The challenge for health in the 21st Century

To tackle the health challenges facing the UK in the 21st Century, we must empower patients with the knowledge and technology to be able to care for themselves, and stamp out the fear-of-failure culture plaguing our health professionals, says Lynne Maher.

What are the biggest health challenges facing the UK in the 21st Century?

One of the largest overall challenges is that we have a rapidly aging population and linked to this, rising numbers of people with a long-term condition, such as diabetes or chronic airways disease. Against this background, we've got rising expectations about what healthcare can and needs to deliver.

What is the current situation?

A lot of healthcare is still provided on the basis of visits to a healthcare organisation or healthcare professional. Clinically, some of those visits aren't necessary and care could be provided in a different way; for example, by making greater use of email or telephone technology.

Many people would welcome the opportunity to take more responsibility for a greater proportion of their own care, if we provided them with the information and tools to do so.

Patients who have long-term conditions do need regular monitoring to make sure their condition is stable, such as those with high blood pressure. But a visit for that regular check can take much valuable time when you consider the whole episode, including travelling and waiting time.

We need to think more clearly about who really needs the specific expertise of a doctor or other health care professional, and who might access care in a different way including managing more for themselves.

What is being done to redress these problems?

From a national perspective, the NHS Institute support people to stand back and examine their current service; to ask what is working well and what could be even better.

We are also gathering great examples of improvements to services, such as the GP surgery that provides an automated blood pressure machine so that patients can pop in and take the measurement at a time that suits.

How are healthcare devices and processes becoming more innovative?

Over the last few years there have been massive advances in healthcare technologies. Take, for example, new diagnostic scanning devices.

They virtually eliminate the need for surgery or minimally invasive surgery, which means that people have faster and less painful recovery from their operation.

There is a big focus now on devices that can be used by patients at home. For example, devices to take and analyse their blood samples and then transfer that data electronically to the doctor's surgery.

There's also a lot of work going on in genetics and DNA testing to try and predict people who might be more susceptible to certain forms of illness or disease.

What other innovations are emerging in healthcare?

There's a lot of really interesting work being done to make homes safer for elderly people who live on their own. For example, if they haven't opened their fridge or put the kettle on, movement sensors will send an alert to carers or family.

Joint replacements have been around for a long time now, and they have enabled independent living. But they do wear out and that means the need for another surgical intervention. With recent advances, we'll soon have joint replacements that will last more than 20 years.

What are the barriers to innovation in the health sector?

The health sector is innovative and many ideas result in new technologies and services, which are better for patients. However, I think there is still a massive amount of untapped potential, and it would be wonderful if we could liberate that more.

One important aspect of innovating is to take a risk - and this can be a problem for healthcare staff who absolutely need to maintain a high level of safety for patients.

The tendency is to not be comfortable with high levels of risk. One of the solutions might be to strengthen our risk-management processes so that staff can maintain safety, while enabling new ideas to be tested.

If an idea doesn't work there is a tendency to think of that as a failure - and this can often block the progress of new ideas.

We need to change the focus, and the culture, so we view ideas that do not work as valuable learning rather than failure. If something doesn't work it's important to celebrate that, so we can teach others to do it differently.

What needs to happen to change these types of attitudes?

I think we need to see some test cases of people who have tried something that didn't work. We can then use it as a learning opportunity or examine what they've managed to achieve.

We also need to support people who do want to be innovative, and enable new ideas to be developed and tested. Some of these will provide valuable learning, while some of them will radically improve healthcare services resulting in benefits to millions of patients.

Lynne Maher is Head of Innovation Practice at the NHS Institute for Innovation and Improvement.

Published March 2007