Early in the new century the number of people needing some form of daily care and support will more than double, whilst the number of potential carers will fall by a factor of at least three. At the same time those gainfully employed in creating wealth - the UK GDP - will halve. Perhaps even more critically, the people capable of becoming professionals in any field will also fall dramatically as a percentage of the total population. We may also see people failing to financially provide adequately for a longer period of old age, and their siblings refusing to pick up the tab. This is all due to a combination of the demographic time bomb (the population getting older faster), the success of medical science and our expectation to live longer and be treated better. We seem to have subsumed the California Syndrome; we expect treatment no matter what the cost, and death is now seen as an unnatural act.

How then are the diminishing band of healthcare professionals going to cope in a world of exponentially growing customer expectation and demand, when resources and funding will at best remain static, and most likely fall? No doubt clinicians and carers will continue to refine their techniques and processes to become ever more efficient. And administrators will continue to desperately shave out costs, reduce bed occupancy averages, and push care patients back out into the community even faster. But none of this will be enough to stem the tide of demand and the growing inability to respond. Something new and radical is required to change a paradigm that has fundamentally been in stasis for well over a century. Compared to leading industries the Care Sector appears to be in desperate need of innovation and change.

Looking at administration first, it is clear that care processes now lag behind the best of breed in industry. For the last decade industry has been delayering and reducing management numbers, embracing IT and changing everything. In healthcare the height of absurdity has been reached in some USA hospitals where each patient now has a dedicated administrator. No one can defend more administrators than medical staff!

As a prime target for change, consider patient records and the number of times information is entered into the medical systems. GP, nurse, specialist, consultant, radiologist, anaesthetist will all gather the same basic information during just one illness. This process will then be repeated again for successive illnesses and/or visits. The biggest single innovation in patient records during the last century has been to redesign the cart in which the paper folders are carried. Do we really need all that paper and multiple recording of data - or could IT do a better and more efficient job?

In principal there is no reason why every patient record, symptom, diagnosis, treatment, outcome, X-Ray, and all other data could not be on-line. The impact of the availability of such a wealth of information cannot even be estimated. Correlating all past histories and experiences with the more recent and immediate would be of incalculable benefit to all healthcare professionals.

Patients travel to hospitals, doctors, nurses and specialists travel to patients and hospital. What a waste! With head and hand mounted cameras, computers, high definition displays, VR headsets and video conferencing, it is now possible to affect remote diagnosis, and guide treatment on the spot. It has been demonstrated that A&E support of Paramedics at an accident site, dermatological examinations, foetal scanning, endoscopy, and operations of all kinds can be undertaken effectively without the need for physical travel. This technology has moved far beyond the experimental trial stage and has demonstrated it afford great advantage and economy.

Using standard dial up ISDN (digital phone) lines the scanning of pregnant ladies in the Isle of White, with remote diagnosis in London, has realised savings of £1000's per patient. By digitising the ultrasound scan image, it can be transmitted and be displayed at some remote site along with real time voice and images of the medical staff involved. Obviously it is not quite as good as being by the bedside, but it is sufficiently effective for accurate diagnosis, and soon if there will be no alternative. The technology also affords the dual advantages of reducing diagnosis delays to hours instead of weeks, patient stress, physical transport, whilst increasing the effectiveness of all the medical staff involved. In fact, like much of IT, it classically delivers much more for much less. Better patient care, better results with fewer people and less time and money.

In a similar manner Hospital A&E Departments can virtually attend major accidents to support ambulance crews during the patient primary care and extracation period. Hopefully the effects of injuries can be minimised, A&E occupancy reduced, effectiveness increased, and hospital bed times reduced by the appliance of readily another available technology. All that is required is a TV screen in the A&E Department linked by radio to a head mounted camera worn by a paramedic at the accident scene. Voice communication by headsets, and an eye mounted display unit for the paramedic, affords doctor and surgeon and to extend the reach of their expert hand to the point of application. Paramedics then become empowered by Just-in-Time (JIT) skills and expertise, whilst the patient care and chances of survival are increased.

Traditionally the teaching of many surgical techniques has been physically limited by the number of students that can crowd around the subject. If a surgeon wears a pair of miniature head mounted cameras above each eye, and microphones above each ear, it is now possible for thousands of students wearing VR headsets to see and hear in a new way. They are effectively standing inside the surgeons head looking and directly experience the scene with stereo vision and sound. Reversing the process means that a student, or surgeon, performing a procedure for the first time can have the support of an expert stood inside them. No body heat, no unnerving presence, just an internalised feeling of support. This might seem a fantasy, but it is fact, it has been done. Operations with expert and student at the far end of telecommunication links have been successfully performed over 100s of miles, but it could have been thousands, distance is no limiter.

Similar successes with endoscopic examinations have also been recorded and the economical advantages demonstrated. The problem of bringing expertise and patient/customer together can now be solved for almost every situation face by the healthcare community. At a simpler, and more prolific level, consider the nurse who gives up her handbag for a laptop computer, digital camera and GSM mobile phone. At the push of a few keys the abilities of a GP can be extended to some remote location with an image of a wound or infection captured on screen and transmitted back to the remote surgery. Pictorial records of progress can be archived for later comparison and use, whilst reassuring consutlancy is always to hand.

Not many people would consider technology as caring, but computers that do are coming in the form of body worn health monitoring and support units. Everything from an artificial pancreas, to more general automated drug and medicine dispensers, plus heart and general health monitors will made available. These will have links to hospital and home computers that will reduce the need for hospital visits, increase patient independence and awareness.

Beyond the demands for medical care, we will see a rise in loneliness and need for verbal and visual support. Everyone has a TV, radio and telephone. Many have camcorders and PCs. The technology for video conferencing is now fundamentally inexpensive and available for a few £100s. Support communities on the Internet already exist for just about any disease or condition imaginable. Thousands of people world wide communicate and compare notes, offering advice and experience beyond that available via traditional routes. Extending this facility to all is potentially inexpensive as Web-TV (a set top box that facilitates simple WWW browsing and communication) systems roll out at about the price as a SatCom terminal.

Beyond all of this, there now lies a potential threat. The smart patients will, and are already, using IT to get ahead of the medical and care profession. By accessing on-line databases and educational material, they can become better educated and up to date, ask more perceptive questions, demand the latest treatments and be far more demanding customers. But perhaps worse still, other countries will start to export their medical services to compete in other marketplaces. Interestingly, whilst the UK has been ahead of the game in demonstrating the benefits of telecare and telemedicine, it is the USA hospitals that are already delivering services into the Middle East. Back in the UK of course the debate about the cost effectiveness and efficacy of the technology continues. Using the net it is already possible to by-pass UK restrictions on the drugs and medicines available over the counter. Soon it may be diagnosis and treatment that is on immediate offer.

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