The Topol review: creating a digitally savvy health care workforce

The Topol Review led by cardiologist, geneticist and digital medicine researcher, Dr Eric Topol, looks at how to prepare the healthcare workforce to deliver the digital future. This independent report on behalf of the Secretary of State for Health and Social Care, makes recommendations that will enable NHS staff to make the most of innovative technologies such as genomics, digital medicine, artificial intelligence and robotics to improve services.

Ground breaking review debates how technology will impact the NHS workforce

The executive summary makes reference to the changing workforce, with millennials having new expectations and most seeking a good work-life balance through flexible careers. It adds that the NHS Long Term Plan identifies the need for more healthcare workers to respond to this increasing demand. And that health technologies “should not be seen as increasing costs, but rather as a new means of addressing the big healthcare challenges of the 21st century.”

The review anticipates how these healthcare technologies will impact the roles and functions of healthcare staff. It does not suggest that these technologies will replace healthcare professionals but will “augment them” giving more time for a deeper doctor-patient relationship, along with a reduction in doctor “burnout” that currently affects a significant proportion of clinicians.

Tackling the differences in digital literacy of the current workforce

This is a key theme in the review which highlights that “Within 20 years, 90% of all jobs in the NHS will requires some element of digital skills.” – and so “All staff will need digital and genomics literacy.” But the starting point would be to look at the digital literacy of the existing workforce.  

But with the introduction of digital and genomic technologies in healthcare, there are ethical considerations.

On technology and patient care, the review says that there must be mechanisms in place to ensure advanced technology does not “dehumanise care” and while automation will improve efficiency, “it should not replace human interaction”. So interesting comments on maintaining respect for human dignity – “users should know whether they are communicating with a person or a machine.”

Issues on patient safety are highlighted with the need to clinically evaluate digital healthcare technologies to avoid patient harm and remaining “faithful to the core ethical principle of medical care: ‘do no harm’.”

There is also commentary on data governance and the importance on having in place robust and legally enforceable, data governance structures, policies and practises without which the promises of digital healthcare technologies could be undermined.

But will it resolve the workforce crisis?

Possibly. We know that the NHS is overstretched and has a shortfall of 100,000 staff and only recently, a new report from the Health Foundation highlights that NHS staff numbers are failing to keep pace with demand and that there is ongoing deterioration in workforce numbers in critical areas, such as primary and community care, nursing and mental health. To close this gap will require a “Herculean effort” says the report. 

What does the review say?

The review provides advice on how these technologies and developments will change clinical roles; how staff can be prepared for that change, and therefore the changes required in the education and training of staff. It sets out how new technologies will be able to speed up processes like diagnostics, such as providing patients with quicker, better treatment and freeing up additional clinical time to provide further care.

But ultimately, for the NHS to benefit from digital technologies, there must be a focus on “building a digitally ready workforce that is fully engaged and has the skills” to adopt to new technologies in practice. But there is recognition that the health service needs leaders who can “inspire and implement sustainable, systemic change”. Equally, Boards require the expertise to make informed investments decisions, to drive improvement.

The recommendations aim to support the NHS Long Term Plan and inform the workforce implementation plan designed to improve the NHS over the next decade.

So, where next?

The challenge though for the NHS is the culture shift required in learning and innovation and the willingness of the workforce to embrace technology. But time is of the essence, with the review recognising that there will be a five-to-seven year time lag to full adoption. So there is no time to waste.

The Department of Health and Social Care will formally respond to the recommendations in due course.

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