NHS innovation: personalised medicine and the human factor
19 September 2016
The NHS Health and Care Innovation Expo 2016 took place in Manchester in the first week of September. Sir Bruce Keogh, National Medical Director for NHS England said in his welcome to delegates: “All countries are grappling with the escalating cost of healthcare coupled with changing public perceptions and expectations. Part of the solution to improving quality of care and meeting demand lies in awareness of emerging science and technology, embracing innovation and constantly asking 'is there a better way of delivering this service?' . This is what NHS Expo is all about.”
So, what was there to learn about how science, technology and innovation can improve healthcare delivery? Perhaps a better initial question was, who was there to learn about it? There were many speakers, exhibitors and delegates from NHS England and related bodies; health trusts and commissioning groups were considerably less in evidence, although new Minister for Public Health and Innovation Nicola Nicola Blackwood MP did put in an appearance. As she is tasked with a daunting portfolio of responsibilities ranging from health protection and improvement to data and technology, life sciences innovation, genomics and antimicrobial resistance (to mention but a few - really), this was not to be sneezed at.
A paean of praise for personalised medicine
The Minister was swiftly conducted to the swish Personalised Medicine Zone, presided over by NHS England’s Chief Science Officer Prof Sue Hill, who is responsible for the development of the organisation’s Personalised Medicine Strategy. The event saw the launch of NHS England’s short report Improving Outcomes Through Personalised Medicine, which outlines plans for ‘working at the cutting edge of science to improve patient’s lives’. Naturally, the 100,000 Genomes Project was a central element of these plans, and indeed of the Personalised Medicine Zone itself, where most speaker sessions focused on achievements and ambitions of the project, including early examples of patient benefit and the intention to grow the number of Genomic Medicine Centres (GMCs) from the current 13 to over 100 by mid-2018. There were also a series of recorded presentations.
Perhaps the most interesting element of the Personalised Medicine Zone was, surprisingly, the sponsor organisation, Merck, which (I learned) not only has broad healthcare activity (including therapeutics for various indications in neurology, oncology and immunology and over-the-counter consumer products) but also produces a wide range of life sciences discovery products and performance materials. In this respect they are potentially well placed to comprehend the likely future of personalised healthcare, which is undoubtedly firmly embedded in genomics but also extends much more broadly to a whole host of other technologies and applications.
What then, of personalised healthcare beyond the 100,000 Genomes Project? As Sue Hill herself recently observed, by harnessing diagnostic advances ‘then coupling it with data linkage, computer analytics and mobile technologies, the NHS is paving the way for more precise prediction, diagnosis and treatment of disease’. The Digital Health Zone was (appropriately) constantly busy, and Professor Bob Wachter’s review of digital usage in the NHS was a major event in the Innovate programme of presentations. Many companies with digital information products and services were in evidence, notably the veteran patient-controlled access portal provider Patients Know Best.
Patient involvement and patient-centred care were also a recurring theme in the New Care Models Zone, which outlined experiences of innovative changes in NHS Vanguards. A striking session was led by Professor Alf Collins, national policy advisor in person-centred care, who acted out a consultation scenario where the patient was also a doctor, suggesting it was was a good model for all doctor-patient interactions, exploring what the patient knew and wanted, and setting out options.
A concept introduced in the care models area but arising particularly in the adjacent NHS RightCare Zone that was relatively new to me was the PAM (patient activation measure). This is an important factor in current attempts to deliver more personalised and sustainable healthcare, providing a tool to assess and record patient knowledge, motivation and ability to engage with efforts to manage their own long-term health conditions. The idea is that by understanding (and not making assumptions about) a given patient’s understanding, concerns and drivers, health professionals will be better able to tailor support to meet their needs. Unfortunately, talk of ‘patient activation’ seemed to me rather depersonalising (I heard someone observe that they didn’t much fancy being ‘activated’) – but there were some interesting new apps and software highlighted that could help providers tailor patient advice and support to clinical and individual needs and preferences.
Looking to the future
It should not be forgotten that an Expo is primarily a showcase, and there were indeed some tools that gave an appealing (technology-focused) glimpse of possible future care. NHS England’s Director of Digital Experience Juliet Bauer told delegates that the NHS “has to find a way to work with the best people out there at building the best apps, the best wearables, the best websites” – a sensible conclusion, and there were a fair selection in evidence. My favourite remained the AliveCor devices that allow mobile phones to be used to record ECGs and blood pressure, but there were many others, not least the 3D printing used to create bespoke orthopaedic shoe supports. Whilst less glamorous, I imagine it could make a major difference to patient quality of life.
Finally, the event provided one important reminder of the essential human factor that personalised medicine has to address alongside scientific innovations: the conference app failed to promise any utility beyond that provided by the hard-copy Expo guide I was handed on arrival, so I for one didn’t bother with it.