way. In this environment
Beyond this the public, private and community based
organisations that support the wider contexts of our we need to make the light shine as brightly as possible
work, life and play will also shape the environments to help guide us in the right direction while working in
that will also be instrumental to our long term health the foreground where we can see the detail.
and flourishing.
1Of Strategies, Deliberate and Emergent ; Henr Mint berg
and James Waters; Strategic Management Journal, 1985
13
Chronic Disease needs new answers
LTC patients spend less than
The rise and rise of Chronic Disease An aging population is leading to the rise in multiple
LTCs accompanied by additional co-morbidities. The 0.1% of their time with a
Aging populations, the increased consumption of Kings Fund estimates that the average cost per year
processed food, more sedentary lifestyles and the of treatment for a person with a single long-term
Healthcare Professional (HCP)
increasing stress of modern life are all factors that condition in the health and social care system is £1000. and over by themselves
have radically changed the balance of disease that For a person with two long-term conditions, the cost is
impact the NHS and social care services. £3000. For those with three the estimated cost is
£8000.
70% of total expenditure on health and care in great responsibility on patients to take ownership of their
England is associated with the treatment of the 30% Managing Chronic disease & its causes daily care. Studies have shown, however, that LTC patients
of the population with one Long Term Condition (LTC) spend less than 0.1% of their time with a Healthcare
or more, and the number of people in England with
new approaches needed
Professional (HCP) and over 99.9% by themselves so
one or more such condition currently 15 million is The current health and care structure has been many face this alone.
projected to increase to around 18 million by 2025. designed to optimise and deliver parcels of care
Care for LTCs presently accounts for 55% of GP based on different functional specialities. The heavily The health outcomes of people with chronic disease is
appointments, 68% of outpatient and A&E siloed and transactional nature of this model worked therefore highly dependent not on what happens in the
appointments. well for a world of acute and episodic illness but has consultation room but what happens during the daily
meant that care for patients with chronic diseases is patterns of a patient s life. The complex management of
often fragmented with multiple hand-offs between treatment regimens and the adjustments required to other
Healthcare spending per person rises sharply with age
GPs, specialists, nursing and, if required, social care. health behaviours and other life issues are often poorly
managed leading to the worsening health outcomes and
Patients therefore have to wrap themselves around higher downstream system costs we are currently witnessing.
the complexit of the s stem rather than the s stem
wrapping itself around the needs of patients. This Chronic disease management therefore needs a radical new
leads to people owning the responsibility for approach. One that recognises that moves beyond the
integrating their own care with many falling down clinical only perspective to one that embraces a broader
between the gaps as their condition worsens. health coaching frame. It is only through more holistic
support, tailored to individual circumstances that will help
The very nature of a LTC is one in which a person has people to take more ownership of the adjustments required
to live with a debilitating condition as a permanent to effectively manage the continual presence of chronic
feature in their lives. Managing this reality places disease in their daily lives.
14
Prevention is the most effective cure factors need to form part of any holistic approach to North Central London (NCL)
prevention. Population health needs therefore to be
It has been clearly established that the onset of chronic managed holistically within distinct geographical Overview of NCL Health system
disease is causally linked to a range of habits and areas to enable to the management and orchestration NCL comprises 5 Clinical Care Groups (CCGs)
lifestyle behaviours such as diet, exercise, sleep, of the most effective suite of supporting interventions. Barnet, Camden, Enfield, Haringey and Islington
alcohol, smoking and drugs. Currently less than each covering the same area as the local London
6% of healthcare spend is targeted at prevention The range of interrelated factors that influence health Borough. There are around 1.44m residents in NCL
leading to many to believe that the National Health behaviours mean that blunt single issue interventions and the area spends £2.5bn on health care and
Service should be rebranded as the aimed at influencing individual health behaviours will £800m on social care. There are five acute hospitals,
National Sickness Service . not be enough. These need to be replaced by systemic three specialist hospitals, three providers of community
approaches involving the orchestration of a wider services and three providers of mental health services,
Lifestyle behaviours are rooted in psychological, ecosystem of stakeholders if significant progress is to as well as 237 GP practices.
cultural, economic and social beliefs, values, norms, be made on making a dent on the incidence and
expectations and opportunities meaning that trajectory of chronic disease.
engaging with behavioural change raises a number
of complications that are beyond the reach of the Population health overview NCL as an
traditional clinical gaze. example
Getting to grips with improving the health and North Central London (NCL) is an inner city area of
wellbeing of the nation is essential if the rising misery London that comprises 1.44m residents and includes a
and costs associated with managing chronic disease full range of social groups from affluent
are going to be brought under control. Most people neighbourhoods to areas of high deprivation. NCL is
drift into chronic disease through adopting unhealth one of 44 regional partnerships that have been
patterns of lifestyle behaviours. Prevention and active instructed to provide a Sustainability and
support for wellbeing and healthier living needs a Transformation Plan (STP). These describe how
much more integrated and nuanced approach that regional health actors intend to work together to
addresses both individual and systemic causes. improve the population health, provision of care and
Enhanced personal wellbeing support needs to be at financial sustainability in their areas. The Royal Free
the centre of any future health and wellbeing system. Trust is a leading hospital provider serving NCL.
Population and place based health People are living longer but in poor health: the
number of older people is growing quickly and older
The incidence and progression of chronic disease is people have higher levels of health and care service
heavily correlated with social factors meaning that use compared to other age groups. Older people in
access to resources and social and environmental NCL are living the last 20 years of their life in poor
health, which is worse than the England average.
15
There are high rates of mental illness and chronic health service delivery. Large numbers of people also
22% of people use 63% of health and care resources
disease with many going undiagnosed. It is estimated come into NCL daily to work.
there are up to 20,000 people with undiagnosed
diabetes and 13% with untreated hypertension. There are financial and healthcare system coordination
challenges leading to pressure points around A&E,
There are differing levels of health and social care delayed discharges, particularly for elderly patients,
needs: the majority of people are largely healthy, but variation in planned care and access to mental health
there is high use of health and social care by those with support services.
long term conditions, severe mental illness, learning
disabilities and severe physical disabilities, dementia NCL STP strategy
and cancer.
It is recognised that there is much fragmentation of
services and an insufficient focus on prevention. The
Complicating factors
current STP sets out a direction that embraces a holistic
Lifestyle choices put local people at risk of poor health population health approach and calls for:
and early death: there are high levels of childhood • Greater investment in prevention and alleviation of
obesity and almost half of people in NCL have at least social determinants of health
one lifestyle-related clinical problem (e.g. high blood • Greater collaboration across health system actors
pressure). The biggest killers in NCL are circulatory to enable joined up and integrated person centred
diseases and cancer; these diseases are also the healthcare services delivered closer to patients
biggest contributors to the differences in life where possible
expectancy across NCL. • Investment in the core enablers of people, STPs across the country are dealing with similar issues while
properties, systems and processes to enable reflecting the different demographics, disease profiles and
Poverty and deprivation are key drivers of poor health greater integration of health and social services socio-economic circumstances present within their
and wellbeing outcomes. Many local children grow up geographic boundaries. While these developments are
in poverty and many adults are claiming sickness or Significant challenges remain in terms of aligning heading in the direction (removing siloes, focusing on
disability benefit. There are stark inequalities in life incentives, financing and operational processes of population health), and the vision described in the sections
expectancy in NCL; for example, men living in the most separate siloed organisations to create a truly below is consistent with these principles, our premise is that
deprived areas of Camden live on average 10 years transformational system model for delivering the starting from here approach, while absolutel
fewer than those in the least deprived areas. population health outcomes. The recently announced necessary, is not sufficient to drive the level of change
move towards Integrated Care System (ICS) models by required to meet the long term challenges facing the UK
NCL has diverse ethnic population with 25% not having NHS England points to a future structural and financial health system.
English as their first language. There are also high model that has the potential to start to create the
levels of homelessness. In addition there is significant organisational structures and incentives to shift the In the next section, we describe a complementary, but
movement into and out of NCL: almost 8% of local focus from reacting to sickness to one focused on different approach.
people move into or out of NCL each year, which has improving population health.
a significant impact on access to health services and
16
A new vision for a new health system
Chronic disease a new system required Can a new health system evolve organically? Nothing is more difficult to undertake,
The NHS was structured to address the needs of a nation The continuing emergence of new innovative digital more perilous to conduct or more
where the burden of disease required visiting a doctor for technologies, apps, diagnostic tools, clinical insights, treatments uncertain in its outcome than to take
clinical advice or a clinical intervention. The massive and and health data all represent exciting innovations that offer
growing burden of chronic disease calls for a radically the potential to improve the effectiveness and performance of the lead in introducing a new order of
different paradigm of care. It calls for a new approach the wider health system. There are fundamental challenges things. For the innovator has those for
that moves beyond a narrow clinical focus to provide the however for a wider complex health system of absorbing this enemies all those who have done well
personalised and holistic health coaching support required drip feed of new pieces of innovation that include the
to either avoid or manage the complex challenges of living following: under the old and luke warm defenders
with chronic disease. who may do well in the new
Innovations to care delivery
A new system capable of tackling chronic disease • It becomes difficult to know what new shin thing
prevention and management will need to be: represents a sustainable long term solution versus a
The Prince , Niccolo Machiavelli
tactical stop gap solution
• Person centred a future system should be organised • There is a risk of adding digital silos on top of existing
to embed a holistic person centred health coaching silos that reinforce the underlying problems and just • Cross organisational transformations to models of care
philosophy into the heart of its operating model if it add to overall costs will require coordination and strategic planning to
is to have any meaningful impact on the chronic • Adding lots of new fragmented digital health solutions adopt and integrate new technologies, platforms and
disease problem risks creating more complexity for patients and end data
users of services who need more integrated solution
• Personalised medicine ready a future system will approaches It s an understatement to sa that pulling off this kind of
need to be designed around a personalised medicine • There is a risk of duplication and problems with transformation is extremely challenging. Indications are that,
model that embraces these supporting innovation diffusion of innovations due to multiple different while STPs and ICSs are driving talk around integrated health
trends rather than issuing antibodies to reject it. This innovations being sourced by different parts of the and social care, progress is very slow as existing structures
will include ensuring that this future system has the skills, system to solve the same issues and siloes try to collaboratively evolve from their current state
capabilities, resources, partnership models to support to radically new future.
richer and more holistic models of care System level transformation
• Any larger changes or advances to integrated and One interviewee argued that the current approach to creating
• Population health based a future system will need to person centred models of care will require more a fit-for-the-future healthcare s stem was like getting a
be structured, managed and incentivised to encourage strategic system level approaches to technology hippopotamus and an elephant to mate and expecting them to
and facilitate collaboration across all stakeholders to adoption and integration produce a flock of ga elles .
improve population health outcomes
17
Its 1948 again - why a new vision is required and infrastructure investments that will either represent
the new building blocks for transformation or act as The key elements of our approach
Transforming a heavily siloed and fragmented future blockers to achieving the vision.
healthcare system into a leading 21st Century person • To develop a vision that can act as a beacon for a
centred healthcare system will be a huge undertaking. The vision we lay out in this report health service, geared around population health,
A clear overarching and compelling vision will be fully using technology in a reimagined system as a
essential to inspire and give direction to this journey as This is a big and complex landscape so this report has stimulus for debate and potentially agreement on the
well as giving clarity and inspiration to the public, sought to take a s stems thinking approach based on direction we are heading in; and a shared
integrating expert perspectives and rolling forward understanding of the scale of ambition and the issues
employees, policy makers and the wider healthcare that would need to be confronted to get there
system actors in the transformation journey ahead. existing trends to imagine what person centred health
and wellbeing could look like in a 10-15 year period. • To describe the vision in a person-centred way
New breakthroughs are transforming our rather than starting with institutional practice; the
understanding of the human body, the nature and The vision in this report describes what is possible in a appropriate system would be an output of this
causes of disease; they will require engaging people 10-15 year time frame if the opportunities provided thinking
and communities in managing their own health as well by the trends identified are fully embraced. It is
as the organisational and incentive models that support recognised that there are many significant challenges • To take current trends and roll them forward. Our
enhancing population health. and issues that this vision raises that have yet to be intention is not to develop new ideas, but to layer a
solved. Rather than see these as barriers that prevent wide range of current trends and imagine how they
would manifest together
A dynamic, self improving healthcare system will be progress we have highlighted them as challenge areas
essential to adapting to the emerging health and for new and innovative thinking. • To employ whole-system thinking to develop a
wellbeing needs of individual and populations in the coherent model involving technology and medical
coming decades. It will also be key to creating a The health system may be at a fork in the road a advances and, potentially, actors outside the current
public health system that can be the engine of choice is needed between realising the potential that health system that may be required to deliver the
innovation and leading practice. It could also provide new technology can bring or succumbing to the vision
a massive opportunity. Creating a system wide engine unaffordability of long term care of chronic conditions.
of innovation could propel the UK to a world • To be playful and optimistic. As this project is
The objective of the vision described is to act as a funded by the Royal Free Charity, and is therefore
leadership position in research, digital health and Life
independent of formal NHS planning processes, we
Sciences as well as opening opportunities to lighthouse showing the wa forward to a world
can step back from the NHS necessar focus on the
commercialise healthcare system capabilities and know leading 21st Century system of health and care nearer term issues; take an optimistic view of what is
how to other national markets around the world in a capable of delivering radically improved health and possible and what it might take to get there; be
post Brexit world. wellbeing outcomes for the whole population. exploratory and throw up as many questions as we
answer
From a practical perspective, common agreement on a We wish to provoke a debate amongst stakeholders
shared vision helps to provide a strategic framework (the public, policy makers, healthcare leaders and the
to guide short to medium term transformation and wider health and care ecosystem) leading to a shared
investment decisions. This will be particularly important vision; and to encourage the ambition, leadership and
in decisions that relate to long term technology, clinical action needed to make this vision a reality.
18
Scope of the report
This report describes a vision that covers emerging innovations that will have become mainstream within the
1 vision timescales such as personalised medicine, bio sensors, wearables, IoT, communications, robotics and AI
The aim of this report is not to concentrate on the innovations per se but recognises that these technologies
2 are a means and therefore we aim to describe the ends to which these technologies can be harnessed
into a newly configured healthcare system in pursuit of enhancing health and wellbeing outcomes for patients
and populations
The focus in this report is on a vision for person centred care in the context of everyday life or as an
3 outpatient; we have not addressed the needs of patients or the healthcare system within an inpatients and
A&E context. We have not fully explored the implications for social care and mental health policy and
service delivery but hope to address these more deeply in subsequent versions of this report
4 Although a vision of person-centred care will inevitably encompass a holistic set of health and wellbeing
needs with general applicability across the system, the context for this report and its recommendations is the
Royal Free Trust. However, in developing the report, the scope has widened to generalise the Vision as a
wider provocation for the sector.
5 Stakeholders consulted in the research included representatives from Primary care, Academia, patient
advocacy, NHS England strategy, Public Health, Policy bodies and leading tech companies with an interest in
health operating in the digital health and artificial intelligence fields and senior leaders within the Royal
Free Trust. We also worked with a small group of Junior Doctors at Barnet Hospital to develop the stories of
person-centred experience of the vision.
6 Given the breadth of topics and themes covered in this report we have not sought to do a detailed
evaluation of every component of this vision nor sought to give specific detailed strategic or policy
recommendations but instead of concentrated on drawing together the higher level themes to provide a
systems level view of what a person centred healthcare system might provide and the substantial benefits to
citizens and to the healthcare system triple bottom line
19
Stakeholders Questions and Provocations
Citizens/ patients How will the new advances in health and care described in this vision help to maximise the health, wellbeing, and quality of
How to read this report life for myself, my family and for society? What will be different from the care I receive now, what level of self care will
become possible, how would it work, why should I care, would I want this and support this as a direction for public healthcare ?
Trust, primary care & How will this vision enable the long term goals of our organisation and what would it mean for our organisational strategy in
In setting out a future vision it is necessary to
social care Leadership terms of new models of care, partnerships, financing, new capabilities, new skills and new organisational models?
consider both the perspectives and the impact
on a wide range of stakeholders who are Medical/ Clinical What would the impact of this vision on be the practice of medicine and care delivery? What changes are envisaged in future
likely to form the basis of the future healthcare Operations clinical/ nursing care models and what are the long term changes, skills and CPD journey to enable this to happen?
ecosystem.
Finance How does the vision address the sustainability challenges of the current system? What would be the financial, business model
We recognise that although many will be and resourcing impact of delivering the vision and what would be the roadmap and investment case to achieve it?
interested in the overall vision many will also
be interested in how this vision could impact CCIO/ IT What capabilities would be required to deliver the vision and what would the long term IT, data & AI strategy, standards,
their specific area of interest or responsibility. business models, roadmap and partnership models required to deliver it?
HR How do we use this vision to rally all employees of the our organisation around a shared inspirational vision of the future?
We have therefore created a set of questions
and provocations that we believe will be What are the resourcing, skills, behaviours and training required to embark on the journey to delivering the vision?
helpful for different stakeholders to have in
mind when reading this report.
Others:
This report itself is intended as a first step to STP/ ICS leadership How does a longer term vision assist in helping to shape the short to medium term plans for promoting closer integration of the
provoke wider debate about the future. We teams local health and care economy in ways that support realisation of the long term vision?
therefore encourage readers to engage
critically and constructively with the ideas NHS England/ Policy How does this long term vision impact and inform the longer term strategy for building a sustainable national health and care
contained here so we can collectively realise a makers system capable of addressing national health priorities. What changes would be required to enable this future?
sustainable 21st Century health ecosystem that
provides value to all stakeholders. Pharma/ Medtech/ How does this long term vision support/ align with the long term R&D and commercial opportunities. How could greater access
research community to real-time health data to improve and accelerate innovation and development as well as monitor post-launch performance?
Tech and digital How does this long term vision align/ inform longer term technology development? What partnership models arise out of
health Industry building the roadmap to the vision and how can the adoption and diffusion of key technologies be accelerated?
20
3. Mega Trends Impacting Health
If a person centred healthcare system is required to address the We extrapolate the revolutionary new trends in healthcare
prevention and management of chronic disease then what do including developments in genomic and personalised medicine,
we mean by person centred health and what new digital health and AI. Combining these trends, we explore the
breakthroughs are happening that enable us to rethink how this impact on personalised healthcare support as it begins to extend
system would work? out of traditional clinical and care settings to individual settings
supported by AI-powered virtual digital health coaches.
In this section we summarise the key clinical and technology
megatrends that will impact the landscape for health and We also explore some of the emerging research exploring the
wellbeing in the next 10-15 years. These changes offer the psychology of health and the considerations that will be key to
potential to radically rethink the delivery of prevention, people using new technology based solutions to assist them in
diagnostics, treatment and disease management to deliver becoming more actively involved in their own health and
better outcomes and quality as well as reduce overall wellbeing.
healthcare system costs.
It is in the combination of these diverse fields of expertise that
the potential for a new, truly transformative vision emerges.
Introduction Socio-technological trends Systems biology Personalised Medicine Medtech Innovation Data & AI powered health Psychology of health
Introduction
It is clear that the world has changed dramatically This is a vast area to consider. There is an
since the formation of the NHS in 1948. The industrial enormous amount of work going on in each area
revolution which began in the UK in the late 1700s and increasingly deep specialisms of knowledge
has made its way through 3 phases: from steam, to and expertise.
electric and now to an economy powered by
computing and IT. The future of healthcare will be the result of the
interactions between these trends.
We now stand on the edge of a new era or 4th
Industrial Revolution (as termed by the World In this report, our goal is combine the impact of all
Economic Forum) which will bring about the fusion of of them envisaged within a single system. This is an
technologies that blur the lines between the physical, ambitious undertaking.
digital, and biological spheres. AI, nanotechnology,
synthetic biology and materials engineering are In particular, we are aware that our audience
leading to almost exponential levels of innovation comprises a wide range of specialisms and
which will transform every industry including health. stakeholder groups. It is inevitable that when reading
about your specialism, you will find the content high-
Here we explore 6 key megatrends that will shape level and simplistic. We have endeavoured to make
how the healthcare landscape will change in the next the content and language accessible to all potential
10-15 years: readers with an interest in the area.
1. Socio-technological trends We hope that in reading about other specialisms,
therefore, that you will find the content accessible
2. Systems biology and relatable.
3. Personalised medicine Our primary goal is to provide a platform for
4. Medtech innovation different specialisms to see the bigger picture Figure 1: In this report we project forward six key
and to provoke a debate on the longer term trends to envision an integrated healthcare system
5. Data and AI powered health shape of healthcare. that could be enabled by the combination of them all
6. Psychology of health
22
Introduction Socio-technological
Socio-technological Systems biology
trends trends Personalised Medicine Medtech Innovation Data & AI powered health Psychological
Psychology ofhealth
health
1. Socio-technological trends People are usually afraid of
change because they fear the
Digital lives Augmented reality (AR) will become much more unknown. But the single
prevalent enabling digital information to be overlaid
The last 10 years have brought a proliferation of onto the real world through smartphone screens, greatest constant of history is
digital services across all sections of society. In this eye-ware and ear mounted hearables . Virtual
time we have seen the explosion in smartphones, apps reality (VR) will enable entry into simulated 3D
that everything changes
and the mass adoption of social media, mobile banking worlds enabling new immersive forms of learning
and ecommerce. and entertainment. Yuval Noah Hariri
Innovation across all consumer facing industry sectors is There are likely to be a number of challenges ahead
set to accelerate even faster in the next 10 years in this area privacy and data security issues for
focused on creating and enhancing digital experiences example many of which will be particularly
to bring greater convenience, speed and ease of use to heightened when relating to personal health data.
all aspects of daily life. The distinction between digital In the longer term, while there will be privacy crises
and real worlds will become increasingly blurred as along the way, we believe these will be addressed
digital services become ever more tightly woven into and the direction of travel will continue.
the daily fabric of everyday life and become an
indispensable part of our engagement with the The rise of AI and virtual assistants
world around us.
The leading tech players such as Google, Microsoft,
Sensors are set to appear in everyday objects allowing Apple, Amazon and Facebook are all committed to
them to be connected into wider networks enabling new delivering virtual assistant services where AI
ways of interacting with smart homes, smart cars and observes, learns and personalises itself to adapt
smart cities. Artificial intelligence(AI) coupled with new to the needs of each user.
natural language interfaces will enable objects and
services to be increasingly personalised and These general purpose virtual assistants will
controlled through the human voice. increasingly replace Apps to offer ever richer and
more powerful services integrated and personalised to
AI in general will be applied to most devices, leading the needs of individual users. These assistants will no
to the appearance of driverless cars, intelligent drones longer be tied to specific devices like smartphones and
and robotics with the likely appearance of domestic be able to be summonsed through whatever screen or
and care robots to carry out domestic chores and basic device is at hand using a range of intuitive visual and
care support. The arrival of Quantum Computing will natural language user interfaces. * See Appendix x: Reasons to Believe
take AI to the next level of sophistication*.
23
Introduction
trends trends SystemsPersonalised
biology Medicine
PersonalisedMedtech
MedicineInnovation Medtech Innovation
Data & AI powered health
Data & AIPsychological
powered
Psychologyhealth
of
health
health
Changing public relationship with services Levels of stress and anxiety are likely to remain high or The rise of digital services
increase further as society struggles to adjust to new
The growth in the use of digital services is set to challenges such as rising automation, job insecurity and changes the nature of the
expand across all sections of society as government the more complex and changing nature of the world.
and the private sector actively expand increasingly This means that it is highly likely that mental health and
relationship between people
powerful digital services into all areas accompanied its determinants will need to figure even more strongly and the institutions that serve
by more intuitive and natural interfaces. in a future healthcare system. Mental health is highly
correlated with unhealthy behaviours and failure to them. Instead of going to the
The rise of digital services changes the nature of the manage with chronic disease. service the service now comes
relationship between people and the institutions that
serve them. Instead of going to the service the service Health and wellbeing becomes a target for to the person in the form of
now comes to the person in the form of increasingl industry increasingly personalised apps
personalised apps for banking, shopping,
entertainment, social media etc. Going to a bank for
Business models in the digital world have increasingly
for banking, shopping,
access to the bank s services is being replaced b
24/7 digital access to managing my finances.
transitioned to ones where free or low cost services entertainment, social media
have been offered in exchange for obtaining user
data that can be monetised in other ways. This trend etc.
This is likely to accelerate the existing trends of
is set to expand as new and existing digital companies
increased expectations in terms of wanting immediate
seek out new areas of opportunity to harvest valuable
response, reduced deference to authority and service
data. In the health care arena, it will be important
on m terms . And it will mean that expectations from
to avoid or resolve tensions where the goals of
a public health and care system will continue to rise,
maximising profit comes into conflict with delivering the
adding an additional imperative to move away from a
best health advice and support.
paternalistic provider centric model to deliver a truly
responsive and person centred service.
Health and wellbeing is set to be a big target area for
all kinds of organisations seeking closer ties with
The cumulative impact of personalised and digitally
customers and opportunities to acquire valuable data
mediated society is that life is becoming faster and
about personal health and associated behaviours. The
more complex with many cultural norms and traditions
leading tech players are already making moves to try
are being replaced with more fluid social relationships.
to position themselves as the primary health platforms
This liquid modernit as sociologists have termed is
for offering a range of prevention and disease
reducing and dissolving man of the certainties that
management solutions. Pharma, Medtech, Food, retail
anchored social and psychological life.
and lifestyle organisations are all expected to make
moves into this space.
24
Introduction
Socio-technological trends
trends trends SystemsPersonalised
biology Medicine
PersonalisedMedtech
powered
Psychologyhealth
of
health
health
A future public health system needs a seat There is both an opportunity and a risk associated with
at the table the public health system finding its health relationship
with the public being disintermediated by powerful
The science of health and wellness is rapidly private sector and digital economy players. Those who
developing at the same time that western societies are gain a dominant position as the primary health support Socio-technological 10-15 year
adopting a culture of individualism where crafting will gain ownership of huge volumes of health-related trend summary
one s own identit is becoming a more central lifelong data that further strengthens their position. Commercial
project. Individual appearance and health related logic means that certain demographics would be more
behaviours are being harnessed into the performative attractive to pursue than others leading to greater risks
of a two tier health and care system and even greater 1. Digital becomes fully embedded in daily life
constructions of this self identity. The internet has
spawned a growing range of experts on hand to health inequalities.
2. Virtual assistants become our digital servants
offer health and wellbeing advice to cater for a
growing market of increasingly anxious customers The future of disease prevention, detection and
management will be increasingly fuelled by the new 3. AR and VR blur real and virtual worlds
desperate to seek quick fixes and the latest solutions
to real and perceived health and wellbeing concerns. insights revealed through new sources of data. If
locked out from this digital health future public 4. Mental health remains a serious problem
Around 80% of people have turned to search engines healthcare systems risk losing access to the data
for health related information. Google estimate 5% of needed to drive research and increased understanding 5. Higher expectations and less tolerance
all Google searches are now health and wellbeing that will be key to delivering a next generation person
related. The absence of trusted sources of information centred care system able to address chronic disease 6. Private sector players seeking to dominate
made accessible, relevant and engaging to people will challenges of the 21st Century. To sleep walk into this personal health market in goldrush for data
increasingly open up a space for more commercial disintermediation would be a policy decision in its own
players of highly variable quality to play a greater right and have substantial downstream consequences
role as the primar source of the public s health and for the role and structue of public health systems
wellbeing understanding.
This risks becoming a greater challenge for a future
healthcare system as more and more people come to
their HCP encounters armed with home sourced health
and medical knowledge . A more literate and
knowledgeable public is a good thing but without a
greater presence of high quality, accessible and
engaging public health information this need to know
more will be filled by an army of alternative experts
eager to attract audiences and to dispense their
wisdom .
25
Introduction
Introduction Socio-technological trends trends
Socio-technological SystemsPersonalised
Systems biology biology Medicine
PersonalisedMedtech
powered
Psychologyhealth
of
health
health
2. Systems biology
Introduction The new age of Systems Biology
Even the first scholars of medicine going back as far as DNA with its double helix of 3 billion base pairs of
Galen of Pergamon (c. 129 216 AD) recognised that genes holds the source code for each human and is
although medical symptoms appeared in discrete parts stored in the nucleus of each cell. Gene instruction at
of the body, disease needed to be understood at the the molecular and cellular level is largely mediated
level of the whole person. In recent times the explosion through RNA and expressed through the language of
in knowledge has led to greater and greater levels of proteins.
medical specialisation, leading to a drift away from a
whole person medical gaze in favour of siloed schools Since the sequencing of the human genome in 2001
of knowledge and practice. and the rise of sophisticated molecular analysis
techniques, the science of genomics has exploded and
The huge breakthroughs now taking place in genomics now stands to create the greatest disruption to the
and molecular biology are now giving us a much understanding and practice of medicine since its first
greater understanding of the human body as a whole inception.
person. Systems biology is the study of the holistic,
complex biological mechanisms and the emergent Living organisms communicate biological information
properties of the hierarchies of molecular, cellular and through networks that are hierarchical in nature starting
organ networks that comprise each human being. with the genome and extending all the way up to the The Human Body
entire body. These integrated networks are responsible The human body is an extremely complex biological
These biological networks are not immune from outside for determining the biological processes involved in the
system:
influences and therefore a systems biology approach full life cycle of development, maturity and aging.
also takes into account the impacts of external factors
• There are an estimated 37 trillion cells in the
such as health behaviours and the wider social and If these networks are disease perturbed then genomic, human body
environmental determinants of health. molecular and cellular irregularities will eventually • If all the veins, arteries and capillaries were laid
propagate up through cellular networks to manifest into out end to end the would stretch 100,000km
This emerging systems biology perspective places the organ level disease states (e.g. chronic diseases) and 2.5 times round the earth
person at the centre and seeks to understand the become noticeable and symptomatic for the individual. • The human brain is the most complex thing in the
interrelationship of the various biological, behavioural, known universe. There are more than 100 billion
social and environmental mechanisms that underlie The bod through its genome is not destined to neurons in the human brain with up to 10,000
wellbeing, disease and ageing. This s stems thinking develop and age in a predetermined manner.
connections for each neuron making the number of
approach to health will require new cross disciplinary Environmental factors place external stimulation and
stresses on this hierarchical network leading to genes to possible neural pathways greater than the
forms of knowledge and practice capable of bridging
existing silos. Achieving this will require new forms of express themselves (epigenetics) in response to these number of particles in the known universe
collaboration between research, medical practice, data factors leading to the resulting phenot pe or ph sical
science and policy makers. manifestation of this nature vs nurture interaction.
26
Introduction
PersonalisedMedtech
Data & AI powered
Psychology
health
of health
These external stimuli cover the whole spectrum of The rise of systems thinking
external factors including nutrition, the gut biome, Figure 2: in a world of systems biology, extends our
exercise, mental states, toxins and all the social and Scientific research will be undertaken by an ever understanding of the determinants of health downwards in
environmental determinants that have a causal impact expanding global scientific community pushing the scale from organs to genes; and upwards to encompass
on these. A holistic approach to prevention and frontiers of knowledge ever deeper into the complex behavioural, social and environmental levels. The
management of chronic disease will increasingly world of molecular biology and human behaviour. This interactions of these determines how the predispositions of
broaden in scope to encompass the genetic and will require an increasing need for further specialism
molecular impacts of the behavioural, social and genes express themselves into the physical manifestation
while at the same time call for new scientific inter-
environmental drivers of disease. disciplinary approaches capable of understanding of the phenotype
holistic health at the person and population levels.
27
Introduction
PersonalisedMedtech
powered
Psychologyhealth
of
health
health
With accelerating scientific breakthroughs come 1. Genetic sequencing the costs of genetic
greater levels of specialisation. There is a risk that this sequencing are tumbling as next generation
will lead to greater silos of knowledge and practice sequencing techniques continue to evolve. Already
making it paradoxically more challenging to pool approaching $1000 it is forecast to fall by
knowledge and expertise to further the development another order of magnitude enabling the
of whole person understanding of health. A recent potential for routine genetic sequencing by public
study revealed the growing challenge of assimilating health systems as well as encouraging multiple
the exponential rise in new medical knowledge. The private sector new players to enter the market.
study showed that 1.2 million medical biology related Genetic sequencing enables specific risk factors to
papers were published in 2016 with the average be identified and personalised health behaviour
research scientist able to read only around 250. recommendations, screening and treatments to be
tailored at the individual level.
The rise of AI and machine learning hold the promise
of being able to ingest entire bodies of knowledge to 2. Gene editing for genetic diseases or genes
be assimilated, cross referenced and analysed in near heavily implicated in the likely onset of disease,
real time. This automated synthesis of emerging huge progress is being made in the ability to
knowledge will help minimise unnecessary duplication deliver specifically targeted molecules with the
of studies as well as giving rise to new forms of system abilit to cut and replace sections of DNA or
level knowledge and understanding that is beyond the individual genes. CRISPR-CAS9 and its newer Figure 3: The body as a system.
capabilities of individual human researchers. This rise derivatives borrow a gene splicing technique used The human body is comprised of a seamlessly integrated
in meta cognition in the causal determinants of health by bacteria and offer radically new gene hierarchy of networks ranging from the genetic and
will serve to further accelerate scientific research and modification possibilities. Gene editing has the molecular up to the organs and whole body structures
understanding of health at a systems biology level. potential to offer single shot cures to many that support human life.
diseases that would otherwise require a lifetime
The promise of genomic and molecular of medication and suffering. Somatic gene editing
medicine describes genetic modification that is confined to
the individual and is not passed on to future
Genomic sequencing has enabled significant progress generations. Germline editing involves modifying
in understanding genetic and epigenetic processes as genes that will be passed on to future generations
well as the individual and collective genes involved in and thus raises greater ethical considerations.
a variety of diseases. Molecular biology has made
significant progress in understanding the role of RNA 3. Gene synthesis progress is now being made in
and proteins in gene expression and how these are chemically building gene structures that will
either involved in healthy functioning or indicate the enable corrected genes to be inserted into
precursors to disease at a molecular and cellular level. fault genes to enable the avoidance of
genetically determined or high risk diseases.
In the coming 10-15 years there will be significant Further into the future the abilit to print whole
progress in the following areas that will have a genomes through programmable pol merase
material impact on the potential for early detection will in time offer alternatives to gene editing.
and intervention for chronic disease:
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4. Biologics describes a broad range of
therapeutics that use complex molecules that mimic
biological processes enabling the potential to
create drugs that can target any molecule for
alteration or elimination. These range from Figure 4: The external determinants of health
specialised molecules able to be delivered into
the cell using viral agents to take out harmful New cross disciplinary understanding of the
proteins or edit genes right through to modified
interplay between behaviours, social &
antibodies capable of targeting localised cancer
cells (e.g. CAR T-Cell therapies). Huge and rapid environmental determinants will yield greater
developments currently underway will insights on improving personal and population
revolutionise the understanding of the granular health and wellbeing
causal mechanisms in chronic disease and usher in
the availability of highly targeted early stage
interventions. Treating diseases that have
propagated into wider body networks will require
more complex combination therapies.
5. Stem cell treatment - regenerative medicine can area with significant ethical and policy implications as these external factors could play a greater role in
overcome the human bod s built-in obsolescence. private clinics seek to cash in on demand for body and determining health outcomes than genetic factors.
Stem cell medicines can repair the bod s capability enhancement.
damaged cells rather than simply mask symptoms A systems biology approach therefore needs to frame
as traditional medicines do. By repairing damage Developments in each of these areas are accelerating health and wellbeing through a broader context to include
at the cellular level, it will be possible to restore and within the 10-15 year timeframe of this report, it factors related to behavioural norms, resources and
the function of key organs affected by chronic is likely that they will, combined with the impact of the communities in which people are born, grow, live, work
disease such as the heart and brain which in turn other trends, progressively enable transformational and age. As digital life expands into these areas there
improves and extends life new approaches in many areas of healthcare. Health will be vast new sources of data from which to gain new
policy and structural design of a future health system understanding of causality and opportunities for constructive
Clearly, it is impossible to predict the speed of the needs to be such that these new capabilities can be support within the lives of both individuals and local
ongoing scientific advances that enable the above embraced into improving health outcomes as they populations.
although many positive results are being shown in appear and not leave a legacy system locked out
early stage trials. One of the many implications of or unable to take advantage of the revolutionary Behavioural change & habit formation - The health
unpacking the various upstream causes of toda s new capabilities. behaviours associated with exercise, eating, drinking and
common conditions is that many of these conditions will sleeping are typically embedded in daily routines. Many of
be reclassified as a collection of sub conditions or The promise of behavioural science & these are determined by routine patterns of life and work
rare diseases requiring specialist treatments instead population health but many choices within this are the result of habits.
of common therapies. Changing these habits is often hard even if the harmful
Health is not just determined by genetic inheritance but consequences are known. The pleasures and rewards which
As gene editing techniques develop further the is greatly impacted by factors external to the body are experienced in the present have a greater allure than
potential for human augmentation will become such as health behaviours as well as broader social abstract potential dangers in the future leading many
possible. It is likely that this will become a contested and environmental determinants. Studies indicate that people to sleep walk into ill health.
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Habits reflect choices that are done without much Social & environmental determinants the social
active thought and encompass choices originating out determinants of health are the social and Systems biology 10-15 year
of either personal preference or have been adopted environmental conditions in which people are born,
as part of particular cultural practices. Understanding grow, live, work and age. They include factors like trend summary
the psychological processes involved in generating socioeconomic status, education, housing, the physical
lasting behaviour change will be key to the design environment, employment and social support networks
of next generation health and wellbeing services. that people depend on within the course of their daily
life. These factors can also negatively impact on 1. Human biology is increasingly understood as a
Goals, motivations, beliefs & triggers traditional mental health, stress, anxiety, loneliness and quality of holistic system based on a network of networks
harms based public health messaging has focused relationships which in turn often result in poorer health
on warning of future health issues. These public behaviours and outcomes. 2. Rapid new breakthroughs are revealing the
information approaches have so far failed to contain
the growing epidemic of chronic disease. There are huge discrepancies and inequalities across genetic based processes that underlie health
different communities in factors such as obesity, chronic
There is emerging evidence that tapping into deeper disease and early mortality that correlate with many 3. The generic and protein based precursors to
motivational drives can have greater impact. of these factors. This is particularly evident along disease are being identified
Understanding individual s personal life goals and socio-economic and ethnic dimensions where poorer
showing how healthy behaviours can be harnessed to health outcomes are not only profoundly different but
help achieve them are much more effective in also are more deeply embedded in these communities 4. Rapid advancement in genetic and
motivating and pulling through the desired leading to intergenerational propagation of poorer biomolecular medicine will generate new
behaviours. These goals can be aspirational ones with health behaviours and outcomes. Addressing these cures/ treatments
their roots based on the desire for self improvement large inequalities in population health will be one of
and personal flourishing or be more fear based the primary challenges of the 21st Century.
triggered by the desire to avoid disease, or from the
5. External behavioural, social and environmental
shock of being faced with a health issue. Addressing the complex interrelationship between determinants impact many disease pathways
many of these issues will be key to improving health
Future directions in health education and behaviour outcomes. Many of these social determinants fall 6. Holistic cells to cities approaches are
change therefore will combine increased knowledge outside of the clinical realm with many different public, needed to drive improved health outcomes
and understanding of health with a personalisation of private and community based actors involved. The
advice that is contextualised to the goals, habits and absence of a holistic systems biology approach makes
outcomes that are most likely to motivate and sustain it extremely difficult to determine the causal processes 7. This will require new holistic approaches to
behaviour change. Achieving healthier lifestyles earlier involved, tailor care or target interventions that will engaging individuals and populations in health
in life has been shown to be key to sustaining life long maximise health outcomes at an individual or
approaches to health. population level. 8. Rapidly expanding data sets and AI will
Population level behaviour change will require The future digital world with integrated smart homes enable a new systemic approach to health
encouraging the adoption of healthier beliefs and and smart cities promises to generate huge new data
behaviours amongst more receptive individuals, sets thereby supporting a more holistic systems biology
families and communities. This will require fostering the approach to health. This will include improved policy
spread of these to the wider population through wider making and greater collaboration across a wider
health promotion, peer influence and social norms. health ecosystem to improve national health outcomes.
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3. Personalised systems medicine
Introductions: decoding the practice of Today s era of symptomatic medicine The rise of personalised digital medicine
medicine
Since the beginning of medical practice the trigger for Fundamental to a personalised medicine approach is its
seeking medical support has been appearance of person-centred focus. Instead of seeing each individual
The practice of medicine since its inception many s mptoms . These are either or observed or felt as as a recipient of a suite of standardised, transactional and
thousands of years ago has followed the basic something is not right leading to a decision to reactive treatments, each person will be seen instead as a
formula of: present these symptoms to a medical expert. Upon person existing within a continuous holistic health journey.
presentation of these symptoms the medical expert Data from inside the body from key physiological networks
1. Person becomes aware of a problem and biomarkers will be combined with data sources based
(with the help of further tests if required) uses his/her
2. Person presents to an expert for examination medical knowledge to find a best fit between these on current and past health episodes and treatments plus a
symptoms to a disease classification and recommend continual stream of data relating to health behaviours,
3. Expert examines problem and compares with the best surgical or chemical intervention. social determinants and environmental context.
existing body of knowledge to diagnose issue
4. Expert matches diagnosis with body of A personalised systems medicine approach will involve data
knowledge on best available treatment For a disease to have progressed to a point that a being collected, stored, analysed and continually added to.
patient becomes aware of symptoms, it has to have This will in time evolve to become a form of data double
5. Person takes treatment and expert checks progressed such that one or more organs have via the creation of a holistic data model of each person.
progress to confirm effectiveness or provides become diseased to the point of causing visible This model will enable simulations of potential future health
alternative or noticeable signs. outcomes to be modelled based on modification of a range
of future health variables and assumptions. These will
At each stage of this formula, information or data Chronic diseases therefore have typically presented replace basic EHRs and, while starting as low fidelity
is collected. The body of knowledge associated with and been understood and treated at the organ level, models, will become increasingly comprehensive over time.
interpreting this data and matching it to recommended leading to the proliferation of the organ and major
treatments is the algorithm of medicine which has disease medical specialties and chemical based What are effectively personal data clouds will provide
been encoded into the professional practice of pharmaceuticals we see today. Up to now, there has holistic, continuous and actionable insights to help the
modern medicine. been no other choice but to organise our systems of individual in the management of their health and wellbeing
medicine around this model due to our current levels and provide relevant healthcare professionals with insights
Major and rapid advancements in the understanding of understanding and interpretation of the functioning and trends needed to support clinical and care delivery.
of the underlying molecular biology of the human of the human body and treatment. As we have seen
body are set to open the door to a new paradigm genomic medicine and systems biology approaches Issues of privacy and security will become more important
in the understanding and practice of the formula promise to completely revolutionise how we think as will the challenges of storing, communicating and
of medicine. and deal with chronic disease and the wider processing the large amounts of information involved.
practice of medicine. Costs will fall rapidly; and designing for a personalised
medicine future will make possible a coherent data strategy
that enables value to be progressively released over time.
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Predictive and Preventive The personal dynamic data clouds will be the key
individual repositories of data from which new insights
can be derived and on how wellness, disease and
Personal dynamic data
The falling costs of DNA sequencing will in the next
10-15 years make it commercially possible to introduce ageing develop and the causal factors involved at clouds will have profound
genetic sequencing as standard for the population. both individual and population levels. This will enable
The ability to identify (and increasingly influence) the a fundamental shift in the ability to predict and implications for how a future
genetic factors involved in improving physical health prevent disease, heralding a new era in which
and enhancing wellbeing as well as avoiding disease comprehensive stratification and targeted prevention healthcare system directs its
are powerful motivations likely to drive wider public can at last become a possibility. This has profound resources and provides the
acceptance of DNA sequencing as part the personal implications for how a future healthcare system directs
medical record. its resources and provides the basis of a new health basis for a new health
compact with the public.
At the molecular level, organ-specific proteins found in compact with the public
the blood will be analysed in a longitudinal manner Personalised health support
across the individual s life. Changes in baseline
measurements at the molecular level will enable early Individually sequenced genomes combined with the rich
disease warning. Breakthroughs in systems analyses of personal data held in personal dynamic data clouds
the dynamics of disease-perturbed networks will will enable a unique model of current health status and
enable a s stems view of disease progression the ability to predict future risks relating to wellness
heralding the opening for new drug categories and disease. This personalisation of healthcare opens
aimed at preventing and blocking disease progression. up a world that replaces the predominant one si e fits
all diagnosis and treatment model of healthcare to
At the higher organ network level the ability through one where treatment and advice can be tailored and
sensors to baseline and longitudinally monitor the personalised to the specifics of each individual in a
ph siological markers across an individual s life number of ways:
will yield additional insights into the early signs
and progression of disease making it possible to • Personalised wellness once sequenced, it is
trigger early interventions or predict the onset of becoming possible to decode the function and role
adverse events. of individual genes held within the human genome.
This will not only reveal risks of disease but also the
At the level of individual health behaviours and social personal biological dispositions with relation to
and environmental determinants, the ability to track nutrition, sleep, exercise, energy and mood. The
and monitor these longitudinally will also reveal ability to provide people with tailored advice on
deeper insights into the combinations of factors that how to improve their sense and experience of
have causal impacts on both wellness and the onset and wellbeing will transform the nature of health
progression of disease and ageing. promotion awa from a harms based discourse to
one that connects health behaviours to maximising
individual wellbeing. As DNA sequencing costs fall
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to a mere cost of sales level, there will be a • Personalised health coaching and care for any
growing market for companies who see economic person with one or more chronic diseases there will
potential in offering their own DNA sequencing be a need to provide holistic person-centred Personalised medicine 10-15 year
services in order to cross-sell tailored wellbeing support. A combination of personal disease risk trend summary
services around diet, exercise, sleep and mental factors, personal disease progression pathways,
health, etc. personalised medical treatments and personalised
health behaviour recommendations will require ever
• Personalised risk stratification and diagnostics more personalised healthcare support delivered 1. The practice of medicine has historically been
the modelling of personal risks of developing through a coaching model of care support. based on people presenting with symptoms
disease based on genomic, phenotypic and Personalising this care support to meet the needs
behavioural data will enable healthcare providers and preferences of each person, their goals and
to identify and track particular disease risks. The priorities, the resources required and the progress 2. Personalised medicine will enable the
use of biomarker and physiological tracking offers being made all make personalised health coaching detection and treatment of the upstream
the opportunity to locate and diagnose early planning and delivery a dynamic process. precursors of disease
stage disease signs long before they become
symptomatic and more serious, enabling earlier • Personalised community care - The wider social
and more targeted interventions to treat or cure and environmental context in which people live has
3. Personal data clouds will integrate personal
these early-stage disease-perturbed networks. a material impact on health outcomes. Access to data into data doubles for health modelling
resources such as affordable and healthy food,
• Personalised treatment Genome sequencing and employment, learning, healthcare, community 4. Longitudinal modelling of disease will enable
base-lined biomarkers for each individual will activities, safe spaces for exercise etc. all create
enable the identification of the specific causes of the contexts in which healthy lives can be lived. The
a radical shift towards prediction and
diseased biological networks for each individual ability to digitally track and support the use of prevention
and the specific treatments that will have the most wider community resources will enable investment
impact. This will lead to a wider range of more and development of these resources to maximise 5. Personalised wellness will offer opportunities
targeted treatments that are likely to cost regional and local population health outcomes. to increase engagement in healthy living
significantly more than traditional biochemical
medicines used to treat ongoing symptoms. The
one shot cure potential of these new treatments, 6. Personalised medicine will open up care to
however, offers the potential for long term more holistic and personalised health coaching
savings. Furthermore, when more traditional
pharmacological chemical-based treatments are 7. Richer data, profiling and risk stratification
required, it will be possible to identify the best
possible treatment from a range of options plus will enable health resources to be better
the optimum dosage. This will create dramatic targeted
savings to current chemical-based pharmaceutical
budgets as these can be more targeted and
dispensed in a more granular way.
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4. Medtech innovation
Introduction Biosensors and point of care diagnostics
New breakthroughs in nanotechnologies and
As computing power continues to increase in speed and microfluidics are enabling molecular assays to be to
processing power while reducing in cost, medical be miniaturised onto chipsets. These micro sensors
devices will continue to become more sophisticated, are capable of measuring genetic or protein based
smaller and more portable and cheaper. biomarkers or organ level physiological measurements.
As progress continues, it will become increasingly
The addition of sensors, software and AI will mean that possible to passively track in real time the factors
many devices such as scanners, imaging and point of associated with healthy functioning or disease at
care diagnostics will transition from being standalone multiple points in the hierarch of the bod s
to ones that are increasingly able to record and biological networks.
interpret data and be connected into wider intelligent There is increasing evidence that protein based
health and care systems. biomarkers, pathogens and very early stage cancer
cells all leave traces in the blood making liquid
New devices will appear on the market optimised to biopsies a particularl exciting area for sensor Figure 5: in coming years, advances in
new clinical and diagnostic procedures. development. The development of biosensors for biosensor technology will enable disease to
continual passive monitoring will herald a new era in be diagnosed much earlier and progression
These devices and sensors will increase the range and early stage disease detection and health monitoring to be monitored more consistently
precision of the monitoring of both clinical and non- that will change healthcare for ever. potentially in real time
clinical factors situated across the systems biology
Many of the current point of care diagnostic (POC)
landscape. Increasing levels of miniaturisation and
and medical imaging devices used in clinical settings
sophistication of devices and sensors will also enable are being progressively enhanced and developed
a shift of diagnostics and monitoring away from further. Not only are these devices becoming more New portable devices are able to be used by HCPs with
expensive clinical settings into community settings and powerful, cheaper and connected but they are also less formal training opening up the possibility for more
ultimately into the bodies and real-time contexts of becoming more portable. This enables devices once diagnostic activity being undertaken in community settings.
people s ever da lives. restricted to use within more expensive clinical With the smartphone becoming a more powerful computing
environments to become more portable and able to be device there will be further development of POC devices
used in the contexts where they can offer most value. capable of being attached to a smartphone e.g. handheld
ultrasound, pulse oximeter and blood sugar measurements.
Medical imaging will be further enhanced with greater
computing to generate richer 3D imaging.
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Moving clinical care closer to patients
The ability to transfer the
location of clinical services
Innovation in biomedicine, the collection of holistic into community settings will
person centred data and the development of next
generation medical technologies will transform how dramatically increase access and
and where diagnostics, clinical interventions and
ongoing management is performed. convenience for people requiring
clinical support and care.
As greater precision in locating causes of disease and
matching to treatments becomes possible, so it will be
possible to use more algorithmic processes supported
by technology to deliver personalised medical care.
This in turn will enable the clinical diagnosis and
treatment of a growing proportion of well understood
disease conditions to be transitioned from scarce high
cost specialist care resources out into lower cost and
more convenient community settings and ultimately to
the person themselves.
The ability to transfer the location of clinical services Figure 6: next generation point of care
into community settings will dramatically increase diagnostics and understanding of disease
access and convenience for people requiring clinical
will enable more care to be standardised
support and care. The ability through innovation in
smart sensors in and around the body will open up the and moved out of hospital settings and
opportunity to embed intelligent healthcare support closer towards the person
into people s dail lives.
The more that chronic disease prevention and
management can move away from a dependency on
episodic appointments to being embedded into daily
life the more effective a future healthcare system will
be in supporting people to successfully integrate
healthier behaviours and disease management into
their lives.
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Treatment and medication management Wearables and behavioural tracking
Breakthroughs in technologies for tracking medication The past few years has seen the rise of wearable The development of more sophisticated body mounted
are opening up new possibilities for managing devices capable of measuring movement, sleep, stress sensors will enable more precise measurement and tracking
adherence and validating medication. Poor adherence and a growing range of physiological markers. Smart of health behaviours associated with nutrition, exercise,
is a key reason for accelerated deterioration of watches, wrist bands and other body sensors will sleep and emotional health as well as other higher risk
chronic disease patients. These include digital tracking continue to evolve as people become more interested behaviours such as smoking, alcohol, drugs, risky sexual
of medication, medication reminders and automation in measuring and tracking various aspects of their behaviours etc. These will be valuable to healthcare
of dosage calibration (e.g. insulin calculations). health and wellbeing. New form factors such as ear professionals in assessing health impacts but also key to
mounted hearables and skin mounted electronic helping individuals in assessing and managing aspects of
Examples of new medical technologies used in tattoos are emerging. These open up new passive their health and wellbeing.
treatment include miniaturised ingestible cameras, means of measurement as well as introducing new
nanobots able to carry out targeted observations and interactive possibilities of engaging with real time
repairs as well as bod on a chip technologies that body data.
enable specific organ tissues to be grown and used for
medical drug testing.
New treatments for psychological, cognitive and
behavioural conditions are being developed based on
Virtual Reality. The ability to use targeted gaming
experiences to stimulate areas of the prefrontal cortex
associated with a condition shows promise for
providing an alternative to traditional
pharmacological treatments.
Huge breakthroughs in the miniaturising and precision
of print nozzles and the development of molecular
and cellular inks are opening up new possibilities for
3D printing of medicines, personalised prosthetics,
medical supplies and even human organs.
These technologies have profound implications Figure 7: advances in sensors and
for medical supply logistics, organ replacement smart technology in all areas of
and pharmaceutical testing. the social and environmental
system will enable the
determinants of health to be
tracked and measured in real
time
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Environmental tracking and support
The rise of smart environments such as smart homes, Medtech innovation 10-15 year
smart medicines, domestic care robots will enable data
and tracking of the contexts of everyday life. Social trend summary
connectedness is a key determinant of health and
wellbeing so digital services supporting the activities
and social contexts of family, friendships, work,
learning, community and interests will help to people 1. The miniaturisation and sophistication of
to thrive in wellness, disease and ageing. medical technology will continue to accelerate
The development of smart, connected environments will 2. Biosensors will be capable of tracking
offer growing opportunities to provide advanced
monitoring and support solutions for seniors and those biomarkers and detect early stage disease
with conditions that impair their ability to care for
themselves. These will offer new tools and customisable 3. POC diagnostics and medical imaging will
solutions for HCPs, social carers and family members to become cheaper and more portable
ensure seniors are ok, detect early warning signs or be
notified of the need for immediate interventions. 4. Diagnostics will move progressively out of
Smart sensors in the environment offer the chance to clinical care settings and closer to the person
track in real time air quality plus other public health
issues and allergens at a highly localised level. This 5. New forms of treatment and management will
will enable tailored support and real time advice to be enabled by new technologies and 3D
both individuals and populations. Environmental sensors
will also offer the chance to detect airborne pathogens printing
or pollutants offering early detection and more
effective tracking and management of potential 6. Wearables will adopt new form factors,
outbreaks of disease, pandemics or acts of biological increase in capability and integrate their data
or chemical terrorism.
7. Environmental sensors will enable tracking of
pathogens and air quality into personal care
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5. Data and AI powered health
As we have seen, the practice of clinical medicine is
based on collecting data, interpreting data and
matching it to a set of treatments and monitoring
progress, making adjustments as necessary. A systems
based precision medicine approach is fundamentally
different from symptomatic medicine in that it
encompasses the assessment of a much broader range
of factors from the molecular to the environmental
from cells to cities .
With the influx of potentially terabytes of data
coming 24/7 into personal data clouds and being
made available for clinical assessment it is clearly not
possible for clinicians to manage this quantity or range
of data types using traditional medical records.
Clinical practice in the future will become highly
dependent on the use and interpretation of data.
Data and its interpretation will therefore form the
oxygenating life blood of any future healthcare
system. Having the right information at the right time
at the right place will need the help of new
technology. The integration of new data and
knowledge from across multiple domains in real time
heralds a future that will witness a rapid expansion
and development in health knowledge and practice.
Figure 8: bringing together data from
across the systems biology landscape
will drive revolutionary new insight
into population health and wellbeing
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Critical importance of ML and AI in health In the medium term, AI will be harnessed to help From 0.1% intervention to 99.9% support
gather and interpret health related data and insight to
The rapid rise and accelerating development of support health professionals and patients achieve their The fact that even chronic disease patients spend less than
Machine Learning (ML) and Artificial Intelligence (AI) objectives in a more holistic and tailored fashion. 0.1% of their time with a healthcare professional and over
represent an invaluable set of core technologies highly Intelligent and holistic decision support systems will 99.9% by themselves means that health and wellbeing
relevant to the future healthcare challenge. bring a combination of richer precision based medicine outcomes are determined by the actions and biological
health insight, personalised treatment options and the factors occurring during people s dail lives outside of
As we have seen next generation healthcare opens latest clinical and care knowledge to the fingertips of these appointments.
up the full complexity of the interaction between the all those involved in delivery of care.
internal workings of the human body and external It is only through digital services that heath and wellbeing
factors that influence it. Healthcare therefore HCPs will be helped by reduced need for record support can move beyond the abstracted advice of the
represents the most profound complex adaptive keeping, the automation of routine tasks and the rise consulting room to be permanently present in the daily
system yet known to mankind. The collection and of more intuitive interfaces. More sophisticated visual contexts of people s lives where it can be most useful.
interpretation of the interplay between genomic data representations of information accessible from multiple This is the new battleground where the fight against rising
and continual data harvested across the entire systems devices and through multiple types of interface will levels of chronic disease will be won or lost.
biology spectrum over the course of a lifetime will enable any place any time access.
need a different order of analysis and interpretation. Toda s digital apps, online health content, medical devices
Toda s focus on improving efficienc and and sensors are designed independently to address specific
ML technologies are making great leaps forward in effectiveness of the factor of care deliver will be atomic solutions leading to a range of fragmented
analysing large complex data sets to reveal hidden supplemented by focus on orchestrating the delivering experiences, health advice and data stores. This leaves
patterns. ML can be trained to zoom in to analyse the right care to individuals based on their specific the individual person as the integrator and consolidator
specific disease-based patterns and medical imaging needs. This will both drive efficiency and effectiveness of these multiple fragments of advice.
or zoomed out to look at new correlations and as care resources will not be wasted where the don t
potential causal pathways across wider domains of the add value. Configuring resources to maximise health There are myriad choices, decisions and actions that are
healthcare landscape. outcomes will not only reduce costs but will have the undertaken each day, each week and each month that
added benefit of reducing future demand. impact wellbeing and the management of any ongoing
Ongoing developments in AI and ML technologies will health conditions.
enable self learning whereb AI powered s stems Future AI systems will be capable of intelligently
will be able to dynamically adapt (re-program) managing and coordinating multiple domains of care The highly fragmented digital health support landscape has
themselves to improve their performance in response support at the same time. This will lead to the rise of so far failed to make a compelling and sustained impact on
to the data received and the outcomes from any intelligent self optimising care management systems prevention and management of chronic disease. Future
interventions they initiate. ML and AI therefore opens spanning several different clinical, behavioural and developments in AI offer the opportunity to draw upon
up the potential for a transformative new model of social support considerations at the same time. data from personal data clouds to radically change this,
care delivery, one that dynamically optimises itself providing always-on care via the next generation of
in response to what it learns. This stands in contrast ML and AI will have profound impact on both research medically expert virtual assistant.
to toda s more fixed, codified, one si e fits all and development. It is likely to vastly accelerate
care delivery. learning across the systems biology landscape as well
as accelerate drug discovery. The ability to simulate
molecular processes to understand protein folding and
new agent binding formulations should dramatically
lower costs and speed time to market.
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Virtual Assistants pulling it all together Nested AI modules are likely to manage the various
medical and behavioural sub goals with meta AI
By taking a person-centred approach to health and modules orchestrating the overall health coaching
wellbeing support, AI will increasingly be able to take relationship.
data from multiple physiological, behavioural and
contextual sources and integrate these into more This will occur through three different levels of AI
holistic health support and coaching models to be learning :
delivered through some form of virtual assistant or
digital health coach . • Supervised learning is explicitl targeted b
medical professionals towards certain goals making
AI based approaches will increasingly enable expert it ideal for monitoring and advice targeted at goals
advice and health and wellbeing coaching support to associated with tightly defined precision medicine-
be adapted to the personal goals, preferences and based outcomes.
needs of each person. This will open up the possibility
for a fundamental inversion of healthcare to one in • The evolution of deep learning technologies
which AI acts as the agent working on behalf of the provides opportunities to sense and respond b
person, pulling together or gaining access to the discovering the underlying interrelationships in a
information and resources to integrate it, make it complex set of health behaviours (known as
understandable, relevant and actionable. unsupervised learning ). This enables new insights
as to the causal relationships between the various
This expertise and advice will draw from genomic factors involved in health behaviours and
insight and be under the clinical direction of healthcare subsequent disease.
professionals but be able to take it, combine it with
real time sensor data and contextualise it into the • The development towards Artificial General
moments and patterns of daily life for each person. Intelligence technologies (AGI) will take things
This will extend to gaining access to information and further and enable AI to take learnings in one
support on request as well as controlling, automating domain and apply them to solving other related
and triggering smart medical and care technologies problems. The development of this meta learning
where needed as part of any disease management or will be particularly valuable in health as many
care support. health behaviours are likely to share similar
underlying causes, mechanisms and behaviour
This advice is increasingly likely to be delivered change characteristics. This will also massively
through virtual assistant technology enabling speech, reduce the data sets and processing power to train
screen and gesture based communication tailored to general purpose AI powered personalised health Figure 9: the aggregation of individual holistic data
the preferences and personality style of each person. coaching virtual assistants. into a personal dynamic data cloud will provide the
Its dynamic nature also means that it will have the data insights from which to drive an ongoing
ability to learn and adapt to the emerging patterns,
preferences, health risks and disease states. personalised health coaching relationship
40
Introduction
SystemsPersonalised
biology Medicine
Medicine Innovation
Data Data & AIPsychological
& AI powered health Psychology
Psychological
powered of
health
healthhealth
health
AI powered EHRs and clinical support
For health and care professionals, the next 10-15 years
From static systems of record to dynamic systems of engagement
will be radically different as precision and systems
medicine will involve an exponential rise in the quantity
of data streaming from, in and around the persons being
cared for. Personal data clouds will involve the collection
of rich physiological, behavioural and contextual data
that will need the ability to draw out the salient insights
important for directing clinical care and, where required,
social care support. Medical data held about people will
transition from static s stems of record to d namic
s stems of action .
The rise of rich and dynamic data sets including genomic
data, molecular insights on signs and progression of
disease along with insights on health behaviours and
treatment impact will allow the transition from a
reactive to a predictive model of care support.
As described earlier, these rich data sets will
increasingl represent a digital double whereb
biological and non biological data can be used to
construct a digital model of each person s health status.
These digital doubles will enable predictive modelling to
be undertaken to enable advanced risk stratification
and the design of care support strategies that are
increasingly targeted at prevention-based
interventions rather than just treatment.
The ability to track wellness, risk factors, early stage
disease triggers, early stage diagnosis, assign precision
based treatments, monitor progress and rehabilitation Figure 10: the comprehensive real-time streaming into
with much greater precision will fundamentally change the personal data cloud will enable the creation of a
the role of medical and care professionals. digital double in which a simulation can be used by
HCPs to assess real-time health status and model
AI powered clinical and care decision support will
become key new tools and healthcare professionals will predictive outcomes based on different interventions
need to become much more capable in managing much
more holistic and finely grained health and care support
using data analysis.
41
Introduction
SystemsPersonalised
biology Medicine
Medicine Innovation
Psychological
powered of
health
healthhealth
health
AI powered self-learning healthcare system This has the potential to usher in an evidence driven Cooperation and coordination with the medical and public
polic approach to health s stem management where health research communities will accelerate the learning
In 10-15 years, the ability for health and care actors real-time population health can inform more and innovation within the wider UK health ecosystem.
to have shared secure access to rich person centred enlightened policy making. The continuous feedback Example areas where significant advances in R&D are
data and modelling (subject to permissions) will enable and identification of what is working best opens up likely to be made from increased cooperation on shared
enormously more detailed and real time insight to the possibility for replacing a approach based on set data include:
individual level wellness and disease as well as rules and fixed clinical guidelines to a health
enabling aggregate insights into overall service ecosystem capable of self-learning, self-healing • Disease genetic and molecular biology mechanisms
demand and population health drivers. and self-improving. involved in healthy functioning and the early onset and
progression of disease and effective treatments to halt
Toda s landscape is one in which care is provided b Research Academia and health ecosystem or reverse these
healthcare professionals using the knowledge and
intuition from both formal learning and experience. innovation
• Environmental pressures and determinants the
Care in this model is one of HCP as a craftsperson, lifestyle behaviours, social and environmental factors
acquiring and using historical knowledge and The access to large near real time data sets across the
that impact health behaviours, gene expression and the
experience to guide care decisions. systems biology spectrum at a population level will
onset of disease
yield a revolution in academic and scientific research.
The ability of AI to collect and analyse real time data In our10-15 year horizon, there will be breakthroughs
for both individuals and across whole populations will in the understanding of wellness, disease and ageing • Ageing longitudinal life course trajectories and the
transform how medical knowledge is collected and offering the potential for radical new genetic, genetic, molecular and cellular mechanisms of ageing
shared. AI will enable the rise of a shared national technology-based and personalised and loss of functioning plus effective treatments to halt
learning platform able to synthesise real-time medicine-based treatments. or reverse loss of function associated with ageing
knowledge about symptoms, determinants, treatments
and outcomes putting the best decision support advice The ability to have access to data at scale to facilitate • Person centred health coaching sustainable
into the hands of every HCP. No human powered discovery and innovation will be crucial no only to techniques of technology assisted behaviour change,
system would be capable of achieving this. improving national health outcomes but also for acting motivation and habit formation
The creation of a national real-time knowledge as a catalyst and innovation resource for the UK
platform for decision support will be nothing digital medicine and Life Sciences industry. • Pharma drug trials patient access and selection, trial
short of revolutionary. management, effectiveness, contraindications, and drug
ML and AI offer radically new ways to understand safety
Beyond the ability to optimise care support for
individuals it will also enable care providers to assess emergent properties and underlying causal
mechanisms of complex adaptive systems. Traditional • Population health meta analyses and predictive
the status of overall population health. This provide a modelling of causal determinants of population
valuable predictive tool for identifying emerging evidence based research seeks to isolate a causal
relationship, establishes a hypothesis and undertakes wellbeing and disease plus impact and effectiveness of
trends in wellness and disease, understanding disease structured interventions
progression, measuring outcomes and effectiveness of research to prove or disprove this. Applying machine
interventions as well as being able to save costs and learning and deep learning analysis to longitudinal
allocate resources more effectively through improved data covering complex multi-level data sets enables
demand and capacity planning. patterns and causal processes to be discovered.
42
Introduction
SystemsPersonalised
biology Medicine
Medicine Innovation
Psychological
powered of
health
healthhealth
health
Future of digital and data powered • Closed vs open systems the development of
healthcare challenges to overcome open data models will provide the most valuable
model and resource to the wider health ecosystem.
Data, its collection, secure storage, access, analysis It will enable R&D to be accelerated at lower costs
and sharing will be fundamental to any future and access to the widest data sources. Privacy and
healthcare system capable of addressing the permissions will be essential for research and trials.
healthcare challenges of the 21st Century. The handling
of issues relating to technology, capability, openness, • Regulation and patents the development of
ownership, regulation and public trust will all have a open data sources will encourage innovation but
profound impact on what a future healthcare system regulatory care will need to be taken to ensure
will be capable of. Examples of some key issues that that commercial interests such as VC backed
will shape the future are as follows: innovators or patent trolls do not annexe off core
pieces of the systems medicine landscape rendering
• Data aggregation aggregating data from these innovations out of reach for a future public
multiple domains, devices and organisations into health system and the wider public good.
personal and national data clouds will require
comprehensive new models of permissions, • Analytics and data visualisation the
standards, taxonomies, identity management. development of powerful analytics and machine
learning tools will be key to the analysis and
• Data volume and storage the vast amounts of interpretation of the increasing volume and
data (terabytes per person per day) mean that complexity of the healthcare data. Data
secure cloud based systems will be required. visualisation will become an increasingly important
Not all data will need to be stored centrally capability as a way of making this data accessible
and will exist in a distributed form linked with and understandable to healthcare workers at all
a common identity. levels who will increasingly find themselves
operating in a data driven world.
• Privacy and Security health data is arguably the
most personal data meaning that there will need to • Data science and the future of medicine the
be highly secure storage and access control. future of healthcare will transition to one where
Distributed ledgers such as blockchain will offer digital medicine comes to dominate. Current data
secure ways to validate access to records when science skills are poor compared to most other
combined with next generation cryptography. industries. The public healthcare system will need to
embrace digital medicine and data science as a
• Public consent gaining the trust and consent of core capability of the healthcare system if it is to
the public to share their data with a future make the transition to a digital future or avoid
healthcare system will be crucial. Creating being disintermediated by high tech players
demonstrable mutual value from sharing data will seeking to extend their control into the public
be key to the value exchange need to encourage health domain. Partnerships will be key to bringing
greater sharing and the building of trust. access to data science and AI skills and capabilities
but will need to be undertaken on terms that align
with public health goals and principles.
43
Introduction
SystemsPersonalised
biology Medicine
Medicine Innovation
Psychological
powered of
health
healthhealth
health
Each of these could and probably will be the
Data and AI powered health
subject of its own report. Each could and probably
will generate concerns, problems and scandals along
10-15 year
the way that may slow down progress. trend summary
They are described here both as a provocation to
debate and to show what has been considered in the
development of our Vision. They will all need to be 1. A future care system will face an exponential
addressed. We hope that the Vision will provide a increase in health related data
positive context and ambition that demonstrates the
value of addressing them. 2. Transformational value will only be gained if
data is integrated into personal data clouds
3. AI is developing rapidly and will be core to
driving value from this data for individuals,
HCPs, researchers and Pharma
4. The Chronic disease battle will move to daily
life management where AI powered virtual
assistants will play a central mediating role
5. AI will power holistic and intelligent decision
support systems
6. Health knowledge will rapidly expand to
enable a self-learning care s stem
7. Significant value will be created by finding
ways to share data with wider health and
care ecosystem partners
8. There will be substantial issues around public
consent, security and data sharing to
overcome
44
Introduction
SystemsPersonalised
biology Medicine
Medicine Data & AI powered health
Psychological
powered
Psychology
health
of
health
health
health
6. Psychology of Health Our most cruel failure in how we
treat the sick and the aged is the
failure to recognise that they have
Introduction Seen through a rational scientific lens the promotion of priorities beyond merely being safe
healthy living or chronic disease management requires
The rising epidemic of chronic disease has so far producing a set of evidence based information and and living longer.
evaded attempts by the NHS and public health policy communicating it to the public to ingest, understand
makers to counter it. Sometimes referred to as and act upon. Health and wellbeing are, however, Atul Gawande, surgeon, writer, and Public
lifest le diseases the causes and effective deeply intertwined with psychological and social
factors such as fears of mortality, subjective
Health Researcher
management of chronic disease do not lie only in
clinical interventions but also call upon people and experience, agency, personal identity and
wider society to be actively involved in the choices cultural practices.
and behaviours that determine personal health
and wellbeing. Cognitive neuroscience is showing that our perception
of reality is not based on a rational assessment of
So far attempts to increase levels of personal information received through the senses. Rather it is
ownership for health and wellbeing have had mixed past experience that leads the brain to create a
results. This is leading to rising overall rates of chronic narrative to predict the future with sensor inputs
disease and growing inequalities in health outcomes being used to validate this prediction. The result is that
across different social groups. In a personal medicine over time as circumstances deteriorate individuals tend
future there will be huge advances in the ability to slowly adjust their perceptions leading them to
support individuals in the pursuit of their own personal experience their current state as the new normal .
wellbeing and how best to adjust and manage to Sociologists have also drawn attention to the
living with disease and loss of function. These will count narmalisation of povert and ill health where
for little if there is limited success in motivating and people cease to believe that improvement is
engaging people in taking greater self ownership of possible or desirable.
their health and wellbeing.
The internalisation and acceptance of external advice
For a future healthcare system to take the full potential provided b professional experts on issues of
of genomic and systems medicine, it will also be personal health will therefore need to take account of
essential to exploit emerging insights into how people these significant psychological issues. These will need
experience and understand their own health as well as to be fully understood and factored into the design of
what drives sustainable behaviour change. This will be any successful future person centred healthcare system
key to understanding how to engage the public in the that is capable of supporting healthy outcomes through
journey to embracing and engaging in the life s stages of starting well, living well, aging well and
revolutionary new possibilities for improving personal dying well.
health and wellbeing.
45
Introduction
Socio-technological
trends trends
Systems biology
SystemsPersonalised
biology Medicine
PersonalisedMedtech
Data & AI powered health Psychological
Psychological
Psychology ofhealth
health
health
Contexts and forces driving ill health Processed food brain hacking the brain has Spend on public health promotion is a fraction of the
evolved mechanisms of taste and pleasure to assist in marketing of products that play an active role in poor
Modern society has brought with it many substantial directing the food choices that lead to the levels of health and chronic disease. Greater sophistication in
changes to the way life is lived. By 2050, 70% of nutrition needed to maintain health. Food scientists levels of support will be required to counteract this
people will be living in urban settings up from around have now hacked these dopamine pathwa s to messaging as well as policy and regulatory action to
50% today. Traditional nuclear family and community create processed food substitutes designed to minimise the impact of this marketing on younger
structures are being replaced by a technology- stimulate these pleasure centres. children who are more vulnerable to these strategies.
enabled and globalised market economy.
When these dopamine pathways are repeatedly Greater levels of pressure and persuasion enabled
This in turn has encouraged greater individuality and stimulated neural pathways are created that automate through regulatory and political means will be
material consumption while also bringing greater desires that bypass pathways in the cerebral cortex necessary to persuade more food and drink companies
anxieties associated with greater complexity and pace involved with decision making. Triggers and cues then to align their organisations around being part of the
of life. This in turn is bringing lower levels of security invoke desires that lead to consumption behaviours solution rather than part of the problem. This will
associated with employment, relationships and that are more associated with addictive habits rather include greater reformulation of products to be more
personal finances. These forces are set to continue and than considered choices. healthy and encouraging alignment with a positive
deepen over the next 10-15 years. public health agenda
Enabling people to understand and counter these
These societal trends have had a material impact on manufactured desires will be key to future person Paternalistic approaches to health
the rise of chronic disease through the dramatic rise in centred health coaching support but will need to be
consumption and snacking of processed foods and the supported with wider policy and system level activities The traditional model of professional medicine has an
reduction in mobility and physical effort brought about to actively encourage reformulation and the embedded assumption that the expert holds unique
by new technology. Any systemic strategy for availability of healthier choices. knowledge about the individual and that clinical
improving health and wellbeing will need to take into encounters are designed around the professional
account that individual choices are significantly shaped Marketing and the art of persuasion maximising expert making clinical judgements and treatment
by the resources society makes available to them to shareholder value is as a fiduciary duty for publicly decisions which the individual s job is to receive and
choose from. traded corporations leading to behaviours designed to comply with. This paternalistic mode of healthcare
maximise profit. For companies involved in promoting delivery embodies a clear power relationship oriented
There are therefore significant societal headwinds products and services it is important to persuade as around the clinical engagement.
that will need to be overcome in the design of a future many people to want and therefore buy their offering.
person centred model for supporting individuals. The language of medicine betrays this orientation with
Counteracting these forces will be a key to improve Huge amounts of money are spent on using the term patient hollowing out the idea of a person
personal and population health and wellbeing sophisticated psychological techniques to associate and replacing it with an object (patient) who is then
outcomes. products and services with desired emotions and status judged against criteria of compliance and
to manufacture desire for their offerings and adherence to clinical instructions. Medical
normalise consumption behaviours. The processed food, appointments are arranged at the doctor s preferred
confectionary and drinks industries are particularly location at times suitable to his/ her own availability.
sophisticated in using these techniques to promote their
offerings over healthier alternatives. Holistic person centred care needs to reverse this
model by truly placing the holistic needs of the person
at the centre of the care support relationship.
46
Introduction
Socio-technological
trends trends
Systems biology
SystemsPersonalised
biology Medicine
PersonalisedMedtech
Data & AI powered health Psychology of health
Relationships with healthcare professionals in a future • The existential self the conscious and reflective
system need to be founded on listening and self has a feeling of specialness associated with
understanding of the person s wider life context and the subjective experience of being an I , a subject
goals and be based on cultivating mutual trust and in the world. With the joys and possibility of life
respect. This will be more important in a world where comes the deeper fears of our own extinction and
deference to authority is in decline and the less mortality. Confronting health risks and the reality
affluent demographics where higher rates of disease of serious disease can therefore represent an
exist increasingly screen out official health advice existential threat leading many to go into denial
because of its implied value judgements on their way about the realities of their situation and the
of life. lifestyle changes and treatment needed to improve
their health.
Health and the self
• The experiencing self individual health is
People s conception and experience of health and something that is experienced through the feelings
wellbeing covers a broad range of physical and and sensations that accompany our daily lives.
mental factors and changes with age and the realities Sickness is something that is experienced through http://superflux.in/index.php/work/uninvited-guests/#
that come with the onset of disease. symptomatic sensations. Modern science
deconstructs the human body into its biological
Research is revealing that health is much more than component parts and identifies diseased or at risk Superflux Lab Uninvited Guest, developed for the ThingTank
acquiring and acting on the basis of rational mechanisms. Many people find it hard to relate
project demonstrates the tensions that arise when smart
knowledge. It is core to the experience of life and unseen medical issues with the reality of how they
feel. This cognitive dissonance leads man to go objects attempt to manage behavioural change ‘in a
therefore touches important psychological issues that
need to be understood and designed into the core into denial when confronted with a diagnosis of an paternalist manner in a home environment
fabric of a future personalised healthcare support underlying medical condition or health risk when
service: there are little or no experiential symptoms.
• The pleasure seeking self the senses and • The identifying self the rise of urbanisation and • The extended self , whether it be tracking facets of
emotions are important for navigating choices and social media has increased the importance of the wellbeing or being the recipient of medical treatments,
ascribing meaning and significance to experiences health practices and the body as an expression of new objects and data are required to support the pursuit
that comprise daily life. Attraction and avoidance identity. We are how we appear to others and of health and wellbeing. Research shows that we form
play an important part in framing engagement in feel compelled to work on cultivating this self distinct positive or negative relationships with these
many of the choices that impact health and image. While this has benefits in terms of assemblages as the become welcome or unwelcome
wellbeing. In a modern era espousing individual encouraging many to seek out healthier lifestyles, it extensions of ourselves. The emotional and existential
liberty and abundance of choice there is an can also cause many to have negative feelings connection we form with these external objects and data
increased temptation to make choices on food, towards all or parts of themselves, leading to rising is key to their acceptance and value in supporting better
drink, drugs and exercise that maximise immediate levels of self alienation compulsive behaviours, self- health and wellbeing.
pleasures and avoid inconvenience or effort. When harm or self-neglect.
faced with difficulties or stress it is common to self
medicate or reward the self with unhealthy
pleasure giving choices.
47
Introduction
Socio-technological
trends trends
Systems biology
SystemsPersonalised
biology Medicine
PersonalisedMedtech
Data & AI powered health Psychological
Psychological
Psychology ofhealth
health
health
• Cognitive biases Another barrier to rational Intrinsic rewards are the inner feelings of satisfaction,
decision making in health is the presence of self improvement and self esteem that come through Psychology of health 10-15 year
cognitive biases that distort the reasoning process. successfully changing a health behaviour. This is likely trend summary
Key cognitive biases include: to be much more sustainable in the longer term.
• Hyperbolic discounting the tendency to • Social and peer support it has been shown that
attach higher value to a short term gain
over a much greater long term gain. Many
by publicly committing to adopting a new 1. There is a tendency to accept ill health or poor
behaviour that being held to account and receiving levels of wellbeing as the new normal
unhealthy health choices are selected for the peer support significantly improves the likelihood
immediate gratification even when knowing of maintaining motivation and achieving long term
the longer term consequences success. 2. Traditional harms based messaging has
• Loss aversion the irrational tendency failed to stop growing public health crisis
people have to avoid losing something they • Effecting social change not all sections of society
already have even if gaining something are as willing to engage in behavioural change, 3. Modern lifestyles are bringing greater
equivalent or better especially if these behaviours are associated with
or woven into a particular cultural identity. By pressures leading to poor healthy choices
• Confirmation bias the tendency to search identifying and effecting change into groups that
for, interpret and focus on information that are most likely to change, it is possible to create 4. Processed food/sugary drinks are formulated
confirms one s existing preconceptions new social norms that over time create a stimulus & marketed to drive addictive consumption
for change in harder to reach groups.
• Nudge it has been shown that positioning,
framing and structuring choices in particular ways 5. Traditional paternalistic approaches to care
that recognise cognitive biases can preserve choice need to be inverted to contextualise support
but lead to better outcomes . The use of
choice architectures offers subtle wa s to
to the needs & preferences of the individual
stimulate uptake of healthier alternatives
while preserving choice. 6. Issues of health carry deep psychological
associations that need to be understood
• Intrinsic vs extrinsic rewards providing rewards
in the form of cash incentives, points or other forms 7. Decisions & choices that relate to health are
of recognition can often prove quite effective at
stimulating behaviour change attempts. These often non-rational & subject to cognitive
extrinsic rewards however are less effective at biases
achieving sustained long term changes as they
frame the health behaviour change as a means in 8. Intrinsic rewards based on building self belief
order to achieve the ends the reward. Chasing
targets for extrinsic purposes can rapidly start to & confidence are more likely to sustain change
feel like a chore. Once the rewards are removed
the behaviours often lapse quite quickly. 9. Behaviour change in hard to reach groups can
be impacted by peer pressure & social norms
48
4. Vision and its Components
Having laid out the key megatrends that will shape the future We then look at what this vision means for the new role and
health and wellbeing landscape we now we now bring these structure of a future healthcare ecosystem in order to support
trends together to lay out a vision of what will become this. We explore the new forms of collaboration between a
broader set of public, private and community actors that will
possible and therefore what a person-centred health and behind a shared goal of improving population health and the
wellbeing that embraces these possibilities could look like. quality of end of life care.
We describe the overall model and then unpack key parts of Finally, we describe how delivery of this vision not only
the vision to show how they provide compelling new ways of reduces the personal and societal burden of disease and
addressing and sustaining a life long approach to maximising addresses the sustainability of the healthcare system but how
personal health and wellbeing. it also unlocks a greater prize, namely: a country where
people are able to flourish and a more prosperous nation
We explore the role of technology and AI in empowering able to capitalise on its health leadership to succeed in the
people to become much more actively engaged in taking largest international market sector in the world.
ownership for their own health.
Vision summary Person-centered
Person-centered health
health unpacked
unpacked Holistic health coaching New health ecosystem New value
New value
creation
creation
Vision summary
Introduction Technology itself is not an end in itself but simply a • A new model of engagement that tailors wellbeing
means to an end. Determining how this technology is support, disease management and care assistance
For a health and care system in the 21st century to be harnessed into a new paradigm of care is central to around individual needs, goals and priorities
sustainable and address the cradle-to-grave health the success of a future system. Here, we describe what
needs of the population it must be one that is also a 10-15 year vision for person-centred health and • The three core elements of the new system:
configured and equipped to address the prevention wellbeing could look like and the value this will bring if
these trends were to be fully embraced and exploited • Personalised health and wellbeing
and management of chronic disease.
by a future healthcare system. • AI-mediated health coaching
As described in the previous section, huge • The future healthcare system
breakthroughs now being made in both the medical This vision is intended as a provocation to what the
and the technology worlds will usher in the greatest future could look like and not a prediction of its final
form. It is only by inhabiting the future and inspecting Following this summary, we unpack each of the core
transformation in knowledge, new tools and elements of the Vision and then describe how the Vision
capabilities since the birth of medicine over 2000 the new capabilities it will bring that we can truly start
to reimagine the transformational opportunities that lie addresses the key challenge of building a sustainable
years ago. This will require big, bold and imaginative healthcare system. We then explore how the Vision creates
thinking if we are to grasp the opportunities and build before us should we have the ambition and vision to
grasp them. additional value through improving quality of life for the
a 21st Century healthcare system capable of individual, increased efficiency and effectiveness of the
exploiting these breakthroughs to realise the system and contributes to a more prosperous society.
possibility of helping citizens to live longer, healthier There are significant barriers to be overcome in
and happier lives. moving from the current system but, in seeing through
these complexities to the prize at the end of it, we set
Addressing prevention and management of chronic out to paint a vision that can act as a provocation and
disease must move from a siloed clinical model to a an inspiration. It is only by aligning all stakeholders
holistic person-centred approach. This will need to be around a common shared vision that it will be possible
founded on combining personal genomic insight with to galvanise the entire healthcare ecosystem towards
the continuous personal data streams collected from reinventing itself into a healthcare system fit for the
across the whole systems biology landscape to 21st century.
identify opportunities to enhance wellness, early
diagnosis and personalise treatment and care support. In this section we describe:
As we have seen the success of a future system is not • the concept of always-on, person-centred
just dependent on the technical expertise and healthcare that arises from using new sources of
resources it has at its disposal. The ability to engage data to pull together holistic, real-time support for
the population in a new and deeper relationship with personal health and wellbeing
their own health will be an essential to realising
transformational health outcomes. • the key principles that underpin the vision
50
Vision summary Person-centered health unpacked Holistic health coaching New health ecosystem New value creation
Always-on, person-centred healthcare Increasingly sophisticated AI and algorithms that are Instead of relying purely on periodic visits to their doctor or
trained in leading edge scientific knowledge will be variable qualit information online, data from people s own
The trends described in the previous section will able to dynamically learn from growing sources of bodies and environments will increasingly provide the real-
redefine our understanding of health and the practice insight to provide an ongoing picture of current and time information from which to gain potentially moment-by-
of medicine in the 21st Century. likely future health and wellbeing trends. moment insight and guidance for maximising personal health
and wellbeing.
Today people present to the healthcare system when What does this mean for a future healthcare system?
experiencing symptoms of relatively advanced The vision we describe below is based on the use of AI-
disease. The NHS has been designed to respond to, It is clear that it has profound implications for the powered virtual assistant technology to deliver a new form
and manage, disease at this more advanced stage profession of medicine. The what, when, where and of person-centred care. This is the ultimate destination and
using intuitive or evidence-based medicine via GPs or how of monitoring, diagnostics, treatment and the most complete and transformational form of person-
organ-based specialists supported by surgical or rehabilitation will cease to be an analogue process centred care that has the most potential to dramatically
standard pharmaceutical interventions. that happens onl in a doctor s clinic; and it will improve health outcomes in a future healthcare system.
increasingly move out of the clinic to the person and be
The rapid advances in systems biology, genomics and supported by advanced technology and AI.
molecular medicine will mean that waiting for disease
to develop before initiating treatment will be
increasingly seen as a failure.
The ability to deconstruct disease into its upstream
genomic and early stage biomarkers opens the Figure 11: For all of its history,
window for a new world of early stage diagnostics, medicine has been focused
treatments and disease prevention. narrowly on responding
episodically to symptoms
The miniaturisation and pervasion of connected sensors reported by patients.
in, on and around the body open up the ability to Information being provided by
collect data in real or near real time on a wider sensors (and gene sequencing)
range of biomarkers, physiological and
and analysed in near real-time
psychological measures.
by increasingly powerful AI,
Combined with data on health behaviours, social will mean that future medicine
determinants and environment, this will mean that will be able to be more
data and modelling of health and wellbeing will predictive, preventative,
increasingly become dynamic and personalised to participative and personal a
each individual. holistic, always-on relationship
The ability to sequence the individual genome and
build a predictive model of future health probabilities
of each person will revolutionise how each person s
lifetime health journey can be managed. Genetic
counselling will become a core requirement.
51
Current System Future System New value creation
System focus
Sickness Prevention
System resources are built around a factory based model of care delivery focussed on System resources are dynamically organised around minimising disease and system
reacting to demand and managing disease demand through maximising wellness, early diagnosis & more effective treatment
Figure 12: Principles
underpinning a person-centred
vision. This table describes the
Scope of Care
key principles that are Medical and reactive Holistic and predictive
foundational to taking this Clinical focus that reacts to the presentation of medically recognised symptoms Holistic systems biology focus that proactively maximises population health through
person-centred lens on the consideration of all internal & external factors that influence health & wellbeing
future of health and how this
differs from the current system Point of Care
Hospitals, clinics and labs Personal setting
Diagnostics, therapies and treatment management take place by appointment in Diagnostics, treatment and holistic self care support take place wherever the person
physical buildings is (or as close as possible)
Delivery of Care
Standardised transactional care Personalised always-on care
Patients are matched to multiple siloed standard treatments and pathways and are Care is integrated and personalised into an ongoing co-created support relationship
seen at times and places convenient to the system that balances personal & social needs, genomic risk factors and expert clinical advice
Engagement Model
Paternalistic Coaching and guiding
Expert health and wellbeing advice and treatment is administered by a system that Health, treatment and wellbeing advice and support is tailored to meet individual
seeks compliance and adherence goals, preferences and contexts with a focus on empowering individuals to take
greater ownership of their health & wellbeing
Knowledge Base
Scientifically determined Revealed and emergent
Knowledge is determined by professional bodies, experts and scientists, and is K ledge i e ealed h gh g i g e e ime a i a d he a lica i f
updated via hypothesis based claims validated through gold plated research advanced machine learning to the vast sets of real time individual and population
substantiated by peer review data
Data & Ownership
Provider owned Person owned
Person centred data is fragmented across a myriad of apps, devices and individual Data is the cornerstone of the future health system with all sensors, systems and
health & social care provider controlled records systems with little partial standards devices and providers feeding data into personal data clouds controlled by the person
and taxonomies & limited person access with access granted under their control
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summary
summary Person-centered
Person-centered
healthhealth
unpacked
unpacked Holistic healthHolistic
coachinghealth coaching
New health ecosystem New health
Digitalecosystem
self learning system New value
New value
creation
creation
Holistic health and personal data clouds Virtual health coach and always-on support Empowering self ownership of health and
wellbeing
Within this vision section it is assumed that Person Sufferers of chronic disease today spend less than
centred health care can be provided at 2 levels 0.1% of their time with a HCP and over 99.9% on The explosion of data available both internally and
of fidelity: their own. No HCP will be capable or able to interpret externally will provide new insights and understanding
and act on this data in real time, so AI will be essential for individuals as to what drives both excellent health
1) High fidelity Personalised to the genetic profile to take this data and turn it into meaningful insight and and the onset and trajectory of disease. The ability to
of each individual where this is available guidance for individuals. In order to transition and gain deeper insight into health of their own body and
contextualise care into this 99.9% setting, it will be link this to the impacts of personal environmental factors
2) Medium fidelity In the absence of DNA essential to bring this information to life in a and behavioural choices will empower people with greater
sequencing information, care is personalised using meaningful, relevant, timely and tangible way. It is knowledge with which to play a more active role in
best practice knowledge & observational modelling. through the medium of a real-time personalised virtual managing their own health.
health coach that we believe that this can best be
It is assumed that, due to the benefits, genetic brought to life.
sequencing will progressively become a standard part
of a future health & care system. DNA sequencing will This digital health coach capability would need to be
reveal increasing levels of information from which to integrated intimatel into people s lives and pla the
optimise wellbeing and highlight potential future role of provider of trusted and expert personalised
health risks. This will provide the meta narrative for an information support and health advice. It will also
ongoing life long relationship based on optimising and need to act as an agent of the future healthcare
personalising life long health support. system, ensuring that clinical advice and actions are
aligned with overall health planning and guidance
A future system will need to integrate large volumes of from HCPs and the wider system body of knowledge,
data available on the ongoing status of both internal best practice and regulations.
biological and external environmental determinants of
health in order to provide meaningful holistic support The virtual coach would not be embedded in any
to individuals and insight to healthcare professionals. device but be able to communicate and act through
Leaving data fragmented will only perpetuate whatever devices and user interfaces that suit the
fragmented siloed care and fragmented preferences and contexts of each individual (e.g.
understanding for people seeking to manage their natural language speech or visual display). The virtual
overall health and wellbeing. coach would need to be dialled back to be a more
passive intelligent health record or dialled up to
Data will need to be collected and exchanged from provide more active coaching advice and support
a variety of sources, sensors and environments and depending on individual preferences and/or
therefore the creation of a personal data cloud will be circumstances.
key to the creation of a holistic data model of each
person. The creation and integrity of personal data
clouds be an essential foundation for holistic always-on
health support and lifelong health and care support.
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summary
Person-centered
healthhealth
unpacked
Digitalecosystem
New value
creation
creation
A new model of engagement Health as coaching conversations
Although the onset of disease and loss of function Value based health conversations
Health as value alignment throughout each person s lifetime has a strong genetic
In order to successfully engage people in a new model basis it is through external determinants and lifestyle
based on individuals taking more active control of their behaviours that the trajectory of wellbeing and chronic
own health and wellbeing it will be essential to disease is mainly determined. Focusing on the most
understand how people define value. It is only by appropriate health themes and conversations will be
recognising and realising tangible value that people essential to frame the care support dialogue in order
will be motivated to play a greater role in managing to engage and motivate people to action in the areas
their own health and wellbeing. of concern and interest that matter to them.
Ensuring that support is aligned with what people want For these conversations to have personal meaning and
from their health and not driven by internal system relevance to the particular circumstances, values and
considerations will be essential if individuals and the beliefs of each person they need to be contextualised
population at large are to embrace a person-centred to the goals and realities that matter at the time. The
model of health support into their lives. Harvard innovation Professor and guru Clayton
Christenson has identified a powerful jobs to be
Health is not usually viewed as an end in itself but as a done framework that helps capture this d namic.
resource that enables positive or negative wellbeing.
Positive health (or wellbeing) provides the wherewithal People will use a new solution if it helps them get a Figure 14: health conversations need be
for achieving or maintaining a desired quality of life. job done better than the alternatives. B expanded to include maximising quality of life as
Negative health is associated with restricting quality of understanding the jobs that individuals are trying to well as managing with disease or loss of function
life, loss of function and increasing discomfort. get done in their lives and showing them how healthier
alternatives help them to get that job done better Three core components of the vision
HCPs are able to work with the grain b helping
individuals to achieve what is already important them We envisage that a future health system will comprise three
in a way that delivers better and healthier outcomes. core components:
For younger and disease free populations the • A new approach based on person-centred health and
conversations and underlying jobs to be done are wellbeing
likely to be focused on maximising quality of life and • A virtual, digital coach that enables personalised,
avoiding disease. For older populations suffering always-on care to be delivered
chronic disease and loss of function a broader set of
support themes and health conversations will be • And a health and care ecosystem that is integrated and
required. The figure above right captures an overview able to deliver a combination of specialist and coaching-
of major health themes and how the virtual health based care
Figure 13: engaging people in greater ownership coach conversations are likely to evolve throughout
in managing their own health will come from each person s life course: These components are explored on the following pages:
aligning care to deliver the outcomes they value
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Person-centered
healthhealth
unpacked
Digitalecosystem
New value
creation
creation
The three core elements of the vision
1. Personalised Health and Wellbeing 2. AI Mediated Health Coaching 3. Future Health and Care system
• Empowering individuals through conversations • Personal AI powered real time health coaching • An integrated health and care ecosystem designed
based on information, coaching and nudges to function powered by self-learning algorithms around delivery of holistic coaching oriented person-
make informed choices to maximise wellbeing centred health and wellbeing
• Individual biological, behavioural and context- • Real time personalised data cloud enabling a
based data passively collected and shared under dynamic, holistic health and wellbeing data model • Specialists involved in care will use the AI coach as a
permission for remote coaching, data capture and monitoring
• Mediating and optimising care in support of HCPs
• Gaining the earliest detection to the onset of within the future health and care system • Dynamic data rich and AI powered insight will drive
disease and providing personalised holistic support advanced decision support and system optimisation
to manage disease and loss of function
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Vision
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Person-centered
healthhealth
unpacked
Digitalecosystem
New value
creation
creation
How the three core elements fit together
1. Personalised Health and Wellbeing 2. AI Mediated Health Coaching 3. Future Health and Care system
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Vision
Vision
summary
Person-centered
healthhealth unpacked Holistic healthHolistic
unpacked coachinghealth coaching
Digitalecosystem
New value
creation
creation
Person-centred care unpacked exploring the possibilities for new health conversations
Introduction
In this section we unpack what person-centred care
means and how it is experienced by the individual.
At the centre is the individual. Each individual will need
a basic level of biological, behavioural and context-
based information, skills and self-knowledge that
provide the capability, motivation and opportunity to
empower them to manage their own health. This in turn
is determined by the social and environmental
determinants in which they live. Coaching support will
need to include support for managing these
motivational, capability and environmental factors.
The nature of health and care conversations will
differ throughout each person s life course and
also be determined by the health status of the
individual (shown from green to red around the
outside of the graphic).
These will vary from driving wellness behaviour,
through emotional and relationship health to episodic
health, assessing risk markers for chronic disease,
managing long term conditions and, late in life,
managing loss of function and full-time care
and often be a combination of them.
On the following pages we hypothesise what will be
new in each of these stages in comparison with today
and what the impact will be.
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creation
1. Owning my heath creating health • Greater information about lifestyle behaviours and
awareness and empowerment how to maximise wellbeing will provide new
opportunities to connect healthy behaviours, the
Hypothesis overview pursuit of personal goals and personal flourishing
For most people health is something experienced • The ability to understand current health and
and therefore attracts attention and focus only wellbeing trajectories and the future predictive
when it is lost. Bringing greater awareness and consequences of lifestyle choices will empower and
understanding of the underlying biological motivate people to set realistic goals using new
processes and their connection to feelings of tangible information with which to make trade offs
positive or negative wellbeing will help people to between current choices and their future self
better understand their own bodies. By making the
impact of lifestyle factors tangible, visible and • Greater consciousness about health and healthy
understandable it will help individuals and society living will inspire new health norms in families,
at large develop a greater consciousness, social groups and wider communities
motivation and resources to make health and
wellbeing a greater priority in their lives.
Impact and outcome
What s new • Citizens with greater literacy, understanding and a
more intimate relationship with their bodies and the
• The personal genome will provide knowledge of life choices that impact personal health and
wellbeing
probability of disease and personal factors
impacting wellness and will provide a personal • More citizens empowered with the information,
script from which to set expectations and capabilities and motivation to improve their health
navigate choices on life journey and wellbeing throughout their lives
Figure 15: increased access to personalized real-time
• Personalised information and coaching support • Greater levels of wellbeing and lower levels of information and knowledge about their personal health and
avoidable disease and poor health wellbeing status and how to improve it will mean that
will help create greater knowledge and
awareness of how health and wellbeing can be individuals have the resources, motivation, opportunities
made part of everyday life and, increasingly, capabilities to play an active role in their
own health
• Greater information about one s own ongoing
biological functioning will help connect
experience with greater understanding and
connection to one s embodied self
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2. Maximising social and environmental • Signposting and matching of local resources, social
health networks and community activities that can improve
social connectedness, personal development and
Hypothesis overview wellbeing
• Capture of data associated with engagement with
Social, economic and environmental determinants have available local resources will help prioritise and
a profound impact on wellness and physical/ mental tailor the development of more effective and
health outcomes. Although observed at a population targeted place-based strategies for
level, these are less well understood and able to be neighbourhood, community and urban development.
supported at the individual level.
• Ability to capture data on quality of life
There is a complex web of causal relationships experiences and model their causal relationships
between the factors that lead to poor health outcomes. with health and wellbeing (e.g. work, finances,
Access to resources required for healthy living such as skills, training and engagement with social/
economic security, education, employment, housing community resources)
quality, nutritious food, safe places to exercise, social
and community networks, etc., represent a complex Impact and outcome
landscape where people often need support in • Increased ability to mitigate against or avoid the
navigation and choice-making. The ability to track and impact of toxic or allergic environments on health
model these will bring profound insights to assist in and wellbeing
delivering tailored personal life management advice
and inform more targeted interventional support and • Reduction in negative impacts of social and
enlightened social and regulatory policy. environmental determinants on health and
wellbeing through greater access and use of
What s new community based resources
• Genome sequencing will enable early identification
of potential social, behavioural or learning Figure 16: increased information and access to social and
difficulties that will enable preventative or tailored environmental resources will help empower individuals to
support to be provided to minimise conditions that manage their circumstances, embrace opportunities for self
lead to poorer health outcomes
development, avoid risks and improve the quality of their
• Ability to identify likely sensitivities to pollutants personal and family health and wellbeing
and allergies
• Ability to identify physical and mental skills/
constraints to assist in training and employment
• Continuous measurement of environmental
conditions will enable compensatory/ protective
action to be taken as required e.g. pollution with
asthma or COPD sufferers
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creation
3. Maximise wellbeing health behaviours • Passive tracking of bio markers will reveal
physiological impacts of health behaviours
Hypothesis overview
• Sharing of wellbeing data with doctors (and
Wellbeing is not just absence of disease but also others) at discretion of individual
represents a state of being that has the potential to
enhance individual quality of life through increased • 24/7 coaching support for setting goals, tracking,
vitality and self esteem. Many unhealthy consumption managing progress, behavioural nudges
behaviours are deeply embedded in individual and
family habits and routines or experienced as pleasures • Use of gamification, rewards, incentives using 3rd
or rewards to the self. Addictive substances create parties who wish to participate in offering services
additional psychological and chemical barriers to to support healthy living
change. Changing habits often take effort and will
power to initiate and sustain. • Technology making it easier to effortlessly make
Knowledge of individual factors that drive enhanced wise health choices through behavioural nudges
wellness will create new incentives and added
motivation to pursue targeted wellness behaviours. • Greater social engagement and conversations
Determining personal goals, creating motivation, around wellbeing leading to new social norms
advising on alternative choices, helping set goals,
supporting realisation of new behaviours, managing Impact and outcome
triggers and building self-confidence and belief will • Greater awareness and interest in making wellness
all help to enlighten and empower individuals to a greater part of everyday life and long term
improve their wellbeing. lifestyle choice
What s new • Greater understanding of the causal relationships
between the factors that lead to poor health
• Genetically determined wellness and health behaviours and the strategies most likely to unlock
behaviour advice can be deeply personalised for behaviour change Figure 17: increased information and awareness of how
maximum impact health behaviours, habits and choices are affecting day to
• Lower effort for individuals to make wise health
choices day experiences of wellbeing and the ability to achieve
• Identification of specific opportunities to achieve
personal goals offer opportunities for coaching support and
enhanced wellness (energ , vitalit , fitness, • Greater levels of overall wellness and reducing
weight management, good skin, hair, enhanced self improvement
levels of ill health, LTCs and avoidable system
mental functioning etc) demand
• Passive means of tracking multiple behaviours e.g. • Increased population wellbeing leading to greater
exercise, nutrition, sleep, addictions linked to AI productivity and social capital
for personalised learning
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New value
creation
creation
4. Maximising emotional and relationship • 24/7 expert support for relationship help and
health counselling advice
• Identification and management of triggers
Hypothesis overview
• On demand relaxation and mindfulness support
The pressures, expectations, complexities and pace of
modern life are increasing levels of stress and, by • Social network matching and connection to
extension, levels of anxiety and depression across all community support and/ or shared interest groups
sections of society. Low self esteem, social media, for support, increased social connection and
increased loneliness and social expectations of reduced loneliness
achievement are leading to growing difficulties in
building deep and sustaining personal and social Impact and outcome
relationships. • Improved resilience, emotional wellbeing and
Mental health problems arising in childhood and relational health
adolescence are particularly important to address as • Better mood and more active functioning across all
they often lead to lifelong mental health problems. other areas of life and relationships
Growing levels of poor emotional health have knock
on impacts on family, social relationships and capacity • Lower levels of loneliness and social isolation
to function and work effectively. • Better self management of physical health
The ability to detect mood changes and the associated • Increased productivity and reduced absenteeism
triggers and contexts will enable patterns to be at work
identified so that targeted support and avoidance
strategies to be offered.
What s new
• Knowledge of propensity for vulnerabilities in
mental health driven by genetic or contextual Figure 18: increased awareness of patterns, contexts and
profile will help focus targeted support for triggers of mood changes combined with expert always on
particular genetic or situational vulnerabilities or support and access to community networks will help
predispositions improve resilience and emotional wellbeing
• Potential for continuous mood monitoring mapped
to context and behaviour patterns
• 24/7 measurement of bio markers to determine
physiological impacts of mood patterns
• 24/7 support to identify emerging issues and offer
tailored coaching support
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New value
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creation
5. Gaining support for episodic health • A continuous 24/7 expert medical support service
issues that can triage health-related queries with the
majority of routine queries being dealt with directly
Hypothesis overview using AI generated medical advice and routine
prescription ordering and delivery
Many people have health related questions or issues • Triaged access to medical specialist support for
to which they wish to obtain an answer. Without remote consultations, arranging face to face
medical expertise it is not always clear what the appointments or urgent care escalations where
significance or risk of an unusual or unfamiliar medical required
symptom is. Without immediate access to a trusted
resource many respond in a sub optimal way (e.g. they • Ongoing monitoring and management of any
will either ignore it, search for online advice (often of episodic condition plus treatment/ medication
variable quality) or turn to emergency services such intervention
as an A&E visit).
Impact and outcome
Medical professionals and the wider healthcare system • Greater use of an expert medical first-line
are overwhelmed with growing levels of demand for resource for the majority of routine episodic health
routine and non-urgent symptoms and issues that do issues that both improves access and quality and
not need professional medical help. A constantly reduces demand for routine queries
available trusted health triage solution is required.
• Automation of routine prescriptions and monitoring
Combining access to the latest medical knowledge with of treatments and issue resolution
real time health data will enable a significant majority • Greater trust of AI digital doctors leading to more
of health related queries or episodic health issues to effective and efficient resolution of minor health
be triaged by the digital health coach. In circumstances conditions
where specialist or urgent medical support is required
the digital health coach can access the necessary
expert support while sharing relevant information and Figure 19: ongoing monitoring of health status and the
data as appropriate to enable warm hand over. availability of always-on health expertise will enable most
health related queries can be addressed as they arise with
What s new triaging to care specialists when required
• Genetic sequencing will provide knowledge of
health vulnerabilities that enable tailored
diagnostics and treatments to be identified and
made readily available in case of episodic
incidents
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Digitalecosystem
New value
creation
creation
6. Minimising risk and early detection of • Continuous measurement, analysis and evaluation
disease of physiological and psychological risk factors e.g.
behavioural and emotional issues, SPO2, BMI,
Hypothesis overview blood pressure, cholesterol etc
• Continuous measurement of biological risk factors
Risk factors are often not identified or acted upon associated with pre or early stage disease onset
early enough leading to onset of disease or more e.g. Diabetes, CVD, dementia, cancer etc
serious health problems before action is taken. New
techniques and understanding of healthy functioning • Regular measurement of molecules associated with
and the biomarkers of early stage disease-perturbed healthy functioning and disease perturbed organs,
networks will enable early pre-symptomatic indications tissues, biological processes and mental health
of risk and early stage onset of disease. More people functioning
will be willing to agree to embedded sensors to
protect against the onset of disease. Impact and outcome
• Early stage diagnosis of disease-perturbed or
The complex causal relationships between environment, malfunctioning biological organs/ systems
behaviours and onset of disease is still poorly
understood; the capture of more holistic data sets will • Ability to intercept early stage disease and treat/
enable greater understanding of the role these factors return to healthy functioning
play, leading to powerful new predictive models at • Ability to intercept and change harmful health
both individual and population levels. behaviours at a much earlier stage to prevent
disease onset
What s new
• Reduction in the incidence and improvement in the
• Genome sequencing will highlight key disease risk trajectory of LTCs across the population
areas to focus on
• Ability to identify key health risks and disease
propensities that can be checked regularly Figure 20: Ongoing monitoring of biomarkers, physiological
status and health behaviours will enable detection of early
• People will be willing to have biosensors fitted in
exchange for the early detection of disease stage disease, complications or risky behaviours that will
particularly for those with an existing genetic risk enable early stage interventions and coaching support to
at risk of further deterioration from an existing prevent/ delay the onset of more serious disease
condition
• Ability to diagnose early stage signs of disease
onset or emerging problems prior to manifesting as
physical symptoms
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Person-centered
Digitalecosystem
New value
creation
creation
7. Managing chronic disease • Knowledge of drug/ treatment sensitivity to
identify optimal personalised medication and
Hypothesis overview treatment plan
• Identify the optimum behavioural change plan to
LTCs represent the greatest cost and burden both to slow/ reverse disease progression
the health s stem and to the qualit of individuals
lives. They tend to get progressively worse leading to • Continuous measurement of biological markers and
co-morbidities and further LTCs. Success in gaining lifestyle behaviours related to tracking and
active ownership of managing lifestyle behaviour managing the LTC
change and adherence to treatment plans has • A continuous 24/7 expert health coach providing
remained stubbornly poor. LTC patients need to make ongoing support for all aspects of an integrated
radical changes to their life to accommodate their care plan e.g. treatment regimens, lifestyle change
LTC(s) and are often ill equipped with the information and motivational support
or support to manage; and many end up in depression.
• Personalised behavioural change coaching support
LTC patients spend over 99.9% of their time away including goal setting, planning, notifying, nudging,
from their HCP, so support for self-management will tracking and gamified rewards and incentives
be crucial to success. This is where the digital health
• Expert always-on help, advice and support for
coach will be able to play a pivotal role. Patients are
questions, concerns and emergencies with triaging
often left with insufficient information to fully
and access to specialist support as required
understand their condition or treatment and fully
activate their personal support networks. • Access to support networks for disease and lifestyle
management advice, tips and peer support
The collection of data on personal goals, disease
status, context, medication efficacy, lifestyle Impact and outcome
behaviours and access to expert patient networks will
enable the digital health coach to play an invaluable • Greater patient involvement in decision making and
role in personalising holistic support to assist people to treatment ownership
Figure 21: monitoring and managing the status of LTCs, the
retain the maximum quality of life while managing with • Greater levels of activation and levels of effective provision of medication assistance and coaching support for
one or more chronic diseases. self management of LTCs behavior changes and lifestyle adjustments will assist
What s new • Reduced trajectory of disease progression, better people in managing with a disease thereby slowing/
quality of life and reduced system costs delaying disease progression.
• Genetic knowledge of individual trajectory of
disease and likely co-morbidities
• Knowledge of life goals and personal preferences
that can inform shared decision making for
agreeing preferred treatments and care
preferences
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New value
creation
creation
8. Obtaining assisted / full-time care • Social connection capabilities facilitate connection
support with family, friends, community resources/ events
and wider social networking connectivity based on
Hypothesis overview shared interests
• Access to information, advice and support for
Older people tend to have more LTCs and co- queries or connection to specialist support when
morbidities. As aging progresses, people increasingly required
require greater social support as frailty increases,
limiting their ability to look after themselves. Isolation Impact and outcome
and loneliness is an increasing problem for older
people, leading to greater depression and • Greater self-management and ability to stay
acceleration of ill-health and frailty. Older people independent for longer
generally prefer to stay independent and at home as • Better health trajectories and quality of life
long as possible.
• Better ongoing quality of life including greater
Through the use of sensors, robotics and intelligent connection with family, friends, carers and
support services the digital health coach will be able healthcare specialists
to extend beyond medical support to include • Lower cost to serve due to healthier outcomes and
monitoring and provision of personalised support to minimising demand for residential care
assist with daily routines and activities that maintain
quality of life. This will augment face-to-face care to
include monitoring and support for safety, security and
the identification of incidents or triggers for additional
medical or social care interventions.
What s new
• Genetic sequencing will provide knowledge of Figure 22: Extending monitoring and assistance to include
likely end-of-life trajectory for health and future support for activities of daily living and greater social
frailty support needs
engagement will reduce loneliness, improve quality of life
• Continuous monitoring of bio markers, health and help to maintain independent living for as long as
behaviours and self-care patterns will enable possible
personalised coaching support and provision of
information to carers
• Care robots will be able to provide a range of
routine chores and activities of daily living. These
will include supporting self-care, including
medication management, retrieving requested
items, providing security, meals, entertainment and
communications
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Person-centered
healthhealth
unpacked
unpacked Holistic health
Holistic
coaching New health ecosystem New health
health coaching Digitalecosystem
New value
creation
creation
Holistic Health Coaching
Introduction For people to relate to and create an ongoing Virtual coaches how will they work?
relationship of trust, the virtual health coach will need
At the heart of the vision of a person-centred to appear and communicate in a form that people can As we have seen, the data required to provide a holistic
healthcare future is the personal health data cloud. identify with. It will therefore need to take the form of picture of individual health will go way beyond the
This will integrate all health-related data from a an identifiable avatar or personality. The creation of a information held in a traditional health record. It will
range of sensors, apps, devices and other sources virtual health coach will be powered by advanced self- hold genomic data and health history but will also be able
which an AI-powered virtual health coach will then learning AI using access to real time health data. to include data from a wide variety of sensors, devices
use to turn into meaningful insight and health advice. and environments, many of which will be providing data
The advice provided by the virtual health coach will be in real time.
At its most simple the coach will fade into the informed by learning the individual biological,
background providing a passive yet comprehensive behavioural and context-related patterns and blend This data needs to be linked at the level of individual to
real-time health status that can be viewed or shared this with the latest clinical advice. This advice will need form a whole picture of the individual and held in the form
at any time. In its complete form it will act as a to be blended into ongoing health conversations of a personal health data cloud. This personal data cloud
continual companion and expert offering a full range delivered and negotiated in ways that are relatable will form the foundation for a model of person-centred
of support and coaching advice on maximising health and sensitive to the goals, preferences, contexts and health through the ability to consolidate all the fragments
and wellbeing. personality type of each person. of the health and wellbeing landscape into one
consolidated picture.
The coach will be an ever present feature of people s The virtual coach will be a radical new addition to the
lives acting as a form of digital guardian angel . It 21st Century healthcare landscape so what exactly is There will be potentially large volumes of data with real
will work passively in the background to identify and this coach, what will be the role of the coach and why time streaming, making storage and transmission key
predict any potential threats or risks to health as well will people accept the presence of this in their lives? considerations. The data will need to use new taxonomies,
as being a trusted source of personalised support for reflecting the growing data types, that enable classification
maximising wellbeing, avoiding health problems and In this section we describe: of this data and the construction of a personal data model
managing with disease or loss of function. or digital double .
• how digital coaches will work
The personal health data cloud and health coach will Driven by advanced AI, the coach will use virtual assistant
have a secondary function: to act as a broker that • how to ensure they gain acceptance techniques and deep learning to extract meaning to engage
provides both the person s window into the future in a two-way coaching dialogue. The coach will not be
health and care system and the integrated view of • their role in people s lives constrained to any particular device but will be able to be
each person s health status for all healthcare s stem summoned or engaged with through whatever device and
actors involved in care delivery. • how they will support HCPs user interface is most relevant to the person or the particular
context or place in which an engagement occurs.
It will be able to fulfil this agent of the healthcare • key issues around data ownership and permissions
s stem role b giving a unified and up to date model
of a person s current health and wellbeing status. This • the value and potential uses of the data they collect
will enable HCPs with a means to monitor progress &
modify ongoing future planning and care support.
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Visionsummary
Person-centered
healthhealth
unpacked
Holistic
New value
creation
creation
The virtual coach will be able to use natural language It is widely expected that concern about use of data
to engage in spoken conversation or visually using a and the motives behind providers of digital services
full range of techniques such as use of device screens will only increase in the coming years as more of life
and augmented reality. In time, the coach will also be becomes digital and awareness grows as to the uses
able to appear in other mediums if appropriate such to which their data can be put. The existential nature
as holographic avatars, embodied in robots or of confronting one s own health, sickness and ageing
through inviting people to enter virtual reality worlds. means that acceptance of any new presence as a
trusted resource will need to address certain
The virtual coach will also possess network fundamental concerns.
intelligence enabling it to control sensors, intelligent
devices and appliances to monitor/control relevant It will be essential for widescale adoption that the
events, influence behavioural patterns and observe virtual health coach is seen to act in the best interests
moods and contexts. The virtual coach will be able to of the person and not as a cover for a paternalistic
monitor and where appropriate (and subject to healthcare s stem to reach deeper into people s lives
permissions) control the assemblage of devices, to exert control and value judgements on every day
sensors and environments that make up the internal choices and behaviours.
and external health and wellbeing environment.
Framing health and wellbeing support in the context of
Virtual coaches how to gain acceptance? people s personal life goals and ambitions will be ke
to this. The relationship will need to be framed in the
For all the potential that virtual health coaches might context of helping people with health and wellbeing
have in theory gaining acceptance will be key to support to maximise the quality of life they aspire to
realising the benefits they could bring. By 2030 and protect them from avoidable disease and
virtual assistants will be common as the leading tech suffering. The metaphor of the guardian angel
companies move beyond the current fragmented captures the centre of gravity for the foundational
single purpose app world of today to deliver greater role of the virtual health coach.
value through more sophisticated multi-function AI.
The virtual health coach will need to nurture and
A virtual health coach by definition will occupy a much cultivate a trusted relationship that is sensitive to the
more intimate position in people s lives. Access to context and needs of each person. As well as framing
deeply personal genomic, biological and behavioural and supporting the pursuit of higher level goals that
data will give the coach access to the most intimate will change throughout different life stages the virtual
details of people s lives make the virtual health coach health coach will need to learn and support the daily
occupy the most intimate of all virtual assistants. routines of life where most health behaviours occur.
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What will be the role of the coach? Range of issues that virtual coach support By adopting a more conversational and personal coaching
style, the virtual health coach will be able to not only
will vary depending on health status provide reactive advice but also proactively anticipate or
People will have different needs for support
depending where they are in their life journey and suggest alternative choices and options that help to
the degree to which disease is present in their lives. enlighten and guide people to healthier or more beneficial
The role of the coach will therefore depend on health outcomes. This will include an increasingly broad scope of
status and the range of issues with which they diet, exercise, emotional and physical health as well as
need support. advice around social and environmental factors.
Example 1: Young
This will likely change over time to reflect the As an expert coach, the deep learning intelligence will be
person with no able to take behavioural change and coaching best practice
changing nature and health priorities over the
course of a lifetime. disease techniques and modify them further as it learns what works
and what doesn t in each individual circumstance. This will
For younger people, this will be more focused around include a full range of techniques including determining
maximising quality of life and avoiding disease. higher level life and health goals, beliefs, framing
For those in middle age who are suffering with chronic challenges, setting plans based on laddered goals,
disease the support will extend to managing disease monitoring progress, avoiding and managing triggers,
and maintaining quality of life. For older people who providing intrinsic motivation and rewards, embedding
are suffering from chronic disease and loss of function, self-belief and self-control as well as sustaining
support will transition to include retaining quality of long-term change.
life and independence while obtaining support for any
chronic health problems and mitigating loss of function. Example 2: Middle The virtual coach will also recognise and harness the
age person with opportunities provided by social and community support.
People will have different personal and cultural This will range from engaging with significant others, the
LTC family and carers to signposting and facilitating
preferences when it comes to the levels of support that
they will want from the health coach. At one extreme engagement with relevant community resources or patient
the health coach can remain in the background acting groups that enable and facilitate greater social and
as a guardian angel by passively monitoring community health.
biological health to provide early indications of onset
of disease and provide valuable health data to Given the diversity of health issues, age ranges, cultural and
support ongoing HCP relationships social factors and personal character preferences it will be
important that the virtual health coach is capable of
At the opposite extreme it will need to provide more reflecting the persona, coaching style and preferences that
comprehensive and active coaching and support for Example 3: Older best suit each person.
people who seek or need this more intense level of person needing
informational, psychological and physical coaching
support. care
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Virtual Coach as supporting agent of HCPs The coach will use this input to attempt to fully engage the
This means that the virtual health coach may have a person in actively taking ownership and carrying through
number of different faces reflecting different The coach s secondar role will be that of agent of the the necessary medication, treatment or lifestyle changes
types of health issue being supported e.g. coaching HCPs the wider healthcare system. As a continual needed to enable rehabilitation or manage disease most
for fitness and diet may be quite different from presence in the daily lives of each person, the virtual effectively.
coaching for managing cancer treatment or coach will play an important role as an extension of the
managing depression. future healthcare system. In this capacity, it will be able The coach will also act a point of information and
to take expert advice and decisions on care planning communication enabling the brokering of information
Within this there will be different preferences based and incorporate these into the coaching relationship. requests, remote consultations and scheduling face-to-face
on other variables across the population such as appointments when required.
coaching style, sex, age, ethnicity, education, The personal data cloud will go way beyond current
personality type, etc. It is likely therefore that the conceptions of EHRs to hold all current and historical
virtual health coach will represent itself through a health related data relating to the individual, and will
number of different speciality coaches all working in be structured in the form of a data double a
tandem from the same personal data cloud. simulated model of the systems biology for each
individual. This will enable (subject to permissions) HCPs
to view part or all of this data double to assess current
status, historical trends and run forward prediction
models to explore likely outcomes based on various
courses of action or intervention scenarios.
The ability for HCPs to have a view into the personal
data cloud will enable remote monitoring and
management of clinical or support issues without the
need to bring people to clinical locations.
Remote access for HCPs will enable monitoring of
health and care status based with notification triggers
and flags for incidents or trends that warrant clinical
care decisions or interventions.
Care planning can be coordinated, planned and
monitored in partnership with both the individual
and other actors through having a single shared view
of each person s status and progress. The virtual coach
will then act as the agent who will translate this into
the ongoing support relationship.
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Data, ownership and permissions This model of distributed intelligence means that data
that forms the personal data cloud doesn t need to be
In this person-centred vision, data is absolutely central physically stored in a single place and can exist in a
to functioning of a future system and therefore the federated model linked through a common
collection, storage, security, analysis, sharing and identification model.
ownership of data play a crucial role in underpinning
a future healthcare system.
The explosion of data envisaged and its highly
The types and forms of structured and unstructured personal nature make issues of data management and
data and the range of devices and sensors that will ownership even more pressing. The trends as
collect this are such that new standards and expressed through emerging debate and regulations
taxonomies will be required to enable the such as GDPR suggest that the default position will be
interoperability, identification, exchange and storage that people will own their own data; and organisations
of this data. This will be especially important for the that serve them are granted access by individual
creation of a data double which reflects the s stems permission. Once in receipt of this data, healthcare
biology model of the individual and is able to be providers will have a responsibility for custodianship
stored in a personal data cloud.
of this data ensuring that it is not shared with any
The miniaturisation and increasing power of technology other 3rd party entity.
will mean that data will be streaming from many
different parts of the personal health landscape. Some The nature of the biological, behavioural and
parts of this landscape will be collecting data only contextual data held in the personal data cloud is such
(e.g. blood biomarker sensors) while others will be that security will be pivotal to encourage and sustain
involved in two-way control (e.g. artificial pancreas trust in the system. Strong cryptography and identity
control). Separate algorithms and intelligent routines management will be required alongside distributed
will be required to manage these component parts of ledger technology (e.g. blockchain) in order to
the total health system, but they will need to be
validate and police authorised access and use of
coordinated into the wider person-centred health Figure 23: in most cases the digital health coach will be
management system. data by 3rd parties.
passively collecting data, for use cases involving
measurement and control, AI will use data for the 2-way
The complex need to manage and coordinate multiple It is likely that each person will enable access to base
control of medical and care support devices
interrelated pieces of the health jigsaw mean that AI level medical data (and data double) to authorised
will need to both drive the overall personal health HCPs to enable the provision of medical support in the
coach relationship and manage and coordinate event of emergencies. The data double will be able to
multiple nested health goals e.g. managing anxiety as support clinical queries without the need to share
well as ensuring timely taking of medicines. source level data. All non essential data will be shared
upon the granting of permission of each individual on
the mutual understanding and agreement as to the use
the data will be put to.
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Value and uses of data • Commercial interests all or partial access may
be granted to commercial organisations interested
The data held within the personal data cloud will be of in developing or targeting services or advertising
value to many other potential interested parties to people. This could be for services directly
beyond HCPs directly involved in care. This data relevant to personal health and wellbeing e.g.
should be shareable in identifiable or anonymised personalised nutrition, exercise and personal
forms. Examples include as follows: grooming or to organisations such as consumer
brands and technology companies looking to trade
• Carers/ family all or partial access may be services for exchange of data.
granted to others trusted by people to participate
more directly in their care It is highly likely that support will need to be provided
by the health coach to help people make these choices,
• Health research partial access to health data understand the consequences, manage permissions,
may be granted to health researchers and the validate authorised use and monetise their data
wider healthcare system in order to conduct where applicable.
specific research projects relevant to an
individual s health profile or for wider population
health studies
• Drug and device trials people with specific
health profiles may be invited to partake in trials
of new treatments or review of existing treatments.
The rich holistic data sets held within personal data
clouds will provide access to extremely rich and
valuable data sets that will support more holistic
understanding of the direct and indirect impacts
and causal processes impacting treatment efficacy
and impact
• Government and social research partial access
to health data may be granted to social
researchers and the wider public health system in
order to conduct specific research projects relevant
to an individual s social and environmental factors
as they relate to health and social outcomes
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health coaching Digital
New health ecosystemNew health self learning system New value
ecosystem New value
creation
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New Health Ecosystem
Introduction Person-centred holistic provision of care The clinical relationship will need to change to one that is
much more coaching and collaboration-based. Active
What will a future healthcare system capable of At the heart of a personalised medicine future will be involvement of individuals in joint health planning,
supporting the 21st Century person-centred model of a detailed personal data model enriched where behavioural change and treatment choices will be key to
care described in this vision look like? If we are to possible with the sequenced genome for each person. gaining commitment and consent for the use of sensors and
move from a reactive, siloed, episodic and acute Creating incentives and for people to agree to have more comprehensive personal data. The availability of
focused system to one that is optimised and organised their genome sequenced will be key. This is likely to be ongoing data streams interpreted through algorithms and
around a preventative, holistic, person-centred and most achievable during pregnancy when checking for AI will automate many standard assessment functions
always-on coaching model of care then certain genetic diseases, offering the chance for gene editing enabling more time to focus on higher value collaborative
structural principles will need to be put in place therapy to be offered if necessary. For the rest of the coaching relationships.
to support this. population, the potential for personalised wellness
and more effective personalised treatments offer The episodic clinical relationship will also change to support
As we have seen, a future system will need to support additional incentives to make genome sequencing an always-on connected model. Ongoing monitoring of
a transformation to a personalised medicine model a foundational part of the personal data model health, behaviours and treatment will be done passively
underpinned by a vastly greater use of digital for each person. with key events triggering interventions as and when
technology and quantity of real time data. Deep required. This will sit alongside and inform the virtual coach
personalisation of healthcare will also bring deeper The personal data model will act as both a current which will be managing the primary daily relationship with
collaboration and integration between all parts of a status but also predictive model from which all HCPs each individual.
future healthcare system as well as the individuals and can assess, collaborate and plan ongoing care
populations they will serve. Furthermore, a future strategies. This will also enhance decision support tools Supporting carers
healthcare system will need to align itself and invest in to enable each HCP to understand the overall life For each individual there is likely to be one or more others
a longer term preventative agenda recognising that impact and health implications when providing acting as a carer for that person. This will either be a family
the returns from investing in overall population health specialist support. HCPs in this future system will rely member, friend or other professional or volunteer.
will often be realised over much longer timeframes. much less on physical examination and much more on The ability to support the carer with the relevant
assessing and analysing data and dashboards of information and support for them to carry out their
In this section, we describe: ongoing health status and key trends. motivational, companionship, observational and care
support roles will be important both from the perspective
• The changing clinical relationship required to The availability of data through sensors of via liquid of empowering the carer to carry out their role most
provide holistic, person-centred care biopsies revealing biomarkers and/ or pathogens, effectively but also to support the carer in maintaining their
cancer cell DNA, etc. will provide much more complex own health and wellbeing in what is often demanding
• High level principles for a future healthcare diagnostic assessments and more complex circumstances both physically and emotionally. The digital
system structure combinations of personalised molecular treatments health coach will need to share the relevant information
(and where appropriate germline or somatic gene on a permission basis with the carers and other family
• Incentives and required capabilities for the editing therapies). Decision support (supported by AI) members to facilitate these important support networks.
new system for identifying, providing and monitoring the impacts
of more complex therapies will be essential.
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Future healthcare system structure
From institutional to systems base care
Toda s primar , secondar and specialist institutions of
healthcare were born from a 19th century conception of
healthcare. This resulted in legacy structures that have more
in common with an industrial model of thinking based on
optimising a factor production line. In this model patients
are moved around institutional settings to receive care from
the relevant clinical specialists based on the latest symptoms
or conditions being presented.
These institutions are then given arbitrary annual transaction-
based targets within which to manage the efficient use of
their resources. This approach has encouraged care deliver
as a factor process . This has paradoxicall made things
worse by making it more difficult to achieve a person-centred
approach leading to fragmented care, patient confusion
leading to worse health outcomes and lower staff morale
due to a target-driven culture that promotes achieving
the numbers ahead of holistic quality of care and
patient experience.
In contrast, a future holistic person-centred care system that is
focused on maximising individual and population health will
need to function as an integrated system able to think, act
and allocate resources in a holistic manner. For this to occur
there will need to a holistic approach to care support both
within any new institutional care settings as well as across all
actors operating in the holistic care system. This will also
involve the transition of care support to settings that are
best placed to deliver person centred health outcomes in
the most economical way.
Targets and leadership need to be reconstituted to
encourage collaborative holistic care and align with these
goals. This will need a fundamental cultural change away
from HCPs as individual craftspeople following ever stricter Figure 24: Over time, precision-based diagnosis and treatment and falling cost and size of equipment will
rules to ones able to operate as team players using care- lead to an increasing number of procedures migrating from expensive specialist facilities to community
oriented principles and able to thrive through being curious based poly-clinic settings and ultimately to the digital coach supported individual
collaborative, compassionate, consensual and creative.
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The care setting migrates from hospitals towards the Community based care centres/ polyclinics Technology will augment support by facilitating continuous
person The majority of care for chronic disease management contact with health coaching teams to shared information,
As the origin and nature of disease is better and common or routine conditions requiring clinical arranging face-to-face support and facilitating remote
understood, more precise methods for diagnosis will be support and intervention will be done at community consultations where appropriate to improve convenience
created. Combining this knowledge with miniaturisation level. This will be expanded to include a full range of and minimise unnecessary travel. The ability to draw on an
and more sophisticated machine learning algorithms preventative wellbeing and social care services. This increasing pool of real-time individual and population
will make it possible for standardised medical will either be done in a localised polyclinic health knowledge means that care and decision support will
procedures to move out of high cost specialty facilities environment offering a full range of diagnostic, become increasingly sophisticated and help minimise
such as hospitals to community care locations. treatment and health and wellbeing services or will be unwarranted variations in care delivery.
provided by mobile community-based holistic health
As sensors in, on and around the body proliferate so and life-coaching resources. By embedding these centres in the community it will also be
the possibility for real-time monitoring, diagnostics and possible to broker and facilitate access to local community
care support for early-stage disease detection and In place of a reactive model of healthcare provision, resources and facilities to provide people with additional
chronic disease management will ultimately move to each individual will be supported with a personal levels of practical and social support for the health and
the end-person themselves supported by the digital health and wellbeing plan, co-created with them to wellbeing related challenges most relevant to them. This is
health coach (see figure 24 on previous page). reflect their goals, beliefs, values, priorities, likely to include both access to public, private, 3rd sector
circumstances and contexts. This will form the basis of and local community resources, projects and groups. An
Hospitals and Specialist care centres their health coach support priorities enabling the right expansion of social prescribing will enable man of these
Hospitals are both expensive to run and inconvenient level, intensity and focus of support to be developed. non-medical interventions to offer tangible and real
for most people to attend. As more of healthcare is alternatives to traditional biochemical modes of treatment.
codified and managed through technology-supported The polyclinic will house a multi disciplinary team
processes, diagnosis for common conditions and chronic comprising of a range of expertise such as health End of life care centres
disease care will increasingly transfer to community coaches, dieticians, physiotherapists, GPs, community When due to disease or loss of function it becomes
settings. Hospitals (or specialist facilities) will therefore specialists, mental health experts and social care impossible to sustain independent living it will be necessary
retain specialised skills and facilities to deal with specialists. These teams will work in collaboration to to support people in their end of life stage in care centres.
inpatient procedures and assume ownership of severe ensure support and resources are aligned to the In a next generation care centre it will be important to also
or complex cases requiring specialist interventions. ongoing individual needs of each person in their care. take a holistic person centred approach to residential care
support in order maintain dignity, maximise quality of life
For more complex conditions with multiple co- People for whom their conditions or age result in loss and ensure that people can die well with minimum of
morbidities, a multi disciplinary solution approach will of function will be supported by community based unnecessary suffering or emotional distress.
be needed. This holistic solution shop approach will social care teams. These will be able to configure care
require care to be holistically managed and support to maximise sustainable independent living. Smart sensors and holistic data capture will enable not only
coordinated across teams of functional specialists to holistic health to be monitored and acted upon but also
give integrated person-centred care. Patients The ability to remotely monitor and support people in activities of daily living and wellbeing to be monitored and
requiring ongoing support from specialist teams will be conjunction with the digital health coach will enable the supported in pursuit of these goals. The digital health coach
managed remotely with warm handover to community- maintenance of a continuous 360 degree view of will be augmented with additional care centre data and the
based teams minimising the need for unnecessary individual health progress. This will enable information shared with multi-disciplinary health, wellbeing
travel to appointments. Ongoing monitoring of health comprehensive risk assessment to occur across and care support teams working in the care centre and with
status will be visible to all care team members with populations which in turn will enable resources to be remote health and care specialists.
trigger events and notifications requiring action targeted on either preventative interventions or
directed to the appropriate lead specialist. recovery for those most struggling to manage.
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Using population level data to coordinate wider Population health modelling will also provide rich Required incentives and capabilities of the
ecosystem insights into causal links and correlations between future system
In order to maximise population health outcomes it social and environmental determinants and disease
will be necessary to coordinate and where possible for different social and ethnic groups enabling more A future healthcare system will need to be incentivised to
integrate the advice, actions and support of a wider enlightened and precisely targeted local and national maximise population health through an increased focus on
group of ecosystem players. Shared data, investment policies to support the improvement of prevention. This will mean removing perverse incentives that
understanding and alignment of goals will be key health and wellbeing. encourage resources and priorities to be pulled away from
to enable this life blood of understanding, maximising individual and population health priorities.
collaboration and shared learning to flow between Relationships with academia and the R&D It will also mean that investment in resources and initiatives
all players in the system. departments of supporting Life Science industries will are considered over longer time periods to reflect the
be key to supporting the whole system acceleration of longer term impacts and savings that come from investing
Population health-level management of local and health and wellbeing knowledge. Rich anonymised in prevention.
regional populations will be supported by holistic data real time data sets will provide a world-leading
from regional and national health and wellbeing data resource for UK academia and Life Sciences industry Innovation and continuous improvement will be a feature of
clouds. These will hold population data enabling rich partners from which to understand more of the a future technology-enabled healthcare system. It will
modelling of disease and wellbeing profiles providing genomic and systems biology landscape as well as therefore be important to create the capabilities, culture and
detailed risk stratification and resource planning. identify and accelerating the development of new climate to encourage and incentivise innovation and diffusion
interventions, treatments, medications and devices. The both within the healthcare system and through encouraging
ability to monitor ongoing effectiveness, external innovation and partners to bring in their innovations
contraindications and impact of behavioural, social to support growth and improvement of the system.
and environmental determinants will provided added
richness to ongoing medicines optimisation. Data, analytics, AI and data visualisation will all be central
foundations and need to be core competences of a
The availability of comprehensive health & wellbeing future healthcare system. The building of a centre of
data also enables anonymised data and population excellence for digital medicine or DARPA for health will be
health insights to be shared with other healthcare key to the future healthcare system being able to
ecosystem players to help target resources and proactively embrace or design the future technologies it
coordinate wider strategies more effectively. This will needs rather than depending on external development or
include schools, workplace health, charities, community lagging the rest of the market.
resources and other players in the wellbeing market
such as providers of nutrition, sport, training and New personalised medicine and data skills will need to
careers advice, financial support and other become a core competence in the training of future
government services. healthcare workers.
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New Value Creation
Introduction economic potential. The wider opportunity cost to the
economy and society of poor health is therefore
In deciding what kind of future care system we want in substantially higher than just the cost of care provision.
the 21st Century it will necessary to revisit the
fundamental questions of: The digitally and AI-enabled future care system will
make much greater use of technology to undertake
1. What health and wellbeing outcomes do we want care delivery. In augmenting with more powerful
as a nation from a from our future care system? technology alternatives the economics of software
will play a new and fundamental part of the new
2. What kind of system do we want and how much cost structure.
are we prepared to invest in delivering it? In this section, we describe the key elements of the
economic and social cost to the UK of poor health
3. How will it be funded and run?
and wellbeing.
To successfully implement the vison described in the In making the economic, political, ethical and health
previous sections will require a scale of ambition, long related case for the future care system described in
term thinking and, most likely, upfront investment on a
this vision it is helpful to view value as comprising
par with, if not greater than, the setting up of the NHS
in 1948. three mutually reinforcing areas:
Clearly such an intention requires an understanding 1. Personal value the incremental quality of life
of the returns to be gained. In this section, we describe benefits that individuals are able enjoy courtesy of a
the nature of the returns if the Vision is achieved. public care system. This is based on maintaining
positive wellbeing for as long as possible and
With the viability of the current NHS being called into minimising both the likelihood and impacts of
question it will be essential that the future care system disease and/or loss of function.
envisioned in this report is able to deliver significantly
better population health outcomes for the investment 2. System value for money the economic outcomes
being made, i.e. it offers better value for money. achieved (the return) from the investment in a future
care system (based on the allocation, efficiency and
Health and wellbeing is not just a product to be effectiveness of resources)
consumed but is intrinsic to each person s basic abilit
to function and engage in all aspects of life. The 3. Public value the value perceived by the public
implications of poor health and wellbeing therefore from a national care system based on the personal
ripple outward to impact wider personal, social and contribution and state funding required to support it.
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ecosystem
The costs to UK society of poor health & The costs of a growing burden of disease are not just
the direct costs to the health and social care system. Ill The prize for delivering the vision
wellbeing are set to rise to more than £400bn
health has a profound social cost in terms of the is far greater than just the
By 2030, the UK population is forecast to rise by 5m personal suffering and additional burden for
to over 70m and the number of people over 65 is individuals and their families. This burden is not just in sustainability of care provision
expected to rise by over 40% to 17m. Without major terms of the immediate impacts on individuals, families in the 21st Century.
change chronic, disease is forecast to continue to grow: and their communities but also the intergenerational
transmission of poor health and wellbeing in
• Obesity will rise to 26m by 2030 disadvantaged communities.
• Cancer rates rising 50% to 500k by 2030 Poor health has a significant economic cost also in
• Diabetes is expected to rise to 4.6m by 2030 terms of the dragging effects on productivity and
performance of the UK economy. Levels of
• COPD will rise to over 1.5m by 2030 absenteeism or working while suffering with an
ongoing physical and mental health issue have been
• Dementia rates will rise to over 1.3m by 2030 shown to have a significant impact on productivity and
The inflationary factors that drive health and social employee engagement. Studies have shown up to 70%
of all workers are unable to perform at their full
care costs, namely an ageing population, growing potential due to an issue relating to wellbeing.
levels of chronic disease and the innovation of new
medical treatments are forecast to lead to increasing The wider costs of to the UK economy of poor mental
costs of around 3-5% per annum. Analysis by the health alone are estimated to be in excess £100bn
Health Foundation has shown that, if this rate of per year. Substantial additional costs of over £50bn
growth were to continue over the next 15 years with have also been shown to be associated with the
no step change in productivity or improvement, it negative impacts of obesity, poor physical health and
would require up to £100bn in additional NHS funding chronic disease as well as from the growing social
and £15bn in social care leading to a total spend of crisis of loneliness and social isolation. The prize for
delivering the vision therefore is far greater than just
around £275bn.
the sustainability of care provision in the 21st Century.
If the current system is maintained as is, with none of
the transformation envisioned in this report, then costs
are likely to follow this trajectory. In this case, it is
highly likely that the system will break down with
growing calls to limit access, ration care, raise taxes or
rethink the NHS constitution and introduce charges.
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summary Person-centered health health
Person-centered unpacked
coaching New health ecosystemNew health
health coaching Digital self learning system New value
ecosystem New value
creation
creation
Personal value healthier and likely to reduce demand on a future Co-creation of health The vision calls for a much greater
care system. role for individuals in managing their own health and
Here, we describe five areas of the value of personal wellbeing. Moving from passive patients and citizens to
health and wellbeing for individuals that will be Trajectories of health Each person is born with a set empowered individuals, families and communities offers the
enhanced by the envisioned system. These are: of potential health possibilities determined by their chance for people to have more freedom and control over
• Quality of life DNA. The choices and experiences that are made the quality and destiny of their lives.
• Trajectories of health throughout life have an impact on the body and over
• Life journeys time and accumulate into an overall trajectory of The current framing of health and care is one based on a
• Co-creation of health health that unfolds during a lifetime. notion of access to care . Here health and care is seen as
• Health inequalities the passive consumption of what the institutions have to offer
A life lived unhealthily will lead to a greater likelihood in terms of appointments, treatments and parcels of care. As
Quality of life - A person s capabilit and experience of disease and complications while a healthy life has been discussed even those suffering from chronic
of living a good quality of life is dependent on increases the likelihood of healthier outcomes and a disease spend less than 0.1% of their time with a HCP and
maximising wellbeing and avoiding the suffering and better quality of life. Although it is possible to make over 99.9% of their time on their own indicating that this is
constraints brought about by disease. As we have changes in lifestyle in order to change this health where support is most needed and that the design of
seen, holistic health and wellbeing, which underpins trajectory, the later this is left in life the less scope tomorrow s services need to be co-created to meet the
quality of life, has an interdependency on a wider set there is to change longer term health outcomes. needs of people to achieve this.
of social environmental determinants. The ability for Health inequalities Addressing the large health
people to manage these forces more effectively in Life journeys Throughout life people s health and
inequalities between different communities will be a priority
their own self interest will be key to being able to wellbeing needs change due to reasons of age, life for a new care system. This will be particularly important
thrive and live well in the 21st Century. events and circumstances. The early years are for areas with greater ethnic minorities and social
particularly important as many of the health deprivation. Here quality of life, poor health and social
The test of value for citizens of this vision will therefore behaviours, habits and beliefs are formed in this time problems are more deeply rooted and often transmitted
be the degree to which a new 21st Century care and go on to influence longer term health and through generations causing poor health and wellbeing to
system is able to help individuals and communities wellbeing outcomes. The future care system will become self-replicating.
achieve a better quality of life based on better health therefore need to transition from delivering
outcomes. This will be achieved by a combination of As well as taking the approach outlined in this vision it will
individual support and the stimulation of new social transactional and reactive interventions to one that also be necessar to consider the philosoph of
norms that embed healthy living into the social and acts as a lifelong partner to citizens in this journey. engagement that needs to underpin a new 21st Century
cultural fabric. care s stem. At one end is a radical libertarian view which
From pregnancy, to caring for an infant to child espouses that it is all about individual choice. In this view the
This broadens the scope of action and accountability development, the ability to monitor health and receive role of the state should make available the relevant support
of a future care system beyond a more narrow focus expert support and parenting advice will help to and leave people to make their own choices. At the other
on physiological health outcomes to include a higher ensure children receive the best start in life. Through end of the spectrum is a radical paternalistic approach. This
level concern for the wellbeing and flourishing of the adolescence and into adulthood the ability to view favours direct control, intervention and penalties for
nation as a whole based on individual flourishing and maximise wellbeing and detect the earliest signs of not adhering to instructions from health experts representing
realising potential. disease will assist in helping people to thrive and the state.
flourish. The ability to provide more comprehensive
Individuals and communities fully engaged in pursuing support into old age will help increase the quality of
a higher quality of life will by definition be living the later years of life.
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Vision
Visionsummary
ecosystem New value
creation
creation
In the middle is libertarian paternalism where System value Economics
. of AI and software
freedom to choose is maintained but the choice
architecture is arranged to nudge people towards Quality, safety and efficiency have long been central Advanced digital technology will increasingly be embraced
the options that appear to be in their best interests. to how health and care systems have sought to both in the context of supporting individuals to manage their
measure value. In situations where care delivery has health and internally within a next generation care system.
The work of Amartya Sen whose ideas have been been codified and routinised into standard procedures AI and digital will fundamentally transform the economic
integrated into UN policies offer support for this then these measures of value will continue to play an relationship between capabilities and cost. AI powered
middle way. He identified that many disadvantaged essential role. software is likely to display the following characteristics by
communities vary significantly in their abilities to take 2033:
advantage of the information and resources available The 21st Century care system envisioned in this report
to them in order to improve their lives. Furthermore is one that will make greater use of digital technology • Always-on 24/7 capabilities
man people internalise their state of sickness or and AI. It will also behave more like an dynamically • Scalability ability to replicate instances at zero
povert which then becomes normalised . In this state evolving complex adaptive system rather than a marginal cost
they cease to desire what they believe they cannot factor of care . This will mean that there will be new
achieve. capabilities requiring additional investment that • Dynamic self learning software based capabilities
promise to radically transform care delivery, health capable of self developing and optimising itself at
In a civilised society it is arguable therefore that outcomes as well as productivity. zero marginal cost
disadvantaged communities cannot be held entirely
responsible for their situation and more active forms of In this section, we look at the potentially significant • Ability to integrate, analyse and extract meaning from
intervention and support are both warranted and new sources of economic value that will accrue from almost any sources of data in real time
necessary. This will need to be debated further. the capabilities of the new system; the value from
• Rapidly declining costs of data processing, storage
optimising largely existing resources; and potential
and transmission
new value to be captured by UK in Life Sciences
industries. And we describe the key value drivers that
shape the level of demand on the system all of which
will be positively impacted by the Vision.
We have indicated the sources of value, but have not
at this stage sought to estimated numbers. Clearly the
numbers would be substantial reducing the amount of
time spent living with diabetes by an average of two
years alone could save the system as much as £2billion
a year, for example.
However, as with the system thinking used in
developing the vision, an integrated approach to
thinking about cost, savings and new value is required
and this should be the subject of a separate piece
of work.
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Vision
Visionsummary
ecosystem New value
creation
creation
Economic value from new capabilities c) Holistic dynamic decision support
The ability to integrate and synthesise genomic
The vision outlines a dynamic person-centred care data with continuous streams of holistic health &
system optimised to provide personalised care wellbeing data to create predictive simulations will
support. This will require new capabilities to which radically change how ongoing care is planned and
will deliver significant value not possible before. delivered. The ability to match this against a
These include: dynamically growing body of knowledge and
treatments will offer HCPs unprecedented power
a) Sensing and monitoring and insight from which to tailor care support and
The development of next generation sensors capable health coaching in ways that further maximise
of measuring DNA, biomarkers and a range of health outcomes.
behavioural and situational contexts will make
possible new possibilities for preventative d) Dynamic learning systems
diagnostics that promise to radically disrupt the The ability to integrate and synthesise live health
development and cost of disease and ill health. data from millions of people and combine this will
These are likely to grow in sophistication and reduce real time medical and population health research
in price as the technology develops further and is from around the world is set to create the world s
able to take advantage of the economies of scale. most powerful AI based health learning system. This
learning system will be capable of acting as a
b) Digital health coach knowledge and training resource from which to
By supporting each person with a real time self undertake continuous CPD for all actors involved in
learning digital health coach available 24/7 it will the delivery of care. This is likely to massively
be possible to run over 60m concurrent health reduce the costs and increase the pace of new
conversations tailored to the needs of each person. learning and workforce skills development leading
The core underlying algorithm and digital double to a further enhancement of health outcomes
needed to power the digital coach once developed through smarter care delivery.
could also be scaled millions of times for a marginal
cost of near to zero. This will be transformational. e) Home care automation and robotics
The development of next generation smart home
The AI-powered digital health coaches for each automation and care robotics will lead to a
person will be capable of ongoing self learning-and revolution in the level of support able to be
self-coding their own development again at near provided to those suffering with disabling impacts
zero marginal cost. This would in theory enable a of disease or loss of function due to ageing.
huge real time capability for the entire population to Tailored support and monitoring will enable higher
be developed, scaled and onward developed at the quality of life, improved health outcomes, greater
fraction of the cost of alternative solutions. Given the levels of independence and reduced demand on
impact on health outcomes of personalised always-on more expensive residential care and support
coaching support this is set to be a transformational services. The augmentation of care support through
investment once the technology and data availability the use of technology will revolutionise the quality
has matured. and effectiveness of social care in the 21st Century.
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Vision
Visionsummary
ecosystem New value
creation
creation
Optimising use of existing resources Creating commercial value for the UK b) Internationalisation of UK care capabilities
The person centred healthcare system envisioned will Every country on the planet is struggling with rising The global market for healthcare currently stands at
enable smarter optimisation by enabling resources to costs, rising demand and the challenge of adapting to $7.7trn and represents the biggest industry in the world.
be aligned more closely to population needs rather take advantage of the opportunities brought about by Many national public health systems look to the NHS as
than optimising the engagement of people to fit the precision medicine and next generation digital health a global exemplar of excellence and are interested to
needs of the system. This will be achieved in a number technologies. This provides a major opportunity for the learn from and leverage the know how and capabilities
of ways including: UK to take a lead and capture value on a global that the NHS has built.
stage.
a) Coordination of care around the person If significant progress towards the vision was to be made it
The delivery of holistic care through a community a) Innovation and life sciences is highly likely that there would be significant multi billion
based health coaching model means that specialty The use of enlightened incentive and funding pound opportunities for the NHS to licence its know how and
resources can be brought together in a just in time models will encourage and reward improved capabilities to other national health systems. This could
and as required basis to provide collaborative population health outcomes over transactional care extend to offering NHS health services through health as a
care support. This will replace the siloed hand offs delivery. This will help shift the focus and culture platform digital services. Investment in delivering the vision
between HCPs with the all the inefficiencies of away from a static view of care delivery towards therefore offers an opportunity to monetise this investment
duplication and bureaucracy that characterises this one of continuous improvement and innovation. and cross subsidise the delivery of care services to the UK
approach. The higher quality of care provided by population.
collaborative teams will not only deliver higher The UK Industrial Strategy has once again
efficiency but ensure better health outcomes and highlighted the crucial role the public health system
reduced future demand. needs to play in collaborating with the life sciences
industry on the development of new clinical,
b) Optimising resource allocation medical and digital health services.
High fidelity predictive modelling will enable risk
stratification and predictive demand planning to be More active collaboration on innovation will not
carried out at a much higher level of granularity. only support the transformation of the care system
This will allow much more effective demand led towards the model outlined in this vision but also
resource planning and allocation which will enable provide the UK Life sciences industry with R&D
resources to be configured and allocated much opportunities and to showcase its capabilities.
more efficiently. Active collaboration at scale on ushering in a new
age of precision medicine will help the UK Life
c) Reducing unwarranted variations in care Sciences and digital health industries to thrive in
Greater levels of data on real time health status and world markets and strengthen the performance of
treatment delivery will make it possible to contrast UK plc.
and compare performance across different HCPs
and are settings. Identifying best practices will
reduce levels of unwarranted variation in care
delivery and outcomes.
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Vision
Visionsummary
ecosystem New value
creation
creation
Value drivers that shape system demand Four key value drivers
Although there are many opportunities to increase Each stage of the journey from prevention to full time care
productivity and improve effectiveness in care will release more value to individuals and move a step
support it will be in managing demand that the closer to creating a sustainable long term care system.
greatest impacts on costs will be felt. The ability for
a future care system to reduce levels of demand The four key value drivers for a sustainable are listed as
for care support through a step increase in the follows:
success of prevention will drive the greatest
economic returns. 1. Wellbeing and prevention
a) Considering value over a longer time period • Improving wellbeing and reducing onset of disease
The nature of health is such that the link between
interventions and outcomes can vary enormously, 2. Early detection of disease
making investments in health problematic when • Detecting precursors to disease and early
dealing with traditional budget and political intervention to cure or delay onset of disease
cycles. This is further exacerbated in a siloed
system when the benefits accrue to another 3. Management of disease
function than the one making the investment.
• Improve self management of disease to slow
It will be necessary to transition away from a development or cure
narrow focus on costs per intervention to consider • Continually innovate to improve effectiveness and
the lifetime costs of health and wellbeing. It is efficiency of best practice care to reduce costs
through this longer frame that many of the
benefits of interventions will accrue thus enabling • Reduce unwarranted variation in care delivery to
a care system to make strategic investments that avoid unnecessary cost
improve health outcomes and reduce overall
system costs. 4. Assisted independent living
• Improve ability to maintain independent living as
b) Improving the proportion of life spent healthy long as possible to avoid unnecessary social care Figure 25: extending the proportion of life spent free from
The cumulative effect of supporting greater costs chronic conditions will reduce the cost to the system of
health and wellbeing across life course will be to
minimise and delay the impacts of disease and • Improve the quality of end of life experience by health and care provision. The solid line represents the
loss of function. The impact of this will be result in supportive palliative care that avoids unnecessary or current system; the dotted line represents what will happen
a greater proportion of life spent living in a unwanted invasive treatments if a future system is successful in delaying the onset of
healthy condition and minimising the proportion of disease. The area between the curves is the direct value of
life spent suffering chronic disease and in need of reduced demand created by implementing the new system
social care.
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Vision
Visionsummary
ecosystem New value
creation
creation
Public value A Marshall Plan for a health The healthcare Now is the time for a new vision and Marshall Plan for
challenge facing the country is on the scale of 1948. health. One that calls not just for improving the delivery
Framing the future In a world that appears A care system fit for the 21st Century needs to be: and sustainability of clinical and care services but one
increasingly insecure, the NHS holds a special status in that has its ambition in bringing all stakeholders together
the hearts of the British people. This is both a strength • Person centred, empowering and alwa s-on to build a country that has the best levels of health and
and a challenge as any attempt to change the system wellbeing in the world.
risks public outcry and resistance. In the absence of a • Focused on prevention and the causes of chronic
transformational vision and plan, the NHS risks lurching disease By definition this plan will need consultation and
deeper into crisis with the predominant discourse being collaboration with a broad set of health ecosystem
one of cuts to services and disputes over funding. stakeholders, politicians and the wider public.
• Designed to support the ongoing nature of
As we have seen, the vision in this report outlines chronic disease and the challenges of living with The longer term nature of the vision and transformation
a broader value proposition for the people of the disease plan means that it will need to look beyond the typical
UK based not only on taking advantages of new business and political cycles and thus is best lifted out
technology to improve health outcomes but also to • Capable of embracing the transformational of the political party considerations and addressed
empower people to play a greater role in enhancing benefits of the new wave of digital innovation through cross-party consensus.
their own health and wellbeing. This in turn will lead and precision medicine
to a cascade of further benefits to society based on The prize for success will be transformational and epoch
improved quality of life, better health outcomes, a In its 70th year, the NHS it is right to celebrate the making, the risks of struggling on as we are huge both
more sustainable care system and greater economic incredible things that it has achieved in the delivery politically and in terms of the health of the nation. In once
prosperity for the UK. of healthcare to all its citizens. It has rightly been again being a beacon for the world and a leader in
held up as a beacon of what is possible when a health, the UK can create the conditions for social and
Engaging the UK population in an informed debate country chooses to invest in the health of its people. economic flourishing and prosperity. Seeking engagement,
about the future possibilities, the benefits and what support and commitment to build this future should therefore
will be required to get there will be essential to a It was however, designed and structured for a not be seen as a cost to be borne but an investment in the
transformational vision being realised. How this different era and now finds itself at the dawn of a countr s future.
debate will be framed will be of pivotal importance new era facing new challenges that no amount of
if it is not to be seen as cynical move to threaten or incremental fiddling at the edges will be able to
undermine the foundational ethos or capabilities of resolve. Its time for a radical new era of healthcare.
the NHS that is so valued by the British public.
After the Second World War, the US Marshall Plan
brought a new vision and transformational plan for
Europe which ushered in the greatest rise in economic
growth and living standards that Europe has ever seen.
Delivering a care system capable of addressing the
needs of the 21st Century will require a plan with this
scale of ambition.
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5. Future healthcare stories
In this section we attempt to bring to life what it would be like The stories are summarised here. The full stories can be read
for a person to be in receipt of the person centred health and in Appendix 2.
wellbeing support as described in the vision.
We introduce 4 hypothetical characters at different stages of
their lives with a different health concern and show, in the
form of a simple illustrated story, how a future person centred
model of support might work. The aim is to make the vision
more tangible and show how a future system could provide a
radically improved model for addressing issues of prevention,
management of chronic disease and maintaining independent
living for as long as possible
Introduction Jazmine John Peter Vera Next Step
Introduction
It s 2033, and the ke building blocks of the Vision
are in place. Our four personas, developed with the
support of junior doctors at Barnet hospital, are
experiencing a radically different healthcare system A wellness conversation A risk marker conversation
with always-on support integrated into their lives as
appropriate to them individually.
While we have tried to avoid describing specific
technology solutions, we have created one integrating
product a bio-sensor we have called the NHS Dot
to represent a means to collect live data from the
person s bod .
In each case, while the experience feels like a natural
part of everyday life, there is a huge amount going on
in the background driving huge improvements in cost,
outcomes and experience.
These stories, as with the report, are intended as a Managing a chronic condition Maintaining independent living
provocation intended to drive discussion and debate
about the kind of healthcare system we want and
what it will take to get there.
They represent a start of a process in which we hope
to continue to work with junior doctors to further
develop these and other stories so that the people who
will be responsible in the future for running the service
have an opportunity to contribute to the thinking
around what skills will be needed to deliver it.
We are aware that, while the stories represent
different kinds of conversation, the personas are a
relatively mainstream group. Further work is needed to
describe how the system would work for, for example,
harder to reach people. However, as we believe that
the vision describes the way the world is going, this is
a problem to be solved, rather than a reason not to
proceed. We hope to have the opportunity to work
with relevant specialised organisations to do this.
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Vera
Jazmine a wellness conversation
Jazmine is health conscious. Knowing there is a history
of high cholesterol in her family she has always been
interested in her health.
The conversation with her is framed as wellness
helping her to feel as good as she can rather than
sickness prevention. She is keen to have ongoing
support and thus a regular check-in with the coach;
and she s reassured that there is earl warning of
anything likely to go wrong.
The advice she receives is tailored to her genome,
lifestyle and interests; but delivered in a way that
feels natural and appropriate rather than telling her
what is good for her.
Full page pictures of each frame of this story can be found in Appendix 2
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Introduction Jazmine John
John Peter Vera Next Step
John a risk marker conversation
John thinks very little about his health. Despite
increased information on how his lifestyle is affecting
his body and future health prospects, he continues to
indulge in his favourite pastimes without consideration
of the impact. Rational persuasion is not going to
convert him.
He absolutel doesn t want to have an sense of his
life being limited by a far off medical issue that may
never happen; so his decision to get an NHS Dot was
driven by the shock of his Dad dying from diabetes.
Interaction with digital health coach is limited to times
when he needs to take action; and, when he does,
there is a strong accent on behavioural nudges
geared around his interests.
When he interacts with the system, whether through
a generalist medical professional at the polyclinic
or a specialist at the counselling drop-in, his data
and advice based on population level analysis are
available to the HCP and him to determine the best
course of action.
Delaying the onset of type 2 diabetes by an average
of just two years could save the NHS more than
£2billion a year on direct and indirect treatment costs. Full page pictures of each frame of this story can be found in Appendix 2
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Peter managing a chronic condition
With Chronic Obstructive Pulmonary Disease (COPD),
Peter is at high risk of execerbations episodes
which can lead to expensive and distressing
emergency hospital admissions.
Peter doesn t want these and the s stem regards such
admissions as a failure, so the NHS Dot, combined with
vital information from his local environment, delivers
timely advice.
Monitoring falling oxygen levels and increasing CO2
in his blood, combined with raised pollution levels in
the environment provides an early warning signal and
allows a rescue pack to be automaticall prescribed
and dispatched to Peter in time to prevent the
exacerbation at minimal cost to the system.
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Vera maintaining independent living
Like many people at her stage of life Vera is keen
to stay in her own home for as long as possible.
To do so, she needs increasing amount of care; and
is of increasing concern to her daughter.
Ongoing monitoring of data from her NHS Dot enables
a balance of keeping the cost low while maintaining a
high level of care, by notifying carers when there is an
issue that needs to be addressed.
Similarly, a balance of care and physical contact
is maintained through ongoing community activity.
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Next steps a platform for deepening
stories
The stories related on previous pages are merely a
start. We hope to build them into a growing library of
descriptions of how the new system will feel and in
so doing to interrogate what changes will be needed
to deliver it.
We re looking to fund an ongoing project to work with
Junior Doctors to build an online resource geared
around a sense of place (initially within the Royal Free
Trust area) showing how people s lives interconnect
within the community and adding increasing detail to
the map presented here.
Subject to funding, we envisage this becoming a
growing resource available online and we are
developing a prototype.
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6. The transformation journey
In this section we set out the high level journey to achieving As care moves away from institutional settings and closer to a
the vision laid out in this report. Rather than framing the real time person-centred context, we describe a high level
journey by attempting to build on the constraints of the view of how this transition could unfold.
present, we use a future-back approach to identif what
needs to be in place to support the vision and then work
backwards to identify a phased journey to arrive there.
Finally, we summarise the high level policy, governance and
incentive models that will be required to support both the
transformation of services and engagement with the public
We outline some of the key building blocks required to and wider society to enable the delivery of the vision and
support delivery of the vision and propose some high level the context in which health and wellbeing can prosper in
approaches as to how these may be realised. the 21st Century.
Introduction Vision building blocks Phased journey of transformation Management of the process
Introduction Mobilising for change Planning and delivering this integrated and digitally-based
future will require a systems thinking approach and call
The vision of a person-centred 21st Century health As we have explored in this report, the scale of the upon new leadership and workforce skills. The fusing of
and social care system outlined in this report describes challenge facing the current health and care system clinical expertise, precision medicine and advanced
what is possible based on taking forward current can be faced only by galvanising all parts of the technologies to deliver person-centred care will place
trends. healthcare ecosystem around a new vision focused the UK at the forefront of a revolutionary new era of
on the healthcare challenges of the 21st Century. healthcare.
As we have seen, to deliver it will require a radically
different health and care system and a wider healthy- This will require the creation of a broad debate Creating a culture that is both rooted in delivering the best
living ecosystem that is both integrated and holistic amongst all stakeholders about the future and what care at the highest levels of quality but also focused on
in its approach. kind of healthcare system we want and how much we embracing innovation, service design and continuous
are prepared to pay for it. The 70th anniversary of the improvement will require new forms of governance,
It will require stimulating national conversations that NHS and the calls for new and bolder ideas to achieve leadership and motivation. Aligning incentives and
encourage healthier practices and social norms longer term sustainability make now an ideal time for guidelines to the desired behaviours and outcomes will
supported by more comprehensive place-based a serious debate about the future. be essential to ensure that a future system is able to pull
community systems geared to delivering personalised through the change it needs rather than resist it.
healthcare coaching backed up with specialist support. Political ambition
New models of partnership will be required with the wider
In this section we: The size of the opportunity and the transformation technology, life sciences, industry and 3rd sector
required to realise it calls for a new scale of political organisations to mobilise a wider health ecosystem and
• outline the scale of the challenge and what will be vision, will and ambition. Achieving broad cross-party new forms of collective collaboration on creating a
required to mobilise the system to realise the vision political and public consensus on the value and healthier nation for the future.
desirability of a transformation of this scale will be
• look at some of the key underlying building blocks essential if it is to be realised as it will take many Public engagement
and assumptions that underpin the vision i.e. what years and incur significant challenges, risks, new
needs to be true for the vision to be realised legislation and investment before the benefits Although levels of poor health and chronic disease are
will be realised. rising, health and wellbeing is becoming more important
• outline what a high level phased journey of and expectations are rising about the quality and nature of
transformation would look like to deliver this value System leadership the care the public expect from their healthcare system.
over the next 10-15 year period
It will be no easy task to inspire an overstretched It will be essential to engage and educate the public about
• lay out four lenses through which strategic change workforce jaded and cynical from previous attempts to the transformational possibilities for improving health and
will need to be addressed transform the health and care system. The creation of wellbeing that lie ahead. This will be key to gaining their
a common, shared and inspirational vision will be support for the type of healthcare system they want in the
essential to galvanise support and motivation for future and the investment required to deliver it.
building a future that the workforce can believe in and
be inspired to want to bring into being. It will be important to ensure the public has the confidence
and belief that its needs will be placed at the centre of this
future and that a new era of healthcare possibilities awaits
them in the future.
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Vision building blocks . What needs to be true Future system framing building blocks Public engagement building blocks
The vision represents an integrated systems view 1. Making prevention and population health a priority 1. Making the case for self-management of health and
where a significant proportion of daily health shifting resources and focus to actively support wellbeing the vision assumes that, through sensors and
monitoring and support moves to the individual personal wellbeing and higher levels of smart environments, greater information about our
supported by an integrated care system capable of population health instead of waiting to react to health and the impacts of our behaviours will lead to
personalising care support. Li the onset of disease and frailty. greater engagement and interest in taking more
ownership in our holistic health and wellbeing.
It necessarily assumes a number of significant building How do we create a clarity of purpose across the
blocks are in place in order to power this integrated entire healthcare system to shift from a reactive Will the public engage with this new responsibility and
person-centred system model. The following outlines symptomatic care orientation, to a proactive how do we ensure that the traditionally hard to reach
some of the key building blocks and highlights some preventive one? Could this eventually require a new communities are included so as not to increase health
of the challenges that will need to addressed for the constitution for the NHS. inequalities?
vision to be realised.
2. Integrating prevention, healthcare and social care 2. Acceptance of sensors the vision is based on
Our intention is to provoke discussion and debate into a unified care system fully integrating all assumption that people will accept more widespread
across functional silos in each of these areas. In our aspects of care into a unified care system capable use of sensors that measure biomarkers, physiological
research, we have found a remarkable agreement on of delivering holistic person-centred support. status, treatment and medication delivery, behaviours,
the key elements of the vision understandably as we contexts and environmental/social determinants in order
have merely rolled forward existing trends. Where The system is already on this journey with STPs and to manage their own health and wellbeing and/or
there is difference of opinion is in views of how to get ACS initiatives how can this process be support healthcare professionals to support them more
there what are the most significant issues and strengthened and accelerated? effectively.
innovation challenges and how do we address them.
3. Taking a longer term investment perspective Even though many of these sensors are likely to be
In this section, we describe the key functional building investments in prevention are likely to reap invisible and passively transmitting data how are people
blocks that would be required to realise the vision and greater long term value benefits so need to be are likely to react to the idea of using sensors that will
that will define the transformation journey ahead. Each protected from shorter term public health budget surveil the most intimate parts of their lives?
one is already the subject of a great deal of ongoing pressures.
work. Some are so fundamental that they will almost 3. Acceptance of sharing of data It is assumed that the
certainly require new legislation, a new contract with Should there be an independent body that is non default model for the vision will be that people will own
individuals possibly even a new constitution for the political and can oversee investment and provide their own data and grant access to HCPs or others at
NHS and the wider system. Our goal here is to bring independent guidance on strategic transformation their discretion.
them together. towards a future integrated person-centred care
system? What are the privacy concerns, mechanisms for sharing
We divide these into three types of building block: and how will data sharing be managed, policed and
• System framing supported for those who need help?
• Public engagement
• Healthcare ecosystem enablers
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4. Acceptance of a AI powered digital health coach 3. Transformational funding the vision assumes a How will this rebalancing of capacity and care be
personal virtual assistants are expected to radical transformation over the next 10-15 years. undertaken in an economic manner and in a way that
become the most common way of engaging with A central idea of this report is that an ambition on gains acceptance and support from the public?
intelligent technology in many areas of our lives the scale of the 1948 funding of the NHS is
over the next 10-15 years. However, health and required again. 7. Person-centred data strategy expanding medical
medical information and our relationship to it may records to include a much expanded set of real time
be different from other subjects. How will this be funded and resourced while trying holistic personalised data represents a fundamental
to manage current overstretched services? transformation of the data held for each person from
How will people embrace this as a trusted presence being a system of record to a dynamic personal data
and how will it need to function to truly be 4. New clinical care models in an always-on digital cloud against which trend analysis and predictive
perceived as dispensing trusted expert health advice clinical support model people will expect 24/7 simulations can be run. The new data sources will come
while also remaining sensitive to personal clinical care responsibilities mediated through from multiple sources and often different systems.
preferences and experienced as adding value to technology.
? How will this data be given a taxonomy and securely
How will these new clinical engagement models shared by all parties, systems and apps in a way that
work and how will a future care system transform enables all data pertaining to an individual to be
itself to support these new always-on models? How uniquely identified and made usable for real time health
New healthcare ecosystem building blocks decisions?
armed with new information, from swamping the
1. New data skills and capabilities HCPs in the future system? 8. Radical new innovation there will be huge value
system will have to understand how their created from the intersection of massive advances in
particular expertise exists in a larger holistic 5. New funding and governance models taking precision medicine, advanced sensors and AI; this will
person-centred context. The management and forward the underpinning ideas of STPs, regional form the foundation for person-centred 21st Century
support for individuals will become heavily bodies and ACSs, localised population health care.
dependant on managing and interpreting data systems will operate to maximise population
using new digital health and advanced decision health in line with local priorities and contexts. How can these capabilities, skills and centre of innovation
support skills not currently part of the medical and expertise be brought into the heart of a new system? How
care training curriculum What will be the new governance structures, do we create a silicon valley of digital and life sciences
incentives and target structures to create the to support the future care system and UK plc for the
When and how will new data skills become incentives for innovation and transformation future?
integrated into the curriculum? towards the holistic person-centred service vision of
the future?
2. New medical and wellbeing skills genomic and
molecular medicine as well as broader systems 6. New clinical organisational structures advances in
medicine understanding will form a significant precision medicine and treatments will enable
part of future health and wellbeing practice. more routine care and support to be pushed out
into cheaper community based polyclinics with an
How is this knowledge to be included in medical expanded focus beyond clinical care to include
training for both new doctors and CPD for existing holistic health coaching. Combined with continual
HCPs already serving in the healthcare system? monitoring this is likely to substantially reduce
outpatient volumes.
94
Phased journey of transformation Value drivers impacted by transformation
The approach in this report has been to develop a Each phase of the three stage transformation journey listed
clear vision to set a positive context and a shared above will release more value to individuals and move a
sense of direction that can inform shorter term step closer to creating a sustainable long term care system.
decisions even if we can t see the detailed path The four key value drivers for a sustainable are listed as
to the future state. follows:
It also leads to the questions: how do we actually 1. Wellbeing and prevention
get there? What is the link between the short term
• Improving wellbeing and reducing onset of disease
decisions and the long term vision?. This will be
particularly important in the context of strategic
investments in digital systems and the strategy for
data. But equally, there is a significant journey of • Detecting precursors to disease and early
transformation required to transition from toda s intervention to cure or delay onset of disease
siloed acute focused system to the integrated person- Figure 26: by starting with the vision and working
centred system envisaged in the vision. out what is required to deliver it, shorter term 3. Management of disease
In this section, we describe a three stage process.
decisions can be made in a strategic manner • Improve self management of disease to slow
As with the vision, we are projecting forward existing development or cure
activities and megatrends, so the first phase looks On the following page, we show graphically how the • Continually innovate to improve effectiveness and
remarkably like the current five year plan. We then system evolves across the three phases to deliver efficiency of best practice care to reduce costs
extend into further stages that continue to build as sustainable value through transforming:
discrete steps towards the delivery of the end vision. • Reduce unwarranted variation in care delivery to
avoid unnecessary cost
• the individual s experience as the move from
For the purposes of this report and in recognition of passive recipients of medical care to active
the 5 year election cycles that drive policy 3 distinct 4. Assisted independent living
participants in their own self-care
steps are described as milestones towards the vision: • Improve ability to maintain independent living as
• the care system moving from fragmented silos to an long as possible to avoid unnecessary social care
integrated, data-driven ecosystem costs
• Phase 1 Integrated health and care system (0-5 • Improve the quality of end of life experience by
• the engagement between them, moving from
years) supportive palliative care that avoids unnecessary
episodic transactions to always-on support
or unwanted invasive treatments
• Phase 2 Personalised care system (5-10 years) The subsequent pages describe what is happening at
each stage of the through the lens of the value drivers:
• Phase 3 (Vision) Intelligent person-centred care prevention, early detection of disease, management of
system (10-15 years) disease and assisted living support (see box right).
95
Vision summary
Building the vision will require a phased transformation journey
96
Vision summary
Today siloed health and care responded to; the benefits communicated; and policies Value driver improvements in Phase 1
developed.
The NHS Five Year Forward View identified the critical • Prevention and wellbeing this phase will see a
need to close the health and wellbeing gap . This is likely to be a period where the population selection of more targeted digital solutions focused on
In toda s s stem the patient is largel considered develops a more sophisticated understanding of their core health behaviours
as a passive recipient of care. Self-care is largely data; and it will be important to support those who
outside of the system and there is limited presumption need it to grasp the issues. • Early detection this phase would see more
of active engagement by the patient. comprehensive health checks as well as a range of point
In terms of the care system, the separate organisations solutions that capture physiological measurements and
The system is a complex jumble of siloed clinical, public will start to become increasingly aligned to coordinate integrate these into the medical records for ongoing risk
health and social care functions, with a lack of shared around a person-centred model of institutionally assessments
information or co-ordination. As a result the delivered care.
engagement with the patient tends to be as a • Disease management a range of specific digital
number of point relationships which the patient is To do this it will be necessary to have a shared patient support solutions for certain chronic diseases e.g.
expected to navigate often leading to sub-optimal record to enable any person in a care team to have Diabetes, CHD, COPD etc. will emerge. New treatments
health outcomes and multiple levels of inefficiency the right information, at the right time at the right and holistic care planning and support for disease will
within a system. place. Using common electronic records and integrated help individuals better manage their health. Remote
care plans will remove the risks of unnecessary consultations with HCPs via video will become common,
Interim Phase 1 Integrated health and care duplication or error, enable clearer patient reducing the need for unnecessary travel to
understanding of their care and encourage greater appointments
In the first phase, the journey is aligned with the shared decision making among HCPs in different parts
thinking in the Five Year Forward View, the approach of the system. • Assisted living specific smart device solutions will be
of Strategic Transformation Plans and Accountable available for remote monitoring support of certain
Care Organisations/Systems that focus on population This will be a challenging task with issues around factors for those at risk. This will be combined with
health at a regional level. Much of what is described interoperability, where data sits and how and when it greater remote access by video enabling remote check
here is already in progress.* is shared. As new sources of information are collected, ups to supplement face to face visits
questions of ownership of the data and permissions to
In this period, patients will have growing access to use it will become more urgent and require debate
digital health point solutions that will be increasingly and education.
integrated into care conversations and, alongside
sensors in other areas of life, contribute to growing Engagement with the individual will move towards a
interaction with information about their activities single coordinated approach there are many
and wellbeing. examples of this starting to happen now. Engagement
with a healthcare professional will dominate, but we ll * There are differences of opinion as to whether STPs and
DNA sequencing will become ever cheaper and more start to see more digital support solutions reducing the ACSs are the right structures/solutions (and this report is
widespread for reasons of interest (ancestry) and amount of physical interaction and starting to support agnostic on this), however, we found widespread agreement
health management. Ethical debates about what to do a level of always-on engagement and individual that integration of health and social care and moving
with the power of this information will become more responsibility and empowerment. incentives towards keeping people well in a predictive manner
mainstream; privacy and security concerns about are the way forward
intimate personal data will also become widespread.
Privacy and security breaches will need to be
97
Interim Phase 2 Personalised health and care On the person side, we anticipate that genome Value driver improvements in Phase 2
sequencing will be offered as standard, enabling
This second phase of transformation would see individuals to be risk assessed and some key elements • Prevention and wellbeing more holistic health and
prevention, clinical care and social care becoming fully of health and wellbeing advice and treatments being wellbeing tracking platforms will make it much easier
integrated into a community based holistic health personalised using this data. More sophisticated for people to assess their own wellbeing. Genome
coaching model. We expect that this would be based holistic health and wellbeing tracking platforms will sequencing will help drive interest in customising
on a poly clinic model with the majority of non-urgent, enable more holistic insight on multiple health and wellness plans further to take advantage of personal
non-complex chronic care cases being managed wellbeing factors with much of this being optionally variances in sensitivity to foods, exercise and a variety
through these local centres. Referrals to specialist shared into more open and dynamic health records. of health treatments
centres would occur on an as needed basis, moving
towards a hospital visit being the exception. In this phase, the nature of engagement between the • Early detection - regular blood biopsies will be
system and the individual will undergo significant standard to supplement existing health checks in order
A new organisational structure will need to be change. As the sophistication of AI, sensors, to spot signs of disease precursors, enabling early
implemented, with different roles and skillsets personalised medicine, the amount of data collected interventions
emerging as care migrates towards the person, and available to use and the aggregation of it into
geographically, in terms of the level of personalised what will feel like a single source of individual • Disease management - there will be a range of holistic
support and in terms of engagement, empowerment information and advice, all rapidly develop, digital support platform solutions for the major chronic
and responsibility for managing their health wellbeing. individuals will begin to take control of their health, diseases. New more complex treatments and therapies
appreciate how to use the information to set and will have digital tools to(for example) support patient
For HCPs closer to the patient, their role will require achieve their goals and expect to be able to do so. understanding. Holistic care planning and support for
new coach-lie skills working with the individual to disease will use machine learning to blend personal
help them make good decisions and choices; carrying Our understanding of the psychological drivers of data with best practice. Advanced AI powered decision
out an increasing number of tests and treatments; health will also have continued to expand hugely, so support systems will support care teams in their care
analysing individual data; and advising when behavioural triggers will be used effectively at he decision. Remote consultations with HCPs via video will
specialist intervention is required. individual level to drive value enhancing and cost be augmented with AR and VR options to help patient
saving behaviours. understanding
During this period, there is likely to be a shift in
language of care. For example, a new word may be • Assisted living sophisticated smart home platforms
needed to replace patient to better fit the ongoing will support people with many self support tasks as well
relationship outside of episodic treatments as assisting remote carers and care teams to track,
here we use person or individual , but something monitor and personalise support that helps improve
more descriptive may emerge more akin to a wellbeing as well provide comprehensive and holistic
client relationship. health and care support
Similarl , we use the word coach extensivel to refer
to the new skills required of HCPs. We think this
reflects that a coach helps clients to achieve their
goals; is not necessarily more capable to make
decisions than the coachee; but often has a level of
experience which they can bring to help the coachee.
98
Phase 3 the Vision realised Management of the transformation process There is already an enormous amount of activity going on
in all of these areas.
During this phase, the vision of a truly patient-centred The transformation journey will require a combination
health and care system will be realised. We have of top down direction, bottom up innovation and Our ambition with the Vision described in this report is to
described the vision in detail earlier in the report. continuous improvement. This will need to be offer a shared context for that activity; to create a beacon
Here we describe the nature of the change in this encouraged through the incentive and governance against which to assess whether shorter term activities are
final phase. structures that reward improving overall population taking us in the right direction; and to stimulate debates on
health outcomes. Clarity on how to address four distinct the huge issues that will need to be addressed.
In this phase of transformation, the individual will come strategic lenses will be important to support the
to perceive themselves as fully empowered to manage transformation journey and ensure innovation is
their own health and wellbeing with the support of an diffused into the new system
integrated health system available, mediated by a
virtual coach, on an always-on basis. 1. Political, economic and regulatory lens
Managing health and wellbeing will be seen as on Creating the environment to maximise transformational
ongoing activity, with the consequences of behaviours success will be important. Creating a political and
well understood and monitored. public narrative for transformation will be key as will
ensuring the economic resources and the regulatory
The components of the health ecosystem will be framework to support realisation of the vision
understood to go wider than the healthcare system
of today, with other organisations such as food 2. Organisation, skills and culture
manufacturers, community organisations and social
networks all having an increased role to play. Creating the right organisational models and
How to engage them in the system what data governance structures will be key, as will creating an
can be shared and how, for example, will be aspirational culture that embraces pursuit of the vision.
important issues. Significant new workforce skills and capabilities will
be required that need to be planned and delivered in
The fidelit of data doubles will increase as a timely fashion
comprehensive person-centred cells to cit real
time data will allow ever more reliable predictive 3. Models of care
simulations, individual advice and treatment and
population activities to promote good health The focus on prevention and holistic health coaching
behaviours. backed up by genomics, precision medicine, sensors
and AI will provide radically different opportunities to
Individuals will come to perceive their primary redesign pathways and models of care
healthcare relationship as being with some form of
virtual coach; human care will be focused where it 4. Tools and technology
adds most value helping people to understand an
act on their data; providing specialist treatment for Strategic choices for technology and medical tools will
complex cases; and providing reassurance and contact be key to ensuring that they integrate into a wider
for the most vulnerable or lonely for example. digital and data fabric as well as improving models of
care and health outcomes
99
7. Next steps
In this section we set out the proposed next steps to take
forwards the vision and provocation contained within this
report. We outline proposals to widen the debate on the
need for a shared long term vision for public healthcare to
the national level during this 70th anniversary year of the
NHS.
We also outline suggestion for how this report can be used to
inform long term strategy development within the Royal Free
Trust and the wider North Central London area.
Finally we define 10 key fundamental questions that arise
from this visioning work for politicians, the public and a future
healthcare system.
Next steps
This report, and the Vision that it describes, began as 1. Building the debate around the vision to ensure it • Further development of the value creation lens on the
a small project to help the Royal Free Charity to think has impact vision how it creates value and the scale of the value
through how it could best support the Trust with that could be realised
patient-centred initiatives that make sense with a 10- • Pull together a steering group to realise the
15 ear timeframe. In researching the future, we potential of the report to reframe the debate • Public engagement on the vision. Using the Future
found that an integrated vision such as the one we had about the future. This is a project that has become Health Stories as a platform to communicate with the
created did not exist and this was seen by all as a too big for its boots, both in terms of funding and in public about the potential future of the health service
major gap. terms of permission to influence debate. and support research to understand their concerns when
Consequently, we are pulling together a group of understood within an integrated vision. This would
As a result, the report has developed into a wider senior stakeholders within the sector to contribute to require further development of the Story Platform
provocation for the industry which seems to have the the thinking, provoke wider debate and help make described in the report.
potential to have an impact on the debate around the sure the most is made of the opportunity to make a
future of healthcare in the UK. real difference Recommendations for the Charity in its work inside the
Royal Free Trust
We are now actively and keenly looking to extend the • Develop a series of events in the run up to
project to develop further debates in key areas; to NHS70. We are developing a programme of We propose three streams of activity within the Royal Free
do more work on the details of, for example, the sponsored activities events, presentations, Trust:
economic case for the Vision; to build richness into the debates that will take place over the coming
person-centred stories as a tool for engaging with the months. We hope to link some or all of these to • Specific opportunities emerging from stakeholder
public on some of the big issues that will need to be NHS70 research.
addressed. These include:
• Seek funding for the above
Here we identify potential next steps in three areas: • creating an innovation hub for the Trust to support the
2. Unpacking specific areas of the vision. development of new digital innovations in support of
• Build a Steering Group to stimulate debate, While the report covers an enormous breadth of improving patient experience and care. The hospital
initially within the context of NHS70, provoked subject matter, there are a myriad of issues that will has a pioneering history in many regards, but
by this Vision require a much deeper dive. All of this will require tolerance of risk in many areas is currently limited due
additional funding, but we see potential value in: to regulatory and budgetary constraints.
• Further research and thinking to make the vision
more rich, deepen the value case and work on • Prioritise areas for further research and thinking. • developing a patient portal to help patients manage
each building block Work with Steering Group to build on the questions their appointments. Chase Farm has been designed as
arising from the building blocks in the a digital hospital but to date this has been almost
• Recommendations for the Royal Free Charity for Transformation Journey section of the report. entirely on-site digitisation. There is an opportunity to
its support of the Trust s activit in line with the extend the digital footprint by creating a patient
vision portal which can support the patient initially with the
101
• logistics around appointments, but with a view to
building to a more holistic portal for them to start
to manage their own health.
• drop-in counselling for newly diagnosed chronic First provocation: 10 big questions that arise from the Vision
illness sufferers. While not specifically digital in
nature, it s known that there is a high incidence of
people falling into depression after diagnosis
often resulting in failure to take medication and Political engagement Health ecosystem engagement
subsequent illness. This centre, potentially part
staffed by senior psychiatry students, could provide 1. Is there a shared consensus across all 6. How do we create a holistic systems approach
support in the initial stages of LTC care point stakeholders in the healthcare ecosystem on to healthcare that takes a long term approach
people towards existing digital and non-digital this vision? (if not what else needs to be to delivering health outcomes and is inclusive of
support resources and provide learning on how done/changed to gain this consensus?) all stakeholders and determinants of health?
people respond to diagnosis that could help in the
development of new resources. 2. Is there the Political will and ambition to 7. What new forms of collaboration are required
commit to realising this vision? with Technology and Life Sciences industries to
• Develop investment criteria consistent with the encourage innovation that can accelerate the
vision 3. Given the longer term nature of this vision does delivery of the vision?
it make sense to take its delivery out of the
• For projects not yet identified, a set of criteria political cycle through an independent body? 8. What new skills and resources will be required
against which to benchmark proposed projects in this future vision?
would support investment decision-making. Public engagement
These could include: 9. Should we create a world leading centre for
• supporting putting the patient in control; 4. How do we engage the public in an informed digital medicine and healthcare innovation to
• a digital or technology element; debate on how technology and scientific drive and lead the development of the new
• interoperability embedded in the solution. breakthroughs are changing the possibilities of capabilities to deliver the vision?
healthcare and what we want as a nation from
• The criteria could be developed in a co- a future healthcare system and how much are 10. How do we ensure that investments in our
creation workshop between the Charity and the we prepared to pay? future healthcare system are designed in such
Trust. a way that they offer monetisation
5. How do we ensure that realising the vision will opportunities for UK plc in International
reduce health inequalities not increase them? markets?
• Using the vision to help drive wider Trust
strategy
Although the vision has a longer timeframe than
NHS planning can accommodate, it could have
considerable value in providing a positive context
for shorter term activities. From our consultations,
much strategy work feels like a struggle, pushing
into a difficult unknown; the clarity of the vision has
102
• been reported as making it feel like there is a would support investment decision-making.
force pulling them towards the future. The Vision These could include:
could be used to: • supporting putting the patient in control;
• a digital or technology element;
• Support the development and communication • interoperability embedded in the solution.
of Trust strategy
• The criteria could be developed in a
• Provide a focus for conversations within the co-creation workshop between the Charity
North Central London STP and the Trust.
• Act as the basis of materials for involving
Junior Doctors in thinking about the skills they • Using the vision to help drive wider Trust
will need in the future. This could be through strategy
creating future care pathways based in the Although the vision has a longer timeframe than
vision; providing a framework for innovation NHS planning can accommodate, it could have
ideas to emerge; or linked to specific skills considerable value in providing a positive context
development as part of their CPD for shorter term activities. From our consultations,
much strategy work feels like a struggle, pushing
• logistics around appointments, but with a view to into a difficult unknown; the clarity of the vision has
building to a more holistic portal for them to start been reported as making it feel like there is a
to manage their own health. force pulling them towards the future. The Vision
could be used to:
• drop-in counselling for newly diagnosed chronic
illness sufferers. While not specifically digital in • Support the development and communication of
nature, it s known that there is a high incidence of Trust strategy
people falling into depression after diagnosis
often resulting in failure to take medication and • Provide a focus for conversations within the
subsequent illness. This centre, potentially part North Central London STP
staffed by senior psychiatry students, could provide
support in the initial stages of LTC care point • Act as the basis of materials for involving Junior
people towards existing digital and non-digital Doctors in thinking about the skills they will
support resources and provide learning on how need in the future. This could be through
people respond to diagnosis that could help in the creating future care pathways based in the
development of new resources. vision; providing a framework for innovation
ideas to emerge; or linked to specific skills
• Develop investment criteria consistent with the development as part of their CPD
vision
• For projects not yet identified, a set of criteria
against which to benchmark proposed projects
103
Appendices
104
Appendices
Contents
Appendix 1 Glossary
Appendix 2 Healthcare story boards
Appendix 3 Reasons to believe
Appendix 4 Bibliography
This report was commissioned by
the Royal Free Charity from Transform
Report authors: Andy Wilkins and Richard Gold
For further information please contact:
xxx@royalfreecharity.org
@2018 Royal Free Charity. All rights reserved
105
APPENDIX 1: Glossary of terms
Many of the terms used in the report have definitions that
refer to new or emerging concepts and are therefore still
subject to debate. For the avoidance of doubt the report
uses these terms using the definitions listed as follows:
Appendix Glossary
A-C C-F G-M M-P P-S S-W
A AI Artificial Intelligence is the theory and Biomarker a naturally occurring molecule, gene,
development of computer systems able to perform or characteristic by which a particular pathological or
Absenteeism unplanned absence from work due to tasks normally requiring human intelligence, such as physiological process, disease, etc. can be identified.
health or personal reasons. visual perception, speech recognition and decision-
making. Biosensors sensor devices used in order to determine
Academia the institutions and communities the presence or concentration of substances and other
concerned with the pursuit of knowledge, research API Application Programming Interface is a set of parameters of biological interest.
education, and scholarship. subroutine definitions, protocols, and tools that enables
programmers to make one software system Blockchain is a decentralized, distributed and public
ACO Accountable Care Organisations originated in communicate with another. digital ledger that is used to record transactions across
the US as a term to describe a single organisation with many computers in such a way that removes the need for
responsibility for managing the coordination and Assemblage a constellation of separate discrete a trusted intermediary as the record cannot be altered
delivery of all relevant health and social care actors pieces that together form an entity (e.g. solution) that retroactively without the alteration of all subsequent
within a geographic area with the goal of maximising is perceived to serve a coherent role or purpose. blocks and the collusion of the network.
population health.
Assisted living additional support provided for BMI Body Mass Index is a measure of body fat used
ACS Accountable Care Systems is the term used people who otherwise are not capable of carrying out to determine obesity calculated through using a person's
by NHS England for an ACO and represent the the full range of activities required for independent weight in kilograms (kg) divided by his or her height in
formalisation of STPs (Sustainability and everyday living e.g. washing, grooming, food meters squared.
Transformation Plans) into an institutional entity preparation, mobility etc.
with responsibility for planning, commissioning and C
systems leadership for all healthcare actors in a Augmented reality a technology that overlays
given geographic footprint. computer-generated information onto a user's view Capabilities the resources and ability to make decisions
of the real world. and take action in the world.
Acute care where a person receives active but short-
term treatment for a severe injury or episode of illness, B Care robots a semi-autonomous robot designed to support
an urgent medical condition, or during recovery from disabled and elderly people in their daily life activities.
surgery. Behavioural change refers to the ability to initiate
the transformation or modification of individual or Cerebral cortex is the largest and most recently evolved
Agency describes the capacity for individuals to community behaviour. region of the cerebrum in the human brain and plays a key
make and enact choices in the world. role in memory, attention, perception, cognition, awareness,
Biological terrorism the intentional release or thought, language, and consciousness.
AGI Artificial General Intelligence (also known dissemination of biological agents with the purpose
as strong AI or full AI describes the abilit of of causing harm human beings. Chronic diseases - long-term medical conditions that are
software/machine to be able to develop a general non communicable, generally progressive and frequently
purpose learning and intelligence capability enabling Biologics are biochemical molecules that are brought on by unhealthy lifestyle choices e.g. heart disease,
it to successfully carry out (or exceed) any task that adapted from living organisms or contain components diabetes, stroke, and asthma.
a human being can. of living organisms e.g. antibodies, vaccines etc.
107
Appendix Glossary
Cognitive bias is a mistake in reasoning, evaluating, D DNA - Deoxyribonucleic Acid is a molecule that encodes an
remembering, or other cognitive process, often occurring organism's genetic blueprint.
as a result of holding onto one's preferences and beliefs Data analytics - is the process of examining large and
regardless of contrary information. varied data sets to uncover hidden patterns, unknown Dopamine pathways also known as the
correlations, trends, preferences and other useful mesolimbic pathwa or reward pathwa connects the
Cognitive neuroscience is the scientific field that is information that can help organisations gain greater ventral tegmental to the ventral striatum is involved in many
concerned with the study of the biological processes and insight and make more-informed decisions. functions such as learning, motivation and reward which are
aspects that underlie cognition, with a specific focus on highly implicated in the formation of associations of
the neural connections in the brain which are involved in Data anonymisation - is the process of either pleasure, habits and addictions.
mental processes. encrypting or removing personally identifiable
information from data sets, so that the people E
Comorbidity is the presence of one or more additional whom the data describe remain anonymous.
diseases, disorders or complications co-occurring with a EHR Electronic Health Record is an electronic version of
primary disease or disorder. Data privacy refers to the use and governance a patients medical history, maintained over time, and may
of personal data to ensure that personal information include all of the key administrative clinical data relevant
COPD Chronic Obstructive Pulmonary Disease is is being collected, stored, shared and used in to that persons care under a particular provider e.g. visits,
a lung disease characterized by chronic obstruction appropriate and secure ways. notes, reported symptoms, tests, diagnoses, treatments etc.
of lung airflow that interferes with normal breathing
and is not fully reversible. Data science - is an interdisciplinary field Environmental determinants of health refers to
of scientific methods, processes, and systems aiming to properties of the physical environment and access to
CPD Continuing Professional Development refers to extract meaningful knowledge or insights from wide resources that impact on the health of an individual.
maintaining and enhancing the knowledge, skills and sources of data structured in various forms.
experience related to carr ing out one s professional Episodic care - medical and nursing care in which services
activities following completion of formal training. Data security refers to protecting data from are provided to a person at a moment in time for a
unsolicited access, malicious attacks and the particular problem and not as part of a continuous care
CRISPR-CAS9 Clustered Regularly Interspaced Short exploitation of stolen data. relationship.
Palindromic Repeats (CRISPR CAS9) is a gene editing
tool developed to change or edit pieces of a cell's Data visualisation - refers to the techniques used Extrinsic rewards - is a physical or tangible external
DNA using a specially designed RNA molecule to guide to communicate data or information clearly and reward that is provided for accomplishing a task or goal.
an enzyme called Cas9 to a specific sequence of DNA meaningfully by presenting it using visual
where a precise cut of the DNA double helix can be representations.
F
made.
Deep learning self-learning neural networking
based algorithms with the ability to learn and optimise Foundation Trust - a NHS quasi autonomous organisation
Cryptography is a method of storing and transmitting that allows decisions on how best to spend the Trust's income
data in a particular encoded form so that only those for themselves without being explicitly programmed or
provided with labelled training data. to be made by local organisations and communities free
whom it is intended can read and process it. from central government control but monitored by NHS for
Digital health coach an intelligent virtual assistant care quality and financial management.
CVD Cardiovascular Disease generally refers to
conditions that involve narrowed or blocked blood able to provide always-on health coaching support
personalised to the needs, preferences, health status Frailty progressive debilitating weakness and lack of
vessels that can lead to a heart attack, chest pain health or strength typically associated with ageing.
(angina) or stroke. and context of the person.
108
Appendix Glossary
G Health coaching - also referred to as L
wellness coaching, is a process that facilitates healthy,
GDPR - General Data Protection Regulation is a legal sustainable behaviour change by challenging a person Laddered goals larger goals that can be broken down
framework that sets guidelines for the collection and to reflect on their situation, identify their values, and into sub goals or milestones to help provide a sense of
processing of personal information of individuals within provide support to help transform their goals into progress towards the end goal.
the European Union aimed at giving more power and action.
control to people on the ownership and use of their Life sciences industry collective term to describe
personal data. Health ecosystem the constellation of public, companies operating in the fields of biotechnology,
private, 3rd sector and community actors, stakeholders, pharmaceuticals, biomedical technologies, life systems
Genetic counselling - is a counselling process, which resources and services that impact health outcomes and technologies, nutraceuticals, cosmeceuticals, food processing,
aims to help individuals, couples and families whose closer collaboration can improve population environmental and biomedical devices.
understand and adapt to the medical, psychological, health.
familial and reproductive implications of the Liquid modernity the term used by the sociologist
implications of new health risk information revealed Holistic health takes a whole person approach in Zygmunt Bauman to describe the post modern world
by genetic testing. terms of physical, mental, spiritual, emotional, social where many of the social certainties of the past have been
needs as represented through the goals and values of replaced by a more anxious, insecure, fleeting and rapidly
Genomic medicine - sometimes also known as each person in the quest for optimal health and changing social reality.
personalised medicine, is a way to customise medical wellness.
care to the body's unique genetic makeup e.g. perform LTCs Long Term Conditions (also known as chronic
more effective personal diagnosis and tailor-made Human augmentation - refers to technologies diseases) are conditions for which there is currently no cure,
treatments. that enhance human productivity or capabilities and which are managed with drugs and other treatment,
e.g. strength, mobility, cognitive abilities etc. e.g. diabetes, chronic obstructive pulmonary disease,
Genotype - is the complete heritable genetic identity arthritis and hypertension.
revealed by DNA sequencing. I
M
GP General Practitioner is a general doctor typically ICS (Integrated care system) the new name
in a community based setting who is able to treat proposed by NHS England to define Accountable Care Machine learning - is an application of artificial
patients with minor or chronic illnesses and refers those Systems. intelligence (AI) that provides systems the ability to access
with serious conditions to a hospital for specialist care. data and use it to automatically learn and improve from
Identity management - refers to the administration experience without being explicitly programmed.
H and management of individual identities within a
system such as to associate disparate data with a Marginal cost - the additional cost incurred by producing
Hacking - gain unauthorised access to a system particular person/entity and manage permissions, one additional unit of a product or service (this often
or computer with the purpose of accessing or authentication and access to application or information reduces when benefitting from economies of scale, in the
manipulating data for an unauthorised purpose. resources. case of software however this falls close to or equal to
zero).
HCP - a professional who specialises in treating and Intrinsic rewards refers to the internal sense of
managing a person's general or specific health or fulfilment, satisfaction, achievement or mastery that
care needs. comes from achieving a desired goal.
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Appendix Glossary
Medtech industry organisations involved in the NHS - the National Health Service is the publicly Personal data cloud distributed data relating to a person
research, development and production of devices, funded national healthcare system in the United that can be identified and linked to drive holistic insight and
systems and technologies to diagnose, treat or Kingdom which is funded primarily by taxation decision making.
manage a health problem and improve quality of life. and provides free or low-cost healthcare to all
legal residents of the UK. Personalised medicine - a form of medicine and clinical
Meta learning the ability to intelligently and self care that uses information about a person's individual
reflectingly apply learning in other contexts to NHS 5 year forward view - is a wide-ranging genes, proteins, and environment to deliver a personalised
achieve higher levels of multi domain knowledge strategy for the NHS in England that was published and tailored approach to prevent, diagnose, and treat
and intelligence from which to learn to achieve new in October 2014. disease.
or more complex goals.
Nudge theory - is a concept in behavioural science, Pharma a pharmaceutical company responsible for
Microfluidics - is both the science which studies the political theory and economics which proposes that by making, testing and delivering new drugs and treatments.
behaviour of fluids through micro-channels and the presenting choices in nuanced ways it is possible to
technology of manufacturing miniaturized devices e.g influence the motives, incentives and decision making Phenotype - the set of observable characteristics of an
lab on a chip capable of passing fluids for testing into of groups and individuals in service of their broader individual resulting from the interaction of its genotype with
networks of channels with dimensions from tens to self interest. the environment.
hundreds of micrometers.
O Place-based health - a bottom-up and holistic approach to
Molecular assays - is an investigative procedure in the unique needs of individuals and communities in a given
laboratory medicine, pharmacology, environmental Open system Is an IT system that uses a publicly location by integrating local environmental and social
biology and molecular biology for qualitatively known standard set of interfaces to allow anyone to resources into a whole system approach to improving
assessing or quantitatively measuring the presence, use and communicate with that system. population health.
amount, or functional activity of a target molecule
or entity. P Point of care diagnostics - medical diagnostic testing that
can be carried out by a health care professional during a
N Paternalism - the policy or practice on the part of
face to face appointment or encounter.
people in authority of restricting the freedom and
Nanotechnology - the branch of technology that deals Polyclinic a community based multi-disciplinary health
responsibilities of those who are dependent on them
with miniaturised technology with dimensions of less centre able to offer holistic medical and wellbeing support
through making value based choices on their behalf.
than 100 nanometres, including the manipulation of for all but complex, specialist or emergency treatments.
individual atoms and molecules. Pathogens - a bacterium, virus, or other microorganism
Population health - the health outcomes of a total
that can cause disease.
NCL North Central London is the geographic population of individuals within a geographic region,
footprint determined by NHS England for one of the including the distribution of such outcomes within groups
Peer support - occurs when people receive knowledge,
44 regional sustainability and transformation plans and communities in which variations occur.
experience, emotional, social or practical help from
and covers the London boroughs of Barnet, Camden, other people in a non-professional capacity and who
Enfield, Haringey and Islington. Primary care - health care provided in the community for
are often in similar circumstances.
people making an initial approach to a medical practitioner
or clinic for advice or treatment.
Persona - the aspect of someone's character that is
presented to the world or perceived by others.
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Appendix Glossary
Public health - the health of the population as a Risk stratification - is the process for identifying Siloed care multiple health and care interventions
whole, especially as monitored, regulated, and and predicting the degree of risk and severity of delivered individually and often in parallel with no holistic
promoted by the state. worsening health outcomes faced by individuals person-centred approach.
within a given population enabling the prioritisation
Q of resources and care to be made accordingly. Smart city - is a municipality that uses sensors, data,
analytics and automation to monitor the real time use of
Quantum computing undertaking computational RNA - Ribonucleic Acid is a molecule acting principally its physical, social and environmental resources to increase
tasks using the quantum states of subatomic particles as a messenger carrying instructions from DNA for the operational efficiency, share information with the public
instead of the traditional binary use of 1s and 0s to synthesis of proteins used in many of core molecular and improve both the quality of government services and
store information offering the potential for the biology processes that underlie the functioning of the wellbeing of its citizens.
emergence of exponentially more powerful computing living cells.
power than is possible from classical silicon based Smart home - is a home that incorporates advanced sensors
computing. Robotics - is an interdisciplinary branch of engineering and automation systems to provide sophisticated monitoring,
and science that deals with the design, construction, control and customisation over aspects of a building s
R operation, and application of robots and includes physical services and its internal functions to meet the
mechanical engineering, electrical engineering, personal needs and preferences of its inhabitants.
R&D - Research and Development refers to the computer science and others.
scientific, investigative and innovative activities an Social care - the provision of social work, personal care,
organisation conducts to enhance or develop new Royal Free Charity a charity that works alongside protection or social support services to children or adults
products, services and procedures. the Royal Free Foundation Trust dedicated to investing in need or at risk, or adults with needs arising from illness,
and support activities that go beyond the clinical care disability, old age or poverty.
Regenerative medicine - is the branch of medicine provided by the hospital to that help to ensure
that develops methods to regrow, repair or replace patients receive the best overall care experience. Social determinants of health - are the conditions, contexts
damaged or diseased cells, organs or tissue through and social forces in which people are born, grow, live, work
the use of therapeutic stem cells, tissue engineering Royal Free Hospital is a leading UK hospital based and age that are shaped by the distribution of money,
and the production of artificial organs. in London, UK and is now part of the Royal Free London power and resources are the unwritten rules of behaviour
NHS Foundation Trust that also comprises of that are considered acceptable in a group or society at
Residential care - refers to long-term care given to Barnet Hospital, Chase Farm Hospital, as well as clinics global, national and local levels.
adults or children who are cared for in a specialised run by the trust at Edgware Community Hospital,
care setting rather than in their own home or family Finchley Memorial Hospital and North Middlesex Social isolation - is a state of complete or near-complete
home. University Hospital. lack of contact between an individual and the rest of
society.
Resilience - is the process of adapting well in S
the face of adversity, trauma, tragedy, threats Social norms - are the unwritten rules of behaviour that
or significant sources of stress such as family and Self-learning system - an adaptive system whose are considered acceptable in a group or society.
relationship problems, serious health problems performance continually improves through a learning
or workplace and financial stressors. process based on making changes and monitoring Solution shop a term popularised by the Harvard
outcomes to inform continual adaptive and incremental Professor Clayton Christensen to describe a multi-speciality
improvements. care organisation designed to treat the person holistically
instead of fragmenting care into specialist silos.
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Appendix Glossary
SPO2 refers to a person's oxygen saturation level Synthetic biology refers to the design and U
indicating the proportion of haemoglobin carrying construction of new biological components and systems
oxygen in the blood (normal levels are 94-99%). to improve health outcomes that do not exist in the Unsupervised learning - is a method used to enable AI
natural world e.g. artificial enzymes, genetic circuits, algorithms to correlate goals with input data to infer the
Stem cells - a special class of cells that are not yet cells or redesigned biological systems. classification of both tangible and intangible objects
assigned to a specific function and are able to without providing the machines any prior information
differentiate and adapt to form any other Systems biology - is a holistic approach to about the objects.
specialised cell type in the body. deciphering the complexity of biological systems that
starts from the understanding that the networks that V
Stem cell therapy - is the use of stem cells to treat form the whole of living organisms are more than the
or prevent a disease or condition by using the sum of their parts. Virtual assistants - is a conversational, AI based entity
regenerative properties of stem cells to repair or avatar able to provide information or undertake tasks
damaged or missing cellular tissue. Systems medicine - is an interdisciplinary field of for the benefit of an individual.
study that looks at the systems of the human body
STP - Sustainability and Transformation Partnerships as part of an integrated whole, incorporating Virtual reality - is an artificial environment that is created
describe the arrangements in 44 areas in England, biochemical, physiological and environmental with software and presented to the user in such a way that
where local NHS organisations and councils have interactions. the user suspends belief and accepts it as a real
drawn up proposals to improve health and care in environment.
the areas they serve. Systems thinking - is a holistic approach to analysis
that focuses on the evolving properties of an overall
Subjective experience - is the quality of complex system and the way that a system's constituent
W
conscious experience by which we have the sensation parts interrelate within the system.
or mental impression that events are happening to us Wellbeing - a state of individual and societal capability
as experiencing "selves . and existence characterized by health, happiness,
T flourishing and prosperity including the minimisation
Supervised learning - is a method used in AI where of avoidable suffering.
Taxonomy - is the science of classification based on
incoming data is labelled helping the learning a pre-defined system that enables any resulting
algorithms to more easily classify objects, problems classifications to provide a common framework for
or situations. information analysis, retrieval and exchange.
Symptomatic a state or sign that is indicative of an Triage - a process where people seeking help are
underlying issue or problem. assessed, sorted and assigned care support based
on the severity of their medical or care needs.
Symptomatic medicine the reactive system of
medicine that waits for people to present themselves
into the healthcare system when becoming aware of
symptoms of a health problem.
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APPENDIX 2: Future healthcare stories
In this Appendix we attempt to bring to life what it would be The stories are the same as in the main report, but here we
like for a person to be in receipt of the person centred health present the storyboards full size.
& wellbeing support as described in the vision.
We introduce 4 hypothetical characters at different stages of
their lives with a different health concern and show, using a
day in the life story, how a future person centred model of
support might work. The aim is to make the vision more
tangible and show how a future system could provide a
radically improved model for addressing issues of prevention,
management of chronic disease and maintaining independent
living for as long as possible.
Appendix Future healthcare stories
Introduction
It s 2033, and the ke building blocks of the Vision
are in place. Our four personas, developed with the
support of junior doctors at Barnet hospital, are
experiencing a radically different healthcare system A wellness conversation A risk marker conversation
with always-on support integrated into their lives as
appropriate to them individually.
While we have tried to avoid describing specific
technology solutions, we have created one integrating
product a bio-sensor we have called the NHS Dot
to represent a means to collect live data from the
person s bod .
In each case, while the experience feels like a natural
part of everyday life, there is a huge amount going on
in the background driving huge improvements in cost,
outcomes and experience.
These stories, as with the report, are intended as a Managing a chronic condition Maintaining independent living
provocation intended to drive discussion and debate
about the kind of healthcare system we want and what
it will take to get there.
They represent a start of a process in which we hope
to continue to work with junior doctors to further
develop these and other stories so that the people
who will be responsible in the future for running the
service have an opportunity to contribute to the
thinking around what skills will be needed to deliver it.
We are aware that, while the stories represent
different kinds of conversation, the personas are a
relatively mainstream group. Further work is needed to
describe how the system would work for, for example,
harder to reach people. However, as we believe that
the vision describes the way the world is going, this is
a problem to be solved, rather than a reason not to
proceed. We hope to have the opportunity to work
with relevant specialised organisations to do this.
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Vera
Jazmine a wellness conversation
Jazmine is health conscious. Knowing there is a history
of high cholesterol in her family she has always been
interested in her health.
The conversation with her is framed as wellness
helping her to feel as good as she can rather than
sickness prevention. She is keen to have ongoing
support and thus a regular check-in with the coach;
and she s reassured that there is earl warning of
anything likely to go wrong.
The advice she receives is tailored to her genome,
lifestyle and interests; but delivered in a way that
feels natural and appropriate rather than telling her
what is good for her.
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Vera
116
Vera
117
118
119
John a risk marker conversation
John thinks very little about his health. Despite
increased information on how his lifestyle is affecting
his body and future health prospects, he continues to
indulge in his favourite pastimes without consideration
of the impact. Rational persuasion is not going to
convert him.
He absolutel doesn t want to have an sense of his
life being limited by a far off medical issue that may
never happen; so his decision to get an NHS Dot was
driven by the shock of his Dad dying from diabetes.
Interaction with digital health coach is limited to times
when he needs to take action; and, when he does,
there is a strong accent on behavioural nudges
geared around his interests.
When he interacts with the system, whether through
a generalist medical professional at the polyclinic
or a specialist at the counselling drop-in, his data
and advice based on population level analysis are
available to the HCP and him to determine the best
course of action.
Delaying the onset of type 2 diabetes by an average
of just two years could save the NHS more than
£2billion a year on direct and indirect treatment costs
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121
122
123
124
125
126
Peter managing a chronic condition
With Chronic Obstructive Pulmonary Disease (COPD),
Peter is at high risk of execerbations episodes
which can lead to expensive and distressing
emergency hospital admissions.
Peter doesn t want these and the s stem regards such
admissions as a failure, so the NHS Dot, combined with
vital information from his local environment, delivers
timely advice.
Monitoring falling oxygen levels and increasing CO2
in his blood, combined with raised pollution levels in
the environment provides an early warning signal and
allows a rescue pack to be automaticall prescribed
and dispatched to Peter in time to prevent the
exacerbation at minimal cost to the system.
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128
129
130
131
132
133
Vera maintaining independent living
Like many people at her stage of life Vera is keen to
stay in her own home for as long as possible.
To do so, she needs increasing amount of care; and is
of increasing concern to her daughter.
Ongoing monitoring of data from her NHS Dot enables
a balance of keeping the cost low while maintaining a
high level of care, by notifying carers when there is an
issue that needs to be addressed.
Similarly, a balance of care and physical contact is
maintained through ongoing community activity.
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135
136
137
138
139
140
Next steps a platform for deepening
stories
The stories related on previous pages are merely a
start. We hope to build them into a growing library
of descriptions of how the new system will feel and
in so doing to interrogate what changes will be
needed to deliver it.
We re looking to fund an ongoing project to work
with Junior Doctors to build an online resource geared
around a sense of place (initially within the Royal Free
Trust area) showing how people s lives interconnect
within the community and adding increasing detail to
the map presented here.
Subject to funding, we envisage this becoming a
growing resource available online and we are
developing a prototype.
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Appendix 3 - Reasons to believe
In this section we summarise the challenges associated with We explore specific examples of the breakthroughs currently
continuing with the healthcare system as it is and explore being made in genetic and molecular medicine as well as
evidence for why a person centred 21st Century healthcare examples of new treatments and approaches currently being
system based on the vision is both desirable and achievable. developed by the rapidly expanding life sciences industry.
We outline evidence supporting the development and We also explore specific examples of the emerging
direction of the trends we have described that substantiate capabilities in the field of technology and AI and show how
the vision and speculate on the likely impact on the triple these are beginning to influence radical new approaches to
bottom line of improved health outcomes, improved quality healthcare delivery.
of care and improved effectiveness of spend.
Appendix - Reasons to believe
Economics of Impact of vision Emerging models of care Precision medicine Technology & AI Emerging Medtech
ill health on drivers of cost reasons to believe reasons to believe reasons to believe
Introduction The economic impact of disease and ill health
What are the reasons to believe that the vision and By 2030 the UK population is forecast to rise by 5m If the rate of growth in health
the underpinning trends outlined in this report is to over 70m and the number of people over 65 is
possible or even desirable? What evidence is there to expected to rise by over 40% to 17m. Public health
costs were to continue over the
show that the trends and the new models of care factors including obesity are forecast to continue to next 15 years with no step
described in the vision are indeed underway? rise leading to corresponding increases in rates of
chronic disease. change in productivity or
In this section we:
improvement in underlying
• Examine the high levels trends and economic • Obesity will rise to 26m by 2030
implications of the growing crisis in public health population health it would
and rise of chronic disease • Cancer rates rising 50% to 500k by 2030
require up to £100bn in
• Explore the demand drivers of ill health in more • Diabetes is expected to rise to 4.6m by 2030
detail to show how the vision can address some of • COPD will rise to over 1.5m by 2030
additional funding
the underlying factors
• Dementia rates will rise to over 1.3m by 2030
• Examine some of the emerging models of care that
point to a future based on a holistic and coaching These inflationary factors that drive health and social
based models of person-centred care care costs, namely an ageing population, growing
• Highlight some of the breakthroughs and services levels of chronic disease and the innovation of new
becoming available in support of genetic and medical treatments are forecast to lead to increasing
precision medicine costs of around 3-5% per annum. If this rate of growth
were to continue over the next 15 years with no step
• Explore the dramatic advances being made in change in productivity or improvement in underlying
technology, AI and Machine Learning population health, it would require up to £100bn
• Examine the breakthroughs being made in sensors, in additional funding according to analysis by the
point of care diagnostics and medical related Health Foundation.
technology Continuing this trajectory will soon force politicians
to confront difficult choices. In the absence of viable
alternatives to addressing prevention or improved
management of chronic disease these choices are likely
to be framed through a lens of cost containment and
will be based on restricting access to care, reducing
availability of care, raising taxes or introducing
charges.
143
The costs of a growing burden of disease are not just The choice not to transform the health and care system Tackling the drivers of health costs
the direct costs to the health and social care system. and to continue within the current paradigm is a choice
Ill health has a profound social cost in terms of the in and of itself with significant implications for The person centred vision sets out to show what could be
personal suffering and additional burden for politicians, system leaders and the wider public. possible in providing holistic health and care support to
individuals and their families. It also has a significant individuals throughout their life course. The transformation
economic cost in terms of the dragging effects on of healthcare away from a reliance on episodic encounters
productivity due to absenteeism or working while with a fragmented system to one that takes holistic real time
suffering with a sub optimal physical and mental information from one s own bod and context will empower
health. The wider costs of to the UK economy of poor far greater awareness and levels of self management than
mental health alone are estimated to be over £100bn has been possible before.
per year. How will this vision address all four parts of the health value
landscape at the individual and population level to provide
Source: The Health Foundation the level of systemic change needed?
1. Improving wellbeing and prevention
The most significant means of reducing the burden of chronic
disease will be tackling the causes of chronic disease.
Improving personal wellbeing through healthier choices and
behaviours offers the greatest opportunity for personalised
support. The availability of data that reveals to people
their habits and health behaviours and shows both the
immediate and long term effects on physical and emotional
wellbeing.
This will open up new levels of awareness and stimulate
compelling new personal and societal conversations on how
to manage personal wellbeing. This will also in turn provide
a powerful new platform from which to draw in other
private, public and 3rd sector organisation to provide
resources and additional services to support a growing
interest in personalised wellbeing.
Figure xx: Projections of future inflation of health costs
based on different levels of productivity improvement
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Impact of the vision on prevention
Personal wellbeing covers a broad landscape of
factors but from a health perspective the areas of Prevention Domain Current situation How the vision addresses this Likely impact of vision
obesity, nutrition, exercise, addictions and emotional Personal • High levels of health illiteracy • Holistic health planning • Higher awareness & engagement
health have a direct impact on longer term health awareness & skills • Relia ce D G gle • Personalised to needs & genome • Higher motivation & skills
outcomes. • Highly variable information quality • Use real time information • Improved health outcomes
Traditionally these have been considered, investigated
Societal awareness • High levels of health inequalities • Personalised/targeted messaging • Greater engagement
and managed as separate risk factors. There are & social norms • Resistance to health messaging • Coordinated health messaging • Reduced health inequalities
already over 300k health apps that aim to provide
point solutions to many of these areas but to date few Obesity • 2/3 of adults are overweight/obese • Greater insight of weight drivers • Reduced obesity levels
have gained sustained usage at scale due to poor user • ~30% of children are obese • Coaching for weight reduction • Reduced health complications
experience or understanding of the psychological & • Cost NHS over £6bn & society £27bn
behavioural factors required. Exercise • ~40% of adults missing activity targets • Personalised coaching • Improved awareness
It is now clear that many of these factors are • Cost NHS ~£1bn & society £7bn • Targeted nudges • Higher activity & better health
interrelated making the holistic virtual coach approach
advocated in the vision a much more powerful model Nutrition • Higher levels of processed food • Personalised dietary advice • Improved diet & nutrition
of determining with more accurately the causal chain • Unhealthy snacking habits • Greater access to alternatives • Improved health outcomes
of factors and targeting the most effective Tobacco & Alcohol • 9m smokers costing ~ £13bn to society • Personal tobacco/ alcohol advice • Reduced smoking/ alcohol
interventions. • ~1m hospital admissions due to alcohol • Advanced behavioural coaching • Reduced medical/ societal costs
• Costs NHS £3.5bn & ~£21bn to society
According to a report by the WHO if the major risk
factors for noncommunicable diseases were eliminated, Mental Health • ¼ experience mental health issue/year • Increased risk detection • Early detection & intervention
around three-quarters of heart disease, stroke and • ¾ do not receive treatment • Personalised mental health • Greater availability & access
type 2 diabetes would be prevented; and 40% of • Suicide the greatest killer for men < 45 coaching • Greater insight into causal
cancer would be prevented. The size of the prize • costs society up to £100bn year • Holistic life coaching/signposting factors
before taking into account new treatments is the real • Triage & access to support
possibility of halving the burden of chronic disease for Social • Large social based health inequalities • Personalised life coaching • Reduced health inequality
the current healthcare system and the wider determinants • Cost to NHS £5.5bn, £30bn to society & • Targeted interventions & support • Longer life expectancy &
population. This is a prize worth fighting for. £30bn in welfare payments reduced years of disability
Further work will be required to begin to model and Workplace health • High levels of absenteeism/ • Targeted workplace interventions • Improved employee health &
quantify the likely scale of the upside impacts of vision presenteeism • Enhanced wellness planning wellbeing
but the following table highlights the high level • Mental health costs £26bn & smoking • Reduced absenteeism &
benefits the vision will bringing a transformation in £8.7bn in lost productivity presenteeism
the scale and impact of improving population • Greater employee productivity
& engagement
wellbeing and in turn making a meaningful
impact on the prevention challenge.
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Impact of the vision on early detection
Early Detection Current situation How the vision addresses this Likely impact of vision
The other major side of prevention is early detection Domain
of disease. Toda s s mptomatic and reactive model
of medicine means that disease is often quite Risk Factor • Variable levels of take up • Continual always-on • Greater penetration of
advanced and more difficult to treat or cure when Screening • Inconvenient to attend & expensive to measurement population
deliver • Passive monitoring lowers cost & • Richer models of risk
people finally consult a physician for a symptomatic
• Lack of actionable follow up to address inconvenience stratification
medical issue. risk factors • Includes biomarkers that detect • Greater understanding of causal
Pushing disease upstream to the earliest possible point pathogens or precursors to factors & processes
offers the chance to radically alter the downstream chronic disease • Greater understanding of
• Includes behavioural, social & longitudinal disease models
disease probabilities of individuals and collectively
environmental factors • Greater ability to track infectious
transform the burden of disease needed to be disease & possible pandemics
supported by a future care system.
Early intervention • Limited opportunities to detect & make • AI powered algorithms spot early • Earlier & more effective clinical
The advances in everyday precision medicine, medical to cure or delay early stage interventions stage issues & identify best & behavioural interventions
technology and AI anticipated in the vision offer the onset of disease • Limited effectiveness of behavioural interventions • Improved quality of life
chance to radically change disease detection and interventions • Coaching based interventions • Significant reductions/ delays in
hence the economics of care. New gene based e ali ed e g al onset of chronic disease
therapies and protein targeting biologics open preferences • Significant savings in costs & use
the possibilities for an increasing range of disease of health resources
markers leading to a growing proportion of chronic
diseases being either prevented or cured at an
early stage.
The cumulative impact of this early detection and
treatment offers the possibility of progressively
reducing the burden of chronic disease across the
population leading to significant reductions in
treatments and downstream costs of care.
The combination of the arrival of these new diagnostic
capabilities and treatments combined with gaining
public acceptance to engage has the potential to
radically change the balance of chronic disease
and hence the sustainability of the wider care
system in the UK.
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Impact of the vision on management of disease
3. Management of disease
Disease Current situation How the vision addresses this Likely impact of vision
The digital health coach envisaged in the vision will Management
provide always-on person centred support across the Domain
end to end diagnostic and treatment pathway as well
as providing holistic coaching to empower individuals Symptomatic • De e de ce D G gle • Ready access to expert knowledge • More reassured public
support & • Long waits to get GP appointments • Health coach mediated triage & • Fewer unnecessary HCP visits
to make the changes necessary to live and manage
escalations • Over-use of A&E for non urgent issues escalations • Less unnecessary use of A&E
with disease.
Diagnosis • Expert knowledge + intuition • Expert holistic decision support • More accurate diagnoses
The ability to monitor ongoing health will enable • Siloed & organ based diagnoses • Continually updated • Less misdiagnosis
expert triaged support for health queries and • New knowledge is rapidly appearing • Ba ed e da a
symptomatic explanations as well as improving early
stage diagnosis or possible onset of complications or Treatment & • Siloed treatment & care support • Integrated holistic care planning & • Improved adherence & outcomes
co-morbidities. This will significantly reduce holistic care • Duplication of tests & inefficiencies support • More efficient use of resources
support • Poor adherence & outcomes • Optimised testing • Reduced unwarranted variations
unnecessary contact with HCPs and provide
a better experience. Patient support & • Poor visibility of patient status & • Always-on monitoring including • Improved patient support
monitoring progress notifications for interventions • Reduced adverse events
The ability to receive holistic support for all clinical,
care and life management related issues will Self management • Poor overall levels of self management • Always-on coaching support • Improved patient empowerment
consolidate, personalise and contextualise support in • Signposting to community • Improved health outcomes
an ongoing dialogue which will serve to improve resources & support groups
disease management and enable next generation care Life adjustment • Many people struggle to adapt their • Holistic coaching support for non • Greater adherence
teams to collaborate more effectively, improve support lives to the demands of their disease clinical aspects of disease • Improved health outcomes
outcomes and reduce fragmentation and
unwarranted variations in care. HCP appointment • Multiple appointments • Triaged support with real or • No unnecessary appointments
management • Inconvenient & time consuming virtual access to HCP team • Access to hospital by exception
The ability to maintain an ongoing health coaching
Clinical tests & • Long waits for tests • Polyclinic scans & point of care • Faster scans & tests
dialogue with HCPs and care teams through virtual or
interventions • Inconvenient locations testing • Greater convenience
face to face interactions and undertake specific
additional diagnostic tests in community care settings Mental health • Lack of capacity & resources to • Coach based CBT & mindfulness • Greater access to care
will improve health outcomes and reduce the costs, address demand & deliver therapy • Triaged support & escalations • Improved health outcomes
response times and administration of care support. Step down care & • Fixed term treatments leading to poor • Ongoing coach support for • Reduced readmissions
For people struggling with mental health issues access rehabilitation step down care options continuous step down support • Improved rates of recovery
to continual therapeutic support from the digital health
coach as well as specialist support for particular
mental health conditions will augment specialist mental
health treatment as well as providing long term
support to help prevent recurrence and relapse.
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Impact of the vision on social care, assisted living & residential care
4. Assisted independent living & residential care
Social & end of life Current situation How the vision addresses this Likely impact of vision
In addition to holistic support for management of care
disease the virtual health coach will use access to
sensors and, in the future, care robotics to extend care Specialist social & • Constrained resources & capacity • Holistic always-on specialist • Greater empowerment & self
support to include a broader range of monitoring and community care • Specialist care often siloed coaching support management
• Episodic transactions unable to address • Notifications for escalations • Improved care outcomes
care support functions. Digital wellbeing support will
continuous support needs • Triaged access to specialist • Improved control & reduction in
enable greater access and interaction with family support suffering, problems & crises
members, community based activities and access to • Dynamic signposting to
social groups and communities of interests thereby community resources
reducing the risks of depression and social isolation.
Maintaining • Preference to remain independent • Always-on monitoring of health + • Improved wellbeing, quality of
Continuous observational monitoring and care support Independent living • Greater levels of isolation Activities of Daily Living (ADLs) life & social connectedness
will enable individuals to receive support and • Frailty & loss of function drive • Always-on virtual & robotic carer • Extended independent living
coaching for daily tasks and self care that are made increasing risks support • Reduced demand on social &
more difficult due to loss of physical or cognitive • Access to remote services e.g. residential care resources
function. This will both help sustain independent living online shopping & pharmacies • Improved carer support & carer
• Triaged escalations to support wellbeing
for as long as possible as well as provide ongoing
• Signposting to community &
visibility and remote support access for professional social resources
carers, physicians and family members. This should • Carer & family support
significantly improve care support and enable
resources to be more effectively and efficiently Care home support • Poor levels of health monitoring & • Always-on monitoring of health & • Improved wellbeing & quality of
targeted. support ADLs shared with HCPs life
• Low stimulation environment • Virtual carer support & access to • Improved disease management
Taking the digital health coach into a residential care • Low levels of personal wellbeing & high personalised content & interests
context will enable a continuity of medical and levels of depression • Communications & sharing with
wellbeing support that can be augmented through family, friends & communities
integration into residential care sensor systems and End of life & • Loss of function & capacity • Always-on monitoring of health & • Improved quality of experience
support processes. palliative care • Higher levels of fear & anxiety key functions • Reduced suffering and anxiety
• Higher levels of discomfort & suffering • Personalised medication & • Improved and more targeted
The ability for continual health and care monitoring
• High levels of medication to manage treatment tailored to preferences treatment
linked to health and wellbeing support offers the symptoms • Improved communications & • More informed families and
chance to provide greater quality of care and sharing with family & friends carers
maintain quality and dignity of life through the end
of life process. This will enable much greater Carer support • High levels of stress & anxiety • Health monitoring & personalised • Improved wellbeing of carers
coordination and targeting of health and care • Lack of time & attention to personal coaching support for carers • Early access to carer support
wellbeing • Remote monitoring services for when required
resources that in turn should reduce costs and
• Low levels or respite carers
improve both efficiency and effectiveness.
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Economics of Impact of vision Precision medicine Technology & AI Emerging Medtech
ill health on drivers of cost Emerging models of care reasons to believe reasons to believe reasons to believe
Emerging models of care models b) Population health Intermountain c) Integrated social care coaching Buurtzorg
Across the world many health systems and providers Intermountain is a large non-profit health system Buurtzorg provides care in the neighbourhood and offers
are exploring and experimenting with numerous new operating across Utah and Idaho, views the an innovative approach in the Netherlands to deliver home
models of care to address the challenges of chronic communities it serves as its shareholders, and its care. Buurtzorg originated from noted gaps between (a)
disease across primary, secondary and social care purpose to maximize value for them through delivery needs of the client and care and support delivered by usual
settings. These models seek to go beyond traditional of high-value care. They realized there was a big home care, (b) competencies of the staff and the care
clinical models of care to investigate more holistic disconnect between what patients valued and what delivered, and (c) care and support delivered by home
approaches. Many of these models are yielding they were paid to deliver. To repair it, they analysed care and care by other organisations and professionals.
impressive results and provide valuable insights more than 1,400 care processes to determine those
having the biggest impact on the most patients. To deal with the first gap, Buurtzorg built in a holistic
as to what is possible through more innovative
assessment of client s needs, which includes medical needs,
approaches to care delivery. Then they spent over a decade building systems to LTC needs and personal/social needs. Aside from primary
a) Community health coaching IORA health capture the right data to manage and continually nursing care, the individual care plan provides information
improve these reducing unwarranted variation in care that will support the client in his/her social roles and in
Boston based Iora operates 37 practices servicing pathways & improving efficiency, speed and quality. taking up self-care and becoming more independent.
over 40,000 people across 11 states. Iora operates a Intermountain took another strategic leap in 2014 to
disruptive primary care health coaching service that extend its capabilities beyond traditional acute care The second gap seems to be bridged by self-managing
uses relatively inexpensive, non-physician health delivery and into the realm of population health teams of up to 12 people which allows for a better use of
coaches alongside GPs to identif patients unhealth management. staff s competence and for taking responsibilit for a
habits and life styles and guide them toward better greater diversity of care tasks. To deal with the third gap,
choices, before health problems arise or become At the outset this entailed a new mission, Helping the network of informal care of the client is being mapped
serious. Iora trains health coaches to become the people live the healthiest lives possible, and a and involved in the care. In addition, the formal carers are
consumer s advocate and works with the patient and comprehensive effort to shift the organizational culture identified and included. Finally, Buurtzorg has initiated new
the physician to on their agreed health goals and from a narrow focus on care quality and cost to a teams for social support ( Buurtdiensten ), based on the
their plans to achieve them. broader focus on long-term health and care same principles as its home care. In locations where such
affordability. Using a capitated payment model it has sister-activities exist, it is possible to bridge the gap
Iora teams keep track on how their people in their now changed its governance model & care processes between various kinds of services more easily.
care are progressing against their life and health away from a purely transactional targets model to
goals. A 4 tier worr score is used to identif and enable them to focus on population health outcomes Buurtzog reports high levels of satisfaction from its clients as
prioritise those who seem to be struggling most, enabling resources to be reconfigured to provide well as its workers. PWC estimate that the overall costs of
enabling the health coaches to proactively reach out more robust preventative and chronic disease the Buurtzog system at 50% less that traditional home care
and provide support to those who need it most. Early management capabilities. while delivering a superior service and quality of life for
results indicate that inpatient visits decreased by 50%, its clients. Many health and care systems around the world
emergency department visits decreased by 20%, are now looking to embrace the Buurtzog system including
and the total medical spend declined by 12%. NHS Scotland.
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d) Vertically integrated care Kaiser Permanente Precision medicine reasons to believe Companies such as IcarbonX in China are now actively
(KP) heavil investing in leading companies such as patients like
a) Systems biology
KP is based in California and has almost 10m users me across the precision medicine spectrum with a view to
Accelerating progress is being made in the building giant rich data sets from which to apply machine
and is focused on delivering an integrated care model
understanding the fundamental genetic and learning to gather new insights in the nature of wellness,
focused on chronic disease and multi-speciality care
biomolecular processes that underpin biology of sickness and the management of disease at a population
rather than a traditional primary and secondary care.
complex systems such as the human body. More level. The race is on to gather data assets in order to play
KP focus on a 4 level risk stratification model with the
precision based tools and techniques are enabling us a leading role in the next generation of medicine.
core components being on prevention, self-
to see deep into cells and understand the process and
management support, disease management and case b) Precision medicine
language of protein based gene expression and the
management for members. Case management involves
networks of communication and coordination that lead The sequencing of the Human Genome in 2003 and the
integrated multi disciplinary teams working together to
to larger cellular and tissue based structures. subsequent explosion in genetic biology is now being
proactively manage those members with multiple
conditions and high risk of hospital admissions. exponentially accelerated by the availability of new
The emerging understanding of the human body as a
technologies, higher computing power and machine learning.
complex adaptive system impacted by both genetic
This vertical and horizontal integrated model enables Rapid advances are already being made that reveal the
and environmental factors is leading a revolution in
a more holistic approach to population health. All trajectory of progress in many areas over the next 10-15
thinking about health and medicine. Systems biology
entities within the KP group are mutually accountable years. Gene sequencing, gene editing, gene synthesis and
and systems or precision based medicine are now
for a patient s outcomes and positive patient synthetic biology capabilities are set to develop at a
appearing as serious scientific disciplines that
experience and provider incentives are linked to dramatic rate enabling radical new possibilities. Over of
challenge the orthodox specialty based model of
quality of care and patient satisfaction. 50% of cancer treatments in development are based on
medicine. President Obama announced the US
In this regard an episode of acute hospital admission targeted molecular biology therapies.
precision medicine initiative in 2015 dedicating
or readmission is seen as failure of the entire system. significant resources to making the US a leader As epigenetics becomes better understood and the role of
Active management of patients in hospitals is ensured in this emerging field. DNA to RNA to protein processes become clearer a number
through clearly defined and evidence based clinical of advanced therapies are already being developed that
Leroy Hood at the Institute of Systems Biology has
pathways and protocols. In doing so he KP model is target a growing range of messaging & transcription
been a particularly strong champion for a more holistic
allowing the efficient use of human resources and pathways. These range from synthetic antibodies to
approach to systems medicine entitle P4 Medicine.
seamless transitions of care between settings all customised protein capture reagents and molecular based
This advocates viewing the future of health as being
supported by an extensive KP Connect integrated hacking of the biomolecular communications pathways.
Predictive, Preventative, Personalised and
patient records and IT system.
Participatory powered by the insight gained
by the generation of personal data clouds.
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c) Gene sequencing The ability to lower costs and rapidly sequence DNA d) Gene synthesis & editing
is opening up new possibilities for early detection and
It cost $3bn for the original human gene project to As the human genome is analysed and the role of individual
identification of other DNA bearing pathogens and
sequence the 3bn base pairs that form the human genes or gene sequences progressively revealed the
early stage cancer cells. Grail is a spin out from
genome. Veritas Genetics now charge $999 now offer opportunit for correcting for undesirable or harmful
Illumina has already raised $1bn from Jeff Bezos &
for entire sequencing whilst the world leader in genes is revealed. Gene synthesis and editing are rapidly
Bill Gates and several pharmaceutical company
genome sequencing platforms Illumina has committed growing fields where advanced gene editing techniques are
investors. Grail is claiming that by 2022-24 a simple
to delivering a new sequencing platform capable of evolving and individual genetic base pairs and larger gene
blood sample (liquid biopsy) will enable its technology
delivering a fully sequenced human genome for $100 fragments (oligos) can be created for insertion. CRISPR
to detect any form of cancer. Tiny traces of any early
by the beginning of 2018. Sequencing the genome of CAS9 has provided a precise tool for gene splicing and
stage cancer tumour s DNA will appear in blood
the whole population will soon be economically viable replacement with new segments. The recently announced
stream so by sequencing all nucleic acid in blood
as costs continue to tumble over the next few years. Base editing or CRISPR 2.0 breakthrough enables a single
stream an potential earl stage 0 cancer can be
The cost reduction improvements in gene sequencing letter to be replaced without cutting the DNA.
detected. Grail also believe that the unique DNA
capabilities are known as the Carlson curve and this
signature of any early stage cancer cell will indicate Given the fundamental importance of genetic medicine for
is predicting dramatic improvements way in excess of
where the tumour is located thus enabling targeted the 21st Centur , man of the world s leading geneticists
Moore s Law which as seen the doubling of
therapies to be applied. have come together under the leadership of George Church
computing power every 18 months.
The interest of the public in DNA sequencing goes to create a follow on from the Human Genome project
Incredible advances in microfluidics, electronic entitled Genome Project Write or GPWrite . This is an
beyond disease detection and addresses wider levels
technologies and robotics will continue to drive down open, international research project led by a multi-
of curiosity in questions of origin, disease risk and
costs and open up low cost sequencing to more disciplinary group of scientific leaders who will oversee a
optimising levels of wellbeing, Ancestry.com, 23&Me,
pla ers. Biological advances such as sequencing b the grand challenge of delivering a more than 1,000 fold
Evergreen Life and a range of other wellness
s nthesis (Next Generation sequencing) use biological reduction in the costs of engineering and testing large
companies are already offering very low prices to
processes enabling further increases of speed and genomes in cell lines by 2026. Part of the aims of GPWrite
entice people to find about more about their genetic
lowering of costs. It is widely expected that within are to also enable scientists to understand more deeply
heritage, disease risks or to provide a range of diet,
2years there will be a range of health industry brands the opportunities and risks surrounding gene development
exercise and beaut treatments personalised to our
and companies that will be offering genome so as to stimulate and participate more actively in the
genome .
sequencing for free as the cost will be so low it important discussions around the future potential uses
will be seen as something to be written off as of this technology.
a cost of sale in order to gain data to support
a wellbeing or health offering. The chemical process of creating the nucleotides and base
pairs that are the building blocks of the genome is well
known. Constructing more complex gene fragments
comprising of multiple oligos of e.g. 50,000 base pairs
is more complex, expensive and liable to errors. This is
the level required for creating basic enzymes. Bacteria
have around 5m base pairs and are still out of reach for
toda s technologies.
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Twist Bioscience have raised $100m from investors Future of technology reasons to believe Meta One of the leading players in AR/VR is Meta
and offer s nthesis as a service to labs and pharma who have recently launched their new AR/VR headset
companies looking to synthesise new gene fragments. Technology continues to advance at an accelerating the Meta 2 for $950. The creation of 3D objects
Twist use massively parallel robotic processes to rate. Computing performance will continue to improve instead of a 2D screen opens up new possibilities for
create and link sequences of base pairs to create and become more miniaturised while new networking interacting with information and ideas. Meta aspire to
larger oligos and gene fragments. This approach of technologies such as next generation 5G networks will a zero learning curve to interact with notifications or
offering synthesis as a service will rapidly accelerate enable greater bandwidth and lower latency opening 3D objects that will appear in the field of view or be
access to new gene synthesis capabilities and hence up exponential levels of connectivity between objects set in constructed virtual worlds.
the development of the genetic science industry. and systems that will power a new era of intelligent
automation. New technologies are already now Instead of learning a user interface based on menus
e) 3D printing of genes appearing that reveal the trends outline earlier in the and screens to access or manipulate information
report and are already underway and are destined Meta s headsets enable people to reach out with their
New techniques based on 3D printing at the molecular
to have a profound impact on realising the vision. hands to grab and manipulate objects or information.
level are expected to open up new possibilities for
Within 5 years they expect existing headsets will
design and print services for gene s nthesis. a) AR/VR evolve to be barely noticeable rimless glasses
Autodesk already offer Computer CAD packages to
design gene fragments complete with gene libraries to The ability to augment cognition with a layer of meta Already Ikea has an app that enables you to hold up
assist in rapid gene design and synthesis projects. information about the real world embedded an a smartphone camera in your own home and see on
Further out research is now being done on how the cells individual s field of view will have a profound impact screen what it would look like to have a selected piece
on process of gene replication through the use of on how people engage with the world around them. of furniture appear on the screen as though it existed
special pol merase based processes. Nature s wa of The ability of HCPs to integrate data and decision in reality. Apple. Facebook and Google have all
unravelling the double helix and coping DNA strands is support guidance directly into their engagements with invested heavily in making their platforms AR ready
incredibly fast and efficient with an almost zero error citizens for example will enable encounters to become so a significant expansion in AR applications and
rate for a 3billion base pair human genome. more human centred and less about checking screens use cases is expected to appear throughout 2018
and files to obtain relevant information. and beyond.
Looking further ahead in 10-15 year period the
abilit to create programmable pol merase holds The principle opportunities will be around increased b) Recognition systems
the prospect of designing and creating new complex productivity & quality via access to timely and relative
information. Use cases will extend to the ability to The major tech companies such as Amazon, Google,
genetic systems or organisms. This could render some
visualise anatomy in teaching, enable patients to see Microsoft, Apple and Baidu all developing AI powered
gene editing tools obsolete as printing exact genomes
inside their own bodies and enabling both people software to recognise voice, video, images and the
will become a viable alternative. Personalised genetic
and HCPs to use 3D models and virtual worlds for semantic understanding of text. These are being made
treatments would therefore require less gene editing
sharing ideas. available via APIs as building blocks that anyone can
and instead involve the genetic substitution of new
use to build their own applications and services.
genes designed from the ground up.
Already these capabilities are being used in apps to
recognise things such as medicines, skin lesions etc as
well as facial and gesture recognition.
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Google Deepmind, IBM Watson and Microsoft c) AI, Machine learning & Deep learning AI that can transfer learning in one domain and apply it
amongst others are all building image scanning and another as well as manage AI meta learning across multiple
Machine learning, deep learning and AI have been
diagnostic tools that use machine learning to train domains is now being developed as the world s leading AI
around for a couple of decades but it is only now that
algorithms via training data sets to recognise and developers compete in a global arms race to build the
a combination of increasing computing power, larger
diagnose a range of scanned images for conditions world s first Artificial General Intelligence (AGI).
data sets and improved algorithms that the field is
ranging from diabetic retinopathy and Xray bone
undergoing an exponential explosion in investment Benefits to healthcare will come in scaling value from
fractures to cancers. These technologies will rapidly
and development. 3 ears ago AI couldn t recognise narrow tasks to end to end intelligent automation of
develop with libraries of new radiological and
an image of a dog and now it can recognise every healthcare processes and pathways e.g. as tool for
pathology based diagnostic targets that will at first
sub species better than humans. Gartner expect the radiologist image diagnostic support to one that can
assist HCPs but in the future increasingly replace
total AI market to become a massive $25trn market manage case load prioritisation based on scanned images
them as their accuracy rates start to far exceed
by 2025. to eventually automated diagnosis & treatment plan
human capabilities.
The use of deep learning neural networks with recommendations for all incoming patient referrals.
Deepmind is already working with ability to recognise For citizens the ability to used AI based point solutions such
techniques that reward or punish the algorithm such as
and identify diabetic retinopathy at Moorfields Eye as smartphone apps for diagnosing skin conditions and
back propagation machine learning algorithms will
hospital and cancer at UCL as part of a wider primary care triage services such as Bablyon (currently
increasingly learn to code themselves. This means that
programme to create new and more accurate AI being trialled in North London) will develop to include
the future paradigm of software will be less computer
powered diagnostic scanning tools. Zebra Medical ongoing health and wellbeing monitoring and eventually
coders hardwiring code to one where the models are
Vision is now offering a worldwide medical imaging more complete virtual health coaching outlined in the vision.
developed that learn and adapt to deliver the goals
diagnostics service based on its deep learning image
that are set for them. In 2017 Google Deepmind Enlitic is using AI to improve decision support for HCPs.
scanning & diagnostics algorithms. It charges $1 per
successivel defeated the world s leading pla er of Using deep learning technology Enlitic incorporates a wide
scan and currently covers diagnostics for breast
Go using a trained algorithm called AlphaGo in a feat range of unstructured medical data, including radiology
cancer, lung cancer, brain trauma, hypertension with
thought impossible only a couple of years ago. More and pathology images, laboratory results such as blood
many more conditions in the pipeline. Its diagnostic
recently an updated version called AlpaGo plus was tests and EKGs, genomics, patient histories, and electronic
tools are able to be integrated into PACS and RIS
developed that had no knowledge and was given no health records (EHRs). This richness allows higher accuracy
making it compatible with existing radiologist
training data sets. and deeper insights for every patient that empowers HCPs
workflow systems. Its already installed in over 50
hospitals and undertaken over a 1m patient scans. in the diagnoses and care decisions.
AlphaGo plus was given the task of playing against a
The ability to automatically understand human version of itself and within a couple of days had
communication will create profound new opportunities developed a competence at Go that was beyond
for managing patient encounters and improving the human level performance as well as able to defeat the
flow of both inpatient and outpatient pathways. New original AlphaGo. Left to run a bit longer it developed
forms of ID management, security presence detection new original knowledge about how to play the game
as well as the ability to 3D map physical environments that no human in 10,000 years of playing the game
and track human action and conversation will enable had developed. This important breakthrough shows
much greater levels of intelligent automation of patient how AI based systems are becoming much more
registration, care pathway planning and tracking. efficient and being refined to use less training data.
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As AI develops further and becomes more integrated This type of leap forward in computing could one day DNA-SEQ is a scientific task force based out of California
into the fabric of care delivery so new types of ethical shorten the time to discovery for life-saving cancer that provides reports to oncologists to more precisely match
and accountability challenges will arise. How will self drugs to a fraction of what it is today; unlock new the patient s genomic profile with targeted therapies.
authorising algorithms evolve in ways that respect facets of artificial intelligence by vastly accelerating The report is designed to both enhance the oncologist s
human preferences, contexts and dignity? And how machine learning; or safeguard cloud computing traditional cancer treatment decisions and to dramatically
will we hold algorithms accountable in the event of systems to be impregnable from cyber-attack. expand the treatment options that can be offered to the
mistakes or issues? The black box nature of self writing patient. The precision of DNA-Seq s process is delivered
IBM, Google and Rigetti are all working on a more
algorithms mean that accountability and underlying by the focus on crystallography as the optimal methodology
difficult et powerful universal or Gate model of
decision making will need to have the necessary to pin point the position of the cancerous mutation within a
quantum computing. IBM already has a 20 Qubit
levels of transparency. three-dimensional structure. DNA-SEQ s cr stal structure
model and both IBM and Google have announced
screen provides unmatched precision for matching a drug
d) Quantum computing 50Qubit models and hope to show a demonstration
to a mutation. DNA-SEQ uses a combination of machine
of Quantum supremacy over traditional computing
Quantum computing represents a paradigm shift in learning on D-Wave s quantum computing to assist in
by 2018. The power of quantum computing scales
computing as it enables digital coding to go beyond identifying and accelerating the process of cancer
exponentially with the addition of more Qubits.
the binary 0 and 1 (a bit) to include computation diagnosis and drug discovery at the molecular level.
A quantum computer of 2000 Qubits will be more
based on 4 possibilities (a qubit). Many important
powerful than if all the mass of the universe was built
computational problems will only be solved by
into the world s most powerful computer. The medium
building quantum computers due to the complexity
to long term future of quantum computing is set to
of computations required. Quantum computers could
bring revolutionary power to the AI challenges of
dramatically extend our abilities to simulate the
the complex adaptive systems embedded in
structure and properties of molecules, including how
individual and population health.
chemicals, drugs, and hormones interact with the
human body. Through large scale analytics and Another more restricted yet simpler form of quantum
machine learning, they can help shed light on gene computing is called Annealing. The Canadian company
expression, and how specific mutations emerge to D-Wave is leading the way and has doubled its
clinical relevance. Qubits every year since its inception and has now
released a 2,000 Qubit computer now being used
Deep learning is a filtering process that reduces the
by NASA, Google and a number of molecular
available search space of possibilities through
researchers. One of these medical customers
continuous learning. Everything is therefore treated
is DNA-SEQ.
as a probability distribution. A universal quantum
computer uses quantum mechanics to process massive
amounts of data and perform computations in
powerful new wa s not possible with toda s
conventional computers.
154
Future of Medtech reasons to believe Molecular Warehouse is a UK based start up
receiving support form Innovate UK. Molecular c) 3D printing
New breakthroughs in medical technology and point Warehouse have built a miniaturised molecular bio- Huge breakthroughs in the miniaturising and precision
of care diagnostics are demonstrating that from micro- sensing platform that can be attached to a smart sophistication of print nozzles and the development of
biology to social care technology is enabling new, phone to remotely monitor the levels of drugs needed molecular and cellular inks are opening up new possibilities
lower cost and more precise procedures as well as to prevent organ rejection in transplant patients. It for 3D printing medicines, medical devices and even human
shifting the potential for advanced treatments out of intends to extend this to monitoring of dialysis patients. organs. These technologies have profound implications for
expensive clinical settings and towards the person. Other application areas under development include medication supply, organ replacement and pharmaceutical
These trends point to a transformational opportunities monitoring dialysis patients, diagnosis of acute testing.
to improve health and care outcomes and experiences pancreatitis, haemophilia and coagulation, chronic
but also have profound impact on the future design stress, vitamin D deficiency and prostate cancer. Aprecia Pharmaceuticals Spritam this is the first FDA
and operation of next generation care pathways. approved 3D printed drug used in the treatment in
b) Enhanced diagnostics Epilepsy. 3D printed drugs offer new opportunities for
a) Biosensors
The miniaturisation of diagnostic devices means that personalised doses as well the potential for drug
Breakthroughs in nanotechnologies, microfluidics and diagnostic procedures will increasingly be taken out preparation to occur in community care settings or
molecular assays are ushering a new suite of of expensive care settings to be delivered in eventuall in a person s own home
miniaturised technologies capable of rapidly testing community or patient settings. 3D4MD is a not for profit organisation building a library
multiple biomarkers. These are currentl in vivo or
Medtronic Pillcam This capsule based endoscopy of crowd sourced, quality tested medical solutions for
outside the bod but in vivo or internal biomarker
solution offers a low invasive alternative to traditional national, international and for use in space. The creation of
chips are now being worked upon
endoscopy/ colonoscopy for investigating potential low cost medical supplies and assistive technologies on
SomaLogic s SOMAscan assay platform is at the problems in the gastro intestinal tract. The latest location for treatment, disabilities or frailty changes the
forefront of the proteomics revolution. It is a highly version enables high quality images at 35 fps with economics and access to medical solutions. In remote
multiplexed, sensitive, quantitative, and reproducible over 340 degrees of visual field. The ability to locations portable 3D printers and the use of drones enable
proteomic tool for discovering previously undetected remove the need for sedation and specialist surgical specific equipment and supplies to be manufactured and
biomarkers for drug discovery, pre-clinical and clinical procedures makes this a low cost and accessible delivered to remote locations or the case of emergencies
drug development, and clinical diagnostics, across a alternative.
wide range of important diseases and conditions. Universidad Carlos III de Madrid has developed a 3D
The SOMAscan assay is capable of measuring 1,310 AliveCor Kardia Band Kardia Band for Apple watch bioprinter prototype capable of printing human skin and
protein analytes in only 150 µL of serum, plasma or is the world`s smallest medical-grade ECG. By are awaiting regulatory approval. 3D printed skin has
cerebrospinal fluid. touching the watch strap it is possible to track changes already been successfully transplanted onto mice and more
in heart rhythm anytime, anywhere to check for normal recently it was shown to be possible to implant ovaries into
or irregular heart rhythm or in possible Atrial mice using a 3D printed scaffold consisting of gelatin and
Fibrillation. Once captured on the watch it is possible cells. The ability to print more complex organs such as livers
to share medical-grade ECG readings with doctors
and kidneys is expected in the next 6 years heralding the
enabling the capture of potential symptoms as they
potential to create a radically more scalable and cheaper
arise.
alternative to traditional organ transplants.
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d) Medication management e) Wearables
f) Gamification
Breakthroughs in technologies for tracking medication The past few years has seen the rise of wearable
devices capable of measuring movement, sleep, stress Most behaviour change or medication management requires
are opening up new possibilities for managing and a growing range of physiological markers. The people to adopt new habits or routines that often prove
adherence and validating medication. Poor adherence evolution of smart watches, wrist bands and other difficult to adopt and sustain. The gaming industry has
is a key reason for accelerated deterioration of body sensors is continuing to grow as people become developed sophisticated techniques to draw people into
more interested in measuring and tracking various engaging challenges using a combination of approaches
chronic disease patients.
aspects of their health and wellbeing. New form such as laddered goals, variable rewards, building a sense
Abilify MyCite is a drug treatment for people factors are emerging that open up new passive means of mastery and social validation Some developers are
of measurement as well as introducing new interactive experimenting with using game mechanics to engage
suffering schizophrenia or psychotic episodes.
possibilities of engaging with real time body data. people in many of the difficult to engage areas across the
Obtaining sustainable adherence to medication is a health and wellness landscape.
common challenge. The FDA has just approved the Rotex electronic tattoo the Chinese company Rotex
has designed a soft and stretchy long lasting electronic Goalpost stop smoking app this app is part of a suite
Ablify McCite pill which includes an embedded sensor of services run by Melon Health and is targeted at helping
tattoo capable of being fixed to a discreet part of the
that digitally tracks if patients have ingested their skin to measure a broad range of physiological smokers to stop smoking using a 12 week programme.
medication. The system works by sending a message measures. These include real time ECG, SPO2, The service uses a CBT approach and has been designed
from the pill s sensor to a wearable patch. The patch respiration, hydration, temperature and blood as a 12 week game providing users challenges, rewards
pressure as well as gesture recognition and muscle and competitions to help make stop smoking less onerous
transmits the information to a mobile application so
control for measuring mobility and dexterity. and more fun.
that patients can track the ingestion of the medication
The ability to fix a sensor on the skin that can Akili Interactive Labs Project Evo is seeking FDA
on their smart phone. Patients can also permit their passively record and transmit health & mobility approval for a new generation of videogames designed
caregivers and physician to access the information data to a smartphone or tablet for onward sharing specifically to stimulate particular parts of the brain to offer
through a web-based portal. with a HCP or carer opens up new possibilities for a radical alternative to drug based therapies for diseases
health monitoring. or conditions that impair cognitive function. The first game
Medtronic s MiniMed artificial pancreas is the
LifeBeam Vi Earbuds this is an example of a new targeted at children with ADHD and is comprised of three
first FDA approved closed loop system that combines
form factor of wearables termed hearables . This tasks: perceptual discrimination, visio-motor tracking and
an insulin pump and continuous glucose monitoring into
product combines earphones with biosensors, multitasking ability. Each task is performed simultaneously
the same platform for adults with Type 1 diabetes.
gyroscopes and an AI powered health coach. Its during the game, and Project Evo uses adaptive algorithms
The automated adjustment of insulin based on blood
current version is able to measure heart rate and track to assess differences in cognitive ability as a result of
sugar measurements taken every 5 minutes help
exercise routines combined with a voice controlled gameplay and has showed promising results.
dynamically adjust insulin levels. The ability to
dynamically adjust insulin levels offers the hope for health coach capable of providing coaching Akili is developing a range of different video game based
many diabetes sufferers to live a more normal life instructions through the earbuds. The ability to interact treatments for Multiple Sclerosis, Major Depressive Disorder
instead of being imprisoned in a strict regimen of via natural language with a discreet AI powered and Parkinsons. Further in the future Virtual Reality games
dietary restrictions. coach in our ear opens up man new possibilities offer the potential to provide elderly or patients with
for the future. mobility requirements with immersive experiences that
will involve stimulating gestures and movements aimed
at improving physical function.
156
g) Social care & assisted living
The rise of smart homes, robotics and connected
sensors offer growing opportunities to provide
advanced monitoring and support solutions for seniors
and those with conditions that impair their ability to
care for themselves. These offer solutions for HCPs,
social carers and family members to ensure individuals
are ok, detect early warning signs or be notified of
the need for immediate interventions.
3rings home monitoring 3rings works with a range of
sensors to act as a dashboard and integrated system
for passively monitor daily routines. Sensors include
door security, use of appliances, motion detection,
temperature, emergency panic button as well as
integration into Amazon Alexa for spoken requests to
find out how the person is. This type of solution will be
expanded to add a wider range of sensors and more
sophisticated machine learning algorithms to monitor
a wider range of Activities of Daily Living (ADL).
Care-O-bot Robot this is a German designed mobile
robot assistant capable of supporting humans in
domestic environments. It is being used in assisted
living facilities and is able to ferry food and drinks to
residents from the kitchen as well retrieve items
through its ability to navigate unaided. With an inbuilt
screen and video camera it is able to support to video
communication, provide medication and reminders,
provide entertainment and memory games as well as
detecting falls and triggering emergency responses.
The development of machine learning and greater
capabilities is likely to result in more extensive use
of robots in domestic care situations in the future.
157
Appendix 4: References
References have been broken down into the following sections:
An extensive number of resources were used in the Chapter 1 - Introduction and scene setting
preparation of this report. These range widely across multiple • NHS Past and Present
disciplines to include academic papers, research reports, • Public Health and Social Care
media commentary, books as well as videos and podcasts Chapter 2 - Mega Trends
from leading scientists and social commentators. • Future Society
• Systems Biology
These perspectives and insights added to the previous
• Precision Medicine
experience and knowledge the authors have accumulated
• Medtech
from previous innovation projects in healthcare as well work
• Data and AI
undertaken across the private sector on the transformational
opportunities of new technology. • Psychology of Health
• Public Health and Social Care
Chapter 3 Long term Vision
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