Leading health figures claim that the NHS fails to take full advantage of its size and weight to provide patients with cutting-edge treatment.
Since global pharma giant Novartis recently halted a major trial of a new drug for reducing cholesterol, concerns about the ability of Britain’s healthcare system to drive innovation has intensified.
After the UK left the EU, the government was eager to promote life sciences as a strong area. However, experts have pointed out a number of obstacles ranging from dealing with the multiple NHS bodies and funding restrictions.
Some people believe that a conservative mentality among clinicians also makes it difficult to offer novel treatments to their patients.
Steve Bates, the head of the BioIndustry association, a lobby group for the biotech industry, gave many examples of drugs that were successfully introduced to the NHS. These included statins, which combat cardiovascular disease, and treatments for cystic-fibrosis, as well as rare diseases.
He noted that the National Institute for Health and Care Excellence (the public health agency) produced assessments on the value of new treatment. He said that the NHS has national guidance.
He said that the government was “resolutely opposed” to adopting innovation in a coordinated and strategic way. This is evident by the uneven uptake of Novartis inclisiran across the country.
The taxpayer-funded NHS does not always buy and commission care in a single unit, despite its size. It covers the entire British populace.
Some specialist services are contracted centrally. In other cases, companies that wish to enter the market must negotiate with multiple local authorities.
Scientists suggest that this atomisation affects the UK’s ability to improve or maintain its share of clinical trial participation, which gives patients a chance at a longer lifespan.
A forthcoming government-commissioned review is expected to conclude that trials are being hampered by sluggish hospital governance procedures and doctors lacking the time to enrol patients.
Martin Landray, an Oxford University professor who led the Covid “Recovery Trial” and was involved in the trial that Novartis abandoned, had also been involved with the trial. He stated that they had worked closely with Roche and Regeneron in Recovery to benefit both the companies and patients.He warned, however, that the UK could not “compete on an international stage” until it addressed what was slowing down clinical trials, such as having to sign contracts for hundreds of hospitals and trusts rather than one contract for the entire NHS.
The pharma industry shares his concerns. Melanie Ivarsson is Moderna’s Chief Development Officer. She said that Britain must cut bureaucracy in order to catch up to countries such as the US. It’s becoming very slow in the UK to launch trials, compared to other regions.
Moderna is attracted to the NHS’s patient records from birth until death.The Covid-19 vaccine-maker is building an Oxfordshire campus that Ivarsson said would make Britain its “second home” for research. It is working with Protas, a non-profit run by Landray which specialises in large, late-stage trials.
She said that the NHS is unique because it is a closed system of healthcare. This means that you can contact people and follow their health records over time.
Some fear that the culture of the healthcare system can hinder innovation. This is a problem compounded by the chronic funding issues.
John Bell, regius Professor of Medicine at Oxford said: “The NHS is not the best place to adopt new products.”
He said that in Britain, “large swathes” of the medical profession do not trust the pharmaceutical industry. This is unlike other countries where the industry is viewed as the source of innovation that benefits patients.
Inclisiran has been criticized by GPs for not providing them with full information about safety and outcomes.
Margaret McCartney is a GP, freelance writer and medical doctor. She said, “The government has a strong push for innovation. It’s the stuff that hasn’t been well tested. “It is the opposite of evidence-based medical practice.”
Other partnerships have fared better despite the failure of the Novartis Inclisiran Trial. Grail, which developed blood tests that can screen for cancer is currently conducting a large trial. The first results are expected to be available next year.
NHS England is driving the initiative and it does not depend upon agreements with integrated care systems that plan and commission healthcare for their local communities. The tests are conducted in mobile units, not hospitals or GP practices.
Peter Johnson, NHS England’s national clinical director for Cancer, stated that the NHS was taking a “very small risk” in a project like this, compared to the huge risk that the company takes on. The company has enrolled 140.000 people. Of these, 70,000 are having their blood tests “exclusively at Grail’s expenses”.Other life sciences companies have found partners to help them navigate the NHS and overcome its challenges. Gilead has worked with scientists at Accelerated Clinical Trials Ltd to develop a blood cancer treatment.
ACT has a network a research nurses based in NHS hospitals that can speed up trial enrolment. They also have a lab dedicated to processing samples from patients.
Charlie Craddock is a professor of haematooncology and ACT’s non-executive Director. He said that drugmakers “bite off their arm” in order to work with ACT.
Roland Sinker was recently appointed as NHS England’s unpaid director of research and innovation. He said that the goal is to “accelerate innovations with a focus prevention, early diagnosis and integrated medicine”, in a manner which “maintains the strengths of NHS, but minimises additional burden”.
Sinker, the chief executive of Cambridge University Hospitals NHS Foundation Trust and also the head of life sciences, said that in order to achieve this, it would be necessary to develop closer relationships with these companies.
Is it possible for the NHS to reinvent itself on its own? He added, “I think the NHS will be able to do this more efficiently with the partnerships we are talking about.”
The NHS has said that it directly commissions a wide range of services and treatment across the country, “including using our strength as an integrated health care system to negotiate deals with commercial companies for NICE-approved cutting-edge treatments”.
The National Institute for Health and Care Research (a government agency) offers a service to guide industry through the planning and execution of clinical trials. The new “integrated boards” will “provide a more straightforward set-up compared to the old model”, according to the report.