• Eric Topol’s review says NHS digital skill boost needed to avoid patient safety risks and entrenching health inequalities
  • All NHS boards should have executive focused assessing the safe and effective use of new digital technology
  • Nine out of ten NHS jobs will require new digital know-how by 2040, review says

The NHS needs to drastically boost its ability to asses new digital technologies, such as artificial intelligence and genomics, or risk entrenching health inequities and harming patients, according to a government review.

American cardiologist and digital medicine researcher Eric Topol was commissioned by the former health secretary Jeremy Hunt to carry out an independent review of how the NHS, and specifically its workforce, will need to change “to deliver a digital future”.

The review, published today in partnership with Health Education England, said the NHS needed to create a new “cadre of specialists in the regulation and assessment of digital technologies”. Every NHS board should have an executive with direct responsibility for “safe and effective” adoption of new technology, it said.

Staff at the Medicines and Healthcare Products Regulatory Agency, which has seen a sharp rise in the registration of medical software in recent years, would need additional training “to continue to be able to provide meaningful regulatory oversight”.

The review identified a lack of digital skills in the NHS, along with the poor quality of data, as the major barrier to the effective adoption of new technology including genomics, digital medicine, artificial intelligence and robotics.

Dr Topol’s review warns that without appropriate training the pace of technological change will overwhelm NHS staff and create new problems.

This could include creating new safety risks by outsourcing too much clinical decision making to software.

He said: “Without robust, resilient, reliable and effective systems for providing trustworthy and evidence-based guarantees of the safety of digital healthcare technologies, there is a serious risk that their use might result in harm to patients.”

It could also entrench existing health inequalities by failing to account for inherent bias in algorithms and data, the review said.

“There is the possibility that otherwise high-quality data might reflect the bias inherent in the social structure and reinforce existing structural discrimination and inequality.”

The Topol review considers the impact of technology over the next five, 10 and 20 years.

Technology likely to have the biggest impact of how the NHS functions in the next five to 10 years includes health apps, the use of genomic data in patient care and natural language processing. Natural language processing allows for the automatic transferring of voice into structured clinical information, reducing a clinician’s need to manually enter information into a computer.

However, over 20 years the review predicts significant disruption will be caused to the NHS model of care by everything from augmented reality to robotics. By 2040, nine out of 10 NHS jobs will require new digital skills, and all clinical staff will require some basic training in “genomic literacy”, the review said.

For the jobs likely to be most disrupted by new technology, usually highly specialised areas such as oncology or paediatrics, additional royal college accredited intensive training will be needed, the review said.

Additional training places and career paths will also be required for increasingly important technology-focused clinical roles, such as bioinformatician.

Dr Topol said: “These developments will change patients’ lives, change how clinicians work and change how healthcare services are delivered. This is happening now and the NHS is ideally placed to take it further, faster and wider if we act to give our staff the skills and knowledge they need to make them the norm across the NHS.”

Health secretary Matt Hancock said Dr Topol’s report would act as a “blueprint” and technology had the potential to “make working lives easier for dedicated NHS staff and free them up to use their medical expertise and do what they do best: care for patients”.

Health Education England chief executive Ian Cumming said the review’s recommendation would be “made a reality” through the workforce implementation plan being developed to support the long-term plan.

However, Health Foundation data analytics director Adam Steventon warned the strategy would be “little more than warm words” without a significant investment to address the NHS’ workforce shortage.

He said: “Making this strategy a reality will require Herculean effort from people at all levels of the NHS. The NHS is not yet making the most of existing technologies and data analytics.”

Harry Evans, a researcher at The King’s Fund, said: “Technology underpins some of the most ambitious targets in the NHS long-term plan so it is vital that staff are able to use digital tools and understand the data they generate. The Topol Review makes a number of welcome recommendations to create a digitally-savvy workforce with the knowledge and flexibility to embrace emerging technologies.”