Could changes at the top mean fresh opportunities for tech innovation?
For some time it has been clear that Brexit dominates the Prime Minister’s time and will determine her legacy. That cabinet meetings and the resources of Whitehall are similarly given over to the subject is also apparent. Given our emerging understanding of Brexit’s reach into almost every aspect of public policy, and the absence of any detail about the status quo after Brexit, it is a surprise if any government initiative proceeds without mention of the ‘B-word’.
With the NHS turning 70 however, Brexit had to take a back seat for a (short) while as Westminster turned to celebrating and scrutinising this most important of public services.
During the estimates day debate in the Commons for the 70th anniversary, Dr Sarah Wollaston MP, who chairs both the Health Select Committee and the Liaison Committee responsible for these special debates, articulated her desire for the transformation of health and social care with long-term, coordinated planning, encapsulating every aspect of health and across all of government.
Lord O’Shaughnessy meanwhile confirmed (though with little detail) that the health department (and all the others for that matter) were working on contingency preparations in the event of a no-deal Brexit. It comes as no surprise then that the sort of transformative initiatives called for by Dr Wollaston seem to be stalling.
Catalyst for change
Brexit again made its mark on healthcare by providing the catalyst that finally brought change at the very top, and may yet offer renewed vigour to stalling innovation. The new secretary of state for health and social care is Matt Hancock MP and though he has no specific health background, his previous role as minister responsible for building the digital economy means we expect him to be a strong proponent of technology in the NHS.
In a collaboration marking NHS at 70, the Kings Fund, Nuffield Trust, IFS and the Health Foundation produced a series of reports on five key areas. One of these examined what new technology will mean for the NHS and its patients, and looked at four big technological trends – genomics and precision medicine, remote care, technology-supported self-management and data and AI – that have the potential to transform healthcare.
However, given the resource-intensive focus on Brexit planning, the likelihood of addressing the infrastructure required for genomics or AI to be truly transformative, seems far-fetched. Perhaps Hancock’s leadership will provide the drive in this area that has appeared lacking, for progress that had seemed on the cards has recently stalled.
For example, NHS England had been writing a Preparedness specification statement for delivery of advanced therapy medicinal products (ATMPs), which recognised that the ‘size of the population expected to access this service is likely to increase significantly over the coming years as new therapies are developed. This is a rapidly expanding group of treatments with many different applications being researched’. In other words, NHS England knows well the potential of (and scale of the challenge of) gene therapies.
However, work on this service specification has stopped, ostensibly because it ‘indicated the need for future ATMP specifications to be intervention specific’, but an overwhelming sense prevails that these initiatives are simply not a priority for now.
To put it into context, NICE is still not fit for purpose when it comes to assessing relatively standard treatments for very rare (but not ultra-rare) conditions. Efforts to reform the process to enable orphan medicines for very small populations to meet cost effective thresholds have been frustratingly futile. There is much preparation to be done in the technology appraisal space before the wave of gene therapies come knocking at the NHS’s door.
Unfortunately, DHSC seems not to have the capacity to push this agenda while the demands from Brexit remain so high. It is not the case that the UK is not interested – in fact the opposite is true. Our global leadership in genomics is well established. After all, the UK was the first health system to introduce genomic medicine into mainstream health care in 2015 with the 100,000 genome project.
A very recent and positive step advancing precision medicine is the news that from 1 October cancer patients in England will routinely have their tumour DNA screened for key mutations. This ground-breaking service will inform treatment decisions as well as clinical research and is “ushering in a new era of genomic health” according to Mark Caulfield, chief scientist at Genomic England.
As well as its massive contribution in this field, the 100,000 project demonstrated that significant transformational change will be required across the NHS to embed genomic medicine into routine care. The project’s success is one of the reasons why NHS England has approved the setting up of a national Genomic Medicine Service. Its task is to create effective mechanisms for horizon scanning and evidence building, and to develop the expertise to ensure the NHS’s strategic approach is focused on adoption of the most effective and relevant technologies.
There is help available; from industry, think tank reports and from parliament. In April the Commons Science and Technology Committee published a report on genomics and genome editing in the NHS. It was a useful exercise in laying bare the potential for genomics to transform healthcare and also the barriers that lie in its way.
A key consideration for companies investing in these technologies is the practicality of their use in a future market. For the numerous biotech and pharmaceutical companies with gene therapies or diagnostics in their pipeline, it is of growing importance to them to see government and NHS England taking positive steps now.