How then is a diminishing band of carers going to cope with a growing customer demand, when resources will at best remain static, and most likely fall? No doubt clinicians and carers will continue to refine their techniques and become ever more efficient, while administrators shave costs, reduce bed occupancy, and get patients back into the community ever faster.

But none of this will be enough to stem the tide of demand and the growing inability to respond. Something new is required to change the care model that has fundamentally been static for over a century. At present we have something of a dichotomy as industry reduces the number of managers, embracing computers and change, while healthcare seems to go in the opposite direction. The height of this absurdity has been reached in some American hospitals, where each patient now has a dedicated administrator.

Also, consider patient records; with the GP, nurse, specialist, consultant, radiologist and anaesthetist gathering the same basic information during just one illness. This is often repeated for successive illnesses and/or visits. The biggest single innovation in patient records during the past century has been to redesign the cart in which the paper is carried.

Patients travel to hospitals, doctors, nurses and specialists travel to patients and hospital. With head and hand-mounted cameras, VR headsets and video conferencing, remote diagnosis is now possible, as are support of paramedics at an accident scene, dermatological examinations, foetal scanning, endoscopy, and operations of all kinds without expensive physical travel.

At a more basic level, consider the district nurse who gives up her handbag for a laptop computer, digital camera and GSM mobile phone: at the push of a few keys she can capture and transmit an image of a wound or infection to the GP back at the surgery.

Beyond the demands for medical care, we will see a rise in loneliness and need for verbal and visual support. Nearly everyone has TV, radio and telephone, and many have camcorders and computers. The technology for video conferencing is now fundamentally inexpensive and available. Support communities on the Internet already exist for just about any disease or condition imaginable.

Of course there are risks. Clever patients will use IT to get ahead of the professionals. By being better informed they can ask more perceptive questions, demand treatments and be more demanding customers. But perhaps worse still, countries will export their medical services to compete in other markets. The Internet already makes it possible to bypass national restrictions on the drugs and medicines available over the counter; soon it may be diagnosis and treatment that are on immediate offer.

Peter Cochrane holds the Collier Chair for the Public Understanding of Science & Technology at the University of Bristol. His home page is:
http://cochrane.org.uk