FST JOURNAL

We have many technologies already that allow us to monitor people’s health. Some, like Covid tests, have been taken up by the public very quickly. In fact, blood pressure, partial oxygen, glucose, weight, urine infection, etc, can all be monitored quite simply.

The big tech companies have recognised the potential market in healthcare. Apple, for example, have made a success of their Apple Watch. Take a quick look at Amazon: there are all sorts of health offerings on their website, some of which are being used by parts of the NHS. Of course, Amazon is not the only one. Companies like Doccla have technology that can create ‘virtual wards’ at home, getting people out of hospital and monitored in a safe environment.

We are starting to see real evidence of the benefits of home self-management from technologies like NHS Florence, a simple texting system. Give people the ability to self-manage and they can get much better outcomes. Take the management of urine infections for example: sepsis from urine infections affects 65,000 people a year in the UK (sepsis overall kills 50,000 per annum in the UK and 350,000 per annum in the USA). Early discharge, virtual wards or even non-hospitalised treatments with a paramedic checking stitches, etc, can help to improve outcomes across a range of conditions.

In the hospital environment, faster diagnostics and digital technology could mean that blood tests are complete by the time the patient sees their consultant and they do not have to return at a later date. Better prescribing is a potential result from some of these diagnostic tests, such as which antibiotic to prescribe for a really bad urine infection. New technologies can deliver better outcomes from less hospitalisation as well as reduced or more effectively treated chronic disease.

Universities

There is a great deal of innovation and development within universities. At Strathclyde, we have created the Centre for the Future Hospital, looking specifically at current problem areas.  We will work with companies on virtual clinics, aiding rehabilitation, post-surgery and post-stroke treatments. All of these areas could be addressed more effectively in the home with greater use of digital technology.

We are very interested in wellness: if the population does not buy-in to wellness, the NHS will not cope. Lifestyle diseases, often driven by a lack of knowledge in teenage years into the 20s and 30s, become chronic in the 30s and 40s: that should be unheard of in a modern society like ours.

The challenge is to get people truly engaged in this. Preaching is not the answer, it requires an holistic approach. It is a matter of finding what motivates people. Eudaemonia is the science of happiness. It says that a sense of purpose is a key element. How do we engender that in our communities? How do we give people the power to envision their lives differently and change, creating their own wellness? Citizen engagement is going to be critical to the survival of the health service over the next 20 years or so.

The triple helix

To deliver new technologies, we will need the ‘triple helix’ of collaboration between the universities, industry and the NHS. We need the businesses with the technology, agility and money to develop these things with the universities for the benefit of the health services. We must mesh these three groups together to create a coordinated system.

Apple

Sensors form one major area of innovation. Wearable or remote diagnostics are being researched, developed and commercialised by the Medical Diagnostics & Wearables Group in collaboration with the Strathclyde spinout, Ohmedics Ltd.  This has three platforms: one for wound detection and monitoring; one for bacteria monitoring (the next pandemic may well involve antimicrobial resistance so bacterial detection and identification needs to improve); and the third area is the futuristic ‘don't take any blood, have a wearable sensor’.

If there is a sensor that can go inside a dressing, there is no need to take the dressing off for a patient, carer or attending clinician to measure the moisture and decide if the dressing needs changing. We estimate this could save up to half of all hospital dressing changes – and probably about the same in the community.

That of course is very disruptive, especially for wound care companies whose main business is to sell dressings, and patients would be able to take self-measurements to know when their dressing needs changing. In fact, these new technologies are breaking into areas where there are commercial and bureaucratic interests and ways of working. The NHS faces a great deal of change as it introduces these technologies.

In the second category, we have developed a small, portable and rechargeable sensor for home or pharmacy use that can analyse a urine sample. We have worked with NHS Ayrshire looking at wounds and with Glasgow Royal Infirmary for urine infections. The test takes about five minutes to administer and within 20 minutes it can tell if the bacteria has antimicrobial resistance to specific antibiotics.

Technologies like this will make detection and prescribing more accurate. Using them in the home will help avoid sepsis and other serious events that can occur with urine infections.

Wearable tech

On the wearable side, we are working with DSTL, testing a wearable hydration sensor. Interestingly, there has been a great deal of interest from corporate wellbeing departments, looking to get their staff more engaged in personal wellbeing. If you can measure your hydration and perhaps food intake as well, this little tool can be used to motivate staff to take more of an interest in wellness.

This kind of wearable sensor with ‘through the skin’ diagnostics means it will not be necessary to prick a finger to monitor other parameters,  glucose levels for example. We have also carried out a short trial in the Neonatal Intensive Care Unit at the Royal Hospital for Children with two of the consultants there. We wanted to see if we could use it to avoid taking blood from neonates who are sick and premature when they arrive in this unit.

Universities can help to develop and deliver technologies like this, working with the companies and creating spinouts. However, the adoption of new technology is still very difficult in the UK. When I came back to this country some 20 years ago, people were talking about the adoption of technology and how everything was going to be better. Unfortunately, I still hear the same statements today.

The challenges for the NHS remain: how to manage the interface with the commercial world; and how to attract the different types of worker required to implement the changes ahead. We will certainly see a change in the types of health and care delivered in the NHS. We need to create the right structures to deliver that.