Jonathan Ashworth full speech to the IPPR conference
Jonathan Ashworth MP, Labour’s Shadow Health Secretary, in a speech to the IPPR Conference “Keeping up with the science: the future of health and care in the UK”, said:
This year we celebrate 70 years of the NHS and reflect on what the next era of the NHS looks like. My argument today is that an NHS with a strong bias toward innovation, investing in the technologies of the future, becomes more important if we are to sustain the NHS for the next generation and beyond.
Of course the creation of the National Health Service was itself an act of monumental innovation. In Bevan’s words “the biggest single experiment in social service that the world has ever seen.”
Bevan took an idea and applied it across a much larger canvass, in reality rolling out across the country the best of medical innovation he had seen and indeed managed in his home of Tredegar with the Medical Aid Society.
In establishing the NHS Bevan he told us “all I am doing is extending to the entire population of Britain the benefits we have had in Tredegar for a generation or more. We are going to Tredegarise you.” So what are the modern equivalents of that innovation? How do we ‘Tredagarise the NHS for the modern era?
I believe we have to fully understand the challenges in order to fully maximise the opportunities.
But we can confront the challenges with a degree of confidence.
The NHS has always throughout its 70 years been at the forefront of innovation both to improve patient care and to improve efficiency.
60 years ago saw the first mass immunisation programmes offering polio and diphtheria vaccines to under 15s. 50 years ago the first heart transplant; 40 years ago IVF. 10 years ago The Improving Access to Psychological Therapies rolled out.
British doctors and scientists have discovered DNA and have managed to sequence the entire human genome.
British doctors and scientists have developed the clinical thermometer, the intra-ocular lens, the CT scanner, the MRI scanner.
One only needs to look at how some elements of surgical practice have changed in recent decades to see the power of innovation not only to improve care for patients but also to help us to have a more efficient NHS.
Minimally invasive surgery has become the norm with endoscopies conducted with small instruments and a video camera probe.
Recently I saw first-hand the remarkable advanced medical imaging devices for use during minimally invasive procedures on the vascular ward at Southampton General Hospital.
The use of lasers in surgery has become common. The NHS has seen the development of bionic eyes to restore sight. 30 years ago the only way to deal with gastric ulcers was to spend hours removing large parts of a patient’s stomach. Today, new drugs have made such operations entirely redundant. And last month the world’s eyes yet again were on Leicester, the city I represent when we witnessed the extraordinary innovation at Leicester University Hospital Trust safely bringing baby Vanellope, born with her heart outside her chest, into the world.
So a proud track record of innovation not just in terms of new drugs, medical devices, technology and procedures but also new innovation with new pathways and models of care too.
However, too often innovation across the NHS has been too slow to spread, concentrated in pockets of excellence.
The question is how we expand the adoption and diffusion of innovation, how to utilise new technologies to prevent suffering and save lives.
The challenges facing the NHS of 2018 are of a different scale and nature to the challenges facing Bevan’s NHS of 1948 which is why as Bevan himself told us “the service must always be changing, growing and improving.”
I believe those challenges we must confront involve the ageing population, chronic disease and growing health inequalities.
In 1948, 11 per cent of the UK population was 65 or over, life expectancy for women was 71 and for men, 66. Today those figures are 82 and 79 respectively. And the so called ‘oldest old’, those with a substantial risk of requiring long-term care, are now the fastest growing age group in the UK.
Looking ahead, by 2040, nearly one in seven people is projected to be aged over 75 and the number of over 85s is set to double over the next 20 years.
It’s perhaps not a terribly original insight to suggest that the demands of an ageing society mean not only more investment in social care but greater integration and seamless care too in what has become a hopelessly fragmented system.
But as well as integrating services to meet demands of an ageing population we also have to take account of the demands of geography too.
The Centre for Towns recently showed that around three-quarters of the increase in 45 to 64-year olds and over 65s between 1981 and 2011 took place in villages, communities, small and medium sized towns.
The net effect has been for large towns and cities to ‘get younger’ whilst our villages, small communities and smaller towns have grown older.
There are now sharp disparities in ageing between our cities and towns, even within regions. These in themselves have huge implications for health and social care services in towns and cities over the next 20 years and in the coming weeks, along with my friend and colleague Lisa Nandy, and Ian Warren – the founders of the Centre for Towns – we’ll be looking at this more closely.
We must also fully recognise and respond to the reality that the very nature of ill-health is fundamentally changing too. With a relative shift away from acute illness, towards chronic conditions, multi-morbidities, cognitive impairments and long-term frailty. Over 50 per cent of older people have at least two chronic conditions. By 2035, the proportion of those with 4 or more diseases is set to double.
No longer should we consider the health service as a sickness service concerned with relieving the suffering of infectious disease but we must genuinely think of it as an actual health service supporting people to live with chronic conditions such as, for example, diabetes or arthritis that have become a permanent feature of life.
And consider that for example arthritis currently costs the UK economy £2.6 billion annually through 25 million lost working days. Arthritis UK forecast that to rise to £3.4bn a year by 2030. Or that diabetes is costing the economy £23 billion a year- rising to £39 billion by 2035. It becomes even more vital we support innovations to help improve services that support people to live their lives managing these conditions.
And such innovation is beginning to happen. For example, Flash Glucose Monitoring is a new technology that works by inserting a small sensor into the upper arm. A reader device then scans the sensor and displays blood glucose levels instantly, indicating whether their levels are going up or down. Or another example which helps parents monitor their children’s blood sugar levels in real time on their mobile phones using nightscout.
And just we must find better ways to support those with chronic conditions we must also confront growing health inequalities too.
We know that where you are born still has a major impact on your health outcomes in life. Obesity is twice as common amongst children living in the most deprived areas, as compared to children in the most privileged areas. 5 year olds in Blackburn are 4 times as likely to have tooth decay compared to 5 year olds in South Gloucestershire.
Those from the most deprived backgrounds enjoy a healthy life expectancy of just 52 and yet with national retirement age of 67 that leaves 15 years for a person to be out of work, not building up a pension and reliant on the state.
Sir Michael Marmot has warned that this country has, since 2010, stalled in the task of improving the life expectancy of our population with differences in life expectancy between the poorest areas in the country and the English average has started to widen again.
Part of the answer is reversing the cuts to public health and I’ve committed the Labour Party to a big all ambition to improve the health and wellbeing of every child.
But tackling these many inter connected problems will require greater integration of care at local levels. So it’s right that we integrate health and social care and consider new models of delivering integrated care, though we are strongly opposed to any arrangement that allows a role for privatisation of services. It also means investing in mental health services and supporting new innovative models of care such as the social prescribing project I recently visited in Rotherham.
Investment in technology is central to meeting these challenges as well.
But we can’t ignore the fiscal and workforce pressures facing the NHS.
The NHS is going through the biggest financial squeeze in history with years of underfunding since 2010
Indeed funding per person, once adjusted for age, will fall by 0.3 per cent in 2019/20, breaking a key election pledge in the Conservative Manifesto which promised: “An increase in real funding per head of the population for every year of the Parliament.”
Every day we see the real human impact of failing to invest in the NHS with ever lengthening waiting lists, hospitals at capacity this winter, elective operations cancelled, the 18 week target effectively abandoned.
But not only is the NHS experiencing the biggest financial squeeze in its history it also faces a severe workforce crisis too.
Our research last November revealed vacancies across the NHS for 100,000 posts. And if we want staff to pioneer new ways of working then we have to recognise the immense pressures staff are currently under with workforce shortages and rota gaps.
It’s why we believe the NHS needs to take a new look at how it recruits, trains, pays and looks after its staff. The same goes for social care, in fact perhaps even more so for social care, when the system is possibly even more starved of funds, and decent working conditions and career options even rarer.
In recognition of the underfunding and staffing crisis facing the NHS and social care sector at the last general election we pledged an additional £45 billion across a Parliament for health and social care. And to help inform our long term plan for the NHS we are also committed to establishing an Office for Health Budget Responsibility.
Investing in our NHS and our broader commitments on improving public health makes good economic sense, also driving productivity and as the OECED has shown increasing public expenditure in health alongside research and development yields gains in economic growth too.
For me investing in the NHS is not therefore only about providing the best quality of care, I consider it as part of a modern industrial strategy as well. I know this is an argument trade unions including the GMB have rightly made when making the case for more investment in social care too.
The NHS currently sets aside less than 0.1 per cent of available resources for the adoption and spread of innovation, with £50 million approximately spent on supporting the spread and adoption of innovation through the Academic Health Sciences Network. As the Kings Fund says, this is a “small fraction of the funds available for innovation itself” which means “the NHS’s operating units will struggle to adopt large numbers of innovations and rapidly improve productivity.”
By comparison, the annual spend on research and development in the NHS, including through the National Institute for Health Research, is £1.2 billion.
We must encourage innovation as, in some respects, we are falling behind.
Take cancer for example. The Lancet has recently reported that the UK has some of the worst cancer survival rates in Western Europe. It’s my ambition that by investing in innovations, investing in new technologies and expanding R&D, the UK will proudly move up the league tables and boast the best rates of cancer survival, diagnosis and treatment anywhere in the world.
So today I’m pledging to make our NHS the most innovative health service in the world.
I’ve personally been impressed with the Academic Health Science Network having seen the support they’ve given to Leicestershire Partnership Trust to expand their award winning secure text messaging service, ChatHealth which has helped the school nurses network significantly increases the number of young people aged 11-19 that they reach.
But I believe the Academic Health Services Network can do more. So I can announce today that as part of our £37 billion extra funding for the NHS, we will double investment in the Academic Health Science Network to drive innovation across the NHS and we’ll ask that new funding is used particularly to focus on new ways to support those with chronic conditions and narrow health inequalities as well.
We also understand that it is staff on the frontline who often have the most invaluable insights into identifying, and subsequently working up, solutions to frontline problems.
We want to give staff in the NHS the opportunity to innovate. The key element of this is enabling people to share ideas, and to have their ideas valued and listened to.
For example, I recently visited the Royal Lancaster and saw first-hand how interactive ID panels were being placed above every bed, to enable nurses and doctors to see key information about a patient at a glance. This solved a critical problem for medical staff- the lack of a standardised way of recording patient information.
We also want to do more to support frontline staff find new solutions to evolving problems. And so to that end, Labour will also expand the Clinical Entrepreneurial Programme every year.
But of course innovation is nothing without implementation and the implementers, those who give new ideas and projects the greenlight are trust management. By offering the NHS a fairer funding settlement we will free up funds, resources and time for innovation and work with trusts to introduce an Innovation Scout at every board level.
New, and potentially highly productive partnerships, should be strengthened between health and social care staff and sources of innovation such as schools of design and technology in our universities. An interesting example is the attachment of specialist registrars in public health to the architectural studios in the University of the West of England. Our built environment is a major determinant of health and well-being and the stimulation of better design for our built environment could deliver enormous benefits in the future.
We also know how important collaboration and support for our Life Sciences sector is. Indeed thanks in part to the investment and regulatory framework put in place by Gordon Brown, Paul Drayson and David Sainsbury we now have a world leading sector delivering life-changing treatments contributing £30.4 billion to the UK economy and supporting 482,000 jobs.
I’ve recently seen for myself the extraordinary potential of life sciences when I visited Newcastle University and saw the remarkable new way they were growing curved human corneas, solely by controlling the behaviour of cells in a dish. A breakthrough that could provide a solution for the shortage of donated human corneal tissues.
So Labour is also committed to expanding R&D investment across the board by £1.3 billion during the first two years of the next Labour Government and I can also announce we are committed to investing in the infrastructure of the NHS too.
So rather than raiding capital budgets to fund day to day spending we will, as part of the National Transformation Fund that John McDonnell has announced, bring forward £10 billion of capital investment for our National Health Service allowing us to invest for the future in the technology and innovation, including Artificial Intelligence and updating aged medical equipment with our NHS Innovation Fund.
Of course AI will never replace the extraordinary, skill and compassion of our NHS staff but where AI can be used as a tool to relieve pain we should make use of it.
Our Deputy Leader Tom Watson last year commissioned a ground breaking report into the future of automation and AI which emphasised the opportunities of this coming revolution.
The report found that whereas automation will replace jobs in some sectors, health and social care will be one of the most resistant to automation because of the key human faculties of care and compassion that these jobs require.
It also highlighted the major advances in healthcare that using big data and machine learning could bring, not just in research but in diagnostics and providing personalised treatment too.
So far the use of Artificial Intelligence use across the NHS has been limited but its potential is immense. For example cancer treatment will be profoundly improved by the use of AI. Already at Imperial College London, clinicians and radiologists are currently using machine learning to help detect the early stages of breast cancer. AI is helping pathologists detect cancer in tissue samples, deducing which lung nodules might need further action, and in radiotherapy planning for head and neck cancer.
AI is a, innovation, which alongside other assistive technologies, home-based health monitoring equipment and smart use of big data, all have the potential to profoundly change, and improve, care in the home and community.
We therefore welcome NHS England’s commitment to increase the investment in Artificial Intelligence and we’ll be watching carefully as Labour launches a stream of work on how we make best use of AI in healthcare for the future.
Finally last week a friend and colleague made a brave and personal intervention in the innovation debate. Tessa Jowell, spoke about her own experience of discovering she had an aggressive form of brain cancer – glioblastoma
For people with aggressive cancers like this, time is of the essence. That’s why Tessa is calling for adaptive clinical trials so patients can try different drugs at once and adapt and change treatments more quickly. She’s also calling for more international data sharing because cancers like gliobastoma are too big for any one country to solve alone. I hope what Tessa is calling will be implemented.
In that speech Tessa spoke powerfully and movingly for each and every one of us. Because we all depend on the NHS innovating and advancing – whether that’s in providing the new drugs, new technology, pathways or models of service care that will save lives or offer relief for debilitating pain and suffering.
It’s why this agenda has our full commitment, it’s why as Labour’s Shadow Secretary of State for Health and Social Care I’m inpatient for change and its why a Labour government will drive to make the investment available to ensure an innovative, pioneering National Health Service is sustainable for the next generation.