Established in 2010 as part of the Government’s response to the House of Lords Inquiry into genomic medicine, the Human Genomics Strategy Group (HGSG), under the chairmanship of Sir John Bell, has taken a wide and detailed look at the emerging technologies and considered how the NHS can reap the potential benefits both for frontline care and for public health. Their strategy sets out the potential for genomics to transform healthcare delivery in the UK, and, in so doing to ensure that the NHS is a world-class system for innovation and for the adoption of genomic knowledge and technologies.
Such a transformation is by no means a simple exercise, and the HGSG report sets out several important arms of the strategy. These include national policy leadership, a national bioinformatics services, expert advice through the National Commissioning Board, NICE diagnostics and other mechanisms to inform commissioning decisions, re-engineering of pathology services to put in place a hub and spoke network across the country, the provision of genomics training and education for health professionals, the development of public health systems to realise the potential of genomics for disease prevention and improvements in population health, and continued high quality public engagement on associated ethical, legal and social issues.
The report is to be welcomed as bringing together important themes through which genomic technologies can be used to improve health. We particularly welcome the inclusion of a chapter on Public Health, which explicitly links genomic medicine to the health of the entire population, and invokes public health mechanisms for achieving improved outcomes.
In this chapter, the HGSG states their belief that it is essential that local authority based Directors of Public Health understand the potential of genomic technology for public health. They set a challenge for public health systems throughout the UK to develop comprehensive engagement with genomic technologies, and the integration of genomics across all domains of practice from health protection to diagnosis, treatment and care.
The PHG Foundation has for the last 15 years been a leading international champion of public health genomics. This has entailed advocating for the importance of genetic science and genomics in promoting health and preventing disease, and for the need to bring together academics across the sciences and the humanities and social sciences, the clinical community, policy makers and the commercial sector to achieve this outcome.
Genomic science has already delivered results in single gene and congenital disorders and in the communicable diseases for the benefit of individual and population health; it will eventually have a similar impact on patients with common chronic non-communicable diseases.
However, as professionals concerned with the health of the population as a whole we increasingly note the gap between what can be done – the cutting edge of science and technology – and what is actually delivered equitably on the basis of health need across the population. For that, innovations have to be systematised throughout the healthcare and public health services. The HGSG recognises that this is largely not a question of more research, but of implementation: the delivery of carefully thought-out plans that will each require significant resources and commitment over a long time period to deliver. Policy-makers, scientists, clinicians, laboratory professionals, health educators, health service managers and many others will all have roles to play.
The HGSG report stresses the importance of education in genomics across the breadth of health professionals involved in clinical laboratories, health care and public health. In line with this, we strongly suggest that a subset of specialists in public health receive more comprehensive training in public health genomics. Their skills and experience bring the population perspective and an understanding of both commissioning and provision of health services. They are thus well placed to play a substantial change management role in health care planning, health protection and health promotion in tandem with their clinical and managerial colleagues, and so contribute to the aims of the HGSG report.
The PHG Foundation already acts as a training centre for specialist registrars in public health to gain experience in genomics, and are ready and willing to offer this resource and expertise more widely as an integral part of proposed educational strategies for the UK.