It is an economic conundrum that no recent Government has been able to crack. How do you make the National Health Service sustainable and fit for patients in an era of an ageing population, a stagnating tax take and ever increasing costs for breakthrough medical technology?
The latest stab at an answer emerged this week as Theresa May travelled to Liverpool to launch a long-term plan at Alder Hey Children’s Hospital, pledging a £20.5 billion increase in NHS England’s budget over the next five years.
The choice of a children’s hospital was no accident – at the heart of the proposal is an eye-catching pledge to provide genomic sequencing for all children with cancer by 2019. By analysing each young person’s DNA, doctors will be better able to select a specific course of drugs, or treatment path, to suit the specific patient. That means that fewer children will endure gruelling, energy sapping treatments that do nothing, with physicians better informed to pinpoint a strategy that will work.
This pledge gives us a clue to a much bigger answer on making the NHS sustainable: personalised medicine – the relatively new science of scrutinising an individual’s genetic make-up to work out how their body can best be nursed back to health. It’s a new approach that is taking centre stage in an ambitious, and highly impressive, effort to re-tool the NHS.
One of the key challenges facing the NHS is the cost of drugs. According to the Kings Fund, the service’s drugs bill grew from £13 billion in 2010/11 to £17.4 billion in 2016/17 – an annual growth rate of 5%, at a time when the NHS’s overall funding rose by just 1% per annum.
Frustratingly, a lot of that money goes on prescribing courses of treatment that don’t work. Commonly prescribed drugs for asthma are only effective for about six out of ten patients. For arthritis, each drug is effective for about 50% of sufferers; for Alzheimer’s Disease, the figure is 30% and for cancer just 25%. For years, a “try it and see” approach, whereby doctors try different treatments in turn to find the one that works, has prevailed – but that is finally changing.
It is to the credit of those who run the NHS that a decision has been made to make the UK a global leader in personalised care. The first step in this was a completed project by a new agency, Genomics England, to sequence 100,000 genomes from British citizens. A network of 13 genomic centres across the UK has been established to deliver genomic mapping.
The NHS has quite actively taken a decision to work collaboratively with industry to introduce the very latest technology. In contrast to past grumbles from the pharmaceuticals industry about the difficulty of getting drugs adopted, it has been encouraging to see that the NHS has gone out of its way to engage, explore and trial new techniques developed commercially in genomics.
The benefits for patients are immense. In lung cancer, molecular analysis of a patient’s tumour now allows doctors to classify them as either responsive to antibody therapy or responsive to small molecule therapy – enabling them to start treatment straight away on the regime most likely to benefit them. And in September, the NHS adopted a game-changing therapy for blood cancer patients whereby immune cells, known as T cells, are taken out of the body, altered in a lab to recognise and fight cancer cells, and then put back in the bloodstream.
The effect of this has been to reduce the number of patients with early-stage breast cancer referred to chemotherapy from a majority to barely a third, sparing thousands from the heavy impact of side effects and delivering a long-term saving: chemotherapy costs the NHS around £5,000 per patient.
Imprecise use of medicine costs lives. One in every 15 NHS hospital admissions is a result of an adverse drug reaction – taking up 8,000 beds per year, and costing £1 billion. If we can reduce that, and target drugs more effectively, we’ll deliver better outcomes for patients while making huge strides in securing the NHS’s future.
Sir William Osler, often dubbed the father of modern medicine, remarked a century ago that it is as important to understand what sort of a patient has a disease than to know what sort of a disease a patient has. Through a partnership between the healthcare industry and the NHS, we are finally beginning to achieve that.
Steve Ogram is UK Managing Director of Genomic Health