We are at least 20 years into the information revolution, yet we
have barely begun to roll out IT across public services.
Look at the NHS. I remember meeting a research oncologist a few
years ago who reported that one of his proudest recent achievements
had been to finally replace his secretary’s typewriter with a PC.
When it is a struggle to ensure all members of the clinical team
have access to the right technology, it is no wonder that other,
more fundamental, process re-engineering has barely started.
However, just as we begin to see changes in health care that
exploit IT, a bioscientific revolution that will transform health
care is about to hit us. A pamphlet that I co-authored for the
Scottish Council Foundation raises some key questions we have to
First, genomics advances are set to change the rules in many areas
of treatment. Take cancer care. The view of senior clinicians is
that, in England and Scotland, national strategies for improving
care should be in place by 2006. This would all be fine – except
that by that time, new therapies drawing on genomics advances will
be available, blowing a hole in the national strategies.
Second, the traditional British response of lagging five or 10
years behind the US in introducing successful therapies will not
work. The internet means information is available to patients in a
way it was not in the past. As patients organise themselves into
advocacy groups, they create networks that can transmute
information into demands. And those demands cannot easily be fended
off by reference to the National Institute for Clinical Excellence
and its rationing guidelines.
The more transparent the consideration of new therapies is, the
more it invites public contest. Specialists in individual fields
will make plausible proponents for new treatments – and public
sympathy is unlikely to lie with the regulator who wants to choke
access to a potentially successful treatment.
This raises some uncomfortable conflicts. The UK health care system
is based on making available to one patient only what is available
to all, and vice versa. The result is that treatments become
available only when they become commodified and prices have
This hits the further problem not just of accessible information,
but also of access to the personal income that allows people to buy
for themselves – here or abroad – treatments that are not available
on the NHS. Health care technologies could go the same way as IT,
with the well off becoming early adopters. Will there be a
“bioscientific divide” to parallel the “digital divide”?
Hi-tech and Personal, Scottish
Council Foundation, 2003, tel: 0131 225 4709.
John McTernan is a political analyst.