Life Sciences Conference: The ongoing pressures on the NHS and how to make changes

Covid-19 has created “the most compelling case ever” for the NHS to change its ways, one of Scotland’s most senior health leaders told The Scotsman’s online Life Sciences Conference.

Picture: Halfpoint/Shutterstock
Picture: Halfpoint/Shutterstock

Professor Jann Gardner, chief executive of NHS Golden Jubilee, said the health service had to find better ways of working with partners, because staff are exhausted and every treatment needs to count.

She explained: “We all rallied like a wartime army, to step up for the people that we serve. But that takes a lot of resilience. We set out to run a sprint and it has become one of the greatest marathons.

“This has had a really significant impact on our workforce. People are finding it hard, they are tired. Just as we’re coming out of one phase, we go into a new challenge. Just as you rally yourself to start dealing with the backlog, we see a new variant.”

Gardner said public expectation was hard to manage, especially as there was still a huge backlog of non-Covid cases. She said one in ten people inScotland – more than 500,000 – were waiting for a hospital appointment.

“I think people sometimes forget our staff are also sick and self-isolating,” she said. “We’re dealing with a challenge getting worse literally by the day. We cannot resolve where we are today by doing what we used to do.

“But there is opportunity because Covid has created the most compelling case ever for the need to change, for us to make every single treatment count.”

Gardner continued: “We want to develop ourselves and to develop what we bring to our patients, to leave a positive legacy from Covid.

“There’s also been a real change in culture and behaviour, within the NHS and across society. I think people value one another more.

“We know the NHS alone is definitely not the answer. We want to do things differently and challenge ourselves about what we can do.”

Gardner said the “risk appetite” was higher in terms of how the NHS operated: “There is an appetite for different partnerships, working closer with academia, across NHS boards and with industry. There’s a different approach in terms of the governance of strategic partnerships, having honest conversations about what’s in it for you, what’s in it for us, what’s in it for the people we serve. Governance is changing, and I don’t think we’ll go back to the way it was.”

Giles Hamilton, chief executive of ODx Innovations, said a “cultural gap” between the NHS and private sector had narrowed and there was more “directness in the room” in working together.

“My impression is we’re in a new situation now, where there’s relevant support that the private sector can offer in contingency planning,” he said. “I think we’re further up the curve, and better-placed to contribute next time.”

But Hamilton warned of longer-term challenges, such as the growth in antimicrobial resistance (AMR), and the uncertainty of what would come next.

“The likes of AMR are not immediate crises today, other than for those patients directly affected. But they are a significant sleeping challenge ahead.

“One of the curiosities in industry is, what’s the next Covid-19? Is it going to be another respiratory-style virus? Or a mixture of the legacy of workflow challenges and change in the capacity of antibiotics to act as they traditionally have had?”

Hamilton also said in the first half of 2021, some 28 per cent of medical consultations in the US moved to remote and online. He said this was “a staggering shift in a very short period of time”, adding: “I think most clinicians would prefer to see someone face-to-face. But if they aren’t able to, it can be helpful to have a good set of diagnostic information in front of them.

“There’s a very big shift here, to looking at where there are opportunities to move diagnostics out in a decentralised [way]. But this has got to be clinically led, and done in a way that addresses the choke points we’re seeing right now.”

This meant better triage systems and “realism about the constraints we face”, he added.

“Across the world, there’s no new money in healthcare [and] a significant set of challenges to deal with now, using existing resources. Diagnostics can increase and improve the quality of intervention, but it’s going to have to be done in a very honest way, in terms of where we can get the most return on resources.”

Jacqueline Barry, chief clinical officer at the Cell and Gene Therapy Catapult, said more remote monitoring of patients using data, AI and digital tools, opened up great opportunities – including more patients having access to clinical trials.

“You can also start to predict a deterioration in a patient’s condition, which is an amazing thing. Then you can change your treatment regimen and use technology to predict patients who will perhaps have more serious adverse events. You can adapt your treatment, and address and minimise these adverse events, which is fantastic.”

Barry told the online event that she supported Gardner’s point about an increased risk appetite: “We saw that the Medicines and Healthcare Regulatory Agency used a really pragmatic approach to look at the risk-benefit analysis for Covid products. We see that all the time for advanced therapies, they are really pioneering in helping developers move through the clinical trial pathway.”

Hamilton said there were real challenges for non-Covid trials and research, with “a significant gap in the capacity to move existing projects forward”.

He added: “We need to remain really focused on the reality of workflow now. I hope we can improve dialogue so the NHS has the courage to say to industry, ‘We don’t need another one of those – here’s the stuff we’re struggling with; what will you guys do?’

“It’s about having these slightly difficult conversations from time to time and making sure the patient is absolutely at the heart of everything we do.”

Gardner agreed, saying: “We need to re-engage with R&D as quickly as possible because otherwise, we risk losing time and progress when we need it most.

“Clinicians are desperate to create the solutions of the future. Without R&D and investment, we will only have the past and that isn’t engaging to a workforce that is tired, and just surviving.”

Dave Tudor, managing director of the Medicines Manufacturing Innovation Centre, said life sciences in Scotland needed tens of thousands more skilled people to hit its £8 billion turnover target sector by 2025.

“You’re looking at another 40,000 brilliant scientists and engineers working in this sector, and we need to make sure we’ve got a really clear skill strategy and leadership growth plan that makes that happen.

“Nobody needs to panic, the plan we have is brilliant, and the quality of apprentices and graduates we’re producing in Scotland is absolutely fabulous.”

Nathan Barnett of RoslinCT said contract development manufacturing organisations and contract research organisations (CROs) required large volumes of highly-skilled, highly trained staff. However, he said it could take up to nine months to get new graduates independently trained, placing huge demands on a business – but pointed to efforts to speed things up.

He added: “We need people who have worked in process-driven roles in highly regulated and clean environments, working to a very strict process and adhering to good manufacturing practice regulations. These are highly valuable skills.”

John Waller, of Oracle Bio, a digital pathology CRO working on analysing images from cancer studies, said the sector increasingly needed people with a mix of skills.

“We are on that biology/IT interface,” he explained. “We’ve always recruited biologists until a year ago, now we need engineers, data programmers, computer scientists and marketing people. It’s a massive diversification for us from pure biologists to all these different types of individuals that will make our company and make Scotland’s digital future work properly.”

Miguel Bernabeu, deputy director at the University of Edinburgh’s Bayes Centre, said a “top layer of knowledge across different domains” was needed to provide that biology/IT interface.

He told the conference: “A biologist will have the language to talk to a data scientist with a deep skillset on machine learning, and to a software engineer. It’s building [that layer] on top of unique skill sets. Some of the problems we are trying to tackle require a combination of skills that any one individual cannot be expected to master through their lifetime.”

Bernabeu also stressed the need for skills to link meaningfully with industry: “We have MSc projects with a strong component from an industrial partner. I think these can be mutually beneficial and build relationships.”

Barnett believes graduate apprenticeships are a “missing link” in life sciences: “You can stay working, and gain new skills working with an organisation, but also have that qualification. I think we really need to advocate that.”

Bates said the last two years had been a great recruitment tool for life sciences: “Any young person wanting to change the world can see how medical science, the adaptation of fundamental understanding of biology to a pressing global health need. can make a real difference. Hopefully, the flame will have been lit.”

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