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One of the Foundation’s priorities for the years ahead, as set out in our new strategy launched earlier this year, is to support radical innovation and improvement in health and care. And in my last blog I provided a summary of our work planned under this theme.  

What was hard to anticipate then is how much this idea of radical innovation would evolve in just a few months. The emergence of more advanced AI is significantly shifting the context. Bill Gates has called it the second revolution in computer technology since the 1980s.  

We always thought more advanced AI was on its way. But now that it’s here in all its experimental and hallucinatory glory – most visibly through large language models such as OpenAI’s ChatGPT or Google’s Bard – it feels a bit like an all-powerful amoeba rapidly growing into many parts of our lives. No longer a concern for just Chess or Go champions, we now find ourselves with machines answering exam questions just as well as humans, AI writing songs in the style of Nick Cave, and radio stations running solely on AI generated content.  

Indeed, you may wonder, did AI write this blog?* 

This development has profound implications for health and care, too. Eric Topol, the American cardiologist and geneticist who wrote a seminal report on how to prepare the health care workforce for a digital future, has written for some time about AI’s potential changes for how care is experienced and delivered. And the new large language models are already being trained on medical knowledge, or tested for screening and symptom checking. Debates are underway about its safe development and regulation, as well as its limitations

At the Foundation, we will continue to evolve our strategic priority on radical innovation and improvement. Innovation is moving quickly, and so must we. What will remain a constant is our focus on the capabilities, cultures and policies that we need for this innovation to be a successful enabler of a sustainable future for health and social care.  

So what is needed to support this work? 

Embrace the revolution

First, our health and care systems simply won’t be sustainable over the next decades without greater use of these kinds of technologies. So we should embrace this tech revolution – with appropriate diligence and care, of course.  

We are facing ever growing trends in morbidity in our population, alongside a shrinking labour force, and a stuttering economy that is unlikely to generate enough growth to absorb the steady increase in care costs. How we prevent, identify and treat care needs must fundamentally shift towards a more productive, less labour-intensive model of personalised care, rooted in the home and community. We do not know what other innovations may emerge over the next decade or two, but right now digital technologies, driven by data and AI, are the main game in town to help us achieve this transformative shift.

Invest in infrastructure 

Second, long-term, strategic investment in these technologies, including the data and computing infrastructure, is essential. And this means capital investment in health has to rise significantly (from its current level of around half per capita of the OECD average) particularly in primary, community and social care.  

Given the dependencies of health and care technology and data on wider public infrastructure, ideally this forms part of a reformed approach to raising overall investment levels in the wider economy, where the UK lingers in the bottom 10% of OECD countries. We will continue to make this case for greater investment and the importance of this for improving health.  

Fund the change not just the tech 

Third, we need a similarly significant step up in investment in the change, management and evaluation capacity required to adopt and spread innovation and transform care models, including the ways of working, skills and cultures needed. To sustain the innovation needed in the NHS (and social care alongside it), we have to fund the change, not just the tech.  

If implemented carefullyNHS England's new approach to improvement in England could play a critical role here, working with Integrated Care Boards and providers to build improvement capability and culture across a local area. The Foundation, together with its Q community of over 5,000 improvement practitioners, is scoping ways to support this alongside organisations such as NHS Confederation and NHS Providers. Without a strong management and improvement culture, we simply will not realise the benefits of new technologies

Maximise time to care 

Fourth, a major focus for the next few years must be making administrative processes more efficient and maximising time to care. There are many localised examples of this (like this Foundation supported project to simplify patient feedback analysis). But a much more fundamental shift is needed in areas like processing referrals, scheduling, or care record taking and coding.  

This summer, we will start to share our analysis of how we can maximise the opportunities from tech and AI to support workforce capacity and time for care. Alongside this, we want to support the potential to increase the use of technology in areas where this is currently under-explored, such as in the community and at home, including a new funding programme

Create a transparent and open dialogue 

Finally, and probably most importantly, a debate is needed – with the public, patients and service users, as well as with health and care organisations, their staff and the industry – about the benefits of these new technologies. This needs to happen alongside broader conversations about how we are going to manage the risks, and how the sector can collaborate with technology companies. More transparency, dialogue (particularly locally and regionally) and a clearer vision of how care needs to change is likely to help here.  

Recent publications on AI regulation, health and care data and a wider technology and science strategy are welcome, but primarily speak to an expert audience, not patients, service users and the public. In early summer, we will share findings from our polling of health care staff and members of the public about their perceptions of health technology and data, and what will be required to maximise their benefits.  

A focus on long-term change 

Through all our work, we want to contribute to making a strong case for long-term change, and the role of technology and AI in driving this. There is some evidence that politicians recognise this, yet they are likely to remain occupied by short term priorities. There is no time for delay. The next ten, if not five, years – and how we use them to harness AI and new technologies, including supporting care users and staff to adapt – will be critical for our health and to weather the challenges ahead. 


* No, it didn’t. But both Bard and ChatGPT gave me a somewhat bland if very reasonable draft on the future and risks of AI and digital technology in care, in less than ten seconds. 


Dr Malte Gerhold (@Dr_Malte) is the Director of Innovation and Improvement at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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