The Topol Review: An inspiring vision but can it be realised?

Candace Imison admires the ambition of the recent Topol report on preparing the health care workforce to deliver a digital future, but argues we must acknowledge the significant challenges in its way.

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Published: 26/02/2019

“We are at a unique juncture in the history of medicine, with the convergence of genomics, biosensors, the electronic patient record and smartphone apps, all superimposed on a digital infrastructure, with artificial intelligence to make sense of the overwhelming amount of data created. This remarkably powerful set of information technologies provides the capacity to understand, from a medical standpoint, the uniqueness of each individual – and the promise to deliver healthcare on a far more rational, efficient and tailored basis.”

Dr Eric Topol, p6, Preparing the healthcare workforce to deliver the digital future

Dr Eric Topol, cardiologist and leading commentator on health care and technology, spent over a year with a range of experts exploring the impact that advances in digital health care technologies, genomics and artificial intelligence will have on the NHS workforce. The recent launch of his report for Health Education England, Preparing the healthcare workforce to deliver the digital future, was full of hope and inspiration.

A brave new, technologically enabled, future

Experts presented us with a dazzling array of technologies and their benefits. Dr Topol showed us ultrasound images of his body taken through his smartphone, including the kidney stone it had enabled him to spot. Speech recognition software, telemedicine, wearables and sensors for self-monitoring vital signs are all expected to become a routine of clinical practice.

The advances in genomics are far-reaching. While whole genome sequencing is a little way off, for less than £100 it is already possible to ascertain someone’s ‘polygenic risk score’ for many common diseases, including breast cancer. This score clearly raises many ethical issues, but could transform the cost effectiveness of screening and other prevention programmes, ensuring they are targeted at those at high risk, avoiding unnecessary tests and investigations for those at low risk.

Computer algorithms are already surpassing clinical experts in interpreting a range of digital images, including CT scans, mammograms and retinal scans. Artificial intelligence, especially when combined with genetic information, will be able to predict an individual’s risk of deterioration and likely response to treatment. Together, artificial intelligence and genomics will influence every aspect of medicine.

The review was also optimistic about the potential productivity that these new technologies could deliver over the next 10-20 years. Or, as the review framed it, “the gift of time”. It was keen to emphasise that clinical time released by new technologies should be invested in patients not in cash savings. 

The workforce implications are profound

As the presentations went on, the scale of the potential impact on the workforce unfolded. The cultural change and service transformation required are immense.  There will be a need for a whole new cadre of clinical and analytics staff to analyse and interpret the growing body of clinical and other data, and build the intelligent systems to drive service improvement. Dr Topol said in a later meeting that if he ran the NHS, his first investment would be in an AI (artificial intelligence) team.

Nearly all clinical staff will need to be able to interpret and communicate genomic findings, while nearly all staff will require some element of digital skills. Given that half the current workforce will still be working in 15 years’ time, as we underline in our forthcoming report on meeting the workforce challenge, this is a huge skilling and reskilling task for the NHS. Lifelong learning will not be a “nice to do”, but essential.

Will the vision be realised?

The review has 43 recommendations. It would be hard to argue with any of them, but they are not costed and (as far as we are aware) resourced, and frequently lack specificity. This is the point where the review sadly loses its credibility. It fails to acknowledge the significant challenges that the NHS is already facing in recruiting and training staff with digital skills – challenges we will highlight in another forthcoming report on achieving a digital NHS.

While Topol includes some local case studies, the lived reality of technology adoption in many hospitals, GPs and community settings feels a long way from the future described in the report. The review’s remit was constrained to implications for the workforce rather than the technological infrastructure, which was the focus of the 2016 Wachter Review. But there are risks to addressing these issues separately: the two are interdependent. Going forward the two streams of work need to be knitted together. The newly established NHSX needs to ensure it does this.

These deficiencies do not mean we should consign this report to our shelves. As the new chair of HEE Sir David Behan said at the report’s launch, it provides us with “the gift of inspiration”, a compelling vision of the opportunities offered by new technologies. A vision worth nurturing and working towards.

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