A blog by our President, Professor Sir Robert Lechler PMedSci
As the NHS turns 70 this year there will be much discussion of past successes, concerns for the present, and hopes for the future.
I believe that we can have high hopes for the future, and I am hopeful both in terms of the potential for improving the health of individuals, but also for revolutionising the future healthcare the NHS could offer us.
We stand at a time of great opportunity to improve our health, and that of future generations. We are seeing an explosion of insight into disease that could fundamentally change the way we prevent and treat physical and mental illness. At the same time we have opportunities to harness advances in genetics, computing, artificial intelligence, and the use of data to improve public health, diagnostics and treatment.
However, we will only realise this vast potential if the NHS is receptive to, and engaged in, a forward thinking research agenda.
Modern medicine: built on medical research
We are living in a future that was unimaginable 70 years ago, when advances such as genetic testing, antibody therapies, MRI scanners and transplantation were the stuff of science fiction. We should never forget how far we have come since the NHS was established, advances in care, that all came about as a result of biomedical research, have changed the medical landscape beyond expectation.
Giving us the knowledge to live healthier lives
The NHS provides a unique environment to carry out research. We need only to think of the way Richard Doll worked with NHS patients to demonstrate the link between smoking and cancer. By the end of the Second World War 80% of men smoked and the UK had the highest lung cancer rates in the world. Doll used a survey of 650 male patients in London’s hospitals to begin his work identifying smoking as the culprit driving these high rates. His discoveries have saved millions of deaths in the UK alone. Epidemiological studies now inform our diets, the amount of exercise we do, the amount of alcohol we drink and the way we treat disease.
Being in a research-rich environment benefits patients
Not only can research make a difference to patients of tomorrow, but research within the NHS has benefits for patients being treated now. In fact, there are great advantages in ensuring that the UK continues to lead the world in life sciences research, rather than adopts discoveries from elsewhere. Data shows research-rich clinical environments produce better outcomes for patients. We also know that patients entered into clinical trials will also do better – something that will only happen if the hospital conducts research or is connected with a UK centre that does.
We must appreciate what a powerful tool research is for protecting and improving our health, and in doing so, ensure that research is a priority for the NHS.
Protecting research in the NHS
Given that we have so much to gain from research within the NHS, I am concerned that we are not doing enough to safeguard it. We know that in a cash strapped NHS clinicians, nurses and technicians are under significant pressure, and that this impacts on their capacity and ability to be involved in research. We need to monitor this and put measures in place to ensure talented clinicians continue to be engaged with research to ensure laboratory discoveries reach patients.
The Academy of Medical Sciences’ role is to support and develop the next generation of medical scientists so we have a diverse research workforce ready to make the transformative breakthroughs of tomorrow. We recognise the pressures they are under and provide funding, career support and mentoring at critical times throughout the career of medical and health researchers.
We also help make sure the wider environment in the UK is research friendly, including putting the case for increasing the total spend on research and development in the UK to 3% GDP, ensuring regulation supports research, and reaching out to Europe and beyond as we prepare to leave the European Union.
Yet this is not enough. In 2006 the National Institutes of Health Research (NIHR) was established in the UK to ‘provide a health research system in which the NHS supports outstanding individuals working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public’. When the NIHR was evaluated by RAND Europe ten years later they concluded: ‘NIHR has transformed research and development in and for the NHS and the patients it serves’.
Clearly, we have made great progress, but that doesn’t mean we have reached our destination. There is more work to be done.
We must ensure that the NIHR receives continued support and investment from future governments. Team science will be more important to research and development than ever before, so we will need to ensure that researchers in the NHS have greater understanding of other sectors and the ability to work across organisations. We need to cultivate a new breed of leader who understands the whole research ecosystem, who is able to move adeptly between sectors and can break down barriers to improving health.
We also need to continue to emphasise the importance of research in medical settings and put the case for protecting clinicians’ time to carry out research.
Given the financial pressures our healthcare system faces, ensuring these considerations are taken on board will be challenging and will require a concerted and sustained effort.
Public health challenges we face
Beyond the difficulties provided by the cash strapped times we live in, and our move to leave the European Union, our population also presents unprecedented challenges for our healthcare.
Our ageing population, many of whom are living with more than one long term condition, will both expect and require more innovative and joined up healthcare. We need to think differently about the way we treat clusters of mental and physical diseases. We also need to make smarter choices about the way we live, our diet, exercise levels and our built environment, if we are going to continue to improve the health of our population in the next 20 years. Advances in medical research have helped us live increasingly longer lives in recent decades, however after falling for a long time we are now seeing an increase in the number of deaths per year. The inevitable truth remains that we must all die of something and growing evidence from the research community shows how ill-prepared most people are for death. Research can enable us to live longer lives and help ensure those years are spent in good health. It can also help us put death and dying in the context of life and living, to give us the knowledge to take control and understand the choices facing us and their implications. Given our aging population this is an area of research that will become ever more important and something the Academy is exploring thorough a programme of public and patient engagement.
There is no doubt that this is a critical time to harness research and innovation to improve health. The questions we are left with are:
Will we be able to capitalise on the research successes of the past and protect the breakthroughs of the future?
Or will pressure on the NHS and a lack of priority hinder research and the development of new treatments and advances in public health?
If I ask one thing it would be that everyone looks at what research has contributed to the NHS so far and considers whether they would rather live in a future where health is improved by research?
If so, we must make sure that research continues to be a priority within the NHS for the next 70 years.
This blog is one of two blogs from our President on the NHS. Read the first here - NHS at 70: What has research done for us?
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