It is easy to get sucked into thinking that Britain’s National Health Service is a problem to be solved.
Dr Kristin-Anne Rutter is the Executive Director of Cambridge University Health Partners and Cambridge Biomedical Campus Ltd.
It is easy to get sucked into thinking that Britain’s National Health Service is a problem to be solved.
I argue that part of the answer to ‘solving’ the NHS is also a key part of the solution to establishing the UK as a science superpower.
I trained as a doctor at Cambridge, and now work in the city for an organisation called Cambridge University Health Partners, that combines the strengths of academia, NHS and industry to deliver on the promises of the national life science strategy – and to find solutions that we can deliver quickly to the whole of the UK.
The first UK life science strategy in 2011 spoke of the ‘unique opportunity’ of the NHS, as have all subsequent strategy iterations and reviews.
Interestingly, none of the 10 actions in that 2011 strategy focussed on what the NHS needed to do to develop the capabilities to fulfil that ‘unique opportunity’.
Whilst many of the actions in that review have been delivered, there remain significant barriers to introducing innovations into the ‘core NHS’ service. The system is complex to navigate and suffers from limited mechanisms to procure and share value.
Britain’s National Health Service
There is the possibility to mobilise the NHS’s scale and integration to do four unique things:
- To gather detailed patient data over a long period of time – ‘longitudinal’ data is crucial for understanding changes and trends in health outcomes, disease progression and the effectiveness of treatments – and those insights can fuel new, ground-breaking discoveries.
- We can use the NHS to significantly reduce the cost and speed of developing new drugs and medical devices, through trials that can recruit rapidly across a diverse population, access data from national systems and work closely with regulators.
- The service could also provide rapid access to a large market for effective and much-needed innovations in those crucial early years, just after they are launched.
- Finally, it should be able to provide a market for innovations focused on prevention and health, which only a long-term public funding model really allows.
We know it can be done because we have a track-record of creating world-changing innovations. CT and MRI scanners, hip replacements, the monoclonal antibody technology behind a third of the world’s new drugs, IVF, genomic sequencing – all UK innovations that have led the world and where the NHS has played a crucial role.
We did it more recently during Covid, developing the AstraZeneca vaccine, being the first to use the Pfizer vaccine, and running the Recovery Trial which became the world’s largest randomized clinical trial of Covid treatments, recruiting more than forty-thousand individuals and providing the evidence not only for the effectiveness of steroids but also the lack of effectiveness of treatments such as Donald Trump’s favourite Hydroxychloroquine.
We are doing it now with the Galleri trial looking at the value of very early markers of cancer, and the use of personalised cancer vaccines with Moderna. Couple the NHS with the guidance of NICE and the regulatory expertise at the MHRA, and we have powerful team to contribute to any industrial strategy.
However, large and small companies I speak to are still frustrated by the challenges of accessing the service.
Perhaps part of the answer is our perception that leveraging sounds like ‘exploiting’. That is not the case. The fact is, this is good for the NHS. Good for patients, because it means they gain early access to cutting edge research and innovation and benefit from better outcomes more quickly. Opal Sandy’s recent treatment for deafness using Regeneron’s gene therapy is one of numerous examples I could cite. Good for Treasury, because the stark reality is, with our ageing population, we can’t afford to keep managing disease the way we do now. Innovating away from our reactive sick service towards a pre-emptive health service will ease the burden on the system and keep more people in work. Good for staff, because it will make health jobs easier and more interesting, which in turn will attract more talent. And good for us all, because a health is the biggest determinate of a country’s economic well-being.
There are some interesting parallels to other significant national assets such as defence and intelligence. I was listening to the chief of MI6 Richard Moore, speaking about moving from a system where all their innovations were designed in-house, in other words, where Q branch did everything, to a system where they team up with agile and creative external partners, from small entrepreneurs to big tech businesses. He recognised that is where the advances, particularly in AI, are now being made.
The National NHSE Innovation Ecosystem Programme I am involved in is coming from a similar place by asking, ‘how can we be more than the sum of our parts and tempt the very best global entrepreneurs and companies to work with us?’ We want to enable the extraordinary people in our NHS, life science industry and universities to join forces, making it easier for them to develop and roll out new innovations across the country. Innovations to one-day make dementia treatable, obesity curable, and to help people cope with multiple, complex health problems.
Imagine a future NHS that detects and diagnoses disease much earlier, or even prevents it altogether. A service where advances in reading your genes and proteins mean different patients receive different, personalised treatments for the same problem, speeding up recovery, and allowing people to live independently and return to work more quickly. An oft-forgotten side effect of illness is financial hardship.
Most importantly for me, is how we mobilise one of the NHS’s most valuable assets, its data. I often put it like this, we should think that investing in data is every bit as important for the future of the NHS as investing in new beds, theatres and buildings. We need to make sure that the digitalisation programme, the NHS Federated Data Platform and Secure Data Environments are progressed and harmonised to leverage the ‘power of the sixty-million’ for new discoveries and trials.
A different dialogue with the public will also enable this. We need to explain that developing and rolling out NHS innovations is not a side-activity detracting from patient care, it is the future of patient care. That the risk of doing nothing is far greater than the risk of trying something new that might not work. Innovation is hard, it doesn’t always succeed, but that doesn’t make failures a ‘waste of public money’.
I am not optimistic that change can be brought about rapidly and uniformly in an NHS battling with waiting lists, an often-demoralised workforce, crumbling buildings and fragmented IT. At the same time, we are going to need to make progress quickly. That is why the Innovation Programme will look creatively at new capabilities in the space between research and care delivery, creating alignment across industry, regulators, government and NHS on the priority areas, building on the life science missions and then creating scaled-up programmes as we have with genomics, that build the UK’s status as an innovative science super-power and make us a healthier, wealthier nation.
I’ll leave you with three thoughts. Invest in data, it is the foundation of new discoveries. No data, no AI. Just like MI6, the NHS has to find a way to work more effectively with innovators and the private sector. And finally, don’t forget the critical role the NHS can and must have in creating a UK science superpower.
