A roadmap for our scientific future? Reflections on the Lord O’Shaughnessy review

A few weeks ago, the highly anticipated Lord O’Shaughnessy review into the Commercial Clinical Trial landscape in the UK was published. The review was launched in response to the notable decline in clinical research in the NHS over recent years.

Its recommendations have been well received and adopted by key stakeholders across research, the NHS and patient organisations, and the Government has launched its own funding commitments in response. A significant emphasis of the review is rightly placed on making the most of the wealth of health data in the UK, including that from the real-world (RWD) and genomics, which should be better collected, integrated and understood.

The review also makes the compelling case for why we need a best-in-class scientific environment. Emphasising the importance of better health research for our UK GDP is a noteworthy step forward in making the case for why investment in healthcare is the right thing to do not just for patients, but our economy too.

Why does an improved Clinical Trial environment matter?

Much has been said in recent months about the decrease in clinical trials in the UK. The facts are clear; the number of industry initiated trials in the UK has fallen per year by 41% between 2017 and 2021, with pharmaceutical companies increasingly locating trials in the countries like Spain and Australia, and the UK falling from 4th to 10th in the world for the number of Phase III trials. This clearly undermines aspirations set out in the Life Science Vision, whilst also having the potential to weaken the presence of an industry which contributes significantly to economic growth and employment. Mixed in with the ongoing VPAS negotiations, the UK is walking a thin line in its efforts to stay as one of the most sought-after countries to complete scientific research.

Beyond life science investment, why is this negative trend worrying? Unfortunately, there is a direct patient impact, with early access to innovative treatments affected. A reduction in research also increases financial burden on the NHS and the wider economy. Indeed, there is a significant opportunity cost, with the review suggesting that the total direct cost of near halving of patients recruited to commercial research activity in the NHS over the last 5 years was £360 million, money which now has to be found by the taxpayer.

Many actions suggested by the review focuses on the widely accepted challenges in the research landscape including time to set-up trials, awareness about ongoing research, and incentives for NHS workforce. As the review rightly flags, these recommendations are not new, rather re-establishing critical actions that need to be in place to promote traditional ways of doing trials effectively. We know these are achievable given the speed, scale and efficiency of trials like RECOVERY in the pandemic. The burden of running research in an already overstretched NHS is also often cited as an additional challenge. However the review points out that research can be part of the solution here; hospitals that undertake trials have better patient outcomes and improved staff retention.

More innovative actions are also suggested, leveraging the UK’s strategic advantages in genomics, cell and gene therapies, and precision medicine to translate new scientific discovery into patient impact. We explore some of these relevant to our work at LCP Health Analytics in our recent report and below. Finally, the partnership between industry, NHS, academia and patients enabled by new the Clinical Trial Acceleration Networks (CTANs) platforms for tackling ongoing health challenges, such as Alzheimer’s and antimicrobial resistance, has been universally welcomed.

Improving inclusivity of clinical trials

Traditionally trials have tended to recruit a selective sub-group of people, meaning results are not always representative. This can have significant consequences as we saw during the pandemic and the lack of ethnic minority representation in trials. In addition, trials are often held in large academic centres in the country, reducing accessibility for many patients.

It is therefore good to see the review recommend actions to improve inclusivity, such as a single source of truth for patients on which trials they can access across the country, as well as a move towards more trials taking place in primary care, often closer to home for patients than hospitals. This is supported by activities already underway by both industry and the NIHR. For example, the NIHR’S Be Part of Research service makes it easier for people to take part in clinical trials by using the NHS APP to show what trials and studies are taking place across the UK.

Making the most of data and AI

The review rightly highlights how we are not currently making the most of our extraordinary data assets in the UK, by not using all the datasets available to us (e.g. RWD, genomic sequencing) as well as not joining datasets to give a more insightful picture of a new intervention. RWD is becoming an increasingly critical part of health research; not only can it allow novel insight important for the development of new medicines, but it can also typically be more representative of patients in the real world. The recommendations of the review focusing on diversifying evidence used for developing and approving new innovations, as well as further investments in genomic datasets such as the UK Biobank, should enable better treatments to be developed, targeted to the right population of patients, which has the potential to tackle unmet need.

The review also makes welcomed recommendations to develop a strategy for using AI in clinical trial design. AI is set to be the most disruptive technology in drug development in 2023, already used by industry to identify candidate molecules for new therapies as well as improve efficiency of trials themselves. MIT researchers have successfully used machine learning to rapidly find new candidates for antibiotics from millions of molecules. Recognising and proactively pre-empting the potential impact AI could have in this space is a pragmatic next step.

Do better health outcomes equal a better economy?

Health is an established driver of prosperity for individuals and collective societies. This review rightly advocates for improved awareness of the need for clinical research not just for patient outcomes but also economic growth. Directly, there are clear benefits in life science investment for the UK economy but also indirectly, improved patient access and outcomes can drive productivity and growth. As LCP research has shown, reducing NHS waiting lists could bring economic benefits equivalent to £73 billion, largely by increasing workforce participation but also saving money on how much government and households spend on health and care services.

Conclusion

The Lord O’Shaughnessy Review comes at a pivotal moment for the NHS and life science industry. Never before has innovation in new therapeutics been so transformative, but also the healthcare system been under such strain. This review offers a practical roadmap between balancing competing pressures, whilst making the most of the UK’s strategic data advantages and technological innovations in healthcare. Successful implementation of these recommendations is paramount not just for population health but our future UK prosperity.