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The Future of Work in Health – Part 2

March 29, 2017

This is the second of three blogs leading up to a forum on the future of work in health. In this one, David Lye, Director and Fellow of SAMI, and a former Senior NHS Manager and Department of Health official, looks at the trends and factors that will drive change in the way that health and social care will need to work.

The story so far…

In his blog, David Smith, CEO of Global Futures and Foresight, put the world of health into the wider context of applied technology across the wider corporate world. He highlighted the rapid and accelerating changes taking place – noting the prediction that in ten years’ time, 75% of companies in the S&P 500 in will be ones that are not there now. More specifically to health, he noted the observation by Professor Nick Jennings of Imperial College that the rate at which medical knowledge is being generated is doubling every 18 months.

The STEEP Drivers of Change

Looking forward over the next 15-20 years, it is clear that rapid technological advances will drive significant change in the way that health and care services need to operate – and therefore the way that people work within those services, but there is more than technology at play here. Taking the STEEP (social, technological, environmental, economic and political) headings as a primer, we can see key drivers of change across all the headings.

Social

According to the Office for National Statistics, the population of the UK will grow from 64.6m in 2014 to 73.9m in 2039. The median age will rise from 40 to 43. One in 12 of the population will be aged 80 or over.

By 2040 we should be well on the way to being a “post-smoking” society, but there is rising incidence of obesity and its associated illnesses, such as diabetes. An aging population will have a range of different conditions (comorbidities). The over-80s will have a rising demand for social care among the ageing baby-boomers (of whom this author is one). Baby-boomers will be more vocal and demanding service users than their parents’ generation have been.

If there is great instability in the world of work, and greater job insecurity, we can expect a rise in the incidence of mental illness.

Generations X and Y will become the leaders of health care. Last year’s junior doctors’ strikes indicated they may bring a different attitude to their employment. And if Brexit leads to reductions in immigration, this will potentially affect the available pool of NHS and social care staffing. Currently the UK is neither self-sufficient in doctors or nurses. The UK needs 11,000 new doctors each year. UK medical schools train just 7,500.

Technological

Technological change is accelerating. In modern health care the pharmaceutical industry, and the suppliers of medical devices and equipment are joined by Google, whose Deep Mind is being piloted at Moorfields Eye Hospital in London and elsewhere, IBM, whose Watson is being piloted in healthcare around the world, including Alder Hey Children’s Hospital, and many other smaller innovators in IT and artificial intelligence.

Technology will allow quicker and more accurate diagnoses, more thorough scanning for potential drug interactions – important in a population with more comorbidities – and do the routine work of trawling through medical records and test results, quickly and effectively. In the private sector, Babylon is offering AI-based online consultations.

Alongside artificial intelligence, big data is getting bigger – the digital universe is doubling every two years. The ability to hold more data adds to the need for AI machines to mine it.

Robots are being deployed as care and nursing assistants in Japan, as porters in hospitals, and have been piloted within UK hospital pharmacies as far back as 2010.

These technologies empower the patient too. Implants and wearables – such as 24/7 blood sugar screening for people with diabetes, allow people to become partners in their own health care, rather than passive recipients of care. Not all will choose to do so, but the uptake of apps, fitbits etc suggests that most will.

Genetic advances have allowed personalised medicine, pre-diagnosis, targeted treatments for cancer, and gene splicing to address hereditary conditions. Nanotech will allow micro-invasive techniques for screening, diagnosis and treatment. Biotech is opening up the possibility of much-needed new anti-microbial treatments. And 3-D printing and robotics together are beginning to open up the prospect of exoskeletons. There is a constant wow factor on medical websites today as we look forward to a world in which the blind will see and the lame will walk.

Environmental

Advances in technology will change the way in which services can be delivered. People will welcome the chance to access services digitally.

More generally, the change in the infrastructure of urban and rural Britain will impact on health care. If drones can deliver pizzas and shoes, then why can’t they also deliver prescriptions? Will advances in renewable energy lead to better air quality – and thus improve the health of children and other vulnerable people?

On a global scale, might there be major effects of climate change that trigger major migrations? The continent with the fastest population growth in this century will be Africa. Mass-migrations are likely to be towards Europe. This would change the UK’s population figures, add to the pool of younger working-age people, and change the health profile of the population.

Economic

Aside from the economic news of today – Brexit, Trump, a growing sentiment against globalisation – the wider impact of the so-called 4th Industrial Revolution will be felt more and more. We have seen a shift in the balance between capital and labour, favouring “the few” relative to “the many”.

Whilst the changing demography of the UK will drive up demand for health and social care, the availability of public funding lies with the politicians. In this they will be influenced by tax revenues, which are in part, down to the state of the national economy, but also to the ability of the government to collect taxes.

The pressures are real, but the economic outlook is uncertain.

Political

Many of the pressures and drivers above will depend in part on political responses. For example the post-Brexit policy on immigration will affect the availability of staff, or force an increased investment in recruitment and education & training among UK citizens. Government will determine how much money it can afford to invest in health and social care, and the relative priority against other demands for public spending.

Government will use its influence to drive the pace of investment in new technologies and determine the legal framework in which new technologies, such as genetic sciences, are able to operate.

The Government should also recognise the potential strength of the UK as a clinical science and research base, which will be enhanced by the application of AI and big data to the national hospital episode statistical data – which is a unique global resource.

This very brief and high-level overview illustrates how much change is going to have an impact on the health care services that we know. In the final blog, we will start to identify some possible areas in which the world of work will change.

Written by David Lye, SAMI Fellow.

The views expressed are those of the author and not necessarily of SAMI Consulting.

If you enjoyed this blog from SAMI Consulting, the home of scenario planning, please sign up for our monthly newsletter at eSAMIsignup@samiconsulting.co.uk and/or browse our website at http://www.samiconsulting.co.uk

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