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"I thoroughly enjoyed it - an excellent read full of fascinating glimpses into the future of healthcare."
     Antony Jay, co-author of Yes Minister

"Healthsmart 2010 is required reading for anyone with a serious interest in the future of healthcare. It's enjoyable, interesting and a little frightening."
     Dr Mike Smith, broadcaster and author

HOW IS IT that 91-year-old obsessive golfer Tetsuo Hashimoto is operated on the great Anna Ryumin, even though Russia and Japan are on opposite sides of the Manchurian war?

WHY DOES mad old biker George Henderson mark the living will panel on his smartcard "Do not resuscitate"?

WHO LEAKED to the English Enquirer every explicit private detail about Bonnie Henderson QC, lead prosecutor in the notorious Doughnut Case?

In short...

WHAT HAPPENS when doctoring finally goes digital?

Healthsmart is a work of science fiction. Much of the serious content, however, is already fact. Our tale describes certain events in the world of 2010, a date that is already closer to our own time than, say, the Falklands War or the first Space Shuttle flight. So we can predict with some confidence that, in many ways, the world of 2010 will be much like today's. If you prefer to read about a future in which people take holidays on the outer planets, are ruled by a master-race of robots, or reduced to savagery by environmental holocaust, sorry.

In some specific ways, however, life in 12 years' time will be very different to today. This book is about two fields where we can be certain of dramatic changes, information technology and the practice of medicine. We can be certain because the changes are happening today. Even here, we have not assumed any great breakthroughs in technology or knowledge ­ no genetic magic bullet for cancer, for example, let alone artificial brains. We simply extrapolate existing trends, especially the falling price of electronic hardware and communications and the resulting explosion in availability of electronic data. What makes these sectors interesting is the way existing ideas and technologies will interact to revolutionise all our lives.

Today, however, much debate about information technology and the healthcare revolution is confined to a relatively small community. Many doctors, managers and politicians see IT as a subject they can leave to the specialist.

We believe this approach is misguided. The information revolution will change the health service in ways that affect everybody. The debate about its consequences should be equally inclusive.

Healthsmart 2010 is aimed at the people who will use the health service in 2010, as well as the people who will run it and supply its technology.

Starting with the basic premise about the information revolution, Kable set out to interview a large number of knowlegeable people who we thought might have something to say about how these revolutions would change the practice of health care, and in particular the UK?s National Health Service (though most of these trends affect every country?s health system). What they told us provided an informed backcloth for a tale of everyday life in 2010.

Kable would like to thank all the people who gave up their time to be interviewed and the team of interviewers who tracked them down.

A large part of the outcome of these interviews is woven into the following narrative, but of course much as been left out. We claim no scientific basis for our choice. We simply picked the material that seemed to tell a good tale. If any interviewees ­ or sponsors ­ feel that their message has not come across, our sincere apologies. All of them contributed to stimulating a debate, which is what this whole exercise it about. The author alone accepts responsibility for the inevitable errors, over-simplifications and wildly unlikely scenarios that arise when dealing with such a complex set of issues in such a confined space.

The overall consensus of our research was optimism, that the IT revolution does offer ways to deliver healthcare more widely and more efficiently than today. This is a timely message: most people agreed that the NHS badly needs a way of relieving the current pressure created by nearly inexhaustible demand, finite budgets, and expensive new drugs and procedures.

A downside also emerged ­ a risk of widening the gap between peope who have access to the new technologies and those who do not. There are also important questions about privacy and other civil rights in an information society.

Another controversial issue is the future role of healthcare professionals, especially doctors.

If a single consensus emerged from Kable's research, it was that information technology is changing the relationship between health services and the people who use them (whether called clients, patients or consumers). In the world we describe, for the first time, everyone interested will have access to hard information about whether medical treatments are likely to work or not, and which healthcare institutions are best at delivering them New methods of looking inside the body and displaying images, together with the unravelling of the genetic code, will make this information almost frighteningly specific. Tomorrow's patients will be armed with information about their susceptibility to specific diseases and the likely effectiveness of any therapy or surgery.

While there will still be a market for quack cures, and a growing awarness of genuinely useful alternative medicine, the availability of hard facts will shift the balance of power between doctor and patient, changing the practice of medicine in ways that are hard to predict.

Healthsmart is the name we have given to one aspect of this trend, and to the story of how it could, possibly, develop in one quite idiosyncratic family.

Needless to say, the characters in this narrative are entirely fictional. We have taken the usual steps to ensure that the Henderson family and other named individuals are not based on any real person.

Likewise the companies and institutions named. Any surviving resemblences are accidental.

But all these caveats aside, we hope the characters in this story come over as believable human beings. People in 2010 may consider themselves Healthsmart, but they will not be paragons ­ far from it. For this is our story, too.

"Freedom from want cannot be forced on a democracy or given to a democracy. It must be won by them."
     Sir William Beveridge

"The level of public health corresponds to the degree to which the means and responsibility for coping with illness are distributed among the total population."
     Ivan Illich

"Now the rain man gave me two cures, and he said Jump right in. One was Texas Medicine, the other was just Railroad Gin. And like a fool I mixed them, and they strangled up my mind. Now people just get uglier and I have no sense of time."
     Bob Dylan