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Tackling inequalities, improving health outcomes



Panel left to right: Michelle Mitchell OBE (CEO, Cancer Research UK), George Freeman MP (Science Minister), Dr Julia Wilson (Associate Director, Sanger Institute), Dr Nik Johnson (Mayor, Cambridgeshire and Peterborough),Tom Keith Roach (UK President, AstraZeneca) and chairing: Angela McFarlane (Senior Vice President, IQVIA)

This article is the first in a series of features recounting a panel Q&A session conducted on January 20th in Cambridge at the Cancer Research UK Cambridge Institute, for a full video of the event click here.

Levelling-up the conversation brought together an expert panel of leaders in healthcare and life sciences in Cambridge to explore the route map for the UK to become a life sciences superpower. With hidden deprivation and inequalities across the Cambridgeshire and Peterborough region, leaders expressed the need to ‘level-up’ communities and ensure that surrounding areas gain advantages from the socio-economic and health benefits that the life sciences sector brings to Cambridge.

Acknowledging the urgent crisis facing the NHS and giving a heartfelt thanks to those on the frontline, Vice President, Strategic Planning, North Europe at IQVIA, Angela McFarlane opened the discussion on life sciences policy to communities across the country.

An Innovation Nation

Identifying a paradox of the UK Life Sciences industry, Country Managing Director of Boehringer Ingelheim, Uday Bose commented that the adoption of a strategy for the Life Sciences sector was a highly positive development, but for all the UK’s strengths in innovation, adoption and the challenges the NHS face more generally portray a less rosy picture. He asked the panel: “how do you feel global boardrooms in the life sciences sector see the UK?”

In answer to this key question, the Science Minister, George Freeman stressed that the UK is already a research superpower:

“In terms of pure research, the UK is incomparable – it is the world leader… We’ve led the world in terms of sequencing the Covid-19 genome, developing the vaccine and put together the world’s biggest clinical trial – bigger than the next 10 in the world, fast”, he said.

There is no better example than the Cancer Research UK innovation campus in Cambridge, where the event was hosted. In reflection however, the Minister said that the UK is not yet an “innovation powerhouse” and outlined his priority for the UK to become “an innovation nation.”

Video of full panel event

Fundamental to the success of the life sciences vision is the NHS as a partner in the life sciences ecosystem. The Minister emphasised his concern that the UK has become “less good at adoption.” Warning that the NHS is “never going to pay top dollar”, but that the UK can be a global research engine, his hope is that global boardrooms when faced with a new technology will as he mentions“ go to Britain, get it tested, find patients, get real-world data, do your healthcare economics and then you go sell it around the world”.

Expressing the warmth of the public towards the life sciences sector due to the pandemic, UK AstraZeneca President, Tom Keith-Roach expressed two clear opportunities for the sector in this country and they are linked. The first is to create a “thriving life sciences environment” and the second “to make a step change in how we deliver societal good health through the NHS” by addressing healthcare inequalities. Supporting the Minister’s proposition and commenting on why AstraZeneca based its billion-dollar R&D facility in Cambridge, he said “I don’t think you can be a leader in healthcare delivery, unless you’ve got fantastic science.”

However, in a warning to the sector, Keith-Roach suggested that the UK has been slipping-down the international league-tables over the last five to six years for four key reasons:

  1. The UK’s international share of clinical trials has dropped from third to seventh
  2. On data, the UK does not have a single dataset, instead it has an ‘archipelago’ and competitors including Sweden, Finland and the City of Boston have more joined up systems
  3. The UK does not have an attractive tax environment for advanced manufacturing investment compared with Ireland and Singapore
  4. On adoption of innovation, there is variation across the UK which makes it an unattractive market for commercialising innovation

Addressing the audience, Keith-Roach said, “The NHS doesn’t have the capacity or the capability to keep up [with research needs], so now we [AstraZeneca] run less than two per cent of global clinical trials in the UK.” In terms of exports in the context of Brexit, which should be “a massive opportunity,” the UK has slipped from fourth to ninth over the last five years in terms of value of exports. On retaining innovative life science companies, he said “whilst the UK is good at early science, these companies think about funding and move to the US. We need to think about how we keep these companies here in the UK, working with the NHS to get them into clinical practice at scale and eliminating healthcare inequalities.”

Responding, the Minister said that he was most optimistic about manufacturing, highlighting the “biggest investment in a generation in R&D – a 30 per cent increase, allocating £30 billion across UK Research and Innovation (UKRI) and Innovate UK.”

In an honest appraisal, the Minister told the national audience that since he last held the Ministerial position as Life Sciences Minister he was most disappointed by the lack of progress the Accelerated Access Collaborative has made in getting medicine and diagnostic innovations into the front line of the NHS. To achieve his vision, he said that “you’ve got to give access to genomics, tissues, data…I think the UK’s ground-breaking genomics programme has worked in spades.”

“There is no doubt that on developing a vaccine, genome sequencing and clinical trials for the most complex of new treatments, the UK has developed a strong reputation. However, access to new innovative medicines remains a stubbornly difficult problem for the UK life sciences ecosystem.”

Angela McFarlane
Vice President, Strategic Planning, North Europe
IQVIA

The Wimbledon Salute

In one of the most powerful comments made by the panel during the conversation, the Minister paid tribute to one of the vaccine developers, Dame Sarah Gilbert, underlining the support she received at Wimbledon last year.

He said, “never in my wildest dreams did I expect to see Wimbledon rise to salute a life scientist,” explaining that he thinks the public have a better understanding of the importance of clinical research and the life sciences sector for the future of health provision, exclaiming “I think the country has got it.”

Clusters

Recognising the enormous pressures on the NHS to clear the backlog, the Minister said that it is a lot to expect the NHS institutionally to quickly become a research partner especially as it emerges from the pandemic.

With an eye clearly on past attempts to centralise NHS data collection, the Minister said, “asking NHS England and the Department of Health and Social Care to command that it [innovation] should happen isn’t going to work.” Instead, he suggested a new strategy to create large datasets which would be internationally useful and could therefore support the goal of making the UK a Life Sciences Superpower. As we emerge from the pandemic, his first suggestion was that locations that are already strong in life sciences could create “fit city” applications, capitalising on peoples renewed commitment to a healthy lifestyle to create the “front end to a national data spine.” In a similar way, charities could be encouraged to create “disease portals” which would give access to useful information and even trials to those with a particular diagnosis as well as creating huge datasets. “That makes us a global powerhouse in digital, data sharing and trials. I think that’s the key.”

As the obesity capital of Europe, the Minister gave the example of the West Midlands, suggesting that if a consortium came together to reduce the cost of obesity – which currently costs the Treasury £4 billion a year – and reinvest the savings back into healthcare, “we could really drive these collaborations of digital therapeutic, early diagnostic, place-based treatments.”

Prevention is key

Exploring the lessons of the pandemic and in answer to a question from Ben Osborn, President of the Association of British Pharmaceutical Industries (ABPI) and Managing Director of Pfizer in the UK, Chamber panellist and Chief Executive of Cancer Research UK (CRUK), Michelle Mitchell highlighted how “prevention is key” to improving cancer outcomes. With 30,000 avoidable cases of cancer diagnosed each year because of deprivation, the sector is looking to government to set a policy agenda to help tackle those areas of modifiable risk including smoking, obesity and alcohol consumption.

Speaking as the leader of one of the UK’s largest research charities, the CRUK Chief Executive highlighted the importance of the role that charities play in “improving health outcomes and survival in this country.” Last year, £1.9 billion was invested by charities in research, focusing attention on the need for government to collaborate with the whole sector on “early detection, diagnosis and treatment.” Given that datasets were not there at a national level during the pandemic crisis, the Minister outlined that the Government is keen to see patients access community-based disease ‘portals’ – he believes that charities would be best placed to run them.

With NHS bed occupancy at 70 per cent – largely attributed to people who suffer from chronic diseases who are often co-morbid – more should be done to focus on prevention in the community. The UK President of AstraZeneca is hopeful that Integrated Care Systems (ICS) will provide a fundamental role for “inspired commissioning” – to start commissioning services upstream to prevent patients being admitted into hospitals, calling for more investment in the social predeterminants of ill health.

He said, “we really need to get behind this concept of community diagnostic hubs and make sure we build infrastructure in the places where they’re disadvantaged.”

Michelle Mitchell added “We need to look at risk stratification, screening, imaginative behavioural change campaigns, faster diagnostics – all ways in which the NHS, industry and charities can work together to make massive improvements for health outcomes for the British population.”

GF 4
Minister George Freeman discussing innovation uptake with President of AstraZeneca UK Tom Keith-Roach

Final Thought

Chamber UK’s “levelling-up the conversation” panel discussion in Cambridge provided a refreshingly honest appraisal of the UK’s strengths and weaknesses as a global leader in life sciences. In this first part of the discussion some key conclusions were reached.

A dichotomy between the UK’s strength in research ably demonstrated during the pandemic is offset by the delayed uptake in innovative technologies and treatments in the UK. The UK President of AstraZeneca is right, without a solid market for new innovations to transform the lives of patients, it is impossible to see how the UK can become a life sciences superpower. As ICS’ embed, the opportunity is for every level of the NHS to embrace innovation. Without national direction, it is impossible to see this become a priority – therefore it takes real leadership to set direction and tone.

In his second role in Government, George Freeman’s passion was clear. One of his most exciting ideas is to build larger datasets using portals, both location and disease based which will help patients, researchers and the life sciences sector.

Finally, and linking back to the introduction of ICS and lessons of the pandemic is the important message that ‘prevention is better than a cure.’ As the UK ages and NHS health data is enriched, there is an opportunity to free up both budget and hospital capacity by making smaller interventions earlier, encouraging healthy lifestyles which will both improve quality of life and reduce the cost of healthcare in the UK.

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