Written evidence submitted by the National Physical Laboratory (CBP0059)

 

Summary of key points

NHS Backlog: The opportunity to explore ways in which services across the NHS, particularly those areas that have with high patient numbers (e.g. cancer, hip fractures), can be delivered more efficiently through new systems and modelling could have a significant and sustained impact on reducing  backlog. Measurement expertise and data analysis can enable medical pathways to be optimised for efficiency, as showcased by NPL work optimising cancer pathways in an NHS Foundation Trust.

Financial Investment: There could be significant benefits to investing in programmes to enable different parts of the healthcare system and industry to come together to innovate and test new ways of working. Building on these existing networks is vital to speed up the adoption of innovation and need embedding locally, regionally, and nationally. To support this, programmes such as the BEIS-funded UK-wide Measurement for Recovery could be extended to a solve a greater number of health challenges faster bringing together science and industry in a coordinated and effective way.

Service Re-Design: It is important that the wider healthcare system ensures use of good quality data at the outset to deliver long term, sustainable changes to service delivery and ensure best possible patient outcomes. Measurement and data science expertise can make a significant contribution to modelling NHS services redesign. For example, NPL’s building optimisation and pathway optimisation work could be expanded across a range of Trusts and health systems.  

Innovation: Measurement accelerates innovation: the ability to measure the performance of new technologies and services is vital for their development, commercialisation, and up-take. Having confidence that the data being used is accurate from the outset is crucial to the NHS to enable the successful diffusion of innovation and the National Measurement System should be supported to enable this.

 

Context to NPL’s submission

  1. The National Physical Laboratory (NPL) is the UK’s National Metrology Institute (NMI), responsible for developing and maintaining the nation’s primary measurement standards on which all measurements rely. NPL is owned and funded (in part) by BEIS. NPL is a Public Sector Research Establishment (PSRE), and works in partnership with government, academia, applied research labs and industry to deliver the greatest societal and economic benefit for the UK and the world.
  2. NPL sits at the heart of the UK's National Measurement System (NMS) which maintains and develops the UK’s national measurement infrastructure and delivers the UK Measurement Strategy on behalf of BEIS. As the UK’s NMI, NPL represents the UK within an international network of measurement institutes globally that ensure the stability and comparability of measurement worldwide.
  3. In healthcare, good measurement improves productivity, quality and safety; it underpins public confidence and is vital to enable innovation. NPL works with the National Health Service (NHS), government, academia, and industry to tackle some of the world’s biggest health challenges and support the delivery of priorities set out in the NHS Long Term Plan. This includes the increased drive for earlier diagnosis of disease, innovation, and acceleration in the use of precision medicine and personalised medicine, as well as leading the conception of new drugs, treatments and therapies. For more information on this work visit https://www.npl.co.uk/life-sciences-health.

NPL Response to Questions

NHS Backlog:

  1. The challenges of clearing the backlog in outpatient appointments and other diagnostic appointments have been well documented during the COVID pandemic[1]. Addressing the backlog of cancer diagnosis and treatment has been of significant concern to the Government and the NHS given the challenges some Trusts faced in meeting their ‘referral to treatment’ targets before the pandemic[2]. Measurement expertise and data analysis can enable clinical pathways to be optimised for efficiency, identifying potential ‘blockages’ and increasing effectiveness of existing resource allocation. For example, NPL was asked by the Royal Free London NHS Foundation NHS Trust to explore ways in which they could optimise their cancer pathways making them more efficient and build in ‘spike resilience’ (see Case Study 1). The opportunity to explore ways in which services, particularly those with high patient numbers (e.g. cancer, hip fractures), can be delivered more efficiently using existing resource could be have a significant impact on reducing the backlog.

 

Case Study 1: Royal Free London NHS Foundation Trust Optimising Cancer Pathways.

NPL scientists set up an algorithm to minimise the number of breaches in cancer diagnosis time for patients coming into the Trust by referral. The Trust sent NPL data describing the diagnosis pathways for different types of cancer, and NPL turned this into a visualisation where all pathways can be seen in the same diagram (see Figure 1 below). This gave a clearer picture of potential ‘blockages’ or high-volume areas. NPL also formulated a solution to the problem of optimising all the pathways simultaneously in order to give the Trust an idea of optimal resource allocation in order to meet diagnosis targets. This work has now been expanded to be tested across the local cancer alliance with the view to creating a fully integrated clinical management system for use across multiple clinical pathways across a range of clinical pathways and services.

 

A close up of a map

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Figure 1 – NPL Sankey Diagram showing Cancer Pathway ‘flow’

Financial Investment:

  1. There could be significant benefits to investing in programmes to enable parts of the healthcare system to come together to innovate and test new ways of working. Harnessing existing networks such as Academic Health Science Centres (AHSCs), Academic Health Science Networks (AHSNs), regional innovation hubs such as Health Innovation Manchester, and research charities such as Cancer Research UK, is vital to speed up the adoption of innovation and clinical best practice. There is a need to ensure that the networks for supporting innovation and diffusion of innovation are embedded locally, regionally, and nationally.
  2. Measurement accelerates innovation; the ability to measure the performance of new technologies and services is vital for their development, to secure investment, commercialisation, and up-take. It gives confidence to regulators, investors, the public and the NHS. Financial initiatives launched by the Government such as the Measurement for Recovery (M4R) programme supported UK companies to recover and grow by providing vital measurement expertise in the challenging economic environment resulting from the COVID pandemic (see Figure 2 below). In healthcare, M4R drove the pace and scale diffusion of innovations that directly supported the UK COVID response. The M4R programme was designed with agility in mind, enabling businesses to apply for vital support in a matter of minutes, and receive scientific expertise in a matter of days. The programme provided quick and easy access to expertise from the UK’s network of national measurement laboratories (such as NPL) and allowed innovative businesses, some of which had not previously had access to external R&D support, to benefit from world-leading measurement facilities and expertise. The agility and fast-paced research and support was to enable scientists and clinicians to ‘fail fast and learn faster’. The M4R funding model should be explored as a long-term investment model.

 

Figure 2

Service redesign:

  1. There have been well documented examples of where the NHS and individual Trusts have delivered services to patients differently during the pandemic[3]. It should be the case that Trusts will continue with these different ways of working post pandemic which have realised often surprising benefit, such as increased efficiency due to new technologies and digitalisation. Healthcare will increasingly rely on the integration of large datasets and need trusted and robust tools to analyse the data. It is important that the whole system ensures use of good quality data to support long term changes to service delivery and best possible patient outcomes. Measurement and data science expertise is vital in modelling NHS services redesign and understanding uncertainty to underpin the degree of confidence in clinical data. For example, NPL was asked by the Royal Free London NHS Foundation Trust to model the hospital flow to support optimal use of wards, rooms, beds (see Case Study 2). This type of service re-design should be explored across other NHS trusts, and it is important that networks are used to communicate and speed up the adoption of this type of innovation and clinical good practice.

 

Case Study 2: Royal Free London NHS Foundation Trust Building Optimisation.

NPL devised a solution for the Trust which allowed patients to be routed through the hospital and allocated to treatment rooms while minimising interactions with non-COVID patients and keeping to the constraints of staffing and oxygen supply (see Figure 3 below). NPL’s solution resulted in identifying the carrying capacity of each floor of the hospital and generated optimal partitioning of wards and other rooms. This work is helping the Trust manage its clinical, non-clinical and shared space more effectively and with greater confidence going forward.

Figure 3 – Case Study 2

Innovation:

  1. The National Measurement System and NPL’s measurement capability is critical to accelerating research, development, commercial competitiveness, and delivering the UK Innovation Strategy. It supports the government in driving innovation to deliver a strong, sustainable health system to meet ambitions set out in the Mackintosh Report and DHSC’s Digital Vision. Measurement expertise supports UK innovation required to meet current healthcare challenges including those identified in ‘Harnessing Technology for the long term sustainability of the UK’s healthcare system’, the Diagnostics recovery and renewal, and the Regulatory Horizons Council report on medical devices. Linked to this, NPL is supportive of current thinking to form a thinking to form a UK regulatory science and innovation network to accelerate innovations in the device field. Innovation in this space is complex and benefits from multi/inter disciplinary partnerships. NHSx should continue to facilitate collaborative working from across all parts of the healthcare system to support the best possible innovation outcomes and reproducibility.
  2. Intelligent and effective use of data is important to supporting innovation and accelerating its adoption in all areas but is critical to driving improvements in healthcare. The scope and scale of NHS data presents significant opportunities to deliver sustainable, scalable improvement to the NHS and wider care and prevention system. In the future there will be an increasing reliance on the integration of large datasets, some highly complex and confidential, and the resultant need for trusted and robust tools to analyse the data. Trusted measurement has a key role to play in enabling healthcare, industry, and citizens to have confidence in their data and how it is used. For example, NPL runs an inter-disciplinary project on Digital Health data curation and analysis which aims to demonstrate how a ‘metrological mindset’ applied to the curation and analysis of healthcare data and metadata could help solve some of the important and emerging challenges of utilising healthcare data. Having confidence that the data being used is accurate from the outset is crucial to the NHS to enable the successful diffusion of innovation and the National Measurement System should be supported to enable this.

Case Study 3 – Early Detection of Neurodegenerative Diseases (EDoN) Project.

EDoN is an Alzheimer’s UK led project (see Figure 4 below). It is the largest initiative in the world that will collect, share and analyse clinical and digital health data to detect diseases like Alzheimer’s. It brings together a range of experts from 37 Universities, charities and foundations, the NHS as well as NPL. The aim of the project is to ‘revolutionise the early detection of dementia causing diseases through the development of an integrated digital fingerprint tool for the detection of diseases that cause dementia 10-15 years before symptoms using inexpensive, non-invasive, sensitive and scalable digital technologies at population level’. NPL’s role in the project is two-fold:

a)      Standardisation of Imaging data - standardisation of the retrospective imaging data by separating inter-scanner variability from inter-patient variability. This will enable standardisation within the prospective imaging datasets to ensure greater uniformity and hence predictive power from the study.

b)      Data analysis tools to pool information across cohorts - use traceable fully data driven approaches to identify patterns and will develop trajectory modelling for early prediction. Our scientists will investigate the possibility of linking the digital data to electronic health records/primary care records to enhance analysis.

 

Figure 4 – Case Study 3

 

 

 

 

Sept 2021

5

 


[1] UK Government urged to recognise post-COVID-19 cancer backlog - The Lancet Oncology

[2] Eg https://www.bowelcanceruk.org.uk/news-and-blogs/news/two-in-five-patients-in-england-waiting-too-long-for-bowel-cancer-tests/

[3] Best practice and innovation during COVID-19 | NHS Confederation