NHS at 65: Medical science has come a long way

You get a reassuring smile from your consultant, whose face is being beamed live to a screen from his office on the other side of the city.

Then you drift off to sleep before a robot slices you open, takes out one of your vital organs and replaces it with something that was grown in a laboratory.

That’s if surgery is even necessary to treat your condition. It was probably picked up early by the super-scanner that can detect the first signs of a life-threatening disease in seconds. They have one in Tesco.

Maybe the tiny micro-robots as small as bacteria did the job when they were sent into your bloodstream, swam along to the cause of your ailment and delivered their cargo of miracle drugs that cured you from the inside.

Don’t worry about being sent to a care home either. Your own house will be full of artificially intelligent appliances that will cook your meals, run your bath, tidy up and automatically alert the emergency services within seconds should you take a funny turn.

It sounds like something straight out of the imagination of a science fiction writer. But this could very well be the future of the NHS – with some of the technologies already existing, as the brightest minds in the world work on developing the others.

Today, the NHS turns 65, and while the thought of microscopic blood robots at the Royal Infirmary or a replacement liver being made to order at the Western may seem outlandish, innovations like those could quite feasibly be available well within the next six-and-a-half decades.

Sceptical? Well imagine the look on a surgeon’s face on this day in 1948, when free healthcare was made 
available to millions for the first time ever, if you had told them lifesaving heart surgery would be performed through a tiny hole in the groin, premature babies born at 24 weeks would have a decent chance of life and that human hearts, kidneys and livers, as well as the odd pancreas and bone marrow, would be taken out of dead bodies and transplanted to a living recipient hundreds of times a year in Edinburgh alone.

There are almost endless possibilities for healthcare in the coming decades, and there has never been a more exciting time to be a doctor in the NHS or to enter the medical 
profession.

But while the success of the organisation has been borne out by the fact that we are living longer than ever before and can overcome once-deadly diseases and traumas, the NHS is preparing to face the most 
challenging period in its history.

The current population in Lothian is due to grow from 850,000 to 
1.1 million in the next 20 years, with a disproportionate part of that rise coming in the form of elderly people with multiple conditions who will need to call on the NHS more than ever.

Across Scotland in the next decade alone, the number of over-75s will increase by a quarter and continue to go up. According to NHS Lothian’s new chairman, Brian Houston, the health service is facing “enormous” challenges and there is no option but to create a radically different model of healthcare across society.

Malcolm Chisholm, Labour MSP for Edinburgh Northern and Leith, served as the Scottish Government’s health secretary between 2001 and 2004, giving him the second-longest stint in the job, behind Nicola Sturgeon. He said: “People have been saying it for ten years, but we can’t go on delivering services in the same way, not least because of the demographic changes. There has to be a different model of care but we can avoid fundamental change to the ideals of the NHS. I would resist that and members of the public would 
resist that.”

So how does the NHS plan to diffuse the demographic time bomb? Some have suggested that the harsh realities in the age of austerity mean a health service free to all is no longer viable. But as Mr Chisholm states, moves away from the NHS founding principles are not likely to be vote-winners in a nation that treasures its health service like no other.

Alex Neil, Scotland’s current health secretary, today reiterated that care would remain free at the point of use for everybody under his watch, describing the NHS as “the embodiment of a just and equitable society”.

In the coming years, it is hoped that we will spend less time in hospital with more support to be offered in our own homes. Technology, whether used to have remote consultations with doctors or to help out at home, will also play an ever-increasing role. There will be more work on 
preventative measures to stop the onset of disease and illness, with a greater emphasis on health education as well as punitive measures to tackle obesity and alcohol intake.

Eradicating poverty, which has meant those born in the richest parts of Scotland can expect to live ten years longer than those born in the poorest, is also seen as vital to improving the health of the population.

The Scottish Government believes that independence, which would give Holyrood full control of the welfare state including benefits, would allow it to drive down inequality. Those who believe that Scotland’s economy would be weaker if it was on its own question whether the current level of provision could be maintained.

We do not yet have all the answers, but what is clear is that the NHS will be forced to adapt over the next 65 years, and by 2078, we may well be left with an organisation as different as today’s service is to the one which came into being on July 5, 1948.

But whatever the challenges, Dr Morrice McCrae, who began medical school on almost the same day that the NHS was born, is clear that they will have to be met.

The 81-year-old former consultant, now historian with the Royal College of Physicians of Edinburgh, said: “There’s no easy solution, it’s going to be difficult, but it’s a changing society and the NHS needs to change with it. They can’t just say the game has changed and they’re not playing – that won’t do.”

Challenges for the nhs

CULTURE

We are living longer than ever, but Scotland has some of the lowest life expectancy rates in the developed world. Part of this has been put down to the national diet, which has also been blamed for a surge in diabetes cases.

INEQUALITY

The Scottish Government says its biggest challenge is improving the health of the poorest sections of society. It argues that if Scotland votes for independence next year, it will have more power to enact change.

CONDITIONS OF AGE

As people live longer, more conditions will be developed which need NHS treatment. More and more people will get dementia, eye problems and need joint replacements.

FINANCE

Big changes are needed at a time when budgets are coming under pressure. The NHS will have to adapt to do more with less.

NEW DRUGS

Exciting drugs are being developed all the time. These are often very effective but can come at a huge cost. The NHS needs to balance effectiveness and affordability.

ETHICS

Some research that could potentially have incredible benefits for patients raise tough moral issues, particularly involving stem cells.

Monitor vital signs

Professor Lionel Tarassenko, professor of electrical engineering at Oxford University and a fellow of The Academy of Medical Sciences, is leading a series of exciting medical developments.

He said that within a few years we could see “paperless” hospitals, with vital signs checked automatically and then registered on iPads. A complete picture of a patient’s health would be built up, allowing doctors to detect problems far earlier. The technology, now used to monitor jet engines in planes, is being harnessed to help patients.

He is also working on a ceiling camera that watches over a patient. It will monitor vital signs just by looking at a patient’s forehead and will quickly alert staff if something is wrong. It could be developed within five to ten years and will ease fears over single-room wards, as the camera will look out for patients if

no-one else is around.

The technology could also be used in the home, so an elderly loved one’s health could be monitored through Skype.

Professor Tarassenko said: “It’s a very exciting time. In the past six or seven years, funding streams have really been sorted out which is fantastic for these clinically-driven developments. They will make the NHS run more effectively while improving patient safety.”