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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The wildfire victims of forestry neglect - and the trees that saved them

Events in Portugal show how present mismanagement of the natural world reaches far beyond climate change, while also leaving communities more vulnerable to its effects.

When guesthouse owner Liedewij Schieving first heard about the wildfire in nearby Pedrogado Grande, she wasn’t overly concerned. “We always have fires here,” she explains at her home deep in the central Portugese forest.

It was only later that night, eating outside with her 11 guests, that the fear set in: “The wind was starting to smell and the sunset looked weird and dark.” By early the next morning the vast wall of flames had breached their remote valley. “I’ve never been in a war,” Liedewij says, still shaken, “but it was how I imagine war to sound.”

Soaring to temperatures of over 800 centigrade - high enough to melt windscreens and sink tyres into tarmac - the inferno eventually burned over 30,000 hectares of forest. By the time it was quelled, 64 adults and children had lost their lives, some dying trapped in their cars as they tried to escape down an unsafe road. “The biggest tragedy of human life we have known in years,” is how the country’s Prime Minister responded to the news on 18 June.

Two months later, the Pedrogado fire has proved the precusor to another summer of extreme weather events. Across southern and central Europe recent weeks have seen high winds and low humidity whip up wildfires everywhere from Spain to Serbia. At time of writing, 2,000 people in Portugal are trapped in the town of Mação as flames and smoke block their exit. In France, fires recently forced over 20,000 people from their homes and campervans.

Climate change is an unmistakable culprit. A Carbon Brief analysis of 140 studies from around the world found that 63 per cent of extreme weather events are linked to human-caused warming - making them either more likely or more severe.

Yet as countries assess the damage, evidence of humanity’s wider mismanagement of nature is also becoming harder to ignore. In Portugal, the excessive planting of eucalytpus trees is taking some of the blame for recent events. The species is the timber of choice for the country’s powerful paper industry, covering both industry-owned plantations and hundreds of tiny private smallholdings who sell it on. But it also happens to be highly flammable: think Grenfell cladding but spread over nearly a million hectares of land.

Liedewij’s story is evidence of this. Where dense eucalyptus forest once hid her home in dappled shade, the hillside is now charred and bare. “It was terrible,” she says of the moment she opened the gates for the farm animals before fleeing the valley, “we thought we were leaving them behind to grill”. Except that, as in all good disaster films, Liedewij’s goats didn’t burn - and nor did her picturesque house. Instead, fire-retardant willow trees by a nearby stream held the flames naturally at bay. On returning the next morning, she even found the hens laying eggs.

Liedewij Schieving outside her B&B at Quinta da Fonte - the bare hills behind the house show just how close the fire came.

Seen from above, her remote farmstead is now a tiny island of green amid a sea of black. She still panics at the smell from the woodfired heating, but support has poured in from friends both in Portugal and her native Holland, and she soon plans to fully re-open Quinta da Fonte B&B. Many guesthouses in nearby villages have already got back up and running.

Others among her neighbours, however, are not so lucky. Over 10,000 separate fires have destroyed 141,000 hectares of land in Portugal this year alone, with the annual cost of wildfire losses estimated to reach around €200m. A situation that risks further perpetuating the cycle of poverty and neglect that also played their part in the tragedy.

According to Domingos Patacho from the environmental NGO Quercus, the forest has become more hazardous as many of central Portugal's thousands of smallscale landholders leave their land untended to seek better wages elsewhere. Meanwhile, those who remain are often financially dependent on the income from the eucalyptus. They could choose to plant less flammable and water-hungry species, such as native corks or oaks, Patacho explains, but these can take twice as long to mature and provide a return.

The result is rising tension between the Portugese paper industry and the central government. After the June fire, the parliament pledged to push ahead with plans to limit the monoculture plantations. But the country’s Association of the Paper industry has previously warned that any ban on new plantations could hurt exports and jobs.

The reality is that both sides of the eucalyptus spread - both industry-owned and private - need improved regulation. But in a country only recently released from EU imposed austerity measures, debates over how enforcement could be financed are particularly tense. Not least since many areas do not even have an up to date land register, Patacho expplains.

At ESAC, an agrarian research base in central Portugal, professor Antonio Ferreira believes the time is now ripe for discussion between politicians, citizens and researchers about the future of forest land-use as a whole. The country needs to encourage people “to re-introduce native species, which will diversify the landscape and economic activity in those areas,” he says.

And the impulse is far from limited to Portugal. “We need to look at all the social aspects to get the full picture as well as the scientific side of forest management,” says WWF’s Jabier Ruiz of Europe’s wider wildfire problems. One route out of the woods may be greater EU policy support for those living in marginalised, rural areas, he adds.

What is clear is that as the continent warms, the need to improve the balance between social, environmental and commercial interests becomes ever more crucial. And while politicians debate, work at Liedewij’s home is already underway. Over the next few weeks, a group of her eco-minded friends, builders and topographers will help her re-build and re-landscape her farm. From digging terraces to stop landslides, to preventing the eucalyptus from re-emerging too close to the roads, their aim is to regrow a forest that works for all: a slow-burn project perhaps, but a bright one.

India Bourke is an environment writer and editorial assistant at the New Statesman.