The Guardian view on high-end science in the National Health Service
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Version 0 of 1. The NHS has an extraordinary record of medical innovation. The link between smoking and lung cancer, the first baby born through IVF and the first heart, lung and liver transplant were all achievements of the health service. Now the 11 hospital trusts which will pioneer the 100,000 genome project have been named. They will recruit participants in an ambitious attempt to sequence the genetic make-up of up to 100,000 NHS patients, creating a database to allow researchers to identify the links between genetic variations and cancers and other rare diseases. At last the high hopes of gene sequencing may be translated into practical medicine. There is talk of genetics as a diagnostic tool, the development of personalised medicine and new, precision-targeted drugs that would amount to a revolution in healthcare. As the health secretary, Jeremy Hunt, argued in a speech last month, the NHS is remarkably good at advanced medical science. This tradition of medical creativity sits awkwardly with the other image of the NHS, as a sclerotic organisation that is as bad at delivering new ways of managing process as it is good at bringing in new ways of treating people. This may not be fair. Restraining the cost of healthcare is a global preoccupation, and the NHS delivers better outcomes for less money than any other comparable system. All the same, the unique politics of the NHS can lead to damaging contortions, as the weekend’s row over changing ambulance response times revealed. For nearly a year, ambulance trusts have been lobbying to modify the classifications for calls requiring the fastest response times. The way in which emergency care is delivered is changing, with highly trained paramedics now able to provide sophisticated interventions on site. At the same time, demand is rising. In October, the ambulance service took 25,000 calls a day. The experts agreed that the proposals were clinically justified and would result in a better service. The only contentious aspect was when to implement the changes. The reasons for delay until next summer were practical – winter pressure would have eased off, and a wider review of emergency care would be completed. They were also political. The general election would be over. But the decision was taken to go ahead, apparently signed off by Mr Hunt last week. This may have been an NHS England decision, taken in a desperate attempt to save much-needed cash by rushing through a service redesign. But the combination of speed and secrecy makes it look very much like a political decision by the health secretary in order to avoid more missed targets to add to the embarrassment of the alarming rise in waiting times throughout the NHS. That was certainly the conclusion of Andy Burnham, the Labour health spokesman, who challenged Mr Hunt to explain why he did not reveal the decision in the Commons debate just before the Christmas break began last week. It is a charge Mr Hunt must answer. But Labour has to avoid allowing it to appear that none of these dilemmas would occur on its watch. To pretend otherwise merely exacerbates voters’ disenchantment with the political process. It might have been wise to acknowledge that it was not the changes but the rush and the secrecy that were mistaken. The genome project and the row over ambulance services are at two extremes. What is the point, patients could be forgiven for asking, of transformative innovation at one end of the spectrum if, at the other, ambulances cannot get to the sick in time to save them? Is it even ethical to be searching for ways of delivering tailored drugs for the few at unknown but great expense when the delivery of high-quality healthcare to the many is challenging the budgets of every hospital trust in England? The answer is that this is a project that will keep the UK at the forefront of world science, and only a system with the NHS’s universal reach could provide the data. Only a decade ago, the 100,000 genome project would have been inconceivable. Its benefits will not be appreciable for at least a decade to come. It is certainly not safe to predict what they will be now, for the science of genetics has only fulfilled one of the predictions made for it. It has caused a revolution. |