Simon Stevens puts innovation and patients as innovators front-of-house in NHS

Simon Stevens, the relatively new NHS Chief Executive, put innovation front-of-house in his speech to the NHS Confederation yesterday.  He identified it as one of three elements crucial to ‘future-proofing’ the NHS for the challenges ahead.  You can read the full speech here.  But I have also included the relevant extract below as it is worth reading.

A few points and observations of my own:

The competition announced for leading teaching hospitals and clinical research centres to join the Genomics England programme is a canny move that will help build capacity and capability quickly while also assisting with implementation in clinical practice.  It fits with the spoken model of Genomics England as being a reading library rather than a lending library. It also opens up the possibility of better engagement and involvement of patients in personalised medicine.  The TSB funded public dialogue exercise will report its results shortly but it was interesting to speak to a cancer researcher a few days ago and hear how the sort of precision diagnosis now possible with some cancers can amount to overwhelming detail for a patient and their family.

It is easy to read too much into speeches but I did take the ‘if we get our act together’ passage as a call to arms to all parts of the health research and innovation system to work together better.  I also felt that implicit in this was a vote of confidence in, if not  a nudge that long-term support will be available to, AHSNs (Academic Health Science Networks) as the organisations to make things happen.  Whereas the previous regime was far too political in seeing AHSNs as a land-grabbing opportunity, this one seems to see them as instruments of innovation.

There are no surprises that care.data is in amongst the mix.  It should be.  Stevens nearly gets it right in his messaging.  But we could all be more plain-speaking.  It is about using data to make people better.  Hence the tragedy if we can not realise its potential because ultimately we failed to build a robust system that wins public confidence. If you talk to colleagues in the cancer world you will soon hear how the pause in care.data is having knock-on effects for cancer registries and others in how they can use data for research.

Finally, I think it is very, very interesting indeed – if not downright refreshing – that citizens, patients, the public are being mentioned in the same breath as innovation.  In fact being viewed by the NHS’ CEO as key innovators in the system.  I particularly liked his closing sentence to this part: ‘Above all it’s why we should recognise that achieving change in the NHS is not merely a techno-rationalist activity, it’s health as a social movement, working with communities and civil society organisations and local government and faith groups and patients groups and many others.’  It strongly echoes the philosophy behind the NIHR strategic plan: ‘Promoting a research active nation.’

Some will no doubt object to us being seen as ‘renewable energy’.  But it’s better than being fracked to death as before.

Above all, I hope the emphasis on research and innovation in Simon Stevens’ speech will result in greater momentum in NHS England with regards to its research strategy which is into its second draft and badly needed.

Extract from Simon Stevens speech to NHS Confederation, 4th June 2014.

3. Harnessing the coming innovations in modern medicine.

When you’re in the heat of the here and now it’s sometimes hard to stand back and see some of the bigger changes unfolding, some of the wider opportunities ahead. But now is the time to do that.

I say that in part because I believe that all industrialised countries stand on the cusp of at least three quite fundamental shifts in the practice of modern medicine. Will we in the NHS embrace them and harness them to our cause – or will we wait for them to wash over us, while trying to muddle through? That’s our choice.

First, personalisation. A decade and a half on from the Human Genome Project, we’re still in the early days of the clinical payoff. But as biology becomes an information science, we’re going to see the wholesale reclassification of disease aetiologies. As we’re discovering with cancer, what we once thought of as a single condition may be dozens of distinct conditions. So common diseases may in fact be extended families of quite rare diseases. That’ll require much greater stratification in individualised diagnosis and treatment. From carpet-bombing to precision targeting. From one-size-fits many, to one-size-fits-one.

The NHS should be at the forefront of this global medical revolution. That’s one reason why I’m announcing today that NHS England will be launching a  competitive process for the nation’s leading teaching hospitals and clinical research centres to join the UK’s new 100,000 genome programme – one of the world’s highest profile initiatives in this area. We expect to issue the ITT at the end of this month, followed by two bidders’ days and final submissions in July, and the announcement in the autumn of the successful wave one trusts who will begin sample acquisition in early 2015. In parallel we will be consulting on moving to a new model for regional genetics labs to upgrade and industrialise NHS capabilities in this area.

We’re never going to be the country that pays the highest prices, or that adopts new treatments regardless of how well they work – just so we can say we’re ‘innovative’. We’ll happily leave that accolade to others. But what we should be is rigorously pro-science, pro-research, and pro-the rapid spread of useful improvement. That’s where AHSCs and AHSNs have such an important role. If we get our act together, what the NHS potentially has to offer – that many other health systems don’t – is a unique combination of biomedical research, population-orientated primary and specialist care serving diverse patient groups, longitudinal data (to allow matching of phenotypes wit genotypes), an aligned financing system, and a rigorous focus on value creation.

A second area where we’re going to see major opportunities is by using data to drive transparency, quality improvement and the move to more proactive and anticipatory care. For example, researchers have shown that real time analysis of clinical data from electronic health records could have identified increased risk of heart attacks associated with one diabetes drug at least five and half years earlier than actually happened. Similarly while cancer outcomes have been improving dramatically – Cancer Research UK point out that half of all cancer patients now survive at least 10 years, compared to only a quarter in the 1970s – we also know that perhaps a quarter of cancer patients are only diagnosed when they arrive in A&E, and that as result their prognoses are substantially worse. So proper data linkage between GP systems and hospitals and other health care providers to create secure, confidential longitudinal information that allows us to target prevention and quality improvement, as well as help discover new treatments and cures, is essential if the NHS is to deliver for the people of England. That’s why getting programmes such as care.data right is so fundamentally important.

Third, we stand on the cusp of a revolution in the role that patients – and also  communities – will play in their own health and care. Harnessing what I’ve called this renewable energy is potentially the make-it or break-it difference between the NHS being sustainable – or not. That’s why NHS England has, for example, just launched an initiative to support 150,000 people with so-called patient activation tools. It’s why we’re backing the new NHS Citizens Assembly. It’s why a number of patient groups are arguing for personal health budgets that put service users in control. It’s why we should be doing more to support the 1.4 million full time unpaid carers across the country. It’s why the £500 million-worth of volunteer support for the NHS (which I suspect is an underestimate) should be nourished and stimulated. Above all it’s why we should recognise that achieving change in the NHS is not merely a techno-rationalist activity, it’s health as a social movement, working with communities and civil society organisations and local government and faith groups and patients groups and many others.

So – a coming revolution in biomedicine, in data for quality and proactive care, and in the role that patients play in controlling their own health and care. The NHS has to grab these opportunities with both hands, rather than just letting them wash over us, or hoping they’ll bypass us so we can carry on with business as usual.

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