Time for a UK Sovereign Fund in new technologies

Investments going up

People have been talking about setting up a UK Sovereign Fund for years. However, there is still relatively little clamour to support this initiative and make it real.

Of course this is an old idea. Norway set up its Sovereign Wealth Fund back in 1969, with the aim of managing Norway’s oil resources over the long-term. Over the last ten years, the fund has delivered a return of 8.3%, or 36.5% in real terms after annual management charges and inflation. Source Forbes.

Much more recently in 2006, Australia set up a Future Fund which is performing well and is investing in a number of different areas including disability care, medical research and nation building.

The UK could very easily start a Sovereign Wealth Fund and it would be applauded by the majority of people in the country as long as its core principles were right and it was totally apolitical. It’s time we did. We are a small but highly inventive people. We shall become an increasingly small part of the future world and yet there is no reason for our creativity, originality and inspiration not to be captured, supported and indeed amplified through such a fund

We should set up our own “Future technology Fund”. It should invest in technologies that benefit large numbers of the future population. This should include the following:

  • Health
  • Energy
  • Agriculture, landscape and environment
  • Housing

Some of the amazing break throughs that are happening in health technology should be supported and ultimately be part of this Fund. There is too much incredible work that originates here in the UK but that is allowed to be commercialised elsewhere in the world. We need to ensure that the Fund can provide a commercially owned structure which ensures that value goes into future generations living in the UK.

The Fund should be controlled on the basis that no funds can be withdrawn for 10 years minimum and then only a maximum of 2.5% of the value of the fund in any one government as long as the total fund is still always higher than previously. It should be independently managed and separately monitored.

We should incentivise entrepreneurs to bequeath their companies and the assets of these companies to the state. We should do this by providing them with entrepreneurial tax relief on their output as long as at least 25% of the assets ultimately end up in the Fund. This would continue to build on the “innovation and entrepreneur friendly” tax structure that now exists in the UK and which is much envied across Europe.

We desperately need to rethink how we fund our future. This would be an important first step in that direction.

What are the sacred cows in the NHS and UK healthcare system?

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At a time when the NHS is creaking under the strain of ever increasing costs there are a number of sacred cows that frequently get commented upon, but never get resolved and must eventually be key to a better solution. These scared cows graze happily in the grassy uplands of healthcare largesse, content in the knowledge that it is incredibly difficult to deal with them once and for all. Here are eight of these sacred cows:

1.      The ever increasing number of NHS managers and administrative staff at the expense of frontline staff. In spite of years of cross party rhetoric about the need for more frontline staff and less admin staff, the reality doesn’t seem to get a lot better. In fact the number of NHS manager numbers has risen by a quarter in 5 years. More than 6000 managers have been hired since April 2013 taking the number from 26,051 to 32,133 in October 2017. Pay offs for managers have cost £2billion with at least £92million going to staff who were quickly rehired. Now of course this is consistent with other areas of government like the Ministry of Defence where frontline personnel numbers go down while the numbers of civil servants go up

2.      The rising cost of negligence compensation and the role of lawyers in this cost. The total potential NHS negligence liability has risen from £29billion in 2014-15 to £65billion in 2017-18. Legal costs account for 37% of payouts for negligence, but somehow the lawyers are not being chastised.

3.      The significant rises in the average level of GP pay. 15,190 GPs earned more than £100,000 in 2014/15. More than 200 ‘Super GPs’ in the NHS earned more than £200,000 a year in 2015/16. Some GP’s continue to do astonishingly well out of the system.

4.      The cost of agency staff.  The NHS spent £2.9 billion on agency staff in 2016/17 – down from £3.6 billion in 2015/16, but still £700 million more than in 2009/10. Source NHS improvement 2017. Even when employer costs are added, permanent staff working at plain-time rates are a much more cost-effective solution for employers source Royal College of Nursing 2015. Changes to the tax treatment of locum doctors were introduced in April 2017 with the intention of controlling costs further, but it appears that salaries have risen by an average of 6.3 per cent since these staff were moved from payment through personal service companies to PAYE source The Times 23/10/17

5.      The inequality in female pay in the NHS. Full time female consultants earned £14000 less than their male equivalents source BBC 2018

6.      The misuse of public sector time and resources by private consultants. Too many private consultants do use their public sector resources for personal gain. The British Medical Association said: “There should be no conflict of interest between NHS and private work, and this principle is contained in consultants’ employment contracts. Consultants who want to do private work must first offer to do extra work for the NHS, ensuring NHS work is the priority.” But the reality is that it is often hard for these 2 sides not to get blurred. As some have argued, time spent in the private sector deprives the NHS of consultants’ hours, and creates “a perverse incentive” to increase NHS waiting times to further private business. Either way this is a tough nut to crack and no Health Secretary seems to want to tackle it.

7.      Waste. A 2014 year-long study by the Academy of Medical Royal Colleges, the professional body that represents the country’s 250,000 doctors, found that the health service wastes up to £2.3bn a year on a range of procedures and processes that could be done better, more cheaply or not at all. In August 2017 Professor Tim Briggs, national director of clinical quality and efficiency, said the NHS wasted too much money on poor care and “doesn’t deserve more money until it puts its house in order”. The review of NHS efficiency by Lord Carter of Coles estimated that reducing unwarranted variation in how the NHS procures supplies and delivers care could save £5 billion of the £55.6 billion spent by hospitals each year. There is a genuine recognition of the problem, but will anyone actually solve it?

8.      Restructuring mania. Every government thinks that a “good restructuring” will sort out the NHS, but over the years the cold hard analysis would suggest that this is rarely the case. Certainly the Kings Fund concluded that “Politicians of all parties should be wary of ever again embarking on top-down restructuring of the NHS,” after the reforms of 2013.

If we are going to continue to improve the NHS and ensure that it is fit for purpose, then these issues need a resolution. The sacred cows can’t just be pushed into the long grass.

Why don’t we focus harder on non-medical solutions to healthcare issues?

In a recent study published in the Journal of Scientific Reports, it was demonstrated that for people living alone, having a dog can decrease your risk of death by 33 percent and reduce your risk of cardiovascular-related death by 36% -this is in contrast to people who live alone and don’t have a pet.

As a Medcity author commented, it is hard to find any drug or surgery that does the same without side effects and at a comparable cost.

Oh the magic of a pet!

Happy pets

The reality is that there is too little discussion about the unwritten pact between citizens and the state that the people need to take some responsibility for looking after themselves. Surely we should expect a minimum level of exercise from everyone who wants to use the NHS? Surely we should expect that people take some responsibility for their nutrition? In a world where, quite rightly, we all want the latest and most effective health technology, medicines, treatments and equipment, we must ask people to deliver their side of the bargain. It is time for this “pact” to be a mainstream part of the healthcare debate. It is time for the state to ask people to maintain a certain level of fitness, nutrition and self-preservation. This is not a discriminatory action. This is an example of normal everyday life, where people expect to make choices between different things that they do and don’t want.

It’s time I had a say in my medical treatment

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People have been talking about personalised medicine for ages. It’s all the rage in the NHS now with The 100,000 Genomes Project. This project is committed to sequencing 100,000 whole human genomes, from 70,000 patients, by the end of 2017 to help bring in better treatments.

This is because medical professionals are using genetic sequencing to enable them to separate people with similar symptoms into far narrower groups and target medicines at them. For example last year, researchers from the Wellcome Trust Sanger Institute determined that the most common and dangerous form of Leukaemia is actually eleven distinct diseases that respond differently to treatment. Now that the cost of analysing an individual’s DNA is significantly less expensive, it will become possible to link a person’s genes with specific medicines and even diets.

This is great news, in a world where, by way of example, less than 4% of cancer patients actually participate in a clinical trial. In other words fewer than one in twenty five patients contribute to developing the new knowledge about a condition that informs new treatment plans.

So the flaw in the personalised medicine plan is that the only person that the Government and the medical profession are not consulting is me – the patient!

Why not?

I am a patient living with a long-term condition, ulcerative colitis / crohns. I have had this for 30 years. I know a lot about my condition but I am never consulted on my treatment. I have had several different drugs over the years, from azathioprine – which gave me pancreatitis; asacol – which knocked out all my white blood cells, and salazopyrin, which never fully controlled my condition. Over the time my condition has gone up and down.

Now for many sensible reasons, drug dosage is very carefully controlled in any healthcare system and the drug companies are equally tightly regulated. But in a world of ever increasing healthcare problems and healthcare costs, it is time to relook at this approach.

I am on a biologic, vedolizumab, and it is working. I love it. However, it is working too well. I am classified to be in remission and so the NHS now wants to take it off me. If they do, then inevitably my condition will worsen. The NHS attitude is so binary. I am well or I am ill. I take the infusion or I don’t. Why can’t I have a smaller dose? It would cost less and it might work just as well. The answer is that the clinical trials have only led to approval for the drug based on a standard dose. This is therefore what NICE guidelines accept. But why shouldn’t I be allowed a say in this? It’s my body and I have been living with the condition, longer than any doctor treating me. In many ways I am an expert patient with living experience of the condition.

We need to change the approach. It’s time for the individualisation of drug dosage based on personal response patterns to drugs and not on old fashioned and out of date clinical trial methodologies. We need to bring in individual DNA based personalised medicine, and we need to drive active patient collaboration and participation in drug and treatment decisions. We can’t just leave this to the supposed professionals. We need to do 3 things:

  1. Enable patients to have a say in their treatment and in the drug choices and doses
  2. Enable different types of observational research study based on different levels of patient participation over different times.
  3. Establish formal expert patient councils to advise the NHS based on patients living with conditions or disease for long periods of time.

It’s time to get truly personal.

Should we tag all prescription drugs and pills now?

The scale of increase in medication usage across the world is frightening.

There are numerous disturbing facts that accompany this spread:

  1. The NHS drug bill rose by 8 per cent to £16.8 billion in 2016, up from £13 billion in 2011. 4 treatments now cost more than £1 billion per annum. Source Dec 2016 Times
  2. Half of women and 43% of men in England are now regularly taking prescription drugs. Source NHS 2014
  3. It is estimated that £300 million of NHS prescribed medicines are wasted each year
  4. Diabetes accounts for over 10% of the annual drug bill
  5. One in five do not take all their medicine according to a survey of 2,048 people carried out for an Omnicell report by ComRes in 2016
  6. The U.S. is 4.6% of the world’s population, yet consumes 80% of opioid painkillers
  7. Global spending on medicines is forecast to reach $1.4 trillion by 2020, an increase of between 29 percent and 32 percent from 2015, according to IMS Health

The increase itself is fairly well understood by people. The less well known problem is that the misuse of antibiotics can enable bacteria to develop resistance to them. A lot of antibiotic-resistant strains are popping out. If antibiotics stop working, we have no other defence against bacterial infections. When you take antibiotics, you are putting a tremendous selective pressure on the bacterial population. Randomly, a few bacteria of the billions you have, will be slightly more resistant to the antibiotic than others. This means they are more likely to survive your antibiotic doses, and in turn they could evolve in more and more resistant strains, until the antibiotic has no effect on them anymore.

The trick is poisoning these bacteria with the antibiotic faster and stronger than their efficiency of evolving resistance and replicating. That is, if a bacteria narrowly escapes death by antibiotic, and you give it a break so it has time to replicate, you end up having a growing infection with a quite resistant strain of bacteria. If you instead take your pill at the right time, you give it another chemical punch that will hopefully kill it before it managed to replicate significantly.

So given these facts, why are we not finding other ways to reduce the problems. One of these could be by throwing more energy at tagging prescription medicines to enable:

  1. better understanding of whether patients are following the courses and therefore protecting our long-term antibiotic resistance?
  2. healthcare providers to ensure that patients don’t waste or sell their drugs?
  3. more patients to take the drugs that reduce further healthcare costs?

As long ago as 2004 the FDA backed RFID tagging of prescription medicine to track drug products through the supply chain. Now there has been considerable progress made around drug packaging protection with RFID tags aimed at reducing counterfeiting and wastage. In 2015 The University of Vermont Medical Center in Burlington, Vt., announced that five million medications had been tracked using radio frequency identification technology. This allows a hospital to track reliably from ordering through dispensing through administration at the bedside, and so enhance patient safety.

This has been followed more recently with approval in the UK and US for prescription pills that contain RFID chips – in other words ingestible RFID microchip medicine. This came out of Proteus Digital Health’s Ingestion Event Marker (IEM). This can be embedded in a pill, and ingested to monitor the patient and their bodily health. The device will collect measurements such as heart rate, body position and activity. The IEM sends a signal to your smartphone; which then transmits the data to the doctor.

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It is still very early days for this technology, but given the scale of the problems outlined above, we need to adopt this quickly. First and foremost this should be about tracking drug usage. Once this is done then we can begin to explore the sunny uplands of prevention and bodily health checks.

3 great innovations for ageing

I came across these 3 innovations in the “ageing” space and wanted to share them

1. Bedal

We have all been in this situation before, when you have some sort of drip attached to your arm or wherever and you just can’t wash etc. Well obviously this problem is more acute for old people. So Bedal enables patients with IV therapy to wash autonomously. Its neat.

2. Sit and shower

Again this is a problem that we can all recognise. But it is less well known that 80% of falls for Seniors occur in the bathroom. Well this is a full on mobile seated shower that can fit into any bathroom without needing any complicated modifications.

3. Moff

Moff is a wearable IOT (Internet of things) 3D motion technology that allows you to monitor real time movements and is designed to change the way people rehabilitate.