By 2030 a dearth of skilled workers will mean a bigger reliance on automation in medicine, and inexperienced surgeons using technology to breach the knowledge gap.

Speaking at Cambridge Consultants' Innovation Day, associate director of the company's surgical division Simon Karger painted a not altogether optimistic outlook of the future surgical landscape, which will be driven by an ageing population and an "expectation of care for all conditions". His conclusions were the fruits of a panel discussion on the subject attended by 20 companies and educational institutions including Philips, Boston Scientific, Harvard Medical School, John Hopkins University, Vitalitec and Bard. "Globally, the medical industry is going through enormous change and pressure," said Karger. "Skills shortages push and drive this reliance on technology -- even now in medical schools hardly anyone is taking cardiology. We won't have the skills to deliver the volume of care we need so we'll have to find other ways to deliver it -- there will be a shift of skills away from people and towards technology and automation."

Karger cited intelligent and streamlined devices as the beginnings of this -- already we have products such as PediGuard, an electronic device that gives real time audio feedback for surgeons inserting spinal screws for safe navigation, and Orthosensor's range of sensors that transmit post-operative stats wirelessly. The development of both look to a future of cost-cutting procedures, where patients can spend less time in hospitals and complications are reduced. "How these technologies are going to combine over the next few years to allow less skilled surgeons to do these things will be key," said Karger. "For instance, if an orthopaedic surgeon knows how near they are to the nerves, they can start to do spinal surgery; if you can see with absolute clarity, general surgeons can start taking on the role of oncologists. "Today, big Goliaths aren't responding to take these technologies on board, so how are we going to enable surgery to be deskilled? As an industry we must work out how to put all these technologies together in a way that will bring a new surgical environment about, otherwise, 2030 could be a pretty scary place to be."


In an earlier talk at the Innovation Day, Cambridge Consultant's commercial director Duncan Smith explained that it could take a new player coming in to disrupt the traditional healthcare landscape before we begin to see real adoption of the kinds of things Karger is talking about. According to Karger, we first desperately need a regulatory environment that allows these types of debates to take place -- regulation, he says, is becoming a big hindrance to progress. "The biggest fear [on the panel] was from the big names who asked, can we take the technologies on board? How do we absorb those technologies and take them through the regulatory environment without destroying our stock value? But the general consensus was, we're not going to do that in America. The big white elephant in the room was the FDA -- it's inhibiting innovation and it has a role to play. It used to be that it was predictable and slow; that's no longer the case."

The panel suggested there would be a trend of companies seeking ownership of specific procedures and conditions, in order to retain their value in a changing economic system. In a two-tier medical system where procedures are either elective or life threatening, the latter will be part of the classic pay-up model, said Karger, while the former has the opportunity to become more brand-led and aware. Already, marketing surgical devices drives patients -- and even specialists -- to certain hospitals, for instance those that carry the da Vinci surgical system. "In a world where patients are going to have to pay more for procedures, they will want more input and interaction. They will therefore become more brand aware. Various technology coming through -- such as in diagnostics and genomics -- will give them ownership of their own health and drive patient awareness, while fragmentation of care away from a single provider will drive patient ownership of their own medical data and management of their conditions."

Procedures will disperse away from hospitals as a result, explained Karger, who said the 20-group panel spoke a lot about moving procedures out of the classic surgical environments and into ambulances, offices, or even the home. Connected healthcare and post-operative care will have a hand in this becoming a reality, however, personally Karger did not see connected health and at-home healthcare becoming a reality for another 50 years. Products such as Cambridge Consultant's PiOna auto-injector, which makes administering fertility drugs at home quicker, easier and less painful, are an indication of the beginnings of the commercialisation of simple at-home procedures, tailored for the inexperienced.

Other trends that will drive these central themes will be the uptake of outcome driven procedures (not just those qualified as safe), robotics, flexible tools, miniaturisation and tuneable systems. There will be a focus on regenerative medicine and neurostimulation/modification to "harness our bodies' own systems to aid and affect repair", and we will use data across procedures and care to see how, statistically, different procedures effect different patients ("in a world that's more consolidated, we will have better diagnostics").

The dramatic changes, though emerging out of necessity because of cost cutting and an unwelcome skills shortage, will be positive for an industry that has typically been slow to progress in the past. "Surgery has not fundamentally changed -- our tools got sharper, our knowledge of the body better, but 100 years later and we're still just taking sharp things and putting them in the body". If, through technology, we can find smart ways to take those sharp things and stick them in the body, without paying a £500,000-a-year specialist or a lawsuit for a minor misstep, maybe we'll finally have the funds to focus on the bigger picture.