There are currently 625,000 people on a hospital waiting list in Scotland – the highest number on record. It is a sobering statistic, and the causes that lie behind it are complex and multi-factorial.
Inevitably, Covid gets the blame for a lot of it, but the problems of dwindling supply and increased demand has a longer tail.
Even before the pandemic, the number of people waiting for planned procedures was steadily rising. Covid and the cost of living, with the added pressures on an already exhausted workforce, has brought matters to a head.
In response, the government set aside £1 billion in additional investment in the NHS in the next five years. We are already two years into that recovery plan, but there are few signs that the problems are abating.
There are no silver bullets but innovation has a major role to play in addressing capacity issues and shifting from reactive to more proactive forms of care.
If we use data to better inform decision-making, and from research studies to speed up the adoption of innovative products and services, it makes life better for clinicians and patients alike.
Professor Dame Anna Dominiczak is driven by that goal. She is one of the most senior clinicians in the country, a world-leading cardiovascular scientist and current holder of the regius chair of medicine at Glasgow University.
She has already spearheaded some major changes in the way the NHS does business, having played an instrumental role in moving Scotland towards more personalised, “precision medicine”. She also led the establishment of the Lighthouse Laboratory in Glasgow (LLiG), which became the UK’s biggest coronavirus testing centre.
The Polish-born academic and doctor is increasingly focused on making improvements to the clinical use of health data and research. As Chief Scientist (Health) at the Scottish Government, she wants to make the pathway from early research to adoption of new innovations a much more streamlined process.
She says: “We have an end-to-end innovation pathway already in Scotland, which was there when I started this job. I can’t take the credit for that as colleagues from the NHS and the Scottish Government put that together, but what I hope to do is to push it faster.”
She adds: “At 5.5 million people, and with the NHS present everywhere, as we have very little private medicine in Scotland, we are the right size to do things ‘once for Scotland’.”
Just as she took up the role last July, the NHS announced a new Accelerated National Innovation Adoption (ANIA) pathway, based at the Golden Jubilee Hospital in Glasgow’s National Centre for Sustainable Delivery.
Innovations in this “fast lane” have already included a national digital approach to dermatology, where smartphones will be used to submit images of skin lesions and a pioneering remote monitoring and insulin delivery system for Type 1 diabetes.
In the near future ANIA and the Innovation Design Authority, which Dominiczak co-chairs with Tom Steele of the Scottish Ambulance Service, will evaluate artificial intelligence for chest x-rays and simple genetic tests to check if patients are likely to have an adverse reaction to a medicine before they are prescribed it.
There is still a way to go but it is hoped such innovations can be adopted into the 14 territorial health boards in Scotland.
The ‘once for Scotland’ approach is also reflected in three innovation test bed areas across the NHS: the West of Scotland (WoS) Innovation hub; Health Innovation South East Scotland (HISES) and the North of Scotland Innovation hub.
Each of these have contributed on various programmes of research that benefited not just their own health board areas but have the potential to be joined up and delivered at a national level.
Recent work at a breast cancer screening centre in Aberdeen using AI in assessing mammograms could be rolled out at a national level in the next five years.
Dominiczak adds: “I truly want to do things in Scotland that are transformative in a big way, we also need it to be done in a way that is very organised. And when it comes to getting data from the point of request, to doing the research and analysis, we need that to be a lot faster, whether we do it with industry or without.”
But she wants to smooth the path for industry, too. “We need to work much closer with industry. We work in a triple helix partnership, that is academia, NHS and industry. And I think industry is probably the most important part of that triple helix, because I haven’t yet seen great innovation without industry engagement.”
Support for clinical trials is another area Dominiczak sees as key. In England, mobile units have been travelling to where patients are to get them involved in medical studies. She describes the development as “interesting” and something that in Scotland we should “maybe take a look at”.
In addition, she wants every institution, whether a hospital, an outpatient unit, or a GP surgery, to get more involved with research.
She adds: “If that institution is involved in research, patients do better, even if they are not part of clinical trials. This has been found all over the world.
“So, we would like research and innovation to be everywhere across Scottish health and care and prevention.” She says patients are usually very willing to be part of research, if they have a sense it is going to be for a greater good.
Another focus for Dominiczak is linked to supporting healthcare startups and SMEs, and she is in conversations with government colleagues around the economic development agenda.
A thriving health data and research community will benefit from good access to entrepreneurship support and education.
The nationwide tech scalers programme – a recommendation of Mark Logan in his influential tech ecosystem report – is something Dominiczak is keen to be involved in.
“I am a great fan of Mark Logan’s attitude to working with industry and, you know, pushing innovation in general,” she says. “So, we’ve come together, and we’re planning to ‘twin’ the tech scalers with our three test beds to use that school of entrepreneurship approach that Mark introduced and to use this in health.”
She says this could be of enormous benefit to the Chief Scientist Office (CSO) funded Innovation Fellowship scheme across Scotland, which aims to “strengthen the innovation culture to solve real problems in the NHS and social care”. There are currently 11 fellows, usually clinicians, engaged in this work across Scotland.
“Mixing with people in tech scalers, who are all seasoned entrepreneurs, is a great idea because every single transformative innovation we’re looking at have elements of digital, AI, machine learning; that’s how it’s going to be. So, to have our innovation fellows and others exposed to tech scalers I think would be really, really valuable.”
Looking forward, Dominiczak says she wants her period in office – it is a three-year term and it’ll be the 50th anniversary of the CSO post in October – to not only bring forward innovations faster, but to ensure that we build a good foundation of “digital preparedness” across the NHS and social care, in order to best take advantage of emerging technologies such as AI.
Again, the AI-driven mammography project in Aberdeen is potentially a good example of that, as the national breast cancer screening programme is already fully digitised.
But she also wants to ensure that there are more innovation fellowships and that Scottish health researchers are well-connected within the UK-wide science ecosystem, so they can get all the help they need to develop their professional careers.
Crucially, that involves being able to spin-out any research into the next generation of tech companies that can compete on the world stage.
“Whether it’s an AI or machine learning company developing a fantastic algorithm that could be exported to the whole world, whilst giving back to the NHS, I think there is huge opportunity, we just need to work really hard to make it happen.”