Living better, longer

Brian Niven, technical director for health consulting, imagines how the health system might look to three users, 20 years from now.

The citizen

Health AI can access medical information about me and my family that would fill pages, with new data added every day. But the headlines:

Mum, 78, and dad, 80, are fit and independent despite joint replacements and living with cancer. Between them, they shed 20kg in their 60s after mum was warned she was prediabetic and dad suffered a heart attack. They became vegetarian, traded their car in for walking shoes and rediscovered swimming. Data from their smart watches plus routine home testing is used to tweak their medication and treatment regimes. Following a virtual consultation with his specialist this morning, smart technology has booked dad in for a minor hospital procedure next week.

My partner copes with depression, with support from an online counsellor and their employer, who enables flexible working. We’ve found that cycling to work helps with mental as well as physical health. Recent road and streetscape improvements – wide, segregated bike lanes, pedestrian and bike priority at road junctions, and more roadside planting – along with cleaner air as petrol and diesel vehicles have been phased out, make cycling an attractive way to travel.

Genetic profiling has shown I am predisposed to high blood pressure and coronary disease, which has shaped my own attitudes to diet, exercise and work-life balance. I recovered well from malaria, caught locally five years ago. I gather and share data with my family practitioner and also my insurer, who rewards my efforts to remain healthy with lower annual premiums.

My kids tell me their data shows they are both in great shape. They’ve grown up with and embrace ‘digital health’, which they use to monitor and manage their wellbeing, a bit like some people manage their financial investments. If recent improvements in health continue, their lifespan is expected to be five years longer than mine, and they’ll be healthier for longer too – they’ll have a greater ‘healthspan’.

Read our vision for healthcare transformation: Health check 2040

The clinician

The hospital I work at is less than half the size it was a decade ago. That’s thanks to improvements in health and wellbeing across the population. And it’s because many forms of care have shifted from hospitals to more convenient and efficient environments in local communities.

I’m a specialist. Roughly half my consultations are booked for patients by smart technology that they use to track and manage their health and any conditions. I have instant access to the entire medical history of each person I see, which enables me to understand the issues I’m addressing in the context of their wider current health, and any past problems or illness. My ability to see the big picture, identify cause-and-effect relationships and flag any wider concerns is assisted by health AI.

The hospital campus today is barely recognisable, compared to 20 years ago. Car parking has been given over to create an attractive park, with shade-giving trees and a children’s adventure playground. Most patients and visitors arrive by public transport, including very affordable electric taxis. There are great facilities for cyclists.

Robots are ubiquitous, delivering supplies, cleaning and providing surgical assistance.

Existing buildings have been modernised – insulated to achieve thermal efficiency, fitted with solar panels to generate electricity and, wherever possible, remodelled to provide natural light and better outdoor views, which staff, patients and visitors alike appreciate: satisfaction and wellbeing survey scores have ticked up, and patients are recovering faster.

New buildings have been built employing the principle of ‘loose fit, long life’. They’re designed to be adapted as medical and therapeutic practices and technologies change, and to meet different medical needs as the health and age of the population evolves over time. Buildings can be expanded – in response to a future pandemic, for example. And reduced by removing modules – as hoped-for further improvements in people’s healthspan results in less demand for hospital-based care.

Sometimes I’m asked: am I threatened by the shrinkage; do I feel my job’s insecure? The answer is ‘no’. I’m no less busy than I was, but my focus has shifted. My job is increasingly less about fixing people when things go wrong, and more about helping them prevent things from going wrong in the first place – or getting worse.

The data scientist

The 2018 scandal of Theranos, a Silicon Valley start-up that seduced investors with unproven and unworkable blood testing technology, had only a fleeting impact on health technology innovation. In the 20 years since then, there is literally no aspect of healthcare that hasn’t been beneficially disrupted by technology.

Data ethics principles and practices have also evolved to keep pace with innovation – data scientists are expected to adhere to professional codes of conduct on the use of data.

I’m a data scientist, working on apps spanning diabetes to dementia – which is my ongoing focus. Progress in early-stage detection of dementia and swift intervention are already making it far less debilitating.

Since the first version of the dementia app was launched a decade ago, data shows a rise in early detections, which is consistent with the ageing profile of the population. But the incidence of smoking and obesity as aggravating factors has been falling. More people with dementia are living independently and ‘dying well’, as the health service puts it – simply of old age, at home.

Living better, longer

This is the future