In the midst of every crisis lies great opportunity
In the midst of every crisis lies great opportunity
This quote, often attributed to Albert Einstein, certainly applies to today’s healthcare.
“In the midst of every crisis lies great opportunity.”
I doubt that many would challenge the assertion that we are facing a crisis. Healthcare systems worldwide are faced with escalating demand from the populations they serve. This reflects, in large part, the ageing of the population. Ageing is accompanied by multi-morbidity and an increasing number of patients with complex needs. Coupled with the increasing costs of diagnosis and treatment healthcare systems face a crisis of sustainability. The COVID-19 pandemic has thrown the fragility of our current models into stark relief, pushing many to the limits of their capacity. Despite remarkable advances in medical science and the advent of novel therapies for previously untreatable diseases, life expectancy in many developed countries has plateaued and previous gains have not been matched by an increase in healthy years. Health inequalities are also unacceptably high and widening: to give a UK example, someone born in Hull has a life expectancy ten years less than someone born in Hampshire. Finally, the geography of ageing frequently puts those with greatest healthcare needs remote from where healthcare is delivered. These issues require urgent attention. Simply doing more of the same, and squeezing a little harder, is not going to deliver a long-term sustainable solution.
Opportunity in three forms
However, this is truly a moment of unprecedented opportunity. The opportunity comes in three forms.
The first is a fresh approach to health promotion and health inequality. This approach requires the integration of risk stratification using population level genetics and behavioural insights with a more assertive outreach programme in communities. Coupling this with steps to address some of the social determinants of health, such as imaginative local employment and apprenticeship schemes has the potential to shift the dial in some of these seemingly intractable areas.
The second major opportunity is to re-engineer our model of healthcare making intelligent use of existing and emerging technologies. Our current model has changed little since the NHS was formed in 1948 and it is poorly productive. The opportunity exists to radically revise our ways of working using AI-assisted triage, online consultations in primary care, moving diagnostics up the patient pathway and bypassing the obligatory referral to a specialist, community-based virtual multidisciplinary teams meetings involving primary and secondary care professionals, and more widespread use of remote monitoring technologies that will allow more care at home.
The third exciting opportunity is to develop and implement curative therapies. Medicine currently cures remarkably little; bacterial infections with antibiotics, and some surgical procedures such as cholecystectomy for gall stones. For much of the time, our healthcare system supports people living with long term conditions, and sometimes slows the progress of the disease.
The next decade holds the promise of delivering curative therapies as a result of advances in three fields of biomedical science.
The first is gene editing and gene therapy. The most obvious applications of this technology are for single gene disorders. However, it may prove to be the case that in some multigenic diseases there are “master genes”, the alteration of which may alter the course of the disease. These approaches are already in the clinic, however there is much yet to achieved that will transform the outlook for many patients with one of the 6,000 single gene disorders, and possibly for some with more common diseases.
The second field where huge potential exists is immune manipulation. These manipulations can persuade the immune system to attack something that it is inclined to ignore – cancer, and to persuade it to ignore something that it is inclined to attack – in organ transplant recipients and in patients with autoimmune disease. In recent years many of the molecules and cell types that inhibit immune responses have been characterised. This paves the way for removing the inhibition to allow the immune system to make effective immune responses to cancer, coupled with the administration of genetically armed killer T cells to attack the tumour. The corollary is being applied in transplantation and autoimmunity using genetically enhanced version of so-called regulatory T cells. This approach has the potential to create precisely targeted immune suppression and be markedly superior to conventional immunosuppressive drugs.
The third field with transformative potential is regenerative medicine. Many chronic diseases are caused by the irrecoverable loss of cells from tissues that cannot repair themselves. Emerging insights into how to trigger repair mechanisms in these tissues give real cause for hope.
Building a sustainable model of healthcare
Taking the above into account, I believe that there are considerable grounds for optimism as we look ahead. While healthcare systems struggle to deal with the sizeable backlog of activity displaced during the pandemic, and attempt to support an overstretched and demoralised workforce, it is vitally important that we take the necessary steps to realise these opportunities. Only then will we emerge with a sustainable model of healthcare that delivers to patients and populations the care that they deserve.
In subsequent columns I will address in a little more detail the whole system re-engineering opportunity, the workforce implications of these changes, and that steps that we can take collectively to optimise the interface between our healthcare systems and academia from where much of the innovation arises.
Professor Sir Robert Lechler
Associate Advisor to our Global Healthcare Practice at Alumni
Robert Lechler is Senior Vice President/Provost (Health) of King’s Health Partners Academic Health Sciences Centre. He has had a distinguished career in academic medicine and clinical research spanning over 40 years. He was President of the Academy of Medical Sciences between 2015-2020. He has published over 200 papers in the field of transplantation, led an EU consortium, and was awarded the Novartis Established Investigator Award by the American Transplant Society.
In addition, Robert is a Trustee of the British Heart Foundation, a founding member of MedCity which fosters the South East England cluster, and has served on the Mayor of London’s Health Board.
Perspectives
Digital leadership in the GCC healthcare sector
Perspectives
Tough times ahead with reforms in healthcare
Perspectives
Post-pandemic leadership in healthcare