25 January 2018
While recently launching the new UKRI Research and Innovation Infrastructure Roadmap and additional funding for UK medicines development, Science Minister Sam Gyimah reiterated the great potential of the Industrial Strategy and the Government’s continued commitment “to unlock the innovations that will help people live better, longer lives by developing the medicines of the future”. Yet it has become increasingly clear since the launch of the Industrial Strategy, that it will take more than funding and moral support if the UK is to truly capitalise on this enormous opportunity.
The government unveiled its Industrial Strategy late last year, describing it as “a long-term plan to boost the productivity and earning power of people throughout the UK‘. The life sciences sector has increasingly emerged as a key element of the strategy, with Prof Sir John Bell leading on the development of a sector-specific Industrial Strategy and Sector Deal. Sir John appeared before the House of Lords Science and Technology Committee last month to further explain how the life sciences strategy should be implemented, what opportunities and barriers exist, and what this all means for the future of healthcare in the UK.
By the end of this lengthy evidence session it was clear that the success of the ambitious and potentially game-changing life sciences industrial strategy relies on a great deal of unprecedented collaboration between profit-seeking industry and an overwhelmed NHS. It will also require quite radical changes to NHS system structures, UK financial regulations and a successful exit from the EU to ensure the relevant foundations are in place. In short, a big ask.
A traditional concern levelled at the industrial strategies of past governments was again raised by the Lords Science and Technology Committee: the notion of picking winners through “government subsidies for the research and development of favoured companies”. As a quick browse of the Life Sciences Industrial Strategy and Sector Deal does reveal a long list of familiar industry-leading commercial partners, including Astrazeneca, GSK and MSD, it is easy to see where the committee members were coming from.
Sir John was quick to defend the new strategy, acknowledging that it is about picking winners, but from different domains of activity rather than choosing between companies. Taking AI as an example, he stressed that there are a number of areas that will have a profound effect on health and the UK should be the place where companies come to do their R&D and evaluation, to the benefit of UK taxpayers and NHS patients. All companies are welcome and encouraged to engage with the strategy, according to Sir John, and the idea is to make a ‘feeding trough’ for companies (and by extension the UK) upon which to capitalise. Hopefully, as more details and phases of the sector deal are revealed, there will be a wider inclusion of new and innovative players in diverse fields, particularly as a key goal of the strategy is to increase productivity and scale-up British companies.
The Lords Committee were also concerned that the life sciences industrial strategy and sector deal could facilitate regional inequalities, whereby certain areas or ‘clusters’ would benefit disproportionately from additional investment whilst other regions are neglected.
Sir John stressed that the UK life sciences sector does vary across different parts of the country. Medical technology, consumer health products, manufacturing and other industries are all seen in a number of different regions, notably the ’Northern Powerhouse’. He then concluded that the goal of the strategy should be to reinforce and develop the thriving initiatives and areas, such as the fabled ‘Golden Triangle’ (between London, Oxford and Cambridge) rather than trying to ensure the entire country is equally productive – because this is not possible.
Any policy framework that relies on introducing innovations into the NHS where they are then rapidly adopted and diffused throughout the system will inevitably rely on the speed and efficiency of the NHS itself to a great extent. Not only do the appropriate infrastructure and care pathways need to be in place, but staff have to embrace innovation and work flexibly to capitalise on these opportunities to improve the efficiency and effectiveness of the health service. The Academic Health Science Networks (AHSNs) are tasked with leading these moves, but historically have struggled to boost uptake of innovation outside their immediate NHS operating environments.
Sir John acknowledged that, in terms of the eagerness and willingness to collaborate to ensure the industrial strategy succeeds, the “NHS is one of the big unknowns”. He explained that there is support for collaboration with industry at the highest levels, including the Secretary of State for Health Jeremy Hunt and the Chief Medical Officer Prof Dame Sally Davies, but he doubted this is true throughout the NHS. He added that the intention is to create a sustainable innovation cycle where discovery programmes lead to clinical development, which in turn leads to manufacturing and ultimately adoption. While optimistic about the benefits of innovation as a source of motivation for the NHS, Sir John acknowledged that there is still a need for the NHS “to think about how it’s going to adopt innovation much more efficiently and effectively”.
Recognising that ‘the culture across the NHS system is not primed and ready to go in this space’, Sir John stressed that there are “pockets of enthusiasm and support in lots of different places…big centres especially”. As progress in this field is very patchy, he believes that “fixing it will be best achieved by partnering with those who get it” – that is, starting with enthusiasts and early adopters. As healthcare in all domains has been the worst at using innovations to save money, Sir John stressed that the NHS has a ‘gatekeeper for cost-effectiveness but none for determining what goes out or gets replaced’.
He concluded that a new infrastructure must ultimately be designed and developed outside of the NHS and then introduced once it is sustainable. The idea is to use the same model being used to develop genomic medicine in the UK, whereby the NHS owned company Genomics England (GE) was developed outside with a view to subsequent integration into the NHS system via the network of Genomic Medicine Centres. Yet Sir John did not address in great detail GE’s role in establishing a new NHS genomic medicine service, which will depend heavily on the next steps for the as yet incomplete 100,000 Genomes Project and planned reorganisation of NHS genomics laboratories expected later this year.
Supporting provision of genomic medicine within routine clinical practice throughout the NHS is no small ask and remains some way off yet; the latest PHG Foundation report, Genomics in mainstream clinical pathways, found significant barriers to success in the form of workforce readiness alone. Whilst this is not an insurmountable issue, neither industrial drive nor structures developed outside normal clinical practice are likely to offer solutions.
The Life Sciences Strategy is strong in many respects, but the capacity of a hard-pressed NHS to keep pace with and make the most of innovations from an expanding industrial sector is inevitably limited, so much will depend on the nature and extent of support it receives.