‘Innovation across the public, private and third sectors’:
Reflections from Christiana Boules and Hugh Harvey
Part 1: Reflections on ‘What can the healthcare service learn from student-led initiatives?’
“I remember when I couldn’t recall the small bones of the ear and my ENT consultant thought that my knowledge of Latin should make this sort of thing easy. When I told him that I never studied Latin at school, and no, I’ve never been horse-riding, he mocked me for it.” One of our founding HLA scholars, Jahangir Alom, set the tone for the day by sharing his work in widening access to medical school, and his own reflections that he felt he didn’t fulfil the stereotypical criteria of a medical student.
Discussing the topic of ‘healthcare innovation’ in The House of Lords, a certain type of orator comes to mind. In 2014, the Selecting for Excellence report by the Medical Schools Council (MSC) found that 80% of students come from only 20% of schools, and using the index of multiple deprivation (a measure that describes a postcode’s socio-economic status), we know that most candidates reside in the most affluent 20%. Further down the line, the BMA Equality Lens last year showed that the majority of our consultants are white and male. It was therefore surprising, and pleasantly so, to learn that at least half of those on the first panel of the day were trailblazers even before they lent their hand to their respective projects; trailblazers within their families and communities, representing the underrepresented social groups of the clinical world. ‘I was also the first in my family to go to university’, and so on.
Professor Simon Gregory reminded us that it’s not solely socioeconomic and cultural restrictions which impact individuals’ access to vocations like medicine, but there are regional factors at play also. The same 2014 MSC report showed that London medical students are overrepresented compared to other regions in the UK; and the ratio of doctors to people is well over 4 times higher in London than it is in the North East. It seems that if we are struggling to compel a more even spread across this North-South divide, then we need to appeal to aspiring doctors’ and nurses’ sense of ownership and target these pockets of students. If we aim to solve only socioeconomic disparities then we may continue to have the picture we have now: a top-heavy metropolis.
It is not simply an issue of people and numbers, but also of broadening perceptions of those who are already working in the healthcare system. Within healthcare, there are rigid structures which undoubtedly have evolved over time for the paramount aim of keeping our patients safe. But within these structures, we can neglect to empower certain groups (such as nurses, students, and allied health professionals) to identify issues and stimulate change. There may also be issues where clinicians as a whole are restricted from learning about and changing managerial systems. Whatever the cause, we need to widen our workforce’s access to leadership.
Jessica Anstee, another fellow HLA scholar, and student nurse, introduced the phrase ‘imposter syndrome’ to describe the alienation some experience when they feel they don’t fit the usual bill – for example if they are surrounded by doctors from more privileged backgrounds. Many do not feel as though they are responsible for the direction of our healthcare service, not for want of passion, but because many are not made to feel significant enough to have such conversations. We as clinicians should not feel like ‘imposters’. We should all be encouraged to believe that we have the fundamental potential to act as leaders. We should embrace our ownership of our healthcare service, and not simply our stewardship.
Quite obviously, increasing diversity (socially, racially, and professionally) would cultivate a greater scope of perspectives on the problem. And if we are to make the most of this breadth, we need to begin with students. From the start to the end of our qualifications, I, amongst others, have felt at each step a slight dampening of enthusiasm, a slight narrowing of vision. Why risk relying on innovation when our neural networks have been pruned and streamlined towards an already established system?
For innovation in healthcare to be promoted, we need to begin with ourselves. Dr Ike Anya, a keynote speaker, shared his experience of coming from Nigeria. He explained his lack of awareness that some positions of leadership had implicit restrictions. To the surprise of his colleagues, he managed to obtain a post which others said was above his reach. He reminded us to be ignorant to convention as he was – or at least, act like you are. We need a variety of different leaders, but that can only happen when we begin to see ourselves as such.
Part 2: Reflections on ‘Healthcare in 2027: What can we expect?’
Last week I had the honour of sitting on an expert panel at the House of Lords to discuss what healthcare would be like in 2027. The event was organised by the Healthcare Leadership Academy in conjunction with Lord Archy Kirkwood (Lib Dem).
The panel included the founders of Touch Surgery, Drs Jean Nehme and Andre Chow; Dr Bhavagaya Bakshi, founder of C the Signs; Dr Jack Kreindler, founder of the Centre for Health and Human Performance; Anthony Mann, founder of Make Us Proud; Sam Waterson, medical student and founder of the Health X-Ray Podcast, and Dr Seb Roberts, CMO at Clinisent. Dr Ali Jawad, NHS Clinical Innovation Fellow, chaired the discussion.
During the introductions, what struck me most at first was the fact that everyone medically qualified on the panel had had to leave full time NHS clinical practice in order to follow their passions and make their mark. This alone speaks volumes for how important it is for the NHS to encourage innovation from within. Dr Bakshi eloquently described how she balanced entrepreneurship with clinical practice in order to produce a clinical app. Dr Anthony Mann made a very good point regarding the need to embrace failure in order to learn form it, by highlighting his missed opportunity at building a YouTube before it came along. Food for thought, indeed, and we hadn’t even started…
I was asked to kick-start the discussion by outlining my views on how healthcare will look in 2027. I discussed the increasing automation of simple and repetitive tasks, how artificial intelligence (AI) such as speech recognition, concept capture and eventually clinical inference will free up clinician time, and that most importantly the doctor-patient relationship will endure because machines will never be able to empathise. The art in medicine will remain in the hands of humans, while the science will be done by machines. In addition, I mentioned that regulations will likely prevent machines from totally replacing human control, at least for now. Andre Chow countered this point, stating that humans are already trusting machines for a variety of every-day tasks and therefore it’s only a matter of time before machines are doing the bulk of the work of doctors. The example of auto-piloted aeroplanes was raised, countered by someone stating that there are still two pilots in planes, however good the AI may be! Perhaps, the panel debated, human doctors will have a very different role in the future – that of managing data and machines. However – health *management* is very different to health*care* – an important distinction.
Regarding trust between man and machine, Jack Kreindler made the excellent point that “things that die like to talk to other things that die”, meaning that there is something mortal in us that trusts other mortal beings over a machine. Humanity cannot be coded, a sentiment echoed by Andre when he said that “if everything could be solved by lines of code, then it would be a very simple world”. So, it seemed the panel had decided that doctors are here to stay, at least until 2027! This was counter-pointed by an audience member who said that surely nurses would therefore be the only ones left doing the empathising, seeing as they already do so better than doctors!
The discussion then moved on to how all this could be achieved – who would build this technological medical future? I argued that the NHS is too far in debt, too over-stretched to do so itself, and that asking for NHS funding for moonshot projects while nurses are attending food banks would be a little crass. Others agreed that external capital is required, and Jean Nehme highlighted Touch Surgery’s initial struggle to obtain UK funding, suggesting that America and Silicon Valley was a far better bet. The venture capital scene in the UK is minuscule compared to that of America, we all agreed. A public/private partnership was raised, with consideration on how that would affect the political landscape. As the debate continued, the idea of pooling and curating NHS data was floated, one that I am hugely in favour of. The panel discussed the immense value inherent in the ‘gold mine’ of clinical data that the NHS is yet to figure out how to harness.
The growing health inequality gap was also heatedly discussed. It’s all very well trying to build a technological utopia, but we need to ensure that it the results are affordable for everyone, argued Seb Roberts. Medicine and healthcare should not be the toys of the wealthy, they should serve the entire population. Would developing countries be left behind? Or can we ensure that they can ‘leap frog’ into step with the western world, just as African nations had gone from having no landlines, to have almost complete adoption of mobile phones.
The debate was neatly summarised by Lord Kirkwood who highlighted the need to ensure that whatever breakthroughs occur, they need to be available to all, and that political engagement of ideas around infrastructure and research had to be done in a meaningful way to ensure that we not only innovate but we do so with equality of care at the heart of it.
So, for those that missed it, do not fear. Doctors are here to stay, although their roles may dramatically change, and that, with adequate infrastructure and oversight, technology in medicine can and most likely will raise the health status for all not only in the UK, but on a global scale.
I’d like to thank the organisers, especially Johann Malawana and Christiana Boules, and the other panel members for such an inspiring day.
Hugh Harvey – Doctor² (radiologist & academic) MBBSs BSc(Hons) FRCR MD(Res). Clinical AI, machine learning in radiology imaging and research.
Christiana Boules – founding scholar at the HLA and final year medical sctudent at King’s College London.
See our Twitter Moments from the event here.