This morning, The Topol Review was announced, detailing how we should prepare the NHS clinical workforce to deliver healthcare’s digital future. Led by California-based cardiologist, geneticist, and digital medicine researcher, Dr Eric Topol, the review has been long anticipated. Early last year, in a draft workforce strategy, Health Education England (HEE), who look after the education, training and future planning of our NHS workforce, told us that this review would inform us of changes to selection, curricula, education, training, development and life-long learning (naturally, technology is such a huge factor, it demanded its own report). So the question is: has it done that?
There is no doubt that the review has been widely welcomed. Across social media, Royal Colleges, healthtech startups, policy leaders are all praising its sentiments, and who wouldn’t? These recommendations support the aims of the NHS Long-Term Plan and the workforce implementation plan, helping to ensure a sustainable NHS with a tech-enabled, patient-centered, ethical and more efficient future. Technologies including augmented reality, virtual reality, natural language processing, artificial intelligence and robotics are finally talked of, with what finally sounds like acceptance. Can we get excited?
The Review advises on a few key aspects:
1. How technological and other developments (including genomics, artificial intelligence, digital medicine and robotics) are likely to change the roles and functions of clinical staff in all professions over the next two decades to ensure safer, more productive, more effective and more personal care for patients.
Sensibly, as we often advise startups, the focus is on patient-benefit as the central driving criterion, rather than just development and integration of technology for technology’s sake. Furthermore, a vision of AI that enables a workforce to focus on real human-human interaction and care, is as heart-warming as it is essential. As a junior doctor, I struggled daily with the feeling of being spread too thinly and not delivering a standard of care that I desperately wanted to. By setting these goalposts, Topol has provided a vision for how technology could and should be used to address the multitude of problems that affect patients and staff every day; from improving patient experience and financial efficiency to reducing clinician burnout.
Crucially, Topol has also addressed how specific technologies should be handled. Dr. Chris Whittle, founder and CEO of digital health company Q doctor, explains:
Rightly so, the Topol Review calls for ‘robust, resilient, reliable and effective systems for providing trustworthy and evidence-based guarantees of the safety of digital healthcare technologies.’ Even for something as straightforward as telemedicine, there is a lack of robust clinical approach out there – something we have worked at hard at developing.”
2. The implications of these changes for the skills required by the professionals filling these roles.
Interestingly, HEE’s previous draft report alluded to creating more generalist clinicians in a “modern, flexible workforce,” to cope with technology’s rapidly evolving abilities, but it appears this thinking has moved on, with Topol wanting to double-down on technical specialists able to create, work with and adopt new innovations. He goes one step further to even identify professions and sub-specialisms that may be particularly significant in future; for example, he calls for the NHS to attract a continuous pipeline of robotics engineers, data scientists, computer scientists and other technical specialists to create the new technological solutions necessary to improve care and productivity. There is also a call for more senior technology specialists at board level.
External ideas are absolutely critical to foster innovation, so for me, this recommendation must be realized. Topol calls for entrepreneur training programmes, accelerators and test-beds to be scaled up and even suggests that a ‘specialist workforce’ will be working at the very forefront of their disciplines, as early adopters of new technologies. This raises some interesting questions:
- Are these specialists the future go-to for entrepreneurs with new innovation?
- Are there going to be thousands more direct innovation pathways from referral to adoption via these specialists?
- Is this specialized workforce going to be trained in critical analysis of technology and SMEs?
- Will they be quick thinking, autonomous, decisive and safely able to manage more risk?
We won’t know the answers for a while, but if they can be made a reality, I believe these teams could be the difference between a forward-thinking department open to innovation and one with a fax machine still operational in 2050.
3. The consequences for the selection, curricula, education, training, development and lifelong learning of current and future NHS staff.
Quite simply, Topol wants more training around technology and who could really disagree? Patients, healthcare professionals and the future workforce are all covered and, sensibly, there is an acknowledgment of the practical difficulty in doing so when so many organizations would have to be involved.
But is desire or realization enough? We give similar advice to founders who have great ideas but lack the ability to implement them and execute quickly. This review pulls together an expanse of existing evidence and common-sense opinions but falls short at suggesting robust, practical steps for implementation. Topol has, arguably, made a series of recommendations about how the current structure could support change, rather than considering how to negate existing system blockers.
Additionally, given the speed of technology adoption in sectors outside of healthcare in just the last 5 years, the suggested timeframe for impactful workforce adoption of 2020-2040 is slow to say the least, and whilst automation is mentioned as helpful in the context of AI, there remains a question about how we practically select and train a workforce with functions that are likely to become increasingly automated throughout the course of their careers.
However, this is a reminder that this document is the beginning – it is the vision, with a layer of realism around the time-predictions that, for those with an astute eye, might raise more uncomfortable questions about the possibility and practicality of scaling new technology in the NHS without a full, unequivocal system reform.
Topol’s report is the North Star – setting out a clear vision for how an NHS workforce might transform the lives of patients and clinicians through successful innovation and adoption of new technologies. His recommendations will be now taken forward by a number of different organizations to drill down into practicalities; so it will be interesting to observe how the path is plotted and whether we retain our enthusiasm for his encouraging and inspiring words.
Regardless, Topol has given us a solid foundation on which to build practical plans to enable the NHS workforce to speed up its technology adoption. It is difficult balancing an inspiring future vision with realism and practicality, but for now, I’m allowing myself to be optimistic and the healthtech community seems to be with me.
Follow the reaction on Twitter at #TopolReview