The Topol Review

The Topol review was a piece of work commissioned to Eric Topol by the Secretary of State for Health and Social Care at the time, Jeremy Hunt. The intention was for it to be a review of how the changing technology landscape now and in the future is going to shape healthcare and how the NHS needs to respond in order to keep up, and be able to thrive from those advances.

The three technological advances considered in the review were genomics, digital medicine and artificial intelligence and robotics and there were three underlying principles running throughout the review: partnership, evidence and time. To keep up with a theme of threes, for each area of technology three groups of stakeholders were considered, and recommendations made for each: “the citizen and the patient”, “healthcare professionals” and the “health system”.

So, I wanted to read the Topol review because I work in an area that interfaces genomics and data science and these are two things that are heavily spoken about in the review. I wanted to summarise it here for you because, I mean, it’s 103 pages long – I don’t blame you if you don’t want to read the whole thing – but it does have some things in it that I think are pretty important. I’m not going to list the recommendations that came out for each group of stakeholders for each area of tech, because if you were interested in that you would just read the review. But, what I am going to do is talk about some of the things I found interesting that are interesting across the board, and not just to a specific speciality. So here goes.

Exciting things can happen in the NHS over the next 20 years, but only if certain steps are taken by the public, patients, healthcare professionals, education providers, NHS management… basically everyone. We all have a part to play in shaping the future of healthcare and a huge part of this is to do with education. The review predicts that in 20 years, 90% of jobs in the NHS will require some degree of genomics and digital literacy. Not to mention this idea of creating “a partnership between patients and clinicians” where patients can be more involved in their healthcare means that they will have to have some degree of understanding about the data being collected about themselves. As digital medicine, such as wearable devices, encourages moving care to patients own homes where possible this will become ever more important. Reflecting the 10 year plan, a focus on prevention means that patients need to understand how and why they need to take certain steps, for example- how their DNA may predispose them to certain conditions, but they can make anything from small lifestyle changes or big surgical decisions to mitigate that risk. As these technologies filter into all areas of healthcare, clinical staff will also have to develop an understanding of them in order to be able to interpret results and offer the right treatment for patients.

But, we can’t expect people to just go off and learn on their own. There needs to be opportunities for all groups of people to develop this understanding. The review addresses the problem with the fast pace of advancements meaning it can be hard to keep up – but academic institutions need to be creative and ahead of the curve. A quote from Andreas Schleicher: we need to “prepare students for jobs that have not yet been created, technologies that have not yet been invented and problems that we don’t yet know will arise” is particularly pertinent in this regard. Topics such as genomics and data analytics should be included in all undergraduate curricula for healthcare roles. This is great – we’re preparing the next generation of healthcare professionals for this new era of medicine, but what about the current workforce? Well this is addressed too; the NHS needs to cultivate a reputation for training and support and invest in people as well as technology. Not just economically, but in time – allowing staff time away from clinical work to engage with industry, academia and peers to network, learn and innovate. I think the genomic medicine MSc that is funded for all NHS healthcare professionals is a great starting place, but there’s still a long way to go- particularly in the other technologies considered in this review. I also think that the review doesn’t provide enough recommendations on how the public can increase their understanding – or even how scientists and healthcare professionals can help to increase public understanding. Understanding leads to trust, which is ultimately what the patient-clinician relationship is built on so engaging with the public and upskilling them is an absolute priority.

Another consideration that naturally arises with talk of genomics and AI is ethics. The review had a strong view on this and considered it across 4 areas: Patient safety, data governance, respect for human dignity and health inequality. All four of these themes run throughout the review, and apply to each area of technology in a similar, yet unique way- many of which likely stem from misconceptions from pop-culture references. I think these 4 things are relatively self-explanatory but since I’m already here…

• Patient safety: The key here is evidence. All the technology being used in the NHS has been and should continue to be, rigorously tested, validated, verified and implemented based on evidence. It is of the utmost importance that the technology being used is safe. There’s a saying in the tech industry; “move fast and break things”, which has become somewhat controversial, but I personally love as a saying, it’s a real drive for innovation and discovery. But it also highlights the fact that we’re talking about healthcare here – not tech. And that brings along some fundamental differences about implementation and use of “new things”.
• Data governance: All of this technology also brings with it a huge wave of data – implementing ethical frameworks and data governance policies before they are needed are absolutely essential. Definitely not a “cross that bridge when we get to it” type situation.
• Respect for human dignity: One of the core principles of the NHS is to treat each patient with dignity. I think we struggle to see AI providing the same level of personalised and dignified care as humans can. None of this technology is intended to replace healthcare professionals – just augment them. The review assures us that care should not, and will not, be “dehumanised”.
• Finally – health inequality. For those of you who don’t know, there are health inequalities ingrained into society, where an individual’s health is determined by the population group they fall into. It’s not good, it’s not fair and it is not something we want to be enhanced by technology. But, to prevent that we need to acknowledge that it exists so that when we are using algorithms and AI etc., they’re not being trained on biased ideals that will only increase the inequalities that already exist.

There was a lot more than this covered in the review for sure, but I’m trying to fit 103 pages into 2 here, so I’m going to conclude. I think the Topol review did a good job of looking at the potential for the future and there is a lot of potential in these technologies. But it’s going to be a lot of work and it’s going to require the NHS to accept change and let go of the “If it isn’t broke, don’t fix it” mind set. Because the NHS is great, it really is, but if we can embrace the technology available in the right ways, it can be so much better.