Viewpoint Andrew Morris
Convergence of healthcare with research: an opportunity for Scotland…
Convergence of healthcare with research: an opportunity for Scotland
Healthcare systems internationally are under great strain. Despite increased spending on healthcare (8% of GDP in the UK and 17.4% in the US), the pressure continues to mount every year – with increasing life expectancy, new technologies, enhanced patient and public expectations and a “rise and rise” of chronic or non-communicable disease, major challenges in all countries.
The facts about chronic disease are particularly stark: up to three quarters of people over 75 years of age currently suffer from a chronic disease, and the incidence of chronic disease in the over 65s will double by 2030. Last year, a UN summit declared chronic diseases to be a global threat to the future sustainability and affordability of healthcare, and the World Economic Forum estimates that chronic diseases will cost the world economy $47 trillion over the next 20 years.
The quest for better quality at reduced cost remains elusive, but in many countries such as Singapore and Australia, for example, they are focusing on closer integration of science with healthcare provision and public health, facilitating the convergence of research with healthcare, not only to accelerate clinical innovation, but also as a vehicle of economic growth.
Scotland is a relatively small market in terms of global healthcare delivery. Annual expenditure on healthcare provision is about £12 billion for five million people. In life sciences research, however, Scotland has a disproportionate impact. It hosts the UK’s second-largest Life Sciences cluster and one of the most sizeable in Europe, with an annual turnover worth £3.1 billion. Scotland also competes well in health science research, attracting 11.5% (£189M) of the total £1,618M of the health-relevant research expenditure in the UK in the recently published UK Clinical Research Collaboration report.
As a location for research and clinical trials, Scotland has a number of advantages over many other countries, including internationally-competitive universities where academics undertake clinical service as well as research. We also have a stable and improving healthcare system, an emerging nationwide clinical research infrastructure ((NHS Research Scotland), and an informatics capability that exploits electronic patient records, linkable through a unique NHS patient identifier, enabling clinical trials, stratified medicine and genetic studies.
But more needs to be done to ensure Scotland remains a powerful player as part of a UK biomedical science cluster. We need to think global and act locally. Speed, efficiency and costs are three key metrics. We have ground-breaking initiatives such as SULSA,
Generation Scotland and the Scottish Patient Safety Programme, and the recent announcement of Scottish Funding Council Innovation Centres is also highly promising, but it is time to create new alliances before we find ourselves spectators on the global stage.
Four key developments would potentially add value:
1 Structured NHS/academic collaborations focusing on education, research and quality clinical care delivery.
2 A focus on health and biomedical informatics, using electronic patient records to support better treatment, safety and research.
3 A commitment to harmonisation of NHS Caldecott Guardian activities and university
governance, costing and contracting, so institutions can become a single point of contact.
4 Greater collaboration between the biotechnology, pharmaceutical, computer science and medical devices industries, embracing principles of open innovation.
This would not only help position Scotland as a single research site, but also enhance our global competiveness and help us face the challenges of chronic disease.
There is a fundamental shift taking place in the geography of science. Collaborative research networks are expanding all over the world, particularly in the emerging economies, and the influence of more established research centres such as the UK may be waning. Researchers here will need to step out of their comfort zones to keep up with the dynamism of the new players, but there are some optimistic signs that individuals and institutions are willing to take risks, concede a little sovereignty and work across boundaries.
On a recent trip to Sydney, I walked along Macquarie Street, named after Lachlan Macquarie, a Scot who played a leading role in shaping the development of Australia in the early 19th Century. Two hundred years later, there is an opportunity for Scotland to shape the health science agenda – and have a major international impact on chronic disease management and health system design.
Andrew Morris is Professor and Dean of Medicine at the University of Dundee, Chief Scientist (Health) at the Scottish Government and co-founder of Aridhia Informatics.