NHS 70: Lord Darzi on robotics, career development and how the NHS can respond to changing demands
As we approach the 70th birthday of the NHS, one name synonymous with innovation and change within healthcare is Lord Darzi. He has a long and distinguished career with our Trust, having been appointed a consultant colorectal cancer surgeon at St Mary’s Hospital in 1994, as well as within Imperial College. He is known globally for his role in leading the development of minimally-invasive, robot-assisted surgery, has published over 800 peer-reviewed papers and, in 2002, was knighted for his services to medicine and surgery. He was made a Lord in 2007 and appointed parliamentary under-secretary of state to the former Department of Health, where he led a major NHS review.
Here, to mark NHS 70, Lord Darzi talks to us about his career, how the NHS can respond to the changing health and social needs of our population and the technological innovations he sees as having the biggest impact on patient care in the future.
Technology and robotics
I spend much of my time researching technological innovations that have the potential to improve patient outcomes and how we deliver care. That said, I have never believed you could replace healthcare practitioners with technology – the benefit of automation is freeing people up to focus on providing care rather than completing cumbersome, administrative duties.
In the future, I envisage monitors for vital signs will become more sophisticated – allowing us as clinicians to intervene earlier to help patients before they deteriorate. For example, instead of a nurse needing to put a blood pressure cuff on a patient four times a day, patients could be given a wearable sensor that would automatically report blood pressure and pulse rate on the hour. This kind of technological advancement would free up nurses to spend their time monitoring results and acting on measurements, rather than taking the observations themselves.
In coming years, I could imagine the computer algorithms behind monitoring and diagnostic devices will become more sophisticated so they can detect when a patient’s blood profile is deteriorating. For example, if the level of the waste product creatinine increases in a patient’s blood, it can indicate an issue with the functioning of the kidneys. A monitoring device with a more sophisticated algorithm could record that change in the blood, trigger an alert to the patient’s care team and enable the team to intervene at a point where they can prevent the patient’s kidneys from failing.
Future algorithms could also help radiologists read scans faster. If software is able to identify simple fractures on a scan, then radiologists will eventually have more time to focus on the complex images in cases that have the potential to be more serious. It’s in this way that I see automation working hand in hand with clinicians, rather than replacing them. Robotics and other technologies exist to enhance the delivery of care and to improve the patient’s outcomes and experience. A hospital is not a car or aircraft assembly line where you have a robot building a product – we’ll always need healthcare professionals to actually deliver care.
The huge benefits robotic technology has brought us to date lie in precision surgery and the ability we now have to carry out more complicated surgical procedures in a minimally invasive way – via keyhole surgery. I think we will see the robots we now use change. In years to come, I think robots will be smaller and more intuitive; they’ll allow us to deliver targeted therapy. For example, we’ll be able to administer medicines directly to a tumour or use heat to destroy tumours without damaging healthy tissue. I've always said the robotic technology we have now is just the tip of the iceberg. But with any of these advances, you need to prove their validity. It isn’t enough to simply introduce new kit – you need to prove its clinical benefits and cost effectiveness before new technology can be adopted.
Responding to the changing needs of a population
My firm belief is that quality should remain the organising principle of the NHS – regardless of which patient population you are caring for. If you look at the ageing population, for example, you will come to the conclusion that we cannot provide all the care this demographic needs in an acute hospital setting – primary care and social care need to play key roles too and that’s why developing a system-wide, integrated approach to population health and care is so vital. We know that using evidence and data to predict future health and care needs and preventing deterioration translates to the best quality of care. We also know the health risk profile of our population. We need to be much more proactive in reaching out and meeting need, rather than waiting for people to arrive at hospital once they are ill. We need acute hospitals, primary care providers, care facilities, social care organisations and local councils to work in a joined-up way to capture these needs and devise strategies to meet them.
One of my suggestions is removing means testing from social care. That doesn’t mean ending means testing for accommodation but providing the nursing care free of charge to enable patients to be safely managed in the community and prevent deterioration.
If quality is the organising principle of the NHS, we need to start measuring it. Locally, across the system, we should be looking at whether health interventions are actually reducing hospital admission rates and whether the social needs of our communities are being met. For example, we know loneliness and inadequate nutrition impact an individual’s overall health, so we need to consider how we are addressing those challenges too. With data and analytics, we should be in a position to stratify different segments of our population according to risk factors and design local, active interventions that suit the population’s social and clinical needs.
Learning from other healthcare systems
When the NHS was created in 1948, its guiding principle was that every citizen should be able to access care at the point of need, irrespective of their ability to pay. The fact that the NHS has survived for 70 years is testament to the success of this approach. I passionately believe everyone should have access to universal health coverage as a basic human right. I think other countries could learn a lot from the efficiency of our healthcare system. You might not know it from the headlines in the news but if you compare our costs and outcomes to those of other countries, we do well. There is, after all, no perfect healthcare system; it simply doesn’t exist. But we should seek to contrast and compare the NHS with other healthcare systems around the world as there are always ways to learn from each other.
Although cancer outcomes have improved a lot in England in the last 10 years, there is still a lot to be done. In my opinion we need to continue to focus on increasing public awareness of the signs and symptoms of cancer so people know when to seek help. From a research perspective, we are working hard to discover new biomarkers that can help us to identify cancer earlier – and we’re developing tests and devices to make the identification of these biomarkers more easily available. Prof George Hanna’s breath test is a great example of this work. I also believe we need to do more to improve our data and analytics so we can track the health of our population, identify those at greatest risk of cancer and proactively do something about it.
Building a career
When I was first appointed consultant at St Mary's Hospital, I was the only colorectal cancer surgeon on staff. Now we have six other consultants. My clinical practice is not as big as it once was but my research department is considerably larger. I also serve as a non-executive director to NHS Improvement, one of the national regulators, as well as spending time in the House of Lords, writing, and speaking publicly in the UK and abroad. Most recently, I published a review of health and care with the Institute for Public Policy Research.
I am fortunate to have had many opportunities during my career. I'm in a very privileged place at the moment – there is nothing I do that I don’t enjoy. I am working at one of the best hospitals in the country alongside fantastic people.
When I’m asked by young surgeons for career advice, I suggest they look at the opportunities around them before immediately looking up at the next rung in the career ladder. I tell them to focus on why they’ve chosen medicine, to try and get around the inevitable bureaucracy inherent in the system, and seek to improve their skills. It’s important to enjoy what you do and to always challenge yourself. This means looking at the latest innovation and thinking what impact it could have on the care you provide. Always remember that as clinicians we come to work to provide the best possible care we can.
Professor Darzi holds the Paul Hamlyn chair of surgery at Imperial College, London, the Royal Marsden Hospital and the Institute of Cancer Research. He is director of the Institute of Global Health Innovation at Imperial College, London and an honorary consultant surgeon at Imperial College Hospital NHS Trust.