Chamber and IQVIA hosted an event on Scotland’s population health challenges. Ivan Mckee, a member of Scottish Parliament, kicked off the event with a speech all about health policy in Scotland and how new technology can help to curb increasing NHS waiting times in the country.
Following the speech, IQVIA’s Angela McFarlane then hosted a panel session with four health professionals based in Scotland who then provided their own insights into the challenges and potential solutions to health challenges in Scotland. The four-panel members who faced questions from McFarlane and members of the audience were:
- Professor Dame Anna Dominiczak – Chief Scientific Officer for the Scottish Government
- Caroline Lamb – Chief Executive of NHS Scotland
- Brian Forbes – Director for Government Affairs for AstraZeneca across the devolved nations
- Chris Carlin – Respiratory Doctor based in Glasgow
Each panellist was asked to discuss the work they are currently leading on and to provide the room with their vision for how the Scottish population can become healthier.
Professor Dominiczak said “I think what we have realised is that discovery science in our great universities is done very well but when it comes to adoption at scale to health services, whether it’s the NHS or any other health service, that is really, really difficult.
“We’re not inward-looking. We want to take everything that could help our NHS recover and then when ready, bring it at scale to all of our health boards. There are examples of this in operation and one is called the digital dermatology programme, where colleagues in primary care can send a picture of a skin condition to secondary care which negates the need for the patient to physically come into a clinic.
This results in quicker answers which does two things – it reduces waiting lists but also helps with earlier diagnoses of dangerous skin lesions and cancerous lesions. So it has a lot of benefits for patients, for communities, for primary care and for secondary care. I think this is a great example of removing the need to wait and removing the need for patients to travel.”
Recovering lost patients
Dr Carlin focused on COPD – a serious lung condition that affects more than one million people in the United Kindom. Unfortunately during the course of the pandemic, many COPD patients have “slipped the net”. Discussing how Scotland can bring these patients back into care, Dr Carling said:
“For COPD, one of our big challenges is trying to get in front of these unscheduled care admissions and in front of these hospital stays by recovering some of our preventative interventions and primary care.
“We need to get hold of data which highlights the population of patients who haven’t been reviewed over the pandemic period because of access challenges, and then put clinicians with the necessary tools into the practices. Then, allow these clinicians to leave their skills, enthusiasm and knowledge behind so that it’s spread out across the health service to upskill others.
“Yes, there are challenges. That’s why we need to work all together on this. We need to appreciate that we are on a journey with it but we also need to highlight some of the successes and positives.”
Widening our horizons
Caroline Lamb said that she thinks we need to change how we view the healthcare system to help improve general population health, stating that the social care system shouldn’t be neglected and forgotten about. She added:
“Too often we talk about health and social care is a bit of a bolt-on at the end. But we need to be really clear that good quality social care, primary care and community care services are absolutely fundamental to the population of Scotland.
“The vast majority of contact with the healthcare system for many Scottish people takes place in primary care. I think too often we are exclusively focused on what happens in the acute centre but it’s essential we are looking at getting people support closer to their homes and in their communities.
“It’s great that we are thinking about how we can use innovation, how we can use new technologies and how we can use digital to support the workforce and primary care but we also need to think about how we can better support individuals so they are able to manage their health support themselves within their smaller communities.”
Attracting Inward Investment
The first question put to panel members was from the Co-Chair of the Life Sciences Scotland Industry Leadership Group, Mark Cook. Cook wanted to know how Scotland could become more attractive to outside investment, something Caroline Lamb was keen to address.
Caroline spoke about bringing in a “once-for-Scotland approach where health policy is tailored specifically to the complex Scottish landscape. She believes this could help to spread innovations across the nation quicker which in turn would result in more inward investment. She said “It’s important to identify some of the barriers to that and some of those are about the complexity of our landscape. We’ve got 14 territorial health boards, 8 national health boards, 32 local authorities, 31 AJB’s and just under 1000 GP practices so that is a particularly complicated landscape to have to work through.
“Our Accelerated National Innovation Adaption Pathway (ANIA) is an example of something we’re looking at as a once-for-Scotland approach in terms of recognising what we haven’t been great at in relation to taking tried and tested innovations and spreading them.
“We also need to be aware that once-for-Scotland isn’t a one size fits all approach because we do have huge differences in our geography and demographics. We need to be alive to those as well so we might want to think about rolling things out in a slightly different way in some of our more remote and rural communities.”
A Diagnostic Revolution
Another interesting topic that was discussed in the panel session was around the “diagnostics revolution”. Professor Peter Donnelly from the University of St Andrews asked the panelists to ponder the pros and cons of new technology which he says has the potential to detect diseases earlier if introduced correctly.
Dr Chris Carlin said “Early, accurate diagnoses across the diagnostic services is one of the biggest levers that we’ve got to pull to address the healthcare challenges we face.
“We have to clean up data so that it is aggregated, harmonised and accessible and then we can do something really special by investing in these new technologies and acquiring experience with them in the real world. We can then rapidly start dropping those that don’t cut it.”
Dame Anna Dominiczak said “This is a very interesting question and it really goes into the big area of precision medicine that Scotland has a chance to do very well. Medicine is wonderful in that we never go backwards but we correct errors by observing real-world data.
“A classic example would be the liquid diagnosis of cancer. If the first try is not perfect the next or the third will be and we need to accept that in innovation processes if we don’t fail, our risk appetite isn’t high enough. There will be failures but hopefully, they will be flagged early enough in research so that it won’t cost patients.
“It’s not enough to do clinical trials in an ivory tower, you have to do it in the real world and I think that’s where we’re heading in the next decade.”
Balancing Innovation and Pressures
One of the toughest questions the audience faced came from audience member Steve Brown who wanted to know whether forward-thinking innovation could still be a priority at a time when present-day challenges such as long waiting lists are so severe.
Caroline Lamb said “That’s a huge challenge and services are under enormous pressure which means it’s very hard to create the bandwidth either at the system level or an individual clinician level to actually be able to focus on those issues but we have to find ways of doing that.
“We need to keep developing and we need to keep looking. There are a lot of technologies out there and lots of innovation. There are lots of things that we can harness that will actually help in terms of releasing clinicians from some of the very routine tasks of the moment.
“I think the key is finding that balance between promoting innovation that supports people in the here, which in turn will help to release some time to focus on innovation that’s going to really help us in the future.”
Brian Forbes said “there’s looking at the future but there are plenty of things that can be done now that are innovative that aren’t being given to patients that are eligible. There are 1.2m patients in the UK who are eligible for innovative healthcare but aren’t receiving it for whatever reason. This isn’t necessarily the sexy future innovation stuff, but it’s things that are practically going to slow dowdisease, keep people away from services and reduce capacity. So there are plenty of things that can be introduced right now to tackle the challenges of today”.
Watch the full video here:
