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Examination of witness
Roland Sinker.
Q153 The Chair: Good morning. Welcome to the Science and Technology Committee. We are continuing our inquiry on innovation in the NHS, personalised medicine and AI. We are very pleased to have as our first witness Roland Sinker, who is the former CEO of Cambridge University Hospitals Trust. He was in that post for 10 years, and he is the author of the NHS innovation ecosystem review.
Mr Sinker, we are very pleased to have you here this morning. You led the health innovation ecosystem review several years ago. We would like you to briefly summarise the process relating to that review and its recommendations. We are very interested in one of the recommendations made in your review, which is that the NHS should focus on certain areas for innovation rather than trying to do everything at once. Perhaps you could comment on that. Do you feel that innovations related to the NHS ambition to shift to prevention, particularly in personalised medicine and AI, are being prioritised? Perhaps you would like to start by introducing yourself, but those are the questions to start with.
Roland Sinker: Thank you very much for having me here. Chair, I will start with the first half of the question before we come on to the specifics.
The genesis of the innovation ecosystem programme came from three directions. The first was in Cambridge. The interface is very strong between our patients and our community, the National Health Service and the care system, our universities—Anglia Ruskin University and the University of Cambridge—and a very wide range of life sciences industry partners, through to the far end of discovery science in organisations like the Laboratory of Molecular Biology. It is in our blood to work together to think about economic growth and the way that we can improve health and care for our population.
Driver one was: how can we get this working better? Driver two or lens two was: we work a lot with national colleagues, leaders of the trade bodies and industry leadership, and it was quite obvious that relationships in 2023 and into 2024 were far scratchier than they had been in the run-up to and during the Covid-19 pandemic. These are terrific people and outstanding leaders who individually and with their organisations were doing a fantastic job. However, relationships were, to say the least, very strained. People were approaching me to say, “Do you think we could get together and see if we can clear the air and move things forward? It is getting quite difficult. Would you do a review of the health innovation network?” which was one thin thread of the innovation story. I was very grateful to Amanda Pritchard, chief executive, and Richard Murley, who was the then chair of NHS England. Amanda, Richard and I quite quickly said, “No, if you are going to look at the health innovation networks, it is an ecosystem. You have to look at far more than that”.
Chair, that was the genesis of the work. On how we approached it—and then maybe I will pause—we very actively said, “This is not a three-month strategy gig. We are not here to write another report”. As a community of leaders, we were very determined to try to create a new way of working where we felt we had a shared and collective ownership of economic growth and improving healthcare for the population. That is quite a different mindset to “we are going to do some workstreams and write some reports”.
We tried to create something that would have longevity and would be a new way of working that would evolve. With that in mind, we set up four workstreams. One was, “Let us just get on and do some stuff and learn from it. Let us work together as an ecosystem, industry research and the National Health Service with our patient groups and learn from that quickly. Let us draw up a long list of all the things that people are grumpy about and start to solve some of those and put the other ones in the car park for now. Thirdly, there is no point in designing a life sciences innovation ecosystem for the technologies of today. We have to design it for the future. So what is coming down the pipe that we should be designing for?” Then lastly, “Let us write a blueprint for how the whole thing could work better together”.
We got people who were not accountable for their areas to write the reports for the other bits of the ecosystem. Richard Torbett, who runs the Association of British Pharmaceutical Industry, with Lucy Chappell, who runs our research body, the NIHR, wrote the blueprint for how the NHS should take up and spread innovation. Likewise, the NHS wrote what industry should do.
On the very last bit of the approach, as you can imagine you get into hundreds of interviews and round tables. One of the most important things for us was to mobilise our front-line workforce who had an interest in innovation, particularly our patient and third sector groups. It was a classic “mobilise people, have a big diagnostic, and then try to have these co-owned workstreams that lead to the report in the end”. I will stop there on the approach. That was how we went about things.
The Chair: On the question I asked about, you made 14 major recommendations. Would you like to say a bit more on the one about focusing on certain areas of innovation rather than trying to do everything?
Roland Sinker: Yes. In what was my day job as a hospital chief executive, with a local authority chief executive—the Addenbrooke’s chair at the time, Mike—we led our integrated care system for three years until the pandemic. We had a very lived and real experience of what our patients actually need and their experiences.
As we know, increasingly patients are not just suffering from one condition or another. We call it multimorbidity—multiple conditions. We understood that context but we felt very strongly that we should be going after the really big areas of healthcare need, which were relatively tightly defined, around which we could build a collective endeavour, very much in the way we did during the Covid-19 pandemic, or as we have done, I think, superbly in genomics or in elements of cancer, where we have strong leadership and a strong community around that, and where it is quite narrowly defined.
The Chair: We have a lot more questions. The last one I want to ask is about the emphasis on prevention. That came quite clearly through from your review. Is that right?
Roland Sinker: Yes. On putting those teams together—those coalitions of industry, patient groups, the third sector and the NHS—and saying, “Hi, what is the most important question for you to come together to tackle and to answer?” it is enormously important that we are improving the way that we offer and provide transplantation services: liver transplants, kidney transplants and so on. But what we really wanted to go after was: where can we get to on the prevention, early detection and personalised medicine agenda? That is the question we need to answer.
In that workstream that the Association of British HealthTech Industries led, with Kristin-Anne Rutter, on the technologies of the future, what they were really saying is, “How can artificial intelligence enable a new and different workforce to get much more active in the prevention space, using data to risk stratify the population to find the people we really need to?”
Q154 Lord Booth: Good morning. Your review and many of our witnesses have drawn a distinction between piloting innovation at one site and scaling it across the NHS. Scaling across trusts and beyond pilots for innovation to actually commissioning is a huge gap. The reason I am not there today, and have not been for some time, is that my husband has non-Hodgkin’s lymphoma and has been treated for the last 10 months. We have seen personally here in Cornwall, where I live, that the treatment and the testing has happened in different sites across the country, which all adds to a delay in the patient actually being treated. What is going wrong at the point where a proven innovation needs to move from a pilot to a regular clinical pathway from one trust to, say, 50 others?
Roland Sinker: Lord Booth, I am not virtue signalling here, but I am very sorry to hear about your husband. I can imagine the experience that both of you are going through, and the uncertainty and the fractured nature of the care that is provided, as well as the movement that that will require when people are tired. I am sorry about that.
To be honest, it is clear in the analysis that we have a problem in the UK around the scaling of innovation and the spread across the system. You are not saying this, Lord Booth, but I think quite often it is something that we leap to, and really it is a symptom of a struggling ecosystem rather than the thing we need to necessarily chase after. That is a long-winded way of saying, “Gosh, we need to have something that will solve the scaling problem, and therefore the health innovation networks need to do X, Y and Z”—they need multiple things to be enabled to succeed.
The second point I will make is that we have lots of examples where we have enabled standardisation, scale and spread. I have talked about genomics as an example, with elements of cancer being another, although you will give me examples that are not quite where we need them to be. If we think about why it is not working, it can be a combination of—or it is a combination of—stress and pressures on the leaderships of individual ecosystems across the country.
I can think of certain parts of East Anglia or London where I have worked where there is not the bandwidth—there is not the energy to be able to take up an innovation and scale it. You can think about things like the commercial landscape, with intellectual property being what we call the plumbing and wiring that is holding things back. However, having had a bit of a briefing from the Department of Health and Social Care and the NHS England team, I think a lot of progress has been made in the 10-year plan and the life sciences sector plan to start to tackle some of those underlying bits of grit that stop things progressing: commercial, intellectual property and passporting of different innovations.
Lord Booth: Following on from that, we have heard from our previous witnesses that the genomic medicine service is a good example where a national commissioning model, regional hubs and a regular updated test directory allow innovation to be deployed. Do you agree with this and are there other areas where this could be extended?
Roland Sinker: Yes. Sue Hill, who is the architect and leader of our genomics vision and delivery, is absolutely fantastic. She was on the advisory group that developed these recommendations. In many ways genomics was a major example that we were looking to replicate across the rest of the country. It is national vision but then really strong integrated local delivery, integrating industry, the university sector, the National Health Service and a good deal of back and forth, often with quite challenging conversations between the big clusters and the work that Sue was leading nationally.
I could think of multiple other examples where we could apply that model, by which I mean not multiple long screwdriver programmes that solve each problem one at a time but interventions that create an ecosystem that would let us move forward, which was really what the spirit behind the recommendations in the review was.
Q155 Baroness Willis of Summertown: This is an additional question; I hope you do not mind. What I was trying to understand is how the National Health Service determines overall which innovative technologies to prioritise going forwards. In a devolved structure or an ecosystem, who determines this? What are the levers or drivers for saying, “Right, we will put our energies into getting this innovative technology into the health service”?
Roland Sinker: Everybody and nobody is the short answer. That is not necessarily a bad thing, but there is a lot of scope to improve things. If you are in the leadership community of a health and care system—not just a hospital but the way that the whole system works—your front-line teams, your patient groups and your local population will know what challenges you are trying to face in a much deeper way than I as a chief executive could know, really. It is the front-line teams.
A lot of this is about them being challenged and drawing down from a menu of interventions that will enable much better treatment. If you were to look, for example, at smoker’s cough, COPD or emphysema, that will strike in very different ways in different communities. The technologies you might put in place for remote monitoring, support and rapid response would be quite different for different populations and probably led by those communities.
The important thing is that you have the time and space for those teams to be able to find out what is new. There is an expectation that they will improve what they are providing for the patient, and they can draw down quite quickly. That has to be met nationally, though, by these much bigger spines—or nervous systems or magnets—that we put in place that would let us have a much clearer vision for how we would tackle, for example, early detection in oesophageal cancer or the move to making breast cancer a long-term condition for 95% of patients.
Baroness Willis of Summertown: As a scientist myself, I think it is that question of: who is there who has the time to spot the knowledge gaps where the innovative technologies need to come in? On relying on the person at the bottom of the food chain to say, “What is the most recent advance in this area?” when they are so pressurised with time, is there a top-down diffusion of that sort of information as well as a determination of where the money will be spent?
Roland Sinker: Yes. With the recommendations in the review we were really trying to knit that together. We said that we needed to identify the 10 to 20 clusters in the country where there is strength in depth, leadership and understanding of the community. You can imagine the criteria. We apply these for science for the biomedical research centres and ask those clusters to come together. That is what Lucy Chappell is now doing through NIHR and what Ian Chapman is doing through UKRI. You have to focus on impact and partnership.
Those clusters are not Oxford, Cambridge and Manchester alone. The strength of South Yorkshire, and the strength of the south-west of the country, recognising Lord Booth’s experience, is absolutely fantastic. That has to stand up and meet these national missions or goals—I would pick six of the major conditions that we need to go after. We were doing that two years ago with the life sciences missions, which have become goals. It is important we do not lose sight of those.
Baroness Willis of Summertown: Do you think that something like the Medical Research Council or UKRI have a role to play in this?
Roland Sinker: Absolutely. I am enormously supportive and proud of what patient groups and clinicians in the NHS do to change care and their vision and inspiration—often you can get that sort of vision and move things forward. The potential of drawing together a much broader constellation of industry partners and an external perspective on this will let us do extraordinary things, as we demonstrated during Covid.
Where I think we have seen the big leaps is when we have had a much stronger coalition coming together to tackle a challenge. That is quite distinct from a procurement conversation with a pharmaceutical company. In Cambridge we have 200 collaborations with AstraZeneca—between the university, the NHS and AstraZeneca. Those are distinct from any procurement conversation that happens nationally.
Q156 Lord Duncan of Springbank: I am struck by the challenge that money will play in this. Not all trusts will have the same disposable money for any form of innovation. When you were a trust manager, you would have a sum that you could deploy according to local demand but ultimately constrained by what you had available. That distortion would apply across the whole of the ecosystem then because it is actually the underpinning funding that will control the innovation rollout, not the innovation rollout itself. Is that a fair reflection?
Roland Sinker: Yes, it is. There is a huge spread of scale: the size of the organisations obviously, and then their financial position, which can be determined by how they cannot recruit permanent staff so they have a very high agency bill, or how the allocation of funding to that geography by levels of need is different. There are very different environments. Then the leadership teams will have different levels of expertise and experience. If you are on the 12th day of full capacity protocol in a hospital, which means there are people in corridors, your ability and bandwidth to move on from managing patients safely to how we change all this is quite limited.
The honest truth of it is that if we reallocate the way that we spend our money and we create the breathing space, the financial payback is absolutely extraordinary. For example, the move to ring-fenced contained centres to provide orthopaedic care for joint replacement in a non-crowded, non-disrupted environment in Cambridge turned a length of stay from around five days to what is now 23 hours. The prehabilitation of those patients and then the rehabilitation led by physiotherapists, not by doctors, is much better for the patient and much better for the taxpayer.
Lord Duncan of Springbank: The challenge I am coming back to is that that is an extraordinary example of when you have the freedom and the ability to do that, but there will be trusts that simply have no disposable income that will allow them to do any innovation at all because, as you rightly point out, they are caught up in front-line delivery. Therefore, the disparity across the whole of the UK will be really quite significant, derived primarily by how the trusts manage their funds.
Roland Sinker: Yes. That is a reality we will need to keep returning to. The reason we were keen to go after, say, six major mission or goal areas is that, in areas where we have quite a strong national mandate—and cancer is a really good example of this because of the extraordinary need and the perils of not getting it right—you can come up with much more standardised performance management and managed approaches like the faster diagnosis standard, but you can do that in partnership with industry to do it in the right way. You can almost take the decision-making on how the pathway should work away from the organisation: “It’s going to be this but it has to be within a standard deviation”.
Q157 Lord Berkeley: Going on from your comments about procurement, one of the major recommendations in your report was that there had been a benefit from standardisation of procurement across the NHS trusts. How is that going? What progress has been made, and where has it been done successfully? Could you maybe give one or two examples of where it has not been successful at getting innovation from one trust to be adopted more widely? Are there any barriers to that happening or is it just that people have not got around to doing it?
Roland Sinker: I am not fully sighted on where the procurement recommendations in the innovation ecosystem programme have got to with implementation. They went into the life sciences sector plan and the 10-year plan. We almost call this plumbing and wiring: if you can get things like access to data, access to human tissue, intellectual property and contracting right and streamlined, you can then allow our industry, academic, patient and NHS colleagues to crack on with the business of how we innovate and improve—removing all the grit from the system.
My understanding is that the two areas where we are making progress—which I think are good early steps—are intellectual property policy, and then what I will call loosely kitemarking. If we have, “This has been approved in one trust”, that is a kind of kitemark. We can then apply it elsewhere to say, “That gives me assurance that this is good to contract with”. But there is quite a long way to go in this area.
Lord Berkeley: It seems as if there is a bit of a way to go. It is good that you have got those two going, but is there no other bit of standardisation for the trusts around the country that would help a bit more?
Roland Sinker: Yes. I am sure we will come on to data in a moment, but standardisation of access to data and tissue, clinical trials infrastructure and then effectively passporting for medical technology and then intellectual property would be the big four or five we need to go after.
The Chair: We are indeed coming on to data access. Lord Ranger?
Q158 Lord Ranger of Northwood: Mr Sinker, thank you for your time today. You have obviously been intimately involved in this space and can see the problems. One of the pieces of feedback we have had from a lot of witnesses is about the principal barriers to realising that sort of designing for the future that you mentioned in your review: personalised medicine and utilising artificial intelligence. The structural fragmentation of NHS data is fundamentally being cited as a major problem.
Your review at recommendation 6 looked at strengthening data access, information governance and expanding secure data access for research and prioritising testing and monitoring of innovation. How do you think that is progressing in what the Government are doing around that recommendation? Do you think that the Health Data Research Service is on the right track? Following up on that, what would you like to see it accomplish? Are its ambitions really achievable and are the timescales realistic?
Roland Sinker: That is a hugely important set of questions. We have been here before on making data available. The digital innovation hubs is one that I can remember quite well.
To give you a sense of scale, at Addenbrooke’s and Cambridge University Hospitals, we are in our 11th year of using a very advanced electronic patient record that gives you 10 years’ worth of data. We are still having to work incredibly hard to make that data and human tissue, which sits alongside the data, available, in a way that is suitably anonymised and safe for our patients, to industry and university partners. Even in a hospital that I think is still the most digitally mature in the country, we are not in a position where this is all singing and dancing. I am just giving you a sense of scale: if that is Cambridge, the situation elsewhere will be different. The amount of heavy lifting and detail you have to get into to make that data available is extraordinary. It comes down to who the data controller is—I could go on.
On this comment around prevention and population health, it is obviously data that sits in general practice, social care and community services that is important. If you are going to do it, do it once and get the whole shooting match together. That is why we want individual organisations doing that level of work, quite often across clusters—I take the point around not everywhere having the bandwidth to do this, which is where I think the secure data environments are absolutely central.
Those give you the clustering of data that would map into us mobilising our regions to meet the national challenge. So SDEs: yes, big tick. I do not think Mel and Nicola’s work on the HDRS is exactly the right direction of travel. I am hugely supportive, but it is very, very early days on that. That is why I think you have to mobilise the clusters as fast as you can to make the data available to have the mission response alongside docking into Mel and Nicola’s work as they get moving.
Lord Ranger of Northwood: Do you think that is part of the plan, though? If we do not unlock this, we do not get to that position of the ambition of personalised medicine and utilisation of tech. We all know that data is the fundamental barrier, but that is being layered upon the fragmentation of the structure of the organisations and then the internal challenges.
Roland Sinker: Yes. To us, when we did the IEP, data was a major enabler. We called it plumbing and wiring. You have to get that right, but it is not worth a hill of beans if you do not have the workforce to be able to work with it, and the expertise to interpret it. If the data is poor going in, it is poor coming out. Sometimes it tells you really obvious things, like, “There are quite a lot of frail older patients in your beds in the hospital”, which in the NHS is not a big surprise. I think it is about having the workforce to interpret the data in a context where, “Blimey, we have to sort this out because there is an expectation we will respond well”.
Q159 Lord Winston: It is nice to see you. Thank you very much for coming. I want to change the subject a little bit on the workforce, a particular issue being clinical academics. Clinical academics are interesting because a typical model is where they do half time in the NHS and half time doing their research relative to medical treatment. Do you feel that this is an area that is very much under threat?
I think that we are not getting enough clinical academics, who often are the very people who make the most important advances in innovation and connect it directly to the medicine they are doing. Could you tell us how you can make sure that these posts are protected, and indeed funded, because at the moment there are certainly not nearly enough in many trusts. Some trusts are much better than others because of the huge academic areas that are possible, for example in Cambridge, but often that is not the case.
Roland Sinker: In 20 years in the NHS, I was at King’s College Hospital, which also was accountable for the Princess Royal in outer London. The Princess Royal is a district general hospital in outer south-east London. Then, in Cambridge, we have very strong relationships with Norfolk and Norwich to an extent, as the big specialist centre for the region for 7 million people. The data from NIHR is pretty clear that, where you are research or innovation active, patients have better outcomes. To me, they are an absolutely essential part of the lifeblood of economic growth and improving health and care. That is the first point I will make.
The second point is that the mid-career clinical academics—full of energy and well networked into the developments—are our secret sauce. Very senior academics or very senior clinicians have a wisdom and an insight that is very powerful, but if we can harness the mid-career clinical academics we could do absolutely extraordinary things. Chris Whitty’s interview with us for the IEP said, “Find the 300. If we are going to have six missions, which is 50 per mission, where are they across the country? Those will be the leaders who will take us forward.” Protecting those individuals and enabling them to grow with the infrastructure we have talked about against these missions would be incredibly exciting for all of us.
On protecting it, I think it is very, very difficult to do. However, Ian Chapman and Lucy are saying on NIHR, “How are we partnering?” I look at the cuts that the Cambridge Biomedical Research Centre will have to make. What conversation are we going to have with Microsoft, GE and AstraZeneca on how we can co-fund these developments in a way that is appropriate for the patient and the taxpayer? Ros Campion, who has gone from running the Office for Life Sciences to running the Academy of Medical Sciences, is doing a big piece of work at the moment with people like Ros Smyth on how we can protect and develop the clinical academic career.
Lord Winston: The academy has been talking about it for a long time, but there has not been much action because, above all, the funding is very difficult. Certainly in my career, one of the most important aspects was the Wellcome Trust. That made a massive difference because it would fund five or even six years occasionally for somebody who was a promising academic but who had a good clinical background. We do not seem to have that funding anywhere. That system has gone and the Wellcome Trust sadly is not doing that kind of investment.
Roland Sinker: No. I think part of what we should be doing nationally, through both the life sciences sector plan and the NHS 10-year plan, is coming up with investable propositions. We are not unique in this but from a Cambridge perspective the university industry and the NHS picked two major areas of focus. One was cancer and one was children. We said these needed to be partnerships between the cluster. They have led to proposals to build a children’s and a cancer hospital at between £400 million to £500 million capital each in a mixed funding model.
The buildings are absolutely critical, but what is really exciting is what will come out of those as a mixed funding model. I think we will have to be imaginative about how nationally we bring our expertise together. Also, do not do the same research 15 times in different places. Do not say that you are going to do the clinical trial at Addenbrooke’s and then not do it and have GlaxoSmithKline have to replicate it at the cost of £4 million. What I am saying is that there is a lot of money swilling around in the system. We are just not harnessing it correctly.
Lord Winston: Do you think this is sufficiently important for this committee to suggest that we should be looking at the ways they could be funded?
Roland Sinker: This will sound a bit trite, but it is all about people and it is all about leadership, and these are your leaders. To me, it is the absolute centrepiece of what I would be exploring. If I look at what we have achieved in Cambridge and what has been achieved in South Yorkshire, the south-west and Manchester, what people say to you is, “Can you go and have a chat to or can you listen to so and so, who is doing great work here”. Those are the people who will make stuff happen and those are the people who can knock doors down and come up with new ways of doing things—so yes.
Q160 The Chair: One of the important recommendations in your report was incentivising innovation, and you talked about KPIs. Can you tell us a bit more about that? How effective do you think the incentivisation is?
Roland Sinker: Nationally, we track—this is the measuring bit, not the incentivisation bit—medicines, like how much you are using of what you should be versus what we would expect. It is very difficult to do that for medical technology. I think that as the data gets going, we will be in a much stronger position to be able to track productivity or use of new technologies. It could be virtual ward beds. That is a medical technology example where we are keeping people well outside of the hospital rather than coming into an expensive bed. So there is a place to go on tracking. It is very interesting watching Lucy Chappell being able to get us to a point where we are tracking clinical trials data at an organisational level; what gets measured gets done. That is quite important. Let us keep the measurement in place as one element of the incentive.
The more hopeful, inspiring piece to this—I do not want to keep repeating myself—is that people do love to come together to try to make things better, saying, as we have done with the biomedical research centres but we could do much more broadly, “In Leicester, what would be your answer to this population need and how would you come together? How can we help you and what resources would you need?”
One of the things that Amanda and I talked about at length before the 2025 restructuring of NHS England into the department was, “How much of the NHS England budget could we ring-fence for innovation and research? If we are going to pour more funds into the NHS, should it be ring-fenced for major change of the sort that we are talking about to enable us to build NHS 2.0 alongside the existing infrastructure?”
The Chair: Linked to my question about incentivisation is another of your important recommendations about creating time for innovation, particularly for clinicians. How do you think that would actually work in practice?
Roland Sinker: It comes back to this point that, if you are a paediatrician in the winter in a district general hospital in East Anglia, you are probably absolutely extraordinary but you are dealing with—it is quite hard to describe the pressures that you are under—a load of really sick kids with RSV and all the respiratory conditions coming in. You are worried about infection. Time for innovation is pretty limited. We have to create the space for that. I think the networks would enable people to cycle between organisations and to have time out from the front line to be able to work on innovation. It is also having very tight upfront conversations about what they are going to work on, which is not always the thing that they are interested in. There have to be some tramlines we are asking people to work on.
The Chair: Is time out from the front line realistic for a busy clinician?
Roland Sinker: If we work across networks, yes.
The Chair: Lord Patel, do you want to comment?
Lord Patel: I will come back when I ask my question.
Q161 Lord Drayson: Turning to the NHS working with industry, your review says that industry often finds it difficult to establish effective partnerships with NHS providers. What could industry, the NHS and the trust do to establish more effective partnerships?
Roland Sinker: There are a number of different elements to this. It is very important to distinguish when we are in coalition-building partnership mode to change the way that we might provide treatment. Who is drawing that coalition together? A lot of the interventions to meet the ambition and the need for economic growth, which is about UK plc leading the way. For changes to health and care, we will take coalitions of medtech, data and AI, pharmaceutical, discovery science, more core university, and the NHS.
Let us be clear: when we are in that mode and we are co-creating something, and when we are in procurement mode and we are buying something or you are trying to sell me something, the former is difficult but you can see how that can get bounded. On the procurement side, it is doing a lot of the plumbing and wiring around IP and commercial: doing it once, and kitemarking. It is also about the NHS signalling much more clearly what it needs and what it does not need. There is an awful lot of selling of stuff that is not required. Then it is making decisions quickly to say, “Thanks so much but not here”. I think it is just about being honest in the analysis. What game are we playing? Then let us be quick on the commercial side.
The last piece, which I think could be very exciting—particularly as we get better data on outcomes and impact—is moving towards value-based contracting. That could be, “Right, now we are into a proper procurement conversation. If it works, we will pay you. If it does not work, we will not pay”.
The Chair: Sorry, Lord Drayson. Lord Winston, do you want to come in?
Q162 Lord Winston: Very quickly—trusts have made a great issue about medical directors. Some hospitals, of course, have also had academic directors, which has been really helpful. Would you comment on that, because it is really part of that infrastructure, is it not?
Roland Sinker: You have to have some infrastructure on the board at an executive director level where somebody has clear accountability and reports on the interface with the research and innovation landscape. Whether that sits within a chief medical officer’s portfolio—as it does in Cambridge—or whether it is stand-alone and dedicated, it is different.
In Cambridge we had two doctors on the executive team. One was a core medical director, a CMO, and the other was in charge of improvement, innovation and digital, and included the research portfolio. That was because we felt we needed medical leadership to enable medical-led change in the organisation. There were downsides to that. Doctors and clinical academics with a medical background have a very strong perspective. It is often the patient groups, the nurses and the therapists who have a much clearer view of what the innovation could look like in prevention.
Lord Winston: I presume they could lead the metrics as well.
Q163 Lord Stern of Brentford: Thank you very much for coming. This follows the question that Lord Drayson was asking. You signal your areas and you try to identify where you think commercial leaderships could work. Then, of course, once you have done that, there is the technicality of who shares the risks and who gets the value. Your report suggested that we need more innovative commercial models on risk and value. Could you describe a little bit more about that and whether you think there are good examples to learn from?
Roland Sinker: Virtual wards is an example; it is a bit of a curate’s egg. As I have said, virtual wards is a way of looking after people at home, either to avoid them having to come into hospital at all or towards the back end of their pathway in an in-patient bed—you can discharge them to the safety of their own home if that is appropriate. It could be post-surgery for intravenous antibiotics, as an example, in that environment.
You can imagine a commercial contract with a provider for that service where there is a collective incentive to enable the patients to move to that safer place that works both ways. You can imagine feedback from patients as to how it is working. You can start to see a sharing of—sorry, but in very crude business terms—the length-of-stay saving and the bed saving, just as an interesting aside.
Lord Stern of Brentford: How would the commercial firm share the reward and the risk in that? If they got bad marks, would they get paid less?
Roland Sinker: It would be sort of thing where they were failing to get people out and the experience was poor. This is where it gets quite difficult on the commercial side because you say, “I, Roland, was trying to discharge this patient but the team in the hospital did not want to. I was not able to give the hospital that”—who pays for that failure? I think that comes back to: can you get to the right partnership working where everybody wins, which in that example you can do?
Lord Stern of Brentford: Do you think we end up with excessive caution and excessive cost?
Roland Sinker: I think we quite often end up bogged down in long commercial negotiations about risk when we should just get on and do it.
Lord Stern of Brentford: Would that mean standard contracts or—
Roland Sinker: Yes, standard contracts. Virtual wards are quite interesting. A sort of national expectation was set that, “We are going to have a percentage of your bed base comply or explain as to why the number of your beds are not in this sort of a capacity, then crack on and do it”.
Q164 Lord Willis of Knaresborough: Good morning. First of all, thank you very much indeed for all that you are saying. I was in Leeds Hospital last week, and I like to talk to them about the things that we are doing as a committee. I talked to them about this particular report, which they had heard of, although they knew nothing about its implementation. The explicit intention of feeding into the 10-year health plan, the life sciences sector plan and the Government’s health policy more generally was what was expected two years ago. I am asking you: where is the evidence that that is actually happening outside a small number of places where there is this interest? Where is it happening across Yorkshire, for instance, apart from South Yorkshire where, you are quite right, there is a real interest? But elsewhere nothing happens. How does it get there? How frustrating must it be not to be able to tell me that you can do that?
Roland Sinker: We may return to the frustration on another occasion. I was very grateful to Vin Diwakar and NHS England—and to Ros Campion, who is running the Office for Life Sciences—for all the work they did to take the innovation ecosystem programme into the 10-year plan and the life sciences sector plan as well as they did. A number of the people who had worked on the the advisory group, including me, were involved in the writing of both of those reports. You can see that quite a lot of it has made it in. Talking to the NHS England DH team, quite a lot of areas are moving forward within that. This committee in due course might want to invite people from the department or NHS England as it comes together to talk to you about that—Fiona and the team there.
The reorganisation has inevitably slowed some areas of implementation. I would observe that the huge opportunity of having a co-owned industry university regulator organisation with teeth to move all of this forward is a massive opportunity and, if we can regalvanise that, it could help things move forward.
Lord Willis of Knaresborough: Clearly, when people read the reports, they see huge potential in them, and yet two years later they are not seeing it at their level. Where is the problem there? Is this a government problem? Is this something we should be saying to the department in our report?
Roland Sinker: I cannot comment on what NHS England and the Department of Health are doing now because I am no longer involved in that. What I am saying is that the actions have made it in. It would be helpful to get an update from them on the detail of that. I had a bit of a chat to some of the team to say, “Where are things going?” They said quite a lot of it is moving, but the reorganisation has inevitably complicated quite a lot of that. This is the February 2025 reorganisation. So I am saying, yes, get an update.
One of the strong recommendations in the review was that we need much stronger co-ownership with the ability to enforce across the ecosystem. I think that is a recommendation that I do not currently see being taken forward. It feels to me that is an area I would want to pay quite a bit of attention to. Meanwhile, if I look at some of the ecosystems I am still close to—particularly Manchester, Oxford and bits of London, and I am still in touch with South Yorkshire—there are really terrific things happening: the work that Eileen is doing in Oxford and the work that Debbie Prentice and I are doing in Cambridge is quite exciting, so we are trying to crack on and do it anyway.
Lord Willis of Knaresborough: I would like it to happen in Leeds.
Roland Sinker: So would I.
Q165 Baroness Jones of Whitchurch: We were identifying repeat problems with innovation that you have seen in the past, and you are even now identifying some of those barriers, so the pattern is repeating and repeating. One of the issues that we have identified is the short-termism in all of that, and there seems to be lots of innovation taking place, and lots of enthusiasm—you have identified all of that. But is there a danger that—if we take cancer, which you have been talking about, as a national priority—in two or three years we will have a different national priority and the organisation will be struggling to refocus to deal with a new priority? How do we deal with that short-termism that almost seems to be innate in the NHS but seems to be holding us back?
Roland Sinker: You are absolutely right, and you will all have experiences of leading or managing different organisations. If you have a team managing an emergency department in a hospital, a maternity unit or a dermatology clinic, that requires a particular set of skills. You are managing a small team with the patient; you know what you are doing. If you are a hospital chief executive, it is a different leadership managerial challenge. You are part mayor of a small town and you are part chief executive. You have programmes, training and development for staff. I think that sometimes nationally we reach for the major programme lever as the mechanism to try to make things happen in what is a £220 billion organisation using our taxpayers’ money. You need an awful lot of programmes seen through for a long time to deliver.
For all of you who will have been involved in leading complex ecosystems, you may have had enormous success leading multiple programmes. It is far more likely that you have had success when you have thought about this as an ecosystem. To get longevity, it is about creating the fertile soil, the trees and the hummingbirds that enable the right things to happen in the long term. Therefore, my strongest steer is to think about this. There is no silver bullet, or no handful of silver bullets. This is a complex, long-term game and it will take us a while to find those 300 mid-tier clinical academics, but to grow and nurture and support them while we remove the grit and get the contracting right. Where do we pay our attention to let things thrive? We did that in Covid.
Baroness Jones of Whitchurch: If we just sit with the cancer example for a second, I think you said earlier that you thought it was good that the Government had given a national direction to that. Where is the role for the Government? In our recommendations, what can we recommend to the Government? What is their attention on? What can they do well and what do you want to leave to the ecosystem to develop in the way that you have described?
Roland Sinker: In the recommendations, if you assume you can get the commercial landscape right—Lord Vallance has done a superb job getting the commercial drug price piece broadly right, and there has been knock-on into the medtech commercial landscape—we have a field that we can play on together, and you do not have global boardrooms saying, “You know what, we do not want to play in the UK”. If you can get that sort of basic piece right—and that is a government job—the Government can then set the policy framework, which is what we have just been talking about. They can work with partners to say, “What are the big missions we will go after as UK plc?”
Then you are leaving a huge amount to local systems to respond to. We have great examples in this country of doing that—of mobilising that local leadership. It is good that you have to set the framework for that. That is what I am saying. That is what I think Ian at UKRI and Lucy at NIHR are doing at the moment.
Q166 Lord Patel: I was just about to start by saying that the soft questions are over. We are all familiar with glossy reports and good words, and of course they are necessary, but my question will be focused on you as a chief executive of NHS and not all the other things that we have talked about.
In the 10-year health plan, one of the key areas is how the innovation will improve healthcare and outcomes for patients. We need to keep the patients at the centre of all this discussion. Recognising that today we have lots of disparities and variation in care, we now want to put AI, genomics and personalised medicine across the NHS. How we are going to do that is the first question. Is it possible that the whole of the NHS will benefit, or will we end up with centres like yours excelling in it and then other centres, not just Leeds, that will not get any of the benefits? What is required in the NHS to make sure that it is delivered across the NHS? What are the resource implications, not just in funding but including funding, in other research areas that need to be delivered before the vision of AI, genomics and personalised medicine can ever happen?
Roland Sinker: There are two answers, or a number of answers, to the question—three probably. You are absolutely right to identify the patient and the third sector in this. In the advisory group, Jacob and Nicola, who effectively led the patient voices groups and the third sector groups, were absolutely central to mobilising their populations to challenge us on the recommendations in the review. Patient expectation and patient pull for what we are trying to do in innovation is absolutely key, rather than us trying to stuff innovation down people’s throats. You are absolutely right; if the patient is not at the heart of this conversation, I think you are in really difficult circumstances.
The second point is that personalised medicine and AI are quite big words. They are vast drift nets. Peter Ellingworth and Kristin-Anne Rutter, in looking at the technologies of the future, said, “We have identified 120 or so new things that are coming down the pipe that everybody is breathless about”. What they really said is, “We commissioned some leadership pieces. There were three big areas to focus on. One of those in AI was not AI to re-stratify populations or AI for radiotherapy planning”. They said it was AI to support the workforce of the future: district nurses with the right information in front of them on a tablet and with the right route planning, able to access a secure chat to a consultant if they need it, or into social care. That is where we should focus with AI: put patients at the heart of it, with really specific, targeted questions on where AI can apply. In Cambridge, we are doing what we just said on AI. The other two areas we are looking at in AI is AI to support clinical trials—good for patients, good for economic growth—and AI for new drug discovery, which is leveraging our discovery science expertise, and nothing else.
On the point about health inequality of access, as a hospital chief executive for specialist services, I had an accountability for the health of the eastern region. If we are using genomic sequencing for all breast cancer tumours in Cambridge and changing treatment for 40% of those patients on the basis of the genomic profile for the good people of Great Shelford or Signet Court in Cambridge, which faces very significant challenges, our job—my job as a chief executive—was to make that available in King’s Lynn. Likewise, if we are coming up with decision-making support tools for cancer MDTs, we have to make those available in Ipswich and Colchester as much as we are doing into London.
Lord Patel: You talk to chief executives from other areas in England. What do they say to you when you tell them exactly what you just told the committee? When they say, “Well, we cannot do that”, what do you tell them?
Roland Sinker: What was interesting is the prejudice against this work, which was, “Well, it’s just going to be the big 10 teaching centres, the Shelford Group. It will be Manchester, Newcastle and so on”. But we walked quite widely, and I have talked about the south-west of the country and about South Yorkshire. With no academic assets and no major research assets in South Yorkshire, what they were doing in innovation was absolutely extraordinary.
Yes, you definitely meet people who say, “I just do not have the energy to even think about this, Roland”. However, there were plenty of places without those assets that were doing things. I have to say that there are areas in Cambridge where we fall so far short of the way other parts of the country are working. It is the same as saying, “Technology is only good for young people”. No, it is not. There are different populations, young and old, who can use technology in different ways.
Lord Patel: A good example of a healthcare system that is able to put innovation straightaway into practice, whether that is technological innovation in devices or medical innovations in medicines, is probably the United States, despite its terrible overall healthcare service—but it is also very expensive. What we are talking about today when we talk about personalised medicine and using genomics is maybe good medicine but expensive medicine. How are we going to meet the funding challenges?
Roland Sinker: I will say a couple of things. As you started your question and you mentioned systems that could do it well, I was thinking of Manchester and Birmingham. I look at their ability to get into their local populations, understand what their populations need and roll things out quickly, and I say, “Wow, if I could have done that in Cambridge, or if I could do that in Cambridge”. To harness that level of local implementation with the discovery science of Cambridge would be extraordinary.
To your point around cost, yes, it is 11% or 12% of GDP versus 18% or 19% and rising all the time. That is why I come back to these clusters coming together against questions and talking about population health, early detection, prevention and then personalised medicine in the right way—but we have to constantly distinguish there. To go back to smoker’s cough, COPD and emphysema—which is personalised medicine depending on your lung function—that is avoiding you having to come into the hospital in the middle of the night in November. That is very expensive. That is a form of using data to identify people and support them that is distinct from what we will be doing in breast cancer.
Lord Patel: Taking the same theme of prevention—that is what you are talking about when you talk about emphysema and COPD—there is very little in the 10-year plan about using AI and personalised medicine for preventative purposes as a population prevention. Do you have any comments about that?
Roland Sinker: Yes. The 10-year plan is a big document that sets out a long-term aspiration. The delivery of that is not yet clear.
Q167 Lord Duncan of Springbank: If we were to meet again in 10 years’ time—if we are spared—and if we brought you back before us, what would you say were the reasons that the delivery did not happen as you anticipated? What problems will happen between now and 10 years’ time that will get in the way?
Roland Sinker: I am going to repeat myself. The biggest risk here is that we adopt a multiple long-screwdriver multiple-programme approach to what is an ecosystem problem, and that we have the wrong model of change to try to make this happen. If we assume a level commercial playing field, and if we assume that you sit the leaders of the regulators and industry around the table with the expectation of co-ownership—and if you identify the 300 mid-career clinical academics, and get the plumbing and the wiring of data, clinical trials, tissue and commercial sorted, as well as setting some big scary ambitions—we would be in a different place.
Lord Duncan of Springbank: Who does that? Is it the Government’s job to do that?
Roland Sinker: Yes, to set that framework and expectation.
Lord Duncan of Springbank: Do you think the Government are qualified to do that?
Roland Sinker: Yes.
Lord Duncan of Springbank: I only say that because I think a lot of the advice the Government will need will come from people like you, and you have already highlighted that the risk is an approach that might indeed cause the whole thing not to work—and you are the person giving advice to the Government. What are you saying to the Government now? What three things do you think the Government need to do to avoid what will ultimately be a lovely idea that never realises its potential?
Roland Sinker: I am not advising the Government now. I delivered my report. I would have liked to have carried on and done some of the things that we have talked about, but the path wends its way, does it not? I am still very connected into other systems. We have Science Week this week, we had the supercluster conference last week, and we have the Cambridge x Manchester Partnership and the Oxford-Liverpool partnership. There are absolutely terrific people doing exciting things in life sciences—aerothermal and sustainability—so let us not fear. The clusters are mobilising themselves anyway, because they are like that.
The advice I would give to the Government is: level the playing field and have everybody in the room for a long-term plan. My big priorities would be: first, find those 300 mid-career clinical academics as your leaders on the ground; secondly, start to sort the plumbing and the wiring out, as you have started to do; and thirdly, set some big, scary UK plcs to lead the world in early detection in cancer, diabetes, obesity, neurodegeneration and mental health—but be very specific within those.
The Chair: That is a very positive way of ending; thank you very much. Thank you for answering all of our questions. We appreciate you coming to give evidence. We will pause this session now.
