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

Getty
Show Hide image

How the Lib Dems learned to love all-women shortlists

Yes, the sitting Lib Dem MPs are mostly white, middle-aged middle class men. But the party's not taking any chances. 

I can’t tell you who’ll be the Lib Dem candidate in Southport on 8 June, but I do know one thing about them. As they’re replacing a sitting Lib Dem (John Pugh is retiring) - they’ll be female.

The same is true in many of our top 20 target seats, including places like Lewes (Kelly-Marie Blundell), Yeovil (Daisy Benson), Thornbury and Yate (Clare Young), and Sutton and Cheam (Amna Ahmad). There was air punching in Lib Dem offices all over the country on Tuesday when it was announced Jo Swinson was standing again in East Dunbartonshire.

And while every current Lib Dem constituency MP will get showered with love and attention in the campaign, one will get rather more attention than most - it’s no coincidence that Tim Farron’s first stop of the campaign was in Richmond Park, standing side by side with Sarah Olney.

How so?

Because the party membership took a long look at itself after the 2015 election - and a rather longer look at the eight white, middle-aged middle class men (sorry chaps) who now formed the Parliamentary party and said - "we’ve really got to sort this out".

And so after decades of prevarication, we put a policy in place to deliberately increase the diversity of candidates.

Quietly, over the last two years, the Liberal Democrats have been putting candidates into place in key target constituencies . There were more than 300 in total before this week’s general election call, and many of them have been there for a year or more. And they’ve been selected under new procedures adopted at Lib Dem Spring Conference in 2016, designed to deliberately promote the diversity of candidates in winnable seats

This includes mandating all-women shortlists when selecting candidates who are replacing sitting MPs, similar rules in our strongest electoral regions. In our top 10 per cent of constituencies, there is a requirement that at least two candidates are shortlisted from underrepresented groups on every list. We became the first party to reserve spaces on the shortlists of winnable seats for underrepresented candidates including women, BAME, LGBT+ and disabled candidates

It’s not going to be perfect - the hugely welcome return of Lib Dem grandees like Vince Cable, Ed Davey and Julian Huppert to their old stomping grounds will strengthen the party but not our gender imbalance. But excluding those former MPs coming back to the fray, every top 20 target constituency bar one has to date selected a female candidate.

Equality (together with liberty and community) is one of the three key values framed in the preamble to the Lib Dem constitution. It’s a relief that after this election, the Liberal Democratic party in the Commons will reflect that aspiration rather better than it has done in the past.

Richard Morris blogs at A View From Ham Common, which was named Best New Blog at the 2011 Lib Dem Conference

0800 7318496