A Near Future NHS

Progress is the single greatest success of humanity, nowhere could this potentially be more visible in healthcare. Britain has many problems, and one of the biggest is our healthcare system. Over the next few decades advancements in technology and science could possibly create a National Health Service that is better, more efficient, and utopian.

Britain’s healthcare system, the NHS is often held up as the crown jewel of our society, its goal is noble, but its execution is poor. One must also be aware of how a system interacts and operates outside of its own design, by that I mean how the system changes as the people it exists to serve change.

You will read many columns from ‘journalists’, politicians, and professional commentators that argue for a multitude of things. They range from charging for appointments to charging for hospital stays, cutting down on managers, getting rid of equality and diversity positions, banning smoking, and more devolution (if you can believe it). Repealing the Equality Act 2010 is a noble goal which I applaud, but it won’t change the NHS.

The ageing elephant in the room, however, is that the NHS was a system designed to work in a time when there were far more young people, far fewer older people, and a lower life expectancy. One only has to look at the below chart from the FT to see the true cost of ageing to the NHS.

No one in power seems to grapple with this fundamental truth, the ones that do, simply propose more mass immigration to fill the gaps in the workforce and government tax intake. This is a position I am not prepared to accept for a multitude of reasons which I will set out at another time.

As people live longer, they are more prone to need support and help from the NHS due to their naturally weakened state, they visit hospitals more, and they usually require more expensive treatments. I believe it is a positive development for humanity that people are living longer, and that families are able to spend more time with their loved ones. But, the cost of this development is rapidly unravelling the prosperity of our nation.

Not only are people living longer, but they are also living longer whilst simultaneously being unhealthy, the best visual manifestation of this is the sheer number of overweight and obese people scattered across Britain. The Health Survey for England 2021 estimates that around 26% of adults in England are obese and a further 38% are overweight but not obese. That amounts to 64% of England being overweight. With this comes a multitude of health issues that have an adverse effect on the health system and its cost. I don’t need to tell you all the negative outcomes that are massively increased in those who are overweight or obese, but this problem costs the NHS an estimated £6 billion a year, rising to around £10 billion by 2050. I do happen to believe this is a gross underestimation however, obesity reportedly costs the United States around $260 billion a year according to one medical study. The study even states that ‘previous studies likely underestimated the effect of obesity on medical expenditures’. Given that the US spends in total around $4.3 trillion annually on healthcare, the $260bn equates to about 6% of total healthcare spending. If we are to take Britain’s £6bn figure, that equates to about 3.4% of total healthcare spending according to the 2022/23 NHS budget. I accept that rates of people overweight and obese are higher in the US, but Britain is rapidly on its way to US levels, currently rising faster. In terms of total costs to the British economy, this study suggests that obesity costs ‘around £58 billion, equivalent to around 2% of the 2020 UK GDP’.

Staffing is often mentioned in the debate about the NHS. The calls for more Doctors and Nurses go unanswered by successive governments that cannot provide the incentives nor can they seem to lift the cap in place upon medical students. Britain has capped places in its medical schools, in England, this cap is 7,500 a year for medicine and dentistry courses. It was briefly upped in 2020 and 2021 to more than 10,000 but has now been reintroduced by the government. It’s mostly a cost control implementation, courses for medicine and dentistry cost more, therefore the government are less willing to fund them as it costs far more than students pay in fees. It’s this short-term thinking that now means we have a shortage of medical staff. The NHS currently has more than 110,000 vacancies and the Health and Social Care Committee reported that an extra 475,000 jobs in health will be needed by the early 2030s. The staff that the NHS does have are leaving for a better life in countries like Australia.

I don’t particularly blame people for emigrating, they have worked hard and have desired skills, they should have a good life, they aren’t getting it in Britain. The average salary for a Doctor in Norway is reportedly around £130,000 a year, in Britain it is around £76,000 a year. A nurse in Australia earns an average of £46,000 a year, in Britain the average salary is £33,000. This is not to say Britain is chronically underpaying medical staff on purpose, it is merely an indictment of our economic woes. Both Norway and Australia are wealthier in terms of GDP per capita than Britain, they can afford to have higher salaries compared to poor Britain. If you have a poor country, relative to other first-world nations, the ablest and most desirable will move to where they believe they are better valued and better paid. That is what is happening in Britain. India is an example of this, as Doctors and Nurses trained in India emigrate to places like the US and Britain to be paid better and have a better standard of living. We should not be surprised it is happening here.

I should clarify, I am not setting out a vision to entirely fix the NHS, nor I am offering an alternative system even though I do believe in one. This article is simpler in its endeavour, how we can use technology and science in the current system and context of the NHS. I will most likely write an entire piece on my vision for the NHS at a later date, but for now, this article is sufficient. I have detailed three major problems plaguing the British healthcare system, there are of course many more, efficiency, productivity, out-of-date and unaligned computer systems, HR procedures, accountability, and cost. But the focus, for now, is ageing, obesity, and staffing.

The total NHS budget for 2022/23 is £180bn, this amounts to around 21% of all government spending. This is only growing, so to be clear, the proposals below are not overnight fixes, they may not see clear results for years, but as stated earlier, short-term thinking cannot reverse a long-term systematic problem.

The first proposal is AI. Artificial Intelligence has had a massive PR boost recently with the enormous success of ChaptGPT, but its applications are potentially endless. In healthcare, AI could not only save billions but could improve patient care, and free up medical staff time meaning hospitals and practices can become more efficient and productive.

A paper recently published in the National Bureau of Economic Research concludes that ‘wider adoption of AI within the next five years using today’s technologies could result in savings of 5 to 10% of healthcare spending, without sacrificing quality and access.‘ The study is based on data in the United States, but directly applied to Britain, we could see potential savings of £9bn to £18bn annually. The total cost of our Police Force is around £17bn. ‘These opportunities could also lead to non-financial benefits such as improved healthcare quality, increased access, better patient experience, and greater clinician satisfaction‘. Not only will AI save money, but it will also improve the system and experience of healthcare. Healthcare in Britain has historically been far behind the curve when it comes to utilising new technology, there are a number of reasons for this. Systems such as AI require upfront investment, which the NHS does not have, it requires organisational agility, which the NHS is not known for, it also requires specific talent, in the case of AI, why would a young talented engineer or programmer work for the NHS to help develop or implement systems for far less pay than they could get working for Google or Amazon?

It is rudimentary for now, but AI could be placed and marketed as AI Doctor Stations in medical rooms, hospitals or even on the NHS website. Patients would be able to text or talk to an AI doctor that could deal with simple to already-established conditions, if a prescription is required after the AI consultation, the system could send a request to a human Doctor who can then approve. It’s important to realise that the study cited deals with AI currently available/deployable, the savings represent the technology we already have now! Implementation of AI systems can free up medical staff, reduce the strain and buildup in hospitals, improve agility and speed within the entire system that would flow upwards, and would also reduce administrative burden too.

AI systems could also remember patients and all of their details plus medical history, making problems quicker to diagnose and prescribe. Data could also be cross-checked flagging up any potential outbreaks, uptakes or unknown diseases far quicker. Cross-checks could also be done nationally with other patients who have had similar issues meaning treatments can be used with more confidence. Of course, this brings up issues of privacy, but safeguards could be put in place, including anonymising patient data when cross-checking and restricting access.

Imperial College London published an article quoting Professor Daniel Rueckert, Head of the Department of Computing, who leads a group that uses AI to help capture and analyse medical images, he states ‘Even an experienced doctor may not have seen all types of cancer. Learning algorithms can pool the data from hundreds of thousands of rare cases‘ leading to a diagnosis. Imperial also highlights Professor Aldo Faisal and colleagues, who have developed an AI Clinician, which is told to monitor collected intensive care data and to maximise a patient’s chance of survival. The AI Clinician is particularly impressive as described below:

'Based on these real interactions, which the AI only hypothetically experienced, it learns to become better than the average doctor. Better, in fact, than 99.8% of all clinicians in intensive care.” In practice, the AI would not be allowed to take decisions on its own, but only give advice to the doctor or other carers. This makes explainability of paramount importance. “The machine has to say why it is making a recommendation and convince the doctor why it is the right thing to do'.

Better than 99.8% of clinicians. Not only can AI save money, and improve efficiency and productivity, but it could also potentially save the lives of patients that human clinicians couldn’t.

Science and technology are like magic, nowhere is this more apparent than in new drugs and treatments. The most famous of recent years has been the advancement of mRNA vaccines and the rollout of coronavirus vaccines. It’s not an understatement to say the coronavirus vaccines are the most important medicines of the last few decades, if we didn’t have them, some countries including Britain may have still been living under restrictions at the time of this article.

The development, procurement, and manufacturing of the coronavirus vaccines were directed by the Vaccine Taskforce, led by venture capitalist Kate Bingham, the VTF was set up to support and fund already-started private/university sector work on a vaccine. The VTF was an initiative of Sir Patrick Vallance, the Government’s Chief Scientific Adviser and Dominic Cummings, Chief Adviser to the Prime Minister. America had a similar programme called Operation Warp Speed, but I will be focusing on the VTF. Covid and the lockdowns/restrictions were costing the British economy an estimated £20.8bn a month or £250bn in total for the year 2020. The total cost of the VTF including international contributions is reportedly around £8.3bn. The total cost of the taskforce is less than half of what the virus/restrictions were costing each month. This represents great value for money, whilst also supporting the British medical/science industry, and improving our profile/image globally. In a country that doesn’t work as people often like to say, the VTF was a global success and showed other nations and organisations, such as the EU, how things could be done. Britain had vaccines for a global virus in less than a year, the value of speed, agility, and motivation was brought together to show many a new side of the state.

The model of the VTF cannot be applied to everything, coronavirus represented a unique threat and problem, and the cost of throwing money at vaccine developments with the potential of wasting money far outweighed the cost in terms of human lives and the economy.

The taskforce was effectively independent, with Kate Bingham reporting directly to the Prime Minister, this system of management and oversight, allowed Bingham and the taskforce to act decisively, unrestrained by politicians, civil service and institutional blockages. The parliamentary Health and Social Care Committee even stated such:

'It is clear that the bespoke structure of the Vaccine Taskforce together with Kate Bingham’s direct approach to leadership, including building a high performing team around her, were of great importance. It is also very clear that much of the success of the UK vaccine project was attributable to the Vaccine Taskforce, and in particular its bespoke role within the official system—a diverse group of people, led by an independent, industry-experienced individual, and sitting outside the Whitehall hierarchy.'

I will write further detail about this taskforce further down, but for now, respect and enjoy the success whilst also thinking about how this system can be applied further to Britain’s healthcare system. The government are already acting upon this, with an announcement in November 2022 that they are setting up and funding vaccine taskforce ‘style‘ initiatives, however, these are not the same as the original, again, I will detail further down.

Back to the actual vaccines, mRNA vaccines could potentially treat or cure a plethora of illnesses and diseases. Cancer is one of them, in January of 2023, the British government and BioNTech announced a partnership to provide up to 10,000 patients with personalized mRNA cancer immunotherapies by 2030. mRNA vaccines can also be rapidly developed compared to traditional vaccines, and whilst their production cost is higher today, in the future with investment in manufacturing and wider user and research, mRNA vaccines have the potential to be low cost. A universal flu vaccine could be in sight using mRNA technology also, with experiments finding positive results in mice:

'When vaccinated mice were exposed to a flu strain similar to one of those in the vaccine, they stayed relatively healthy, and all survived the viral challenge. In contrast, unvaccinated mice exposed to the same flu strain did not survive.

When the team exposed vaccinated mice to a flu strain that was less similar to the ones in the vaccine, the mice got sick but recovered faster than unvaccinated mice. Most of the vaccinated mice survived, but none of the unvaccinated mice did. Even when the researchers depleted T cells, which can also help protect again infection, from the vaccinated mice, the vaccine remained effective. This result showed that most of the protection was coming from the vaccine-generated antibodies.'

The flu costs the British economy an estimated £30bn a year, a universal vaccine would not only benefit the economy but also effectively wipe out the flu for those who are vaccinated. A cure for cancer could potentially be worth up to £41 trillion. According to a study in 2012, cancer costs Britain an estimated £15.8bn a year, no doubt this is far higher now. Gene editing such as CRISPR is making progress in treating genetic disorders, even gene-edited babies have been born, albeit illegally, in China, the embryos were allegedly edited to be immune to HIV before they were placed in the mother’s womb. In December 2022, Doctors at Great Ormond Street Hospital in London cured a 13-year-old girl who had T-cell acute lymphoblastic leukaemia, a form of cancer, using gene editing.

Those with high cholesterol could also benefit from CRISPR, the cholesterol-lowering treatment could help millions at risk of heart attacks and disease. Cardiovascular disease reportedly costs the NHS more than £7.4bn a year and the wider economy £15.8bn according to the government, although again this seems low. A study published in 2006 estimated the total cost of cardiovascular disease to Britain at £29.1bn, adjusted for inflation it is around £46bn.

A newer form of CRISPR called ‘prime editing’ is in development that could potentially ‘rewrite any type of genetic error’. Ending almost all genetic ailments. We could edit the genes of babies before they are born to erase disabilities and deficiencies. In the US, the CDC estimates birth defects cost healthcare systems upwards of $23bn a year.

AI can also be used in conjunction with the development of new drugs and vaccines, ‘AI software that can “paint” or “hallucinate” structures for proteins that don’t yet exist in nature‘. With this, new vaccines and treatments could be rapidly synthesized with a greater rate of success.

On the issue of obesity, a new drug will potentially be available as early as this year, called Tirzepatide, it was developed by Eli Lilly an American pharmaceutical company, and could be an obesity cheat. Tirzepatide is a once-a-week injection that has a dual effect in lowering body fat and normalizing blood sugar levels, with little to no side effects. In a clinical trial, participants that received 15-mg weekly injections had a 20% reduction in weight, and the ‘loss was similar to that reported with lifestyle-based and surgical treatments for obesity’. We may come to a point in the near future where it is desirable and more effective for people to lose weight using drugs than lifestyle changes or surgery. You may believe this is cheating, I’d agree with you, but it doesn’t really matter. The wheels of progress keep turning, saving the healthcare system billions in the process, and freeing up beds, and staff time.

The government’s vaccine taskforce ‘style’ programme is focusing on four issues, one of them is obesity, they are allocating £20 million to quote:

'trial how best to deliver new medicines and technologies for people living with obesity, particularly in deprived communities across the UK. This will help new medicines coming to market  – some of which have the potential to reduce a person’s weight by more than 20% – to better support people to achieve a healthy weight. The mission will explore how these medicines can be combined with cutting-edge technologies and digital tools to improve long-term health outcomes.'

The ‘more than 20%’ figure is interesting as one could assume the statement is referencing the obesity drug I just mentioned, this could be promising but judgement will be reserved.

A 3D-printed organ transplant may be a thing of the past within the next decade if artificial organs progress fast enough, and combined with gene editing, organs could be transferred from animals to humans. A 57-year-old man named David Bennett lived with a pig heart beating inside his chest for two months last year.

Now, to the ageing elephant in the room I wrote about at the beginning. Immortality and being able to live without the curse of ageing has been a goal for as long as intelligent humans have been alive. To avoid death is to revoke God, and in revoking God humans will become God themselves. It’s no wonder this prospect is so enticing, who doesn’t want to be God? We are closer than ever to revoking God and the natural order, and I do predict by the end of this century we will have reversed ageing almost entirely, and potentially have created humans that could theoretically live forever. This article however is regarding the near future in terms of healthcare, treatments reversing ageing or allowing elderly people to have a longer health span, that is more years of their life in which they are in good health, is the main focus.

If we believe that the upper limit of the human lifespan is around 150 years as many studies suggest, and people are living longer, it is not optimal for people to live decades longer whilst also being a net drain on a healthcare system, especially a system such as Britain’s. It is also not optimal to have an extended healthspan combined with an extended lifespan, as whilst people may have an increased number of healthier years, they will also have an increased number of unhealthier years in which again they will become a net drain on the nation’s healthcare system. As such, science and medicine should be focused on extending human healthspan rather than lifespan, at least for now, focus on lifespan can come later this century. As Nick Bostrom writes:

'a shift of focus would require the biogerontology community to more openly embrace and promote the goal of developing therapies that could significantly extend the human healthspan. Research funding priorities would need to be adjusted to strongly encourage the study of the biochemistry of aging and the exploration of possibilities for therapeutic intervention in the aging process. Although the payoff from this type of research in terms of medical products might be further into the future than is the case for research into individual diseases, the eventual health benefits that could come from such research are enormous. Because a great deal of basic research needs to be done before product development could begin at a large scale, economic benefits are mostly beyond the time horizon for pharmaceutical companies, and there is consequently an urgent imperative for public funding. If the estimate mentioned above is correct and currently only about 0.02% of NIH’s budget is devoted to fundamental aging research, one is led to the suspicion that a socially optimal level of funding for biogerontology might easily be as much as 100 times its present value, or more.'

If we take Bostrom’s suggestion that spending on extending the human healthspan should be 100 times the current NIH (National Institutes for Health US) allocation, translated to British terms, the British state should be spending about £750m a year on this type of research and development. Given that 10 million people alive today in Britain could reach the age of 100, this type of research is of paramount importance. The government committed £300m in 2018 to age-related problems such as loneliness and dementia as well as early diagnosis technology, but this money was not set aside for drug development or investment in anti-ageing.

But as with most things, when the government fails, the private sector provides. Research in ageing and longevity has ramped up massively over the last decade, with billionaires such as Jeff Bezos, Mark Zuckerberg and Peter Thiel all investing in companies that seek to extend human life and reverse ageing.

Unity Biotechnology is a company that seeks to relieve ailments caused by ageing by targeting and removing a type of cell that builds up as we age, called senescent cells. Their drugs won’t make a person live longer but they will reduce pain and inflammation in joints, for example, allowing older people to be more mobile. Unity received investment from Bezos and Thiel, however, their clinical trial involving their lead drug resulted in their stock plunging 60% in 2020 as the trial revealed their drug effectively did not work. The company is still operating, but this failure is an important reminder (especially if the state is involved) that failure is inevitable. We won’t get everything right the first time, and money will be wasted, but in the long term, those failures won’t really matter.

Another company with investment from Bezos is called Altos Labs, which is focused on cell reprogramming, basically the rejuvenation of cells. Another company, founded and based in Cambridge (UK) called ShiftBioscience, is also focused on cell reprogramming to ‘reset cells and tissues to a youthful state’. It’s a youthful company too, with its CEO and CSO both being under 40. It has had private investment but according to Companies House, it has capital of £3m+. The British government should immediately invest in and support our own unique and potentially world-changing company.

Altos, on the other hand, has secured an investment of at least $3bn and recruited scientists from Britain such as Dr Ken Raj, who joined from Public Health England. According to a press release in October 2021, the British government are allocating the Department of Health and Social Care ‘£5bn over the next three years to fund health R&D, with investment rising to £2 billion per year by 2024 – a 57% cash increase since before the pandemic’. The UK Research and Innovation body also offers grants, such as this one to do with ageing with £3.5m in funding. Pretty paltry numbers however if we put them in the context of Altos’ round of investment.

Where venture capital money flows, results usually follow, with a company based in San Diego, Rejuvenate Bio claiming last month that they have successfully extended the lifespan of mice by reprogramming their cells to a younger state. The treated mice lived about 7% longer, a modest extension, but we are just at the beginning of this new phase.

Genetics Professor David Sinclair, director of Harvard Medical School’s Paul F. Glenn Center for Biology of Aging Research was interviewed in The Harvard Gazette and said the following:

'Over the last 20 years, there have been a number of molecules that have been found to retard the aging process, at least in animals, and potentially a couple of drugs that are in humans. That made me optimistic that somebody who might make it to 150 has already been born. In this paper, we’re showing it’s possible to reset the age of the body up to as much as 50 percent. And, when you can reverse aging and not just slow it down, then all bets are off. We now know you can reset the eye multiple times and restore vision in old mice — that was our Nature 2020 cover article. In this paper, we’re showing that we can reverse aging in other tissues as well, using the same technology. So, if you can reset the age of the body multiple times, I think it would be dangerous to set an upper limit.'

This all sounds fairly unbelievable, but science and technology are now moving at a pace so fast we cannot keep up with all the developments. Sinclair concludes:

'If we’re right, there is a universal cause of aging in every tissue and in seemingly every species, from yeast to humans, and diseases like heart disease, diabetes, and Alzheimer’s are manifestations. If we’re able to slow down or reverse the aging process, this would be a radical new way of treating these diseases. The same treatment for heart disease could also cure Alzheimer’s and diabetes, and make you look younger as well. This is an exciting time. We could be witnessing a new approach to treating diseases in general.'

With Britain expected to have 1.6 million people living with Alzheimer’s in 2040, medical treatments such as cell reprogramming would drastically improve the quality of life of those affected, but also save Britain an estimated £94.1bn a year in 2040.

I am not in this article passing judgement on whether people should or should not live longer/forever, I will write about that at another time, what I am saying is that developments in terms of preventing ageing are of major significance if we are to have a sustainable healthcare system, no serious person can ignore this. Although politicians are, that tells you all you need to know about them.

There are of course dilemmas if people are to live longer, the pension system is one of the biggest, but also the effect it could have on younger people in the workforce being sidelined or blocked by their older more risk-averse colleagues.

For now, respect and enjoy the promise of a future healthcare system and society not ravaged by the negative effects of ageing such as illness, ailments and disease.

I have alluded to what is needed to achieve what I have briefly set out, but I will be more clear. Progress, not stagnation must be our guiding philosophy. Stagnation only breeds decay. The proposals and advancements set out may have sci-fi-like connotations but the drug for obesity is already set to be approved in 2023, and the rest, AI, anti-ageing drugs, mRNA vaccines, cancer cures, CRISPR/Gene Editing, are all either accessible now (some more accessible than other), or in development and will be accessible in 10-15 years. That means all proposals in this piece could be implemented very optimistically by the year 2032 and at the latest 2037.

Of course, this is not an easy task, I accept this, but Britain will discover it very quickly has to plan for the eventualities I have set out, or else we will not have a functioning healthcare system, and potentially millions of people could die. This is not hyperbole, this is a real eventuality if nothing changes. As I wrote at the beginning, a system that cannot match the people it exists to serve will cease to function properly.

To implement the proposals, state investment is necessary. My philosophy is state investment, but minimal involvement. At least in the context of our current state, which isn’t particularly good at anything, plus actively sabotages successful programmes, but more on that later. The state should be investing with minimal strings attached, in companies such as ShiftBioscience.

If we combine the cost of ageing/Alzheimers (based on projected 2040 figure), cancer, obesity, cardiovascular disease, and the Flu to the British economy we come up with a basic figure of more than £243.8bn a year by 2040, keeping in mind, that is a figure based on today’s numbers, the figure will be far higher. £243.8bn is around 8% of Britain’s GDP today. That is each year.

The sheer cost of just those select health issues to the economy and society is comparable to how much the coronavirus/restrictions were costing Britain in 2020 and 2021. We cannot afford not to act.

If we look at the Vaccine Taskforce approach, it spent £8.3bn on vaccine development, trials, and manufacturing, it we took this approach to ageing, the returns to the economy would be comparable if not greater than the returns for the coronavirus vaccine. The taskforce, like the coronavirus taskforce, would invest in multiple companies, in Britain and elsewhere, provide the funding and ask how they can help toward the manufacturing process, whether that is factories or supplies. We would inevitably lose money betting on certain companies and products, but the net gain, if even one drug/treatment was successful, would be worth losing our investments on all of the rest. Of course, money should not be spent recklessly, but these are inherently risky investments. The vaccine taskforce worked because Kate Bingham, with her experience as a venture capitalist, accepted the risks, had independence/was outside the structure of government, and was working with a motivated (profit-motivated and image-motivated) and successful private sector.

Whilst the taskforce approach can be applied to the development and manufacturing of drugs and treatments, it cannot be as directly applied to the implementation of AI. An entirely separate article could be written about AI within the NHS, but for now, I will attempt to keep it short. There are three major barriers to AI adoption within healthcare systems, technology, policy and impact. That is a lack of integration, privacy and security concerns, capacity, and methodology. I alluded to the success factors of the implementation of AI earlier (talent), and this study from China discussing success factors impacting AI Adoption in the Telecom Industry can be applied to healthcare:

'Particularly, this framework consists of factors regarding the external environment, organizational capabilities, and innovation attributes of AI. The framework is empirically tested with data collected by surveying telecom companies in China. Structural equation modeling is applied to analyze the data. The results indicate that compatibility, relative advantage, complexity, managerial support, government involvement, and vendor partnership are significantly related to AI adoption. Managerial capability impacts other organizational capabilities and innovation attributes of AI, but it is indirectly related to AI adoption. Market uncertainty and competitive pressure are not significantly related to AI adoption, but all the external environment factors positively influence managerial capability.'

The NHS is doing work with AI, with its NHS AI Lab Skunkworks running ‘short-term projects to investigate the use of AI for improving efficiency and accuracy in health and care’. A skunkworks project is famously an endeavour involving a small team working together with almost full autonomy for the sake of radical innovation/progress. The team does appear to be small, but whether it is leading to actual implementation rather than small experiments is to be determined (if you have any information on this please message me). I’m also interested to know more detail about the structure of Skunkworks if anybody has any information regarding this. One of their projects is using AI to determine which patients are potential ‘long-stayers’, identifying them early and adjusting their treatment accordingly.

This work does bring up an important point, however, which is that innovation does not always have to come from the outside, but, for innovation to progress to implementation, support and push from the highest levels, eg. the government, will be necessary. Small investment is being made by the government, and an interactive AI roadmap was published last year by Health Education England claiming that within 3 years 64% of AI technology available will be ready to be deployed. Bold claims.

As of 6th February 2023.

AI like most things, requires investment, but it also requires a willingness to change, in a governmental organisation like the NHS, change only comes from the top.

I don’t have much faith in any of the proposals I have outlined being implemented for a number of reasons. The NHS and governmental organisational capabilities have time and time again shown themselves to be incompetent. The best example of this is the £10bn that was wasted attempting to implement the National Program for IT (NPfIT) in the NHS, it was the largest public-sector IT program ever attempted. The programme was formed in 2005 and was scrapped in the early 2010s. According to this study:

'The core aim of the NPfIT was to bring the NHS’ use of information technology into the 21st century, through the introduction of integrated electronic patient records systems, online ‘choose and book’ services, computerized referral and prescription systems and underpinning network infrastructure.

Despite the failure of many of these services to be delivered, the government, and ultimately taxpayers, incurred significant costs for the program, including contract transition and exit costs which continued to accrue to a total amount of more than £10 billion.'

I disagree with many, including the author of the study cited that ‘top-down’ projects should be avoided in favour of ‘bottom-up’ projects. Top-down projects can be a success if they are given the proper support, they have the right people leading them and they have a degree of authority and independence. (People, Ideas, Hardware). Implementing AI will need those factors, unfortunately, our system is not amenable or even at times bendable to those factors, as Kate Bingham found out.

The Vaccine Taskforce was an incredible success, but it might not have been had it not been a true ‘skunkworks’ project. Bingham has heavily criticised the institutional blockages that she encountered when she was trying to secure Britain’s coronavirus vaccines. In this article for the Daily Mail, extracted from her book, Bingham details the hindrances she experienced.

On Matt Hancock, the Health Secretary:

'I could barely believe my ears. The Health Secretary was openly accusing me of a lack of ambition, questioning my competence, and doing so in front of his Cabinet colleagues and key officials.

‘You can’t just tell me I’m wrong,’ said Matt. Well, it turned out that I could, and he was. The meeting didn’t end well.

Michael Gove could not have looked more embarrassed. The Business Secretary, Alok Sharma, called me immediately afterwards to apologise. Others sent messages of support.'

On government bureaucracy, organisation and funding:

'If I’d ever been asked the question ‘What is the biggest threat to the success of the Vaccine Taskforce?’ the honest answer would have been: ‘Large parts of the rest of Whitehall.’

Sometimes I would find myself in an Alice in Wonderland situation, with more than a hint of Monty Python to it.

In the summer of 2020, I attended a meeting with Boris Johnson and some Ministers in the big green Cabinet room in Downing Street.

I pointed out to them that the Taskforce urgently needed ring-fenced funds to help develop vaccines – yet our budget hadn’t yet been approved. Boris turned to Rishi Sunak, who was on video, and challenged him about what was going on. Rishi had no idea.

Vaccines had clearly not been high on the list of priorities for the Chancellor’s office.

This was my first inkling of the power of officials, who get to decide what they show to their Ministers for approval and decisions. Yet by then we’d already been forced to waste acres of valuable time in making a business case for our existence to – yes – the Treasury.

There was also a slightly surreal requirement for detailed proofs of ‘value for money’… while we were in the midst of a pandemic, with thousands being hospitalised every week and the NHS under unprecedented strain.

One might have thought that the ‘value for money’ of an effective vaccine campaign was pretty obvious. Apparently not. Yet no one in Whitehall seemed willing to accept that standard calculations were not appropriate while so many people were dying from Covid.'

Saving lives, or filling out forms:

'As part of this nonsensical and irrelevant work for the Treasury, we had to include a risk analysis by the Business Department – which deemed the Taskforce’s risk level of failure to be ‘very high’.

Any scientist could have told them the odds were vastly against finding an effective Covid vaccine, let alone by the end of the year. So what on earth was the purpose of the quantified risk analysis?

We soon found that Civil Service micro-management and distracting demands for data and forecasts were growing all too common. Not only were we building the plane as we were flying it, we were flying in the dark, simultaneously writing the instruction manual and fielding endless petty questions from air traffic control asking about the strength of the orange juice we were serving to passengers.

Having spent my working life in the private sector, I’d entered a world where process apparently mattered more than outcomes.'

Bingham’s complaints exemplify why the current system will never change, and why the proposals set out in this article will never happen. The taskforce approach to ageing, is too high risk, even though it could yield much higher rewards. Officials and politicians are not prepared to take on that risk, partly because we have an infantile media that shrieks if the mundane and time-consuming procedure/regulation isn’t followed. As they did with one of the taskforces coronavirus contracts that was scrapped by the government. The contract was one of eight signed by the taskforce and payment of £214m was given upfront for the development, the vaccine failed and the government lost that money. What journalists fail to understand is the risk of losing that money was already known, the risk was accepted to save lives and save the economy. It was worth it.

This thinking can be applied to medical school places, open more up, if we lose money due to some students dropping out etc, it doesn’t matter, in the long term, the reward outweighs the loss.

Politicians are lazy, and incompetent, if it wasn’t for Bingham and her venture capitalist background, Britain may have been left behind in the race for vaccines. This is why it is concerning that the Whitehall bureaucracy has now absorbed the taskforce, merging it with the UK Health Security Agency (UKHSA) and the Office for Life Sciences (OLS). This negates its original purpose, independence from Whitehall and effective autonomy. I noted earlier about the government applying the VTF ‘approach‘ to other health issues, such as cancer, obesity, mental health, and addiction. Given the approaches are presumably under the management of the civil service, it remains to be seen whether we will see success in these programmes.

All of the proposals outlined are great, truly revolutionary in fact. If I do say so myself. Will Britain ever implement them? Not under the current system.

The only thing the British system is good at is spending money and wasting it. It has no cohesive long-term plan, and when it does the plan gets changed more often than it gets followed.

I have left out the discussion surrounding funding and cost, it’s a contentious issue and this article is not the place to discuss it. Although given that we are expecting people to live longer, and healthier lives, the tax burden cannot fall disproportionately on young, working people, older people will have to pay more, ignoring the economic arguments, simply it’s only fair.

Britain’s healthcare system could be utopian-esque by the year 2050, ultimately a new system of governance will have to be established in order to implement the proposals set out here, as the current system just isn’t up to the job, and hasn’t been for a long time.

I keep repeating it, but by the end of this decade, Britain will be in a much better position, keep the faith.

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