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Discussing Opportunities for Improved Outcomes Through Industry Partnership in Scotland

At the latest IQVIA roundtable in Edinburgh hosted on the 24th of October several interesting subjects were raised regarding the healthcare sector in Scotland which we have summarised here.

Clinical Trials

Several attendees stressed that there needs to be an inward investment and expansion of the life sciences industry as, currently, clinical trials are not active in Scotland frequently compared to comparative rates in other areas. The question debated was, how can Scotland be more competitive? In response to Lord O’shaughnessy’s clinical trials review the health industry in Scotland aims in the next ten years to increase commercial clinical trials. The aim is to implement O’shaughnessy’s recommendations as much as possible (within financial constraints). This would involve investment in the research economy and an increase in staff. To attract staff, the roundtable noted that more needs to be done to show the benefit of research experience for future careers in the Medical Research Council.

To attract subjects for clinical trials they suggested that marketing could explain how trials lead to better outcomes than in hospitals. Subjects would get access to innovative medicines much earlier than the public and for free. At current estimates £19 million in medicines are delivered to people in the NHS through IQVIA’s clinical trials and attendees cited that they have attracted £1.2 billion through economic investment to develop commercial clinical trials. The roundtable questioned Scotland’s lack of biomedical research centres as they are the places where academia, the NHS and industry come together and stressed the need to implement them.

Data and Information Governance

One attendee suggested that the £300 million that the clinical trials industry gives back to the Scottish government could be spent on improving data collection. They theorised that if you cannot measure healthcare then you cannot effectively manage it. This would involve holding the government to account to implement what is needed so that health data efficacy increases at pace and is adequately funded. Until then, they did not believe the industry’s aspirations are realisable while there is no data infrastructure to support them. The roundtable cited notable data gaps, particularly, in primary social care, however it is unclear if this is due to the data not being collected or if it is just not being made readily available.

There were concerns among attendees that health data isn’t joined up which means that it may not be used effectively and opportunities for constructive collaboration are being missed. However, other attendees stressed that there are challenges in public confidence regarding how the data is used. Other attendees countered that some surveys suggest that the public is happy for their data to be used for the purposes of research though this would need to be approached with caution so as not to breach legislation. Some data is collected repeatedly but the collection isn’t stratified and there are also significant delays in processing data requests, some as long as nine months. An attendee cited statistics that suggested as much as 97% of healthcare data is collected and then never used for any purpose. The Covid pandemic being the exception as data was used during the crisis to identify trends and practical solutions in response to the urgent need. However, the attendee noticed that after the pandemic had ended healthcare data usage returned to pre-pandemic levels.

The general feeling was that, initially, primary care data was easy to access immediately post-pandemic but that access swiftly disappeared. There was a demand for data accessibility to return to pandemic levels. Some attendees even suggested the public would prefer for their data to be used, provided it is used for health or improving research. Is further legislation needed for information governance however? During the pandemic attendees noted a relaxation of standards from the information commissioner, and they felt that this may need tightening up. Individual GP practices are the data controllers for the most part, leading to a very decentralised information governance situation. The National Care Service legislation that is being progressed through parliament currently aims to focus on information governance. There were also concerns regarding accountability and some attendees questioned whether clinical data is joined up and if not, then should it be joined up. Thankfully, there are some indications that data access is improving in speed.

Dentistry

An attendee asked how the sophistication and performance of dentistry can be improved through innovation. In response it was explained that there has been notable success in Scotland of toothbrushing for children in large part due to the organisation Childsmile. Childsmile is a large program that has been particularly successful in reducing incidences of tooth decay and disease in children. The organisation has done a lot of work in educating and supporting dental nurses to work better with children. In addition, attendees cited that in Scotland more work has been done with prisoners and care home residents to ensure they receive the right dental care.

An attendee suggested that every contact with health and care professionals should be an opportunity to identify preventative measures for that individual and to signpost them towards other services. They felt that primary care clinicians, dentists, optometrists, pharmacists, and general practitioners have a huge role to play in this. They stressed that there are missed opportunities for tying dental care into the overall health of patients. In their opinion, dentists are primed to identify diseases and conditions first because they present signs and symptoms dentally and thus can be identified before primary care physicians would notice other symptoms. They suggested a short questionnaire could be asked and combined with an algorithm to link this with overall health and identify concerns.

Diagnostic Tests

One attendee suggested that the most significant revolution in biomedicine is diagnostics. They argued that early diagnosis leads to early treatment, greater likelihood of a cure, and saves money. However, they cautioned that many companies develop these tests in an artificially high prevalence population. Whilst it may be an effective test, if it is only conducted in an artificial population, it may not be effective in real world conditions. In the wider world where prevalence could be 5% or even 0.5% the predictive value might be 3-4% leading to potentially 96% not having the disease but the test indicates that which creates large waiting lists in CAT scans. They stressed that such tests need to be implemented cautiously and in a constructive way.

Is a regulatory approach for diagnostics needed? Currently regulatory authorities such as the Mental Health Research Network and the National Institute for Health and Care Excellence insist on having real world data as part of the submission package. Attendees felt that this should be the path for future diagnostic test research and researchers will need to clearly state the intended use of the test and focus on the likely prevalence of the condition in real world settings.

Final Thought

Whilst a number of concerns and barriers were raised throughout the roundtable, many attendees felt that there were actionable strategies for improvement and that the general outlook was cautiously optimistic with a healthy dose of realism. The hope is that these discussions prompt action from the government, healthcare and private sector.

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