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

Photo: Getty Images
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We need to destroy Isil, yes. But the Prime Minister has no plan

And so, until there is a better plan on the table, I will vote against bombing Syria, says Owen Smith.

There are no decisions we make as MPs more important than whether we commit our country to combat, with its inevitable loss of military and civilian lives. That is a view shared by MPs of all parties in the House of Commons, who treat their responsibility on this question with the utmost seriousness. I have no doubt, therefore, that the Prime Minister and all those who have concluded that we should enter more fully into combat in Syria, starting with bombing the Isil/Daesh stronghold Raqqua, have done so after careful consideration, believing that this action is necessary to protect the security of the UK, through defeating Isil and bringing stability to Syria.

However, I respectfully disagree with them, and I will not be supporting a motion to bomb, based on the arguments brought forward by the Prime Minister last week.

My opposition is not rooted in pacifism, it is a hard headed and finely balanced judgment based on what I think the likely strategic, security and military effects of our involvement are.

The Prime Minister is right to set out objectives to defeat Isil and the formation of a stable, inclusive government in Syria.  These are aims that we all should share and at some point the use of British military force may well be required to achieve that outcome.  I might well support military action if a comprehensive and serious plan were put to parliament by the Prime Minister.  However, the case that Cameron currently proposes singularly fails to explain to the country how bombing will achieve his twin objectives. In fact, he is equally hazy on both the end state he desires and the end game to deliver it, and even on the question of military action, it is the Opposition's job to point to holes in the government’s argument.

Though I, like most MPs, am no military expert, I have studied these issues with great care and, along with many military and diplomatic experts, I cannot see that that Britain adding around an extra 10 per cent per cent bombing capacity (we will contribute six to 10 planes) to the US, French and other forces’ capabilities is likely to make a truly telling contribution to what we can all agree should be an agreed military objective: degrading and defeating Isil.  Especially given that there have already been around 3,000 air strikes against Isil in Syria.

I am sceptical that our weaponry is significantly more effective than that of the US, however excellent our personnel. I am also sceptical that bombing can avoid civilian casualties. And am wholly unconvinced that bombing, without significant, committed, united and effective ground troops to hold and build on the territory cleared by the bombs, will deliver the objective. It may not even be enough to chase Isil out of their stronghold in Raqqa. If the Prime Minister had been able to build a coalition of support from neighbouring countries of Turkey, Jordan, Iraq and others, willing to commit troops on the ground to take and hold ground cleared by air strikes then the equation would be very different. However, the current coalition is incomplete, and the ground troops insufficient.

Cameron has talked of there being perhaps 70,000 men under arms in opposition to Isil and ready to engage on the ground, but this does seem to me, as to many others, to be an optimistic assessment. Evidently, some of the anti-Isil and anti-Assad forces can be effective, as the Kurdish militias (the YPG) showed in driving back Isil forces from the northern town of Kobani last year, under cover of US planes. But these successful moments of defence have been few and far between and have mostly either involved these Northern (Rojava) Kurdish fighters or their ethnic countrymen from Iraq, the US-trained Peshmerga. Neither group is in close proximity to Raqqa and both see their primary objective as securing a Kurdish homeland from Syria, Iraq and Turkey. Other groups, some suggest as many as a hundred, are fighting across the region, but have a wide variety of allegiances and aims, tribal and religious, including two powerful groups that are off-shoots of Al-Quaida.  So it seems clear that the Prime Minister’s current proposals offer no realistic prospect of ground forces securing territory in and around Raqqa, which will ultimately be necessary to effectively neutralise the Isil threat, both regionally and internationally.

Nor is it clear to me what Cameron hopes Bashar al Assad will do in the event of increased bombing of Isil.  Assad is currently fighting on several fronts, against Isil, against the Kurds and against other groupings, some of them the ‘moderates’ the PM hopes will help. It remains uncertain as to whether Assad will view the bombing as an opportunity to intensify his fight with Isil, or to crush the moderates whose main goal is to depose him.

Perhaps more important a reason to oppose this action than the apparent holes in the military strategy, is the lack of a plan for what comes after. The current situation on the ground, provides scant hope for a peaceful and inclusive government to emerge, even in the event of Isil being eradicated. Far more likely is the continuation of pre-existing conflicts and the emergence of new crises from the rubble of Raqqa. British bombs might hasten the end of this phase of the conflict, if supported by a real and reliable land army, but it is only diplomatic, financial and, crucially, regional political pressure that stands a chance of any form of stability.

Maybe these questions would shrink in size if I truly felt our security at home would be increased by our bombing Isil in Syria.  But I do not.  Isil is a terrorist organisation, but it is also an insurgent army, an idea and a brand. It’s monstrous reach out of Syria, to Paris most tragically, but potentially to any of our towns and cities, may well be in planning, arming and instigating. And I am sure that the Security Services could draw evil, concrete connections between Raqqa and the Bata’clan. But Isil’s reach, and its strength, is intangible too: in its propaganda and cultural call to arms.

The only way we can be sure of defeating the Isil threat to our streets and in the region, is to find a long term political solution in Syria.  Unfortunately in my judgement, the proposals put in front of us to vote on this week do not offer that potential.  The prime route to ensuring that Isil’s capacity to threaten Western Europe is destroyed is to build on the recent peace talks in Vienna, with the aim of constructing a concerted international strategy on defeating Isil.  For this to be successful, global and regional partners must play a central part in the strategy, showing that the world is united in opposition to the poisonous ideology of Isil. And Arab nations, with Sunni majorities, must be in the vanguard of both peace talks and any military action.  

Finally, I repeat that these are judgements, not facts, and I may well be proved wrong. But I reach my conclusion as an internationalist, a European and someone who loves France and the French people. Their call for us to join with them is, for this MP, by far the most compelling to step up our engagement to actual combat at their side. But it is neither unpatriotic nor cowardly for us not to do so. The UN Resolution and NATO Treaty invoked by France, call on us to engage in ‘such action as it (the individual member states or NATO as a whole) deems necessary, including the use of armed force’. That tells me that any action our Government undertakes, including bombing, will be legal. But is does not tell me whether it will be strategic and wise, politically or militarily. And just as we cannot outsource our defence to our allies in the US or France, nor too can we outsource our judgement.

And so, until there is a better plan on the table, I will vote against. 


Owen Smith is Labour MP for Pontypridd and Shadow Secretary of State for Work & Pensions.