‘Are these the shadows of the things that Will be, or the shadows of things that May only be?’
By Integrated Care Journal-
“We must celebrate the successes of our one shared mission” – Matthew Gould, Chief Executive NHSX.
Public Policy Projects (PPP) and IQVIA joined forces to reflect upon the learnings of 2020 in a ‘past, present and future’ virtual fireside pre-Christmas conversation. This interactive session brought together expert NHS, Research and Pharmaceutical thought leaders with a UK and international healthcare, third sector and industry participants to discuss the potential for the UK to become the most innovative and dynamic country in the world in which to conduct research and bring life-changing medicines to its citizens.
The audience was asked to share what keeps them awake at night in respect of the health of life sciences and innovation and called upon Lord Ara Darzi, Blake Dark, Dr William van’t Hoff, Matthew Gould and Ben Osborn to provide considered recommendations in respect of collaboration, innovation and transformation in research and medicines access in 2021. The discussions covered wide-ranging issues from the learning from the first wave of Covid-19 through stimulators of innovation, access to medicines, research, data development and the future of the life sciences sector.
Angela McFarlane, IQVIA’s UK and Ireland (UK&I) Senior Market Development Director and session Chair, kicked off the discussion by outlining IQVIA’s own involvement in the fight against Covid-19. As the UK’s third-largest life sciences employer, IQVIA has invested over £45 million in the second Life Sciences Sector Deal, supported the UK’s Office for National Statistics (ONS) Covid-19 infection survey and are delivering numerous Covid-19 treatment and vaccine programmes, across the globe and in the UK. Having played a crucial role in the ever-changing life sciences ecosystem, Ms McFarlane looked towards the imminent future to ask, “will we sink or sail, as we approach a new post-Covid world outside of the European Union block? ”
Catalysing innovation beyond Covid-19
Lord Ara Darzi, Director of the Institute of Global Health Innovation at Imperial College London, instilled a sense of optimism when describing his involvement in the Accelerated Access Collaborative (AAC). The AAC aims to accelerate the innovation, introduction and diffusion of new treatments and diagnostics in order to revolutionise patient care. Lord Darzi postulated: “Covid turned out to be the best boost possible for the AAC, it brought disparate groups of people together, whether it was the NHS, the private sector or cross-ministerial departmental contributions, to address the major challenges facing us. ”
The pandemic proved the potential for the AAC to drive innovation at pace and at a national level, something which it will continually deliver post-Brexit. Thus far, the AAC has supported 2700 innovations, nearly 2500 innovators and has included 150 NHS staff in its clinical entrepreneurial programmes. Lord Darzi added: “quality is a moving target, so you have to continually improve. ” The AAC plans to hold onto its learnings from Covid-19 in order to apply them to other areas in 2021, such as tumour diagnostic therapies and localised innovation. The hope is that the AAC is a short-lived intervention used to catalyse imagination for change, ignite innovation and re-engineer patient pathways.
When asked about his proudest achievement within the AAC, Lord Darzi responded: “We have helped people to spend 100,000 fewer days in hospital through the technologies we have introduced. ” In the Covid-19 climate, with bed blocking and overworked, understaffed health services, the AAC’s innovations have given the crucial gift of time this Christmas, and beyond. On top of this, Lord Darzi stated: “We have saved about £50 million recently and this all happened in the context of Covid. ” Lord Darzi stressed that the AAC is simply the broker of change and the “we” he often refers to is indebted to the innovators and healthcare workers who have rolled out these ground-breaking innovations in clinical practice.
Mobilising medicines – from the lab to the bedside of patients
From technological innovations to medicines and access, Ms McFarlane moved to Blake Dark, Commercial Medicines Director at NHS England and Improvement to ask: “what mechanisms have allowed the development of the recently announced ‘GRAIL’ cancer diagnostics test and the medicine? ” Blake proposed that the key to driving access to innovative programmes such as GRAIL is to “truly involve the NHS to ensure aims are aligned with the long-term plan and are truly patient-centric. ” In this respect, access to new medicines is motivated by the principles of addressing unmet needs and providing best value to both the NHS and the taxpayer.
So, what is GRAIL? Blake Dark beamed with pride when outlining the new diagnostic blood test which is able to spot 50 different types of cancer in the early stages, when treatment is most likely to be successful. “If you can detect cancer at stage one rather than stage four, in some cancers, there is a ten times higher rate of survival-and if the trial is successful it could roll out to 5mn patients later”, he said. If GRAIL demonstration trials are successful, this test could be rolled out for up to 10 million patients. Evidently, there is a population health and cost-benefit to the NHS at a population level of Inclisiran from Novartis and the Medicines company which aligns with the long-term plan.
Despite the undeniable challenges brought about by the pandemic, Blake Dark’s contribution detailed a more collaborative and cost-effective approach towards increasing access to medicines. Blake cited a recent article in a UK National newspaper that reported that the NHS has given access to eight of the top ten highest cost drugs in the world, creating a system that delivers high-cost drugs to UK patients and the Commercial Medicines Directorate are working tirelessly towards ensuring British patients get early access to innovation that supports the long term plan more cost-effective prices and market optimisation in 2021.
Angela McFarlane returned to Blake Dark with the same thought-provoking question: “What are you most proud of this year? ” His response highlighted a pertinent topic which has perhaps been overlooked in the shadow of Covid-19. “Following the landmark June 2020 access deal to a cystic fibrosis triple therapy between NHS England and Vertex - negotiated ahead of a licence being granted by the European Medicines Agency-meant that UK clinicians were free to start prescribing the triple treatment to English patients as soon as the licence was granted Blake Dark revealed that “86 per cent of all eligible patients now have access to this treatment. This is uptake where it matters. ” Amongst the dark shadows of Covid-19, Blake Dark concluded “let’s shout about our successes, access to medicines is taking great strides. Moving forwards, uptake is key. ”
Urgent clinical research priorities
Dr William van’t Hoff, Chief Executive of the National Institute for Health Research (NIHR) Clinical Research Network (CRN) added a valuable research perspective to the discussion on the Covid-19 trials and the prioritisation of urgent public health studies. Continuing the positive narrative, he stated: “this year, there has been an incredible collaboration and powerful synergy across the whole health research sector in order to address the government’s research response to the pandemic. ”
Having assumed his role as Chief Executive on 16th March 2020, Mr van’t Hoff switched the whole NIHR team entirely to remote working only a day later and was thrust into the position of coordinating the pandemic research response. When prompted on his experiences throughout the Covid-19 trial effort, he described how the NIHR urgently prioritised 70 public health studies based on their ability to answer key questions in relation to Covid-19, diagnostics and therapies. These studies received a fast-tracked approval with an average five-day transformation period. This swift turnaround proved critical to the immediate upscaling of research capacity across the NHS.
The engagement and support of front-line staff and the general public has been critical to research recruitment. Mr van’t Hoff stated that “current recruitment to urgent public health studies is around 650,000 participants, which is amazing. ” He added “the key message is that the research we are doing is critical to the NHS itself. It's not just about academic benefits, not just about patient benefits, but it really brings huge opportunity to the NHS. ”
Looking ahead, Mr van’t Hoff highlighted “the imminent priority is to translate this prioritisation into the UK’s vaccine delivery system. ” The NIHR was asked to coordinate the new research delivery system and delivered this proudly within just 10 weeks, across 18 UK regions, including devolved administrations. This rapid research response has allowed the UK to achieve three ground-breaking global firsts in relation to the Covid-19 vaccination agenda.
However, with his feet firmly on the ground, he acknowledged the cost of this Covid-19 success. He articulated: “it has been at a cost that prioritisation has affected non-Covid research. I really feel for colleagues, investigators, sponsors and funders whose research has been affected by the pandemic. And of course, for the patients who have not been able to access treatments and trials, that might have been life-changing during that time. ”
If the pandemic has taught us anything, it is that we have the ability to address these challenges head-on. The speed, pace and resilience demonstrated during Covid-19 pandemic must be equally applied to the non-Covid research sector to ensure its imminent recovery in 2021.
Making better use of patient data
“I think it’s fair to say that something quite revolutionary for NHS data-sharing happened in 2020 early on in the pandemic. We released a single page advisory instruction on Information Governance to all frontline clinicians, advising that if data needed to be shared to look after the patient and you are doing the right thing-please get on with it. Historically, the NHS has got itself tangled up with complex data guidance which means patient data has not always been used to best effect. The pandemic was a catalyst for empowering clinicians to do the right thing with patient data and allow data to flow more freely across the NHS. Covid taught us that we could make simple changes to give the system confidence to share patient data’.
Data has transformed the way that direct care is provided and has been vital to the management of the pandemic itself. Aggregating data in more effective ways can provide powerful public health benefits. Clear data guidance is paramount to achieving such benefits. Mr Gould outlined the additions made to patient summary care records using the powers granted by the control of patient information (COPI) notices. This emergency legislation allowed clinicians who were seeing a patient for the first time to review information that could be pertinent to their treatment and lead to improved health outcomes.
Early on in the pandemic, the NHS data store was established. This aggregated data on supply and demand within the system, such as locating where there were ventilators or hospital beds. Matthew Gould argued that this shifted the pandemic response from “a system running according to who was shouting the loudest, to a system which could target resources where they were really needed by aggregating data in a powerful way. ” The COPI notices were paramount in facilitating this change.
Ms McFarlane posed the question: how do we make sure we move beyond the immediate crisis? How do we move forward rather than revert back to where we were before? Both Mr Gould and Lord Darzi agreed that there is an opportunity to create a health and care system which is “genuinely data-led, provides genuinely personalised care and is constantly improving on the basis of data. ”
To transform the UK into the data-driven life sciences economy that it has the potential to be, we must keep the support of the public and the profession. This means being abundantly clear about the privacy of patients. Mr Gould stressed, “Patient data remains sacrosanct. Making better use of it is not at the expense of privacy. ” Quite simply, when implemented effectively, health systems can make data more secure, improve access to data and use it better without compromising patient privacy.
NHSX also established the Centre for Improving Data Partnerships in November 2020. Mr Gould detailed how the centre advises NHS Trusts on the legal and commercial aspects of data deals in order to formalise data principles and allowing data to flow “without paralysing everyone in fear. ” Alongside this, there must be an investment in the workforce, skills and attitudes to make the most of new data systems moving forwards.
As Chair, Angela McFarlane interjected with a key question: “do you think there is a culture change needed to encourage a bolder approach to health data systems? ” Mr Gould’s response adopted a bottom-up approach to data transformation, highlighting that the attitudes needing to shift are a product of the system that has been created. The current inefficiencies in data sharing can often hinder rather than help. The nervousness of data is entirely rational where the rules are so complex. As Dame Fiona Caldicott, the National Data Guardian for Health and Social Care in England, has said: “the duty to share data can be as important as the duty to preserve privacy. ” This attitude must be embedded within our healthcare workforce moving forward.
Transforming the image of the pharmaceutical and biotech industry
Ben Osborn, Managing Director and Country Director at Pfizer, has become an increasingly familiar face in the media following the first Pfizer-BioNTech vaccine approval announcement. Working at the heart of the pharmaceutical and biotech industry, he was able to share insights on the biggest issues for the life sciences sector over the next 12 months.
“The strategic importance of life sciences has never been more visible. We have seen this both nationally and globally. ” Mr Osborn commented on the importance of the UK stepping up to the plate within the global life sciences race in order to be regarded as a global leader. This will require a strategic and coordinated approach across government, the NHS and other clinical research bodies to ensure that the UK life science industry is at the forefront of investment discussions in our post-Brexit world.
It took 260 days to reach the point of authorisation for the Covid-19 vaccine. Scientists collaborated in ways and at a pace that has never been seen before in any disease area, pandemic or not. This in itself has catapulted the UK life sciences sector to the forefront of global discussions. Looking ahead, Mr Osborn stated: “now we have shown that science is winning in this pandemic, we must look to the future for cancer patients, Alzheimer’s patients, cardiovascular patients and the thousands of rare disease patients and ask ourselves, how can we move faster than the impact of this disease? ”
‘While we may not be able to drag and drop the Covid-19 action plan, we can extract these learnings and apply them to other areas of science. For example, rather than the traditional industry model of sequential research milestones and risk gating, over the next 12 months, we should hope to see more parallel ways of working in order to challenge historic research and development timelines’.
Mr Osborn added: “we need to harness the attention that medicines, vaccines and the life sciences sector is getting. We can all agree that having a healthy, thriving life science industry within the UK is great for our economy, but most importantly it is beneficial for patients and the overall health of the nation. ” Both Mr Osborn and Ms McFarlane concluded that the key to achieving this is collaboration under one shared mission.
“What keeps you awake at night? ”
The expert panellist contributions demonstrated that the UK health and life sciences sector has made monumental achievements under the harshest of circumstances in 2020. The pandemic forced the sector to work collaboratively to address challenges head-on. Without the important changes in legislation and operational approaches, it is unlikely that we would be celebrating these gains in efficiency and improved patient outcomes.
Indisputably, the pandemic has also put a spotlight on key areas of weakness within the system. The audience submitted their answers live to the question raised by the Chair answered the question on what keeps them awake at night and raised some key concerns surrounding innovative financing, shared infrastructure and social care. Themes included, how will we continue to share infrastructure, equipment and data from patients? How will we ensure that social care is included in strategic health decisions? How will we ensure an effective supply chain of vital medicines and treatments? Perhaps most importantly, how do we prepare against future unprecedented health events, particularly the ever-increasing threat of anti-microbial resistance (AMR)?
Addressing these concerns means continuing with the progressive approach developed in response to Covid-19, redefining relationships between patients and the public, and establishing a strategy that is emphatically aimed at both health and care. Paramount to each of these elements is collaboration through data, research, technology and medicines and with patients, the health and care workforce, innovators, industry and government.
Angela McFarlane concluded: “We have always thought that the future is uncertain, but Covid-19 has certainly taught us just how uncertain certain it is, our panellists have shown that there are certainly reasons to be cheerful about the discoveries and learnings taken from the pandemic Wave One. By collaborating across the NHS, Industry and Research under one shared mission, we can secure a brighter and healthier future that we so desperately need in 2021.
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