An uneven future: an ageing population needs innovation, but not at the expense of equal care

There are many reasons to believe that the health challenges of the coming decades will look significantly different from those faced today.

Demographic changes, technological advances, and socioeconomic and environmental developments are expected to shape – and in some cases transform – the health and social care landscape of the future. With this in mind, many pieces of research are being launched that investigate what health could look like in the future. 

Longer lives, bigger health burdens

In January 2017, the National Institute for Health Research (NIHR) commissioned RAND Europe to ask 300 experts from across the health and science fields about their views on the likely health challenges in England in 20 to 30 years’ time, and how they might differ from those today. One stark finding was that despite living longer, people will not necessarily be in better health. In the coming decades, England will comprise an increasingly ageing population suffering from even more complex illnesses. Compounding this will be the rising influence of unhealthy lifestyle choices, the burden of mental ill-health, and the threat of infectious disease, in part due to antimicrobial resistance. 

The expected increases in life expectancy together with increasingly complex physical and mental illnesses will continue to exert huge pressures on health systems

Together, these trends present a host of challenges, not just for the healthcare system, but also for society more widely. How can all members of society be empowered to take control of their health? How should a sustainable health system be secured? How should the UK prepare for a potential infectious disease pandemic?

From the survey, it was clear that stakeholders differed in their views on the importance of these questions, and the best approach to managing their emergence in the coming decades. The expected increases in life expectancy together with increasingly complex physical and mental illnesses will continue to exert huge pressures on health systems.

To respond to these challenges, survey respondents stressed the urgent need to introduce new models of care. For example, health and social care could be better integrated, with increased collaboration, both among health and social care professionals and between different health disciplines, to manage patients with multiple, complex illnesses. Fortunately, many efforts are already underway to achieve this more integrated care. 

Innovation and efficiency, but at what price?

Respondents also anticipated that advances in science and technology will have a significant impact on future health and care. Developments in digital technology, such as artificial intelligence and digital apps, are expected to enable more patients to self-manage their health at home. Advances in genomics and personalised medicine, as well as the enhanced use of patient and public data, could hold transformative potential for prevention, diagnostics and treatment. It is hoped that these innovations will help to achieve better health outcomes and more efficient care. 

However, not all respondents welcome these developments. Some question the degree to which personalised approaches could be widely implemented in the NHS in the near future. Others question the transformative potential of technology. Indeed, there were concerns that the focus on costly technologies over prevention and public health could serve to widen inequalities in health outcomes.

Active steps should be taken to ensure access for specific population groups, such as older people, those less well-educated or the unemployed

There is a real danger that those most in need of these innovations stand to lose out. If all members of society are to benefit, active steps should be taken to ensure access for specific population groups, such as older people, those less well-educated or the unemployed. The future clearly presents many opportunities, such as exciting technological and scientific developments that promise to transform health and care, but a range of challenges also exist.

In order for all of society to benefit from future innovations, the social determinants of health inequalities need to be addressed. Therefore, more work is required to ensure the fair and effective uptake and spread of health innovations in the NHS, including advances in technology and genomics.

Using these innovations effectively and fairly to help support an ageing population that is less healthy and more at risk to many different health conditions is likely to be key in the future. 

Camilla d’Angelo is an analyst at RAND Europe. She was one of the lead authors of the ‘Future of Health’ study