Ever faster advances in technology have transformed every aspect of our lives in the 70 years since the NHS was born, none more so than in the NHS itself.
Here we look at Wales’ health technology research from robots detecting cancer and cutting surgery times, to using our own genetic code to uniquely tailor care.
That work is providing new tools for saving and improving lives, but perhaps the NHS’s biggest technology challenge in the next 70 years might just be our acceptance of new tech’s role in our care.
Automatically detecting cancer
Colon cancer is highly treatable if caught early – but the test is invasive and heavy on resources, causing some to opt out and limiting the numbers screened.
In that test, a hospital consultant minutely examines gut interior with a colonoscope (camera on a flexible hose) to spot and remove potentially cancerous growths (‘polyps’).
Now Dr Sunil Dolwani at University Hospital Wales and the team are pioneering semi-automated screening to speed up and simplify things.
"We are really excited about the prospect of robotic colonoscopy with disposable scopes and integrated artificial intelligence (AI) to automatically detect bowel polyps and cancers through computer aided diagnosis being investigated in different settings,” explained Dr Dolwani, and his team, part-funded by the Welsh Cancer Research Centre (WCRC) and the Wales Centre for Primary and Emergency Care Research (PRIME).
“This has the potential to revolutionise early detection of bowel cancer in primary and intermediate care and help with our current constraints with colonoscopy in secondary care," he added.
Robotic arms in the operating theatre
Surgery can successfully treat debilitating epileptic seizures by killing cells in ‘epileptogenic zones’ deep inside the brain. That delicate and complex surgery can take up to four hours, but now a new robotic arm has cut that to under an hour.
“The Renishaw Robot is a significant step forward for epilepsy surgery in Wales," explained Professor William Gray, director of the Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit.
Its use in stereoelectroencephalography (SEEG), or pinpointing the right spot in the brain before operating, and placing intracerebral electrodes to constantly measure brain activity during surgery, saw four-hour operations completed in just 55 minutes.
“It will enable us to investigate and treat even the most complex cases to achieve seizure freedom for our patients. In collaboration with the BRAIN Unit, it will also enable us to perform leading research for measuring brain signals and delivering therapies directly into the brain, across many neurological diseases,” added Professor Gray.
Pioneering precision medicine
Precision medicine, giving each of us uniquely tailored care and treatments at the right time, is set to transform clinical care, driven by technologies.
Ever faster and cheaper screening of our genomes is key to this – decoding our body’s entire genetic instructions for making and maintaining us – to pinpoint features in our DNA code shaping our health, or causing conditions.
The first to benefit could be those with cancer (caused by changes to our DNA) and those coping with diseases affecting only them, or a handful of people worldwide. With that rarity meaning no diagnosis or ready treatments, genomic screening could give them certainty and identify possible treatments for the first time.
They’re the focus of the ground-breaking 100,000 Genomes Project, aiming to establish exactly this care in the NHS. Wales is a key part this world-first, decoding 100,000 genomes from 70,000 people with cancer or a rare diseases and their families.
“This is very much in keeping with the ethos of the NHS,” Professor Julian Sampson of Wales Gene Park, lead of the 100,000 Genomes Project says: “to help patients independent of status and circumstance to access the health care and support they need and benefit from new technological advances such as whole genome sequencing.”
Elsewhere, the same technology is advancing our understanding of diseases like cancer and Alzheimer’s, with discoveries that could transform patient care.
What’s holding us back?
With all the potential benefits of technology clear, how we feel about its role in our care and bodies could be the biggest challenge.
Key public concerns about reliability and safety, data transparency and accountability in automated clinical decisions, and loss of the human touch were revealed in a recent report by the Nuffield Council on Bioethics.
Concerns about AI centred on the possibility of errors, and even computer coders’ prejudices, being buried deep in the software automating disease detection or procedures – with life-changing impacts that may take years to trace back to source.
Similarly, uncertainty over who is responsible for mistakes made when computers are making or informing decisions is another key concern, especially with ‘machine-learning’, or automated improvements by the computer itself, a key feature of AI.
Combined with low levels of trust around data security and transparency, there is clearly much concern about the safety and reliability of automated healthcare.
And in simple human terms, many question whether AI and robots providing routine care would mean less positive human contact for those already isolated due to immobility or old age, further risking their wellbeing and mental health.
It’s clear that we and our NHS will need to work out the best way of managing these risks and concerns in making the most of new technologies – but also that their potential benefits could be huge over the NHS’s next 70 years.
“It's hard to predict completely how the NHS will look and be run in 30 years’ time," said Vaughan Gething, cabinet secretary for health and social services. “When you think about artificial intelligence, what we'll be able to do in genetic medicine, there are lots of opportunities. It will undoubtedly look different in a number of respects but what I think will be the same though is that it will be a public service with public service values.
“For all of the significant advances we can make, lots of services will still require people to be present to deliver care – but working in different ways and across different teams.”