By Integrated Care Journal-
Speaking at the Public Policy Projects (PPP) Virtual Annual Conference 2020, Minister for Innovation at the Department of Health and Social Care, Lord James Bethell, considered using Covid-19 as an inflection point to reboot and upskill the UK’s approach to diagnostics. In line with the NHS Long Term Plan, Lord Bethell described his own commitment to the early intervention agenda, helping people to live longer, better lives within a preventative healthcare system.
The discussion with Lord Bethell, chaired by The Baroness Blackwood of North Oxford, Co-Chair for Healthcare and Life Sciences at PPP, covered a broad spectrum of topics, focusing particularly on the pandemic, the diagnostic odyssey and the provision of innovative treatments and therapies – something Lord Bethell is very passionate about following his father’s battle with Parkinson’s disease.
Opening with his vision of restarting the clinical research agenda, Lord Bethell stressed the need to streamline administrative processes and align the interests of clinicians and researchers in order to improve trial recruitment. Too often capacity is constrained as clinical recruitment lags outside of office hours, limiting the reach of trial programmes. According to Lord Bethell, overcoming this may mean “bringing modern data and marketing principles to bear on the recruitment process, mobilising primary care services and using the weekend more thoughtfully. ”
Baroness Blackwood emphasised that even if clinical research and innovation pathways are addressed, equal importance must be allocated to increasing uptake rates to ensure patient access to healthcare innovations. In agreement, Lord Bethell highlighted the upcoming methods review from NICE which will aid in optimising the UK’s uptake strategy alongside the emphatic case made by the Government to influence uptake behaviours. Recognising the importance of an empowered patient, the Minister stated: “We can only inspire people to change their behaviours by providing them with clear evidence and encouraging them to do so. We have mobilised influencers and provided support to charities to help increase uptake, but there are certain things that only the individual can do. ”
Novel diagnostics and therapies
Lord Bethell showed incredible enthusiasm towards the UK’s new mass diagnostics platform that is powering its Covid testing strategy. He stated that the programme represents “the biggest per head in Europe” and was achieved through “the mobilisation of data and collaboration between research entities and businesses. ” He reflected upon the unfortunate fact that Britain started from a very low base in terms of diagnostics, but currently standing at 500,000 Covid-19 tests per day he said that “we have shown what is possible when something is given the focus it requires. ”
Responding to a question on the quality of remote diagnostics from Baroness Blackwood, the Minister for Innovation said that currently more than half of consultations happen via telemedicine, ranging from advanced televisual consultations to a simple phone call. As a strong advocate for technological investment, he reminisced: “I remember the days when people found it hard to justify the investment in NHS 111. ”
In terms of remote quality, NHSX are currently appraising this phenomenon to ensure the retention of quality and accessibility of new technology. Lord Bethell reported some key findings: “the majority of mental health patients preferred the lighter touch of virtual consultations” – perhaps an unexpected area where telemedicine has made a big difference.
Another area was the use of monitoring equipment throughout the pandemic, whereby patient symptoms were continuously monitored from home and hospital visits were only advised when symptoms deteriorated. Overall, Lord Bethell praised the “quality and convenience of virtual care pathways” but stressed that “some people will always want face-to-face contact and we will always provide that. ”
Ahead of the virtual question and answer session, Baroness Blackwood took the opportunity to address the performance of rapid Covid-19 testing facilities currently being trialed in Liverpool. Lord Bethell argued that with diagnostics, “it’s a case of horses for courses” and that “the most important thing is using the right test for the right situation. ” With the highly sensitive polymerase chain reaction (PCR) tests being “helpful if you are about to go into hospital or a highly sterile environment” and the less sensitive viral load tests being “good at picking up infectiousness at plausible levels” it is clear to see why the Minister is encouraged by the mass testing trial. He added that, with regards to mass testing, having an oversensitive test like the PCR could produce false positives and send people into isolation unnecessarily.
Lessons from the pandemic
The question and answer session provided opportunities to reflect on the challenges of 2020 and identify key lessons to help the NHS return to pre-covid performance levels. When asked about his biggest takeaway from the pandemic, the Minister commented on the communal nature of disease. “It has been a big reminder that my health is not a private matter. My health affects the person in the room with me and my health affects the national health. ”
Lord Bethell praised the science behind innovation within pharmaceuticals and diagnostics but added that diagnostic companies must also take ownership of current challenges, alongside the NHS and Department of Health and Social Care.
Questions were raised on the time constraints for NHS staff and the patient-centric treatment of long Covid. In response, the Minister recognised the frustration towards time spent donning PPE and cleaning but reassured that “the amount of work being done is very nearly back to pre-Covid times” due to the “efficient reallocation of work out of hospitals and into community hubs and primary care locations. ”
With respect to long Covid, Lord Bethell believes it provides an opportunity to close the gap between research and practice and could become a case study in patient centric care. Lingering diseases are more difficult to diagnose but the Minister’s plans to better connect primary and secondary care hopes to produce effective treatment at the fastest rate.
Though the first wave of Covid-19 came with many unknowns, few guidelines and a poor diagnostic infrastructure, Lord Bethell asserted “there is now a confidence surrounding patient control, patient management and PPE and a muscularity going into the second wave that simply wasn’t there before. ” The Minister hoped to leave the audience with a sense of optimism that this time things are different.
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