The NHS has a secret weapon. Why doesn't it use it?

Why is no-one talking about predictive care?

Two different but related stories on the NHS have emerged recently: Chris Smyth in the Times (paywall) reported  on £300m of ostensibly wasted funds from a set of tests focussed on over-40s, which operated in direct conflict with the "best available evidence." In other news, the Daily Telegraph (paywall) reported on a "time-bomb," anticipating that three in four adults will suffer from chronic disease by 2030, stressing the NHS’s ability to cope with patients as it continues to be challenged by budget constraints and a dearth of medical practitioners and support staff.

In the wake of the NHS’ recent 65th birthday, and radical recent structural reform, dealing with both of these issues form part of the broader challenge that must be met to ensure the long-term sustainability of the NHS. The organisation has to deal with severe budget constraints, and insufficient staff, and yet continues to be a jewel in the crown; one of the world’s largest employers and fulfilling the remarkable accomplishment of delivering near universal healthcare in England. An entirely different approach to healthcare is needed to ensure the NHS remains fit for purpose into the future.

What both the Telegraph and Times reports point to are issues that ultimately could be mitigated through better use of information.

In the case of the expensive and unnecessary tests the Times reports on, trials are already underway to deliver "stratified medicine" into the UK –  matching treatment with a patient’s genetic markers to assess not just the tests required, but the treatment options that will deliver the swiftest route to recovery and ultimately, improved survivability. This is already proving that we can  eliminate the need for "unnecessary" tests. The key here is that illness can be dealt with before it manifests into symptoms, at far reduced costs. After all, using a DNA test to prescribe the correct chemotherapy drugs for skin cancer raises the rate of effectiveness from 10 per cent to 70 per cent creating a significant saving in later treatments, hospital and in-home care.

Key to dealing with the staff shortages that the Telegraph writes on is shifting the overall paradigm for healthcare to one that no longer expends 70 per cent of NHS budgets on chronic disease care, dealing with illnesses including cancer, diabetes, breathing conditions and heart disease. Stratified healthcare can clearly play a role here, drawing on patient, environmental, social and genetic data to deliver the best treatment. In addition, increasingly popular advances in "body data" technology including everything from Nike’s Fuelband through to sophisticated wireless sensors deliver an opportunity to the medical profession: the correlation, analysis and interpretation of telehealth, telemetry and genomic data to treat disease pre-emptively. For example; an anomalous heart beat within someone that has a specific genetic and weight profile might be cause for pre-emptive medical intervention (avoiding emergency by-pass surgery in someone who is extremely overweight, for example); for the same symptoms in someone who had a fitter profile, it might be ignored, limiting the risk of "false positives." Similarly, this sensor data could have a dramatic impact in reducing the number of emergency hospital readmissions (that is, people who had to come back to hospital through A&E after being discharged) – of which there were 650,000 in 2010/11, a rate which has been climbing for a decade.

This transformation will need to happen in stages: the NHS will need to continue to make progress in digitising the way healthcare is managed in the UK and there will need to be better and more widespread data sharing between medical authorities, academic institutions and research organisations. Crucially, great care and thought will need to go into securing the privacy of individual health data even as it is used as a resource to provide better healthcare for others.

However – the prize – a significant reduction in the £80bn spent in chronic disease care, and a potentially dramatically improved quality of life for citizens – is one that must be sought after. And doubtless we may still face up to wasted tests or stretched wards – but hopefully this will become the exception, rather than the rule, and the NHS will endure to celebrate its centenary and beyond.

Illness can be dealt with before it manifests into symptoms, at far reduced costs. Photograph: Getty Images

James Petter is the Vice President & Managing Director of EMC, UK & Ireland

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Staying in the EU would make it easier to tackle concerns about immigration, not less

Brexit is not only unlikely to deliver the control people want, it may actually undermine people’s faith in the system even further.

As Theresa May prepares to set out her latest plan for Brexit in Florence on Friday, those on all sides of the debate will wait to see if there are answers to fundamental questions about Britain’s future outside of the EU. Principle among those is how the UK immigration system will work. How can we respond to Leave voters’ concerns, while at the same time ensuring our economy isn’t badly damaged?

We must challenge the basic premise of the Vote Leave campaign: that dealing with public’s concern about immigration means we have to leave the EU and Single Market.

In fact the opposite is true. Our study into the options available to the UK shows that we are more likely to be able to restore faith in the system by staying within Europe and reforming free movement, than by leaving.

First, there are ways to exercise greater control over EU migration without needing to change the rules. It is not true that the current system of free movement is "unconditional", as recently claimed in a leaked Home Office paper. In fact, there is already considerable scope under existing EU rules to limit free movement.

EU rules state that in order to be given a right to reside, EU migrants must be able to demonstrate proof that they are either working, actively seeking work, or self-sufficient, otherwise they can be proactively removed after three months.

But unlike other continental systems, the UK has chosen not to operate a worker registration system for EU nationals and thus has no way of tracking where they are or what they’re doing. This could be changed tomorrow, if the government were so minded.

Other reforms being discussed at the highest levels within Europe would help deal with the sense that those coming to the UK drive down wages and conditions. The UK could make common cause with President Macron in France, who is pushing for reform of the so-called "Posted Workers Directive", so that companies seeking to bring in workers from abroad have to pay those workers at the same rate as local staff. It could also follow the advice of the TUC and implement domestic reforms of our labour market to prevent exploitation and undercutting.

Instead, the UK government has chosen to oppose reform of the Posted Workers Directive and made it clear that it has no interest in labour market reform.

Second, achieving more substantive change to free movement rules is not as implausible as often portrayed. Specifically, allowing member states to enact safeguards to slow the pace of change in local communities is not unrealistic. While the principle of free movement is a cornerstone of the European project, how it is applied in practice has evolved. And given that other countries, such as France, have expressed concern and called for reform, it is likely to evolve further.

The reforms to free movement negotiated by David Cameron in 2016 illustrate that the EU Commission can be realistic. Cameron’s agreement (which focused primarily on benefits) also provides an important legal and political precedent, with the Commission having agreed to introduce "safeguards" to respond to "situations of inflow of workers from other Member States of an exceptional magnitude over an extended period of time".

Similar precedents can be found within a number of other EU agreements, including the Acts of Accession of new Member States, the European Economic Area (EEA) Agreement and the Treaty on the Functioning of the European Union (TFEU). The UK should seek a strengthened version of Cameron’s "emergency brake", which could be activated in the event of "exceptional inflows" from within the EU. We are not the first to argue this.

Of course some will say that it is unrealistic to expect the UK to be able to get more than Cameron achieved in 2016. But put yourself if in the shoes of the EU. If you believe in a project and want it to succeed, moral imperative is balanced with realism and it hardly needs pointing out that the political context has radically shifted since Cameron’s negotiation.

In contrast, a "hard Brexit" will not deliver the "control of our borders" that Brexiteers have promised. As our report makes clear, the hospitality, food, manufacturing and social care sectors heavily depend on EU workers. Given current employment rates, this means huge labour shortages.

These shortages cannot be wished away with vague assertions about "rejoining the world" by the ultra free-market Brexiteers. This is about looking after our elderly and putting food on our tables. If the UK leaves in April 2019, it is likely that the government will continue to want most categories of EU migration to continue. And whatever controls are introduced post-Brexit are unlikely to be enforced at the border (doing so would cause havoc, given our continued commitment to visa-free travel).  Instead we would be likely to see an upsurge in illegal migration from within the EU, with people arriving at the border as "visitors" but then staying on to seek work. This is likely to worsen problems around integration, whereby migrants come and go in large numbers, without putting down roots.

We can do this a different way. The important issues that most drive public concern about EU migration - lack of control, undercutting, pace of change - can be dealt with either within current rules or by seeking reform within the EU.

The harsh truth is that Brexit is not only unlikely to deliver the control people want, it may actually undermine people’s faith in the system even further.

Some will say that the entire line of argument contained here is dangerous, since it risks playing into an anti-immigrant narrative, rather than emphasising migration’s benefits. This is an argument for the ivory tower, not the real world.

There is a world of difference between pandering to prejudice and acknowledging that whilst EU migration has brought economic benefits to the UK, it has also created pressures, for example, relating to population churn within local communities.

The best way to secure public consent for free movement, in particular, and immigration in general, is to be clear about where those pressures manifest and find ways of dealing with them, consistent with keeping the UK within the EU.

This is neither an attempt at triangulation nor impractical idealism. It’s about making sure we understand the consequences of one of the biggest decisions this country has ever taken, and considering a different course.

Harvey Redgrave is a senior policy fellow at the Tony Blair Institute for Global Change and director of strategy at Crest Advisory.