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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Why haven't we heard more about the allegations of Tory election fraud?

Police and prosecutors have joined a probe into election fraud allegations that could erase the Tory majority.

The facts

The Conservative Party is facing accusations of breaking election spending rules during its 2015 campaign. Following a Channel 4 investigation, it has admitted to failing to declare more than £38,000 of expenses, money it says was spent on accommodation for Tory activists.

It’s up to the Electoral Commission, which met this week with prosecutors and police forces, to decide whether or not to launch criminal investigations into this spending.

Allegations that the money benefited campaigns in individual seats have put the Tories in hot water – they may have illegally exceeded the constituency-specific spending limit. Making a false spending declaration in an election carries a punishment of up to a year in prison and/or an unlimited fine, and anyone found guilty is also barred from running in a general election or holding any elected office for three years.

But the party claims that, as the money was spent on “BattleBus” activists who were driving around the country, it counts as national spending from HQ, rather than being part of individual candidates’ spending.

The Electoral Commission, Crown Prosecution Service and representatives of 15 police forces met this week to discuss the claims. This has resulted in extra time being allowed (an extension on the 12 months allowed under the Representation of the People Act) for relevant police forces to decide what action to take.

Up to 29 Conservative candidates are thought to have benefitted from “BattleBus” campaigning, many of whom were fighting marginal seats.

As Channel 4’s Michael Crick reported yesterday:

“It will be interesting to see if they actually start naming constituencies where they think offences may have occurred. That would then put elected MPs, Conservative MPs, in the frame.

“And indeed, if they were to look at all the constituencies that we’ve been making allegations about over the last few months, it could actually endanger the government’s majority in the House of Commons.”

The conspiracy claims

So why haven’t we heard about this? It undermines the credibility of the entire Tory general election campaign. The claims could even constitute a scandal that would trigger by-elections across the country and potentially erase the Tory majority. The Tories have a working majority of 18, so if they lost in 18 by-elections (were at least 18 MPs to be found guilty), then they would lose their majority.

Some, particularly online leftwing voices, have accused the media of conspiring not to cover this story. Our rightwing press and the cowardly BBC, they argue, are ignoring a story that could potentially call the Conservative general election victory into question.

Anger about this story being low on the political agenda is understandable. It hasn’t been prominent, considering it could result in prosecutions (indeed, the Devon and Cornwall police force is reportedly already investigating, following its meeting with the Electoral Commission). And if, say, The Sun were a left-leaning paper, it probably would have framed it in a dramatic way that would have grabbed readers’ attention.

But there isn’t a media conspiracy of silence. BBC News has been covering developments since the beginning of the year, including similar claims about 2014 by-elections, and Grant Shapps MP (Conservative chairman during the election) was hauled onto the BBC Daily Politics sofa to respond to the allegations. And the BBC’s Today programme put the allegations to Communities & Local Government Secretary Greg Clark this morning. Channel 4 News has been investigating the story, and breaking developments, from the start. The Mirror has done a big investigation into each of the MPs’ campaigns that have been accused. And all of the main papers have published news reports on the story.

The reason it may seem like silence, or lack of due prominence, is because this is an ongoing investigation. So far there have been no arrests, and the allegations remain just that: allegations. Care is required by media organisations not to falsely accuse anyone of criminal activity. And, pushed by journalists, the Conservatives have given their side of the story, so we’re not going to get a great deal more from them. Now it’s up to police forces to decide to take action.

So far, the only things to report on have been what would and would not count as a breach of electoral law (rather a dry subject), and whether or not the Electoral Commission would achieve an extension on the time allowed by law for investigating (also somewhat technical). And, however dull, these things have been reported. They may not have been shared a huge amount online, or bounced to the top of “most-read” boxes – but this is because readers aren’t usually that interested in the ins and outs of the Representation of the People Act, no matter how much those who want this government toppled wish they were.

Anoosh Chakelian is deputy web editor at the New Statesman.