'Trusted' NHS must bring R&D benefits to the disadvantaged
Realignment of R&D investment could generate a better return on R&D investment to UK plc by improving access to innovative medicines, reducing variations in health outcomes, reengaging people with the labour market, and improving healthy life expectancy, write Jonathan Pearson-Stuttard and James O’Shaughnessy.
The UK is grappling with two fundamental problems when it comes to the nation’s long-term health. The life expectancy gap between the best and worst parts of the country is 27 years. And half a million people are out of the labour force due to long-term sickness. The first is a problem which has been in the making for decades, while the second is a post-pandemic phenomenon.
Without a reimagining of health research that puts these social missions at its core, there is a risk that the £20bn per year announced for research and development by 2024-25 in last month’s Autumn Statement will fail to solve either problem because of fundamental flaws in the way this money is spent. Despite the many successes of UK’s R&D, poorly targeted funding has the potential to worsen inequality of access to innovative medicines and better health.
A central problem is that some groups are “super-served” and benefit from the latest innovations whilst others may not benefit for years. R&D funding and infrastructure has traditionally focused around the most academic universities, which themselves are often located in relatively affluent areas and among healthier populations. But these are not the places where the need is greatest.
For example, in affluent areas people reach the age of 54 before they are likely on average to be living with multiple chronic health conditions. But in the poorest 20 per cent of areas across England, those aged 46 and above have typically passed this unwelcome threshold. Similarly, the Chief Medical Officer’s 2021 report found 18 per cent of higher stroke rates in coastal areas could be attributed to a “coastal effect”, where coastal communities have some of the worst health outcomes.
Despite this, people living with multiple conditions are often excluded from clinical trials, meaning they are less likely to benefit from medical innovations, and less-affluent areas are frequently overlooked for science funding. This reduces local growth, exacerbating the problem of chronic worklessness that the pandemic has created and which is concentrated in the most economically left behind parts of the UK.
The geographical mismatch of R&D infrastructure, on one hand, and population with greatest health needs on the other, also contributes to variations in access to new therapies once approved.
While patients living near to large academic centres often benefit from new treatments rapidly, there is frequently a substantial time lag in new therapies reaching patients in R&D poor areas.
The way forward is to embed three core principles into our R&D system which could help realign incentives with levelling up health and economic outcomes.
First, we must ensure that health research is conducted amongst citizens representative of patients living with the target disease(s) today and in the future. This means taking R&D to the places where diseases are most common, not where research participants are easiest to recruit. Genomics England’s Diverse Data project is an excellent initiative in this vein.
Second, we should leverage the trusted role of the NHS. Local NHS institutions reach across the UK, are connected to their local communities, and in many cases are the largest local employer. Where health is worst they take a key role in the community and command trust like few other organisations. This anchor institution status should be leveraged to embed R&D in disadvantaged communities so that more clinical research – with its health and wealth benefits – can be delivered.
Third, we need agree that if local “levelling up” is to mean anything, it must involve improving the health of the least well off. Using financial incentives to make sure that the roll-out of new therapies brings most benefit to marginalised communities would create new collaborative approaches to tackling long-standing challenges across the NHS. Not only would this benefit patient health but, through a more efficient use of clinical trial and real-world data, it would likely attract further life science investment.
Getting this right would generate an even better return on R&D investment to UK plc by improving access to innovative medicines, reducing variations in health outcomes, reengaging people with the labour market, and improving healthy life expectancy. It would create a nationwide representative R&D infrastructure that would increase economic activity in many areas that need it most. The covid-19 pandemic demonstrated the fullest value to society (in health, social and economic terms) of R&D and the life-science sector. Putting health-driven prosperity at the core of the UK’s ambition to be a “science superpower” would be a major step towards levelling up.
This article was first published in the HSJ on the 15th December 2022