Social change may have social origins, for example the increasing emphasis on involving service users in the design and quality assurance of services. However, social change may result from technical advances; think of the printing press in the 15th century, or social networking in this century. CLAHRCs have a duty to promote adoption of safe and cost-effective new technologies. Sometimes, the technology is a “bolt on” – it can simply be added to the existing repertoire of services. MRI scanning is an example of such a non-disruptive technology. Yes, it can improve diagnostic sensitivity and improve care, but it can be slotted into existing patient pathways and service schedules in a largely unproblematic way.
Contrast this with the molecular techniques to identify microbes. Out will go laborious processes of plating bacteria on a succession of nutrient media to make a diagnosis. What about conventional histological staining and examination? Molecular techniques, particularly those based on genetic signatures, will sweep away much previous technology. Radical changes can also be anticipated in radiology as increasing imaging techniques follow Moore’s law, becoming progressively smaller and less expensive.
All these advances will enable some low-income countries to bypass existing technology and leapfrog into the new era, as has happened with mobile phone technology. In richer countries, however, disruptive change will ensue as large numbers of relatively skilled jobs are replaced by a smaller cadre of highly-skilled technical and managerial workers. These advances will also “take diagnosis out of the cupboard,” making it directly accessible to clinicians on the ward and in the clinic. Imaging, for example, will become an extension of, and to some extent replacement of, normal “bedside” clinical skills All these advances in microbiology, pathology and diagnostic imaging are truly disruptive.
It is time to broaden our gaze from the technological and scientific aspects, intriguing and important as they are, and consider broader societal implications. By anticipating these changes, the workforce can be gradually re-deployed and/or re-trained so that upheaval is minimised and disruption of the service kept to a minimum. We do not want the work force to be ambushed in the way dock-workers and printers seem to have been in the 1980s.
These changes also have massive educational implications as technology moves from the laboratory to the ward. Portable microchips and ultrasound machines the size of a mobile phone can do harm in poorly-educated hands; a point well understood by Health Education England who are promoting a campaign on education in the new genetics. Yet patients and the public also need to understand the technology and its limitations – a project for Public Involvement in Science. Imaging specialists, micro-biologists and pathology staff should become educators, quality assurers and problem solvers, rather than guilds holding custody of their art.
CLAHRCs have a role in defining the role of new technology (especially determining cost-effectiveness ), in helping to design and implement new services and in evaluation. Our CLAHRC is collaborating with regional partners in the development and evaluation of new ways of working and is a partner in an application to NHS England’s 100,000 Genomes Project. Likewise, there is fascinating and important work to be done on the cost-effectiveness of new technologies in low- and middle-income countries – we will give an example in the next News Blog.
— Richard Lilford, CLAHRC WM Director
— Tim Jones, Executive Director of Delivery, University Hospitals Birmingham NHS Foundation Trust
- Christensen CM, Grossman J, Hwang J. The Innovator’s Prescription. New York, NY: McGraw-Hill. 2009.
- NHS Health Education England. Genomics Education. 2014. [Online]
- Girling A, Young T, Brown C, Lilford R. Early-Stage Valuation of Medical Devices: The Role of Developmental Uncertainty. Value Health. 2010; 13(5): 585-91.