Letter to the Secretary of State for Health and Social Care

Dear Secretary of State,

It was a privilege to be asked to lead an independent review to advise on:

• how technological and other developments (including in 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;
• what the implications of these changes are for the skills required by the professionals filling these roles, identifying professions or sub-specialisms where these may be particularly significant;
• the consequences for the selection, curricula, education, training, development and lifelong learning of current and future National Health Service staff.

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.

From late 2017 to the present, our cross-disciplinary team of experts, including clinicians, educators, ethicists, computer scientists, engineers and economists, reviewed the available data and projected into the future what impact these technologies would have on the NHS workforce over the next two decades. Such an undertaking with experts from multiple disciplines and a country-wide perspective has not, to our knowledge, been undertaken previously.

The Review has been predicated on the following pre-suppositions:

1. The patient must be considered to be at the centre when assessing and implementing any new technologies.
2. There is remarkable potential for digital healthcare technologies to improve accuracy of diagnoses and treatments, the efficiency of care, and workflow for healthcare professionals, but implementation must only be carried out when there has been robust clinical validation.
3. Patients who are willing to take greater charge of their care using digital tools and algorithms will be empowered, but this should always be an opt-in choice for them.
4. A marked improvement in the patient-clinician relationship is possible, owing to the gift of time delivered by the introduction of these technologies. This will bring a new emphasis on the nurturing of the precious inter-human bond, based on trust, clinical presence, empathy and communication.
5. The new medicine as envisioned will require extensive education and training of the clinician workforce and the public, with cultivation of a cross-disciplinary approach that includes data scientists, computer scientists, engineers, bioinformaticians, in addition to the traditional mix of pharmacists, nurses and doctors.

There are, of course, considerable uncertainties in projecting anything, no less such a precious part of our lives – our health. There are three noteworthy changes that we expect to take hold: a much greater proportion of the population will have their genome sequenced; the empowerment of individuals who will increasingly be generating their own health data with the help of algorithms to interpret that data; and a marked improvement in the speed, accuracy and scalability of medical data interpretation afforded by artificial intelligence, which will provide robust support for all types of clinicians. Taken together, this will lead to an evolution of the patient-doctor relationship that we hope can be greatly strengthened, along with the alleviation of burnout that currently affects a significant proportion of clinicians.

Ultimately, embracing and implementing these technologies (including genomics) throughout the NHS, while clearly representing a challenge, is likely to prevent diseases and their complications and produce an overall improvement in health outcomes. We offer a number of recommendations for you to consider. These will require early implementation by education providers, as well as by arm’s-length bodies and employers on behalf of the NHS, if we are to gain the benefits these digital healthcare technologies offer.

I would like to personally thank your Department for encouragement, my extraordinary Review Board and Panels for their expertise and commitment, Health Education England and the secretariat for their work on the Review, not forgetting all those who shared insights and experience in response to our call for evidence.

Yours sincerely

Eric Topol, MD

Executive VP and Professor, Molecular Medicine, The Scripps Research Institute
Founder and Director, Scripps Research Translational Institute