Being a confirmed Europhile I am given to frequent despair over the UK’s lack of clear political leadership in the only territory remaining open to influence in a post-colonial world.

But just occasionally I am shocked to find myself indulging in a minor eruption of national pride and I’m forcibly reminded that localism has some part to play in motivating communities to look after themselves and resist those who would banish diversity in favour of bland conformity.  These everyday battles to achieve some, any, local distinction are, of course, often greeted by UK media complaints of ‘postcode lotteries’ – a reaction that is in itself good reason to fight for choice and variety.

So, in Brussels this week to discuss research into the transformation of health services, I found myself, oddly, on the side of the angels surveying a continental sea of despair.   I have written elsewhere about the impending disasters that await those who are not devising get-well plans for get-well services.  The demographic and lifestyle-induced health time bombs will be every bit as disruptive as floods in Cumbria or other climate change scenarios – the difference is that we can all, as co-producers of our own well-being, help find solutions.  The really good news in Brussels was that we in the UK are not merely on the case but, for now at least, have reasons to be cheerful.

In the course of discussions about remote patient monitoring and personal health systems across Europe it became blindingly obvious that our NHS is truly quite remarkable – not just for the massive investment in healthcare  information infrastructures but for the essential bravery of political leadership in this field.

Having discovered this good news in the course of umpteen in-depth interviews across the UK’s health services and its supporting industry I was able to report on an amazing diversity of viewpoints, energy and willingness to take on the challenge of transformation of healthcare and social-care services.  All this on a day when the Queen’s speech was revealing yet further plans for the care of our increasing legions of older folk.

In virtually all respects it turns out that the UK has much from which our continental cousins (and even those in more distant lands) could borrow and benefit.  The integration of health and social care structures (for so long divided by budgetary and organisational legacies), the greening of the NHS for sustainability, the investment in informatics so that we have real insight into the health impacts of income and housing inequalities, the first-mover advantages of learning how to change the way we do things around here – all these and more are, within Europe, marks of distinction for the UK.

There were only two clouds on the horizon. 

No matter how remarkable our progress in preparing for healthcare transformation, in matters technological the UK is sub-scale.  You might imagine that, with nearly 19 million people with one or more long term chronic conditions, the UK market opportunity for remote patient monitoring products and services (Connected Health and 'Assistive Technologies') would be big enough to attract global manufacturing investment.  Sadly not.   Scale delivers dramatically lower unit costs – and we need at least a pan-European market to deliver the price-points that make for economic sustainability.

The Advanced Wishful Thinking (AWT) that is endemic amongst technology strategists might imagine that switching on the US healthcare market would save our day but the stark reality is that the recent research is an urgent wake-up call for industry – not for more technological development but for vastly greater investment and engagement in policy, practice and market development across Europe.  This is perhaps something where the UK could usefully show the way forward at the March 2010 Health Ministerial meeting in Barcelona.

However, the snag for would-be market developers is that the pieces of infrastructure action needed deliver an appropriate scale are subtly different for each European state.   The different priorities and timings needed for healthcare transformation are likely to induce a 3 or 5-year delay to pan-European market scale development.  It’s already becoming clear that some of the Governance and Procurement enablers are amenable to central policy action and, with an appropriately-scaled media and consumer awareness programme, the delay could be reduced.  Much therefore depends on the industry’s willingness to invest in market development and the European Commission’s appreciation of the need for new policy drivers to assist this process.

The other cloud is much more a matter for UK domestic policy direction – dealing with the one significant  aspect of infrastructure preparation where the UK is falling behind in this good news story.  It may even turn out to be the undoing of all the brilliant, dedicated, work and the investment of a decade of healthcare modernisation.   Technology or Life Sciences are not the problem.  Doctors are not the problem.  We know the scale of our own health and social care challenges - so we cannot pretend it’s not our problem.  Unfortunately, the demand for all this home-based care across the UK is often in places that are woefully under-served by the local access networks needed to connect all this transformational brilliance together.

Traditional telco mindsets look at the data flows and say that they are easily accommodated on last generation networks.  In theory and on their own this may be correct – but localised healthcare virtual private networks running concurrently with multiple services from many different service providers and generating interactive data flows do not sit comfortably with the convenient Telco ‘get by’ asymmetric assumption that for customers it is better to receive than to give.

So despite a buzz of brilliance and leadership and confidence, the entire kit and caboodle may well be undone by the larger failure to join the dots and lighten the load with open-access fibre to the home.  The point about 'open access' is that the utility of the local access fibre connection should not be confused with the vast range and choice of competitive and community services that can travel across it.  In 25^th place and behind Latvia we have a market silo regulated by Ofcom that appears more focused on the AWT desires of the media than the vastly more significant get well plan for the UK.   The agendas for both health and wealth are joined at the hip.  The champions of Digital Britain, ineffective against incumbent-resistance to innovation, did not get it – but the champions of healthcare transformation most certainly do – and their patients (and our patience) will be badly served by a major lapse in joined up policy that rests on reassurances that we can get by without thinking.

Ignorance is not bliss - muddling through will not do.

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The author was a co-founder of the European Connected Health Campus and served as a director for its foundation year.

The interactive bathroom mirror display graphic comes from the Living Tomorrow complex in Brussels and is activated by sensors in the  toothbrush and the floor..

See also 'Fibre more than faster - part 2'