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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How the Brexit referendum has infantilised British politics

Politicians like Boris are not characters in a fantasy show. If they aspire to high office then they must be held to high standards. 

Ancient Greece is the cradle of modern Europe.  From its primordial soup emerged so much of our culture, our language and our politics. Of the three, it seems to be the politics that has made the least progress over the centuries. In fact, if you dropped an Athenian into the middle of politics in the UK today, they would find themselves right at home. This is not because of the direct democracy, the demagogues or the xenophobia, though all are worryingly familiar, but because of the style of the debate itself.

To understand politics in ancient Greece you have to grasp that they had no concept of ‘the truth’. This is not to say that they were liars, simply that the framework by which we judge credibility was not one they would have recognised. The myths and legends that dominated their discourse were neither thought of as being ‘true’ or ‘made-up’, they simply were, and the fact of their being known allowed them to be used as reference points for debate and argument.

Modern politics seems to be sliding back towards this infant state, and nothing embodies this more than the childish slanging match that passes for an EU referendum debate. In the past six years the UK has had three great exercises of direct democracy and it is safe to say none of the campaigns have added a great deal to sum of human enlightenment. Who remembers the claims that babies would die as a result of the special voting machines needed to conduct AV elections? But the EU referendum has taken this to new extremes. The In campaign are executing what is a fairly predictable strategy, the kind of thing that is normal fare in politics these days. Dossiers of doomsday scenarios. Experts wheeled out. Statistics embellished to dazzle the public. One can question the exact accuracy, but at least you feel they operate within certain parameters of veracity.

What is happening on the Out side, in contrast, is the collective nervous breakdown of a large section of the political establishment. Just this week we have had Penny Mordaunt, a government minister, flat-out denying the UK’s right to veto new accessions to the EU. We have seen the fiercely independent Institute for Fiscal Studies denounced as a propaganda arm for Brussels. Most bizarrely, Boris Johnson even tried to claim that the EU had banned bananas from being sold in bunches larger than three, something that nobody who has actually visited a shop in the UK could possibly believe. These kind of claims stretch our political discourse way beyond the crudely drawn boundaries of factual accuracy that normally constrain what politicians can do and say. Surely the people peddling these myths can never be taken seriously again?

But they will. You just watch as Johnson, Mordaunt and the rest slide effortlessly back into public life. Instead of being ridiculed for their unhinged statements, they will be rewarded with plush offices and ministerial cars. Journalists will continue to hang on every word they say. Their views will be published in newspapers, their faces will flit ceaselessly across our TV screens. Johnson is even touted as a plausible future leader of our country, possibly before the year is out. A man who over his meandering career seems to have held every possible opinion on any topic you care to name. Or rather, perhaps it is more accurate to say that the character we call Boris has no opinions at all, simply interests. The public, who have scant regard for a political class they believe to be untrustworthy, seem to have taken a shine to a man who is perhaps the most fundamentally dishonest of Westminster’s denizens.

What does all this say about the state of our politics? If it is true that we are seeing the advent of ‘post-truth’ politics, as some have argued, then it has grown out of the corrosive relationship between politicians and the public. It is both a great irony and a great tragedy that the very fact that people distrust all politicians is what has permitted the most opportunistic to peddle more and more outlandish claims. Political discourse has ceased to be a rational debate with agreed parameters and, like the ancient Greeks, more resembles a series of competing myths. Claims are assessed not by their accuracy but by their place in the grand narrative which is politics.

But the truth matters. For the ancients it was the historian Thucydides who shifted the dial decisively in favour of fact over fiction. In writing his Histories he decided that he wanted to know what actually happened, not just what made a good story. In a similar vein British politics needs to take a step back towards the real world. Broadcasters launching fact-checkers are a good start, but we need to up the level of scrutiny on political claims and those who make them. At times it feels like the press operate as a kind of counterweight to Game of Thrones author George RR Martin, going easy on much-loved characters for fear of upsetting the viewers.

But politicians like Boris are not characters in a fantasy show. If they aspire to high office then they must be held to high standards. If politics is the art of the possible, then political discourse is the art of saying what you can get away with. Until there are consequences for the worst offenders, the age of post-truth politics will continue suck the life from our public debate.