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
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If the left leaves it to David Cameron, we'll have Brexit for sure

Only an upbeat, leftwing case can keep Britain in the European Union.

After months flapping and hesitation, and with much of the reporting and detail so dull that it has barely penetrated the consciousness of even those who speak the language of ‘directives’ and treaty provisions, the EU referendum is upon us. With David Cameron signalling concrete outcomes for negotiations, we seem to be set for June, whatever the protests from opposition parties about the date being too close to local and national elections.  

Cameron’s deal, whose most substantive element consists of denying in-work benefits to European citizens, exemplifies the kind of debate that Conservative strategists want to create: a tedious, labyrinthine parochialism, blending the EU’s procedural dullness with an unquestioned mythology of the little Englander. Try actually reading the various letters, let alone the draft decisions, that Cameron extracted from Donald Tusk, and the agreement turns to putty in your head. But in summary, what Cameron is negotiating is designed to keep the EU debate as an in-house affair within the right, to continue and formalise the framing of the debate as between two strains of anti-migrant sentiment, both of them backed by big business.

The deal may be reactionary, but it is also mediocre in its scope and impact. The worries that many of us had in the leftwing pro-In camp, that Cameron’s deal would push back freedom of movement and working and environmental protections so far that we would be unable to mobilise for continued membership of the EU, can now be put to bed. Quite the opposite of allowing Cameron's narrative to demoralise us, the left must now seize an opportunity to put imagination and ideas back at the heart of the referendum debate.

The British political landscape in which that debate will play out is a deceptively volatile environment. Party allegiance is at a nearly all time low. Inequality is growing, and so is the gap between attitudes. The backbone of the UKIP vote – and much of the Out vote – will come from a demographic that, sometimes impoverished by the legacy of Thatcherite economic policy, sees itself as left behind by migration and change. On top of the class war, there is a kind of culture war underway in today’s Britain: on one side those who see LGBT rights, open borders and internationalism as the future; on the other side, those who are scared of the future. About the only thing these groups have in common with one another is their anti-establishment instincts, their total disdain and mistrust of politics as usual.

The only political movement to have broken through the fog of cynicism and disillusionment in British politics has come from the left. Jeremy Corbyn’s rise to the leadership of the Labour has unleashed something new - and while large parts of the press, and some Labour backbenchers, have portrayed this rise as a crusade of the “croissant eating” metropolitan elite, the reality is very different. The rise of the new Labour left has given voice to a renewed socialist and working class politics; its explicitly radical, outsider approach has given it traction across the social divides – among the young looking for a future, and among Labour’s old base. 

A politics of hope – however vague that term might sound – is the only real answer to the populist Euroscepticism that the Out campaign will seek to embody. Radical politics, that proposes an alternative narrative to the scapegoating of migrants, has to find voice in the course of this referendum campaign: put simply, we need to persuade a minimum wage worker that they have more in common with a fellow Polish migrant worker than they do with their employer; we need to persuade someone on a social housing waiting list should blame the privatisation of the housing market, not other homeless families. Fundamentally, the real debate to be had is about who the public blames for social injustice: that is a question which only the left can satisfactorily answer.

The outsider-led volatility of British politics gives the EU referendum a special kind of unpredictability. For voters who have lost faith in the political establishment – and who often have little materially to lose from Brexit – the opportunity to deliver a blow to David Cameron this summer will be tempting. The almost consciously boring, business-dominated Britain Stronger In Europe campaign makes a perfect target for disenfranchised public sentiment, its campaigning style less informed by a metropolitan elite than by the landed gentry. Its main weapons – fear, danger and uncertainty – will work on some parts of the electorate, but will backfire on others, much as the Better Together campaign did in the Scottish referendum.

Last night, Another Europe is Possible held a launch meeting of about a hundred people in central London - with the backing of dozens of MPs, campaigners and academics across the country. It will aim to provide a radical, left wing voice to keep Britain in the EU.

If Britain votes to leave the EU in June, it will give the Right a mandate for a renewed set of attacks on workers’ rights, environmental protections, migrants and freedom of movement. But without an injection of idealism and radicalism,  an In vote will be a mandate for the status quo - at home and in Brussels. In order to seize the real potential of the referendum, the left has to approach the campaign with big ideas and demands. And we have to mobilise.