Michael Simpson reflects on the NHS at 75
The president and chief executive of Clinisys marks the 75th anniversary of the NHS by considering the phenomenal partnership it has developed with pathology providers and looking ahead to a future shaped by further innovation.
Clinisys is incredibly proud to be a critical supplier to the health service. We’re not quite as old as the NHS; it turns 75 this year and we turn 40. However, I like to think we have values in common. The NHS is focused on taking care of its users and we are focused on taking care of our customers.
Over the past four decades, that has enabled us to form a phenomenal partnership with pathology providers and the clinicians who depend on them. Just look at how NHS pathology has changed over the past 15-years and the role that our systems have played in that.
In 2008, Lord Carter of Coles published the first of two reports arguing there was too much variability in pathology services, and efficiency and quality could be improved with consolidation. Since then, 27 pathology networks have been formed across England.
The majority are using our laboratory information systems to streamline their operations and our order communications and results reporting solutions to communicate with ward staff and GPs. Today, we can send information back and forth in seconds that used to require hours of printing, handling post, and chasing up by telephone, and we should all be incredibly proud of that.
Covid-19: Changing the landscape
Even so, Covid-19 was a turning point. It had a significant impact on us as a healthcare company. Like every commercial organisation, we have to make a profit, but the pandemic brought out our altruistic side.
We had people working all-hours to extend licenses and plug in machines as labs scrambled to increase testing capacity. We had people with clinical backgrounds asking to volunteer to support the NHS. It was a phenomenal period, and one that also had a lasting impact on pathology.
Covid took pathology out of the basement. It made policy makers and hospital managers and patients aware of just how much testing matters. A stethoscope may be the universal symbol of healthcare delivery. But, as we know, a physician doesn’t diagnose a condition like lung cancer by listening to our chest.
It requires a test, as do 80% of the decisions that a physician makes about us. And the pandemic demonstrated the importance of being able to deliver fast, high-quality, tests at scale.
The new world: POCT, automation and AI
The pandemic also showed the potential of home testing. Before Covid-19 arrived, few of us would have thought the public would be able to do their own lateral flow tests; but they did, and they got it right most of the time. So, I think the challenge now is to expand on that.
There are some issues to address. We’ll need to make sure there’s clarity about why home tests and point of care tests are being done, and maintain quality, and find a way to write the results back to the patient record in a way that makes clinicians confident about acting on them.
But if we can do all that, we can reduce some of the pressure on our laboratories, so they can focus on where their expertise adds value. Meantime, there’s more innovation coming to those labs.
Now that WinPath Enterprise is in place or being deployed across pathology networks, and instances of ICE are being consolidated, laboratory leaders are starting to think about layering-in the next generation of technology. That means automation, to improve efficiency by relieving humans of mundane handling tasks.
It means digital histopathology, to convert the traditional glass slide into an image that can be reported from many more locations, and it means artificial intelligence to help direct work to the right clinician at the right time, and to support the work of those clinicians.
The support point is important, and it’s why we don’t talk about artificial intelligence, but augmented intelligence. A lot of testing still means looking down a microscope for hours, counting cells. It’s tedious and can be error prone, and AI can do it in seconds, so the clinician can focus their expertise on interpreting that information. AI is not going to be making clinical decisions, but it is going to be supporting clinical decision making, and it’s coming down the road very fast.
The future: healthier and safer
Of course, the pandemic also had negative impacts. None of us should forget that Covid-19 took a terrible toll on individuals and communities. It left the NHS with an enormous backlog of elective work that it will need to tackle while dealing with rising demand, an ageing population, and a shortage of resources.
The health service has a long-term plan in place to address these issues, which is looking to create more integrated, more personalised care, and to encourage a ‘left shift’ from treatment to prevention and public health.
Clinisys has an important part to play in that shift. Experts all agree that another pandemic is coming; and it is our systems that enable labs globally to undertake the disease surveillance that will give us early warning of when it arrives. We have the ability to help the UK to prepare for that next pandemic and to monitor the UK population to track the outbreak and spread of disease.
At the same time, over the past couple of years, we have made a huge investment in systems that support laboratories that carry out other types of public health surveillance. We have recognised that a lot of sickness starts with the food that communities eat, and the water they drink, and the air they breathe. That’s why we have updated our vision to say that Clinisys is about enabling healthier and safer communities.
The challenge here will be to get data from these labs and systems to the integrated care systems, or the GPs, or the individuals, who can act on it. However, I think the NHS has two huge advantages over some of the other healthcare systems in which we operate, globally, when it comes to doing that.
The first is that it’s a single payer system, which means we can work with one set of government and NHS bodies, on these issues, rather than a mass of public bodies, insurers, and private providers. And the second is that it has the NHS Data Spine in place to move data securely from one point to another and layer-in the analytics required.
The NHS is 75: here’s to its next three quarters of a century
We’re not quite ready to realise that potential. NHS75 has triggered a public debate on how the NHS is doing and whether it needs more funding and reform. I think it has a great core but it’s over-funded in some places and under-funded in others: like prevention. So, what it needs is not more change but stability, so it can get into the long-term plan and align its funding with its ambitions. If it could do that, I think the NHS could be uniquely positioned to tackle environmental healthcare, and to start making the world a healthier and a safer place. Wouldn’t that be a great ambition for its next three quarters of a century?