New tools of technology are revolutionising health care in Scotland

In its constant struggle for excellence in delivery, innovation is key. Bold new thinking and pioneering action has the potential to make the lives of patients better by bringing more targeted and personal treatment. 

That boosts efficiency, saves money – and helps in the struggle against climate change, too.

The new technology of targeting patients individually and producing tailored treatment plans is known as precision medicine. It is something we are likely to hear a lot more about, as it is set to become one of the defining technologies of the 21st century.

In Scotland, this ground-breaking approach is being championed by Precision Medicine Scotland, one of the country’s seven dedicated Innovation Centres.
These are collectively charged with bringing together academia, businesses, the public sector and other special interest stakeholders to collaborate on projects in areas where we have the ability to become an international leader.

The Herald is partnering with this network of innovation centres to host an important one-day online environmental conference next month. The aim is to facilitate cooperation and discussion on climate-related issues in the countdown to the COP26 gathering in Glasgow next year.

This COP26 event is set to be the most important international meeting on the environment since the 2015 Paris agreement 

“Precision medicine is very much focused on the individual patient,” explains Marian McNeil, Precision Medicine Scotland Innovation Centre’s CEO. “It’s about looking at all the different factors that affect an individual.

“It’s not just about their DNA sequence, but about examining all the information  healthcare professionals gather on them. That could include blood tests from their GP, hospital scans and other procedures. 

“The aim is then to take all this information, learn from it and and put in place recommendations for individual patients based on these new insights. We can then work out what would be the most effective treatment for that patient.”

By examining an individual’s entire pathology and finding out why drugs and interventions work in some people but not in others, a picture can be built up. Studying individual biomarkers – patterns of disease - can identify if patients will be likely to respond to a particular treatment.

“It’s about the right treatment for the right patient at the right time,” Marian McNeil says. “It’s already being used in oncology, cardiology and a few other disease areas, but we now want to roll it out much more widely.”

Much of the work is driven by technology and data analysis. “We’re building something called Data Commons. By deploying various analysis tools including artificial intelligence (AI) we can gain a better understanding of often complex diseases which in turn will lead to more effective treatment options for the patients. 

“We started with projects in cancer and inflammation (e.g. rheumatoid arthritis) but we are now also looking at other areas such as liver disease, multiple sclerosis and dementia which are very prevalent in Scotland.” How, though, can this impact climate change? 

“Precision medicine will enable patient journeys and treatments to be more effective and as a result there will be less wastage of medicines. People will not have to come in and try and change their prescriptions two or three times before they find one that works for them.”

While well-intentioned, Marian points out, current treatment regimes can be inefficient. “If one doesn’t work, then the patient will come back after taking the first medicine and say that it isn’t making a difference or that they are having side effects.

“So they try another medicine, and then perhaps another one after that. So there’s a cost to that. And a lot of patients opt out and stop taking the tablets altogether. Which from a health perspective is not ideal and it can be wasteful. It’s better to advise not on the most commonly prescribed medicine or the cheapest medicine, but on the best medicine for that particular patient.

“If they only take what works for them, then there won’t need to be all that travel to and from hospital. Imagine someone having to go from Stornoway to Inverness or Aberdeen for their treatment and the number of times they have to do that if the treatment is not right for them.”

If the journey totals can be reduced, then clearly that has a direct and beneficial effect on carbon emissions. And if they only take the medicine that is most likely to work for them, then there will be less wastage of medicines being taken with no benefit or discarded. 

Precision Medicine Scotland also recently worked on the Cancer Innovation Challenge with two of the other Innovation Centres, The Data Lab and the Digital Health & Care Innovation Centre. 

This challenge was set up to find innovations that would allow patients to use an app to report symptoms and outcomes from their treatments remotely – a development that would once again potentially reduce travel.

It is important, Marian adds, that patients do not feel that they are being pushed away from face-to-face appointments. But that they have options available to allow them to have the most effective patient journey for them as individuals. 
“It’s about making their lives easier where we can. As far as climate change is concerned, every small difference we make adds up and eventually makes a big difference. Just think of all the patient journeys and medicine waste that can be reduced. That helps the environment, saves the country money and supports the NHS.”

Precision Medicine Scotland will co-host a session at the Countdown to COP26 event along with another Innovation Centre, the Digital Health & Care Innovation Centre (DHI). This will focus on health and wellbeing.

Marian will be one of the speakers, along with Professor Clive Badman, Executive Director at the University of Strathclyde, and Professor George Crooks and John Jeans, CEO and Chair of DHI respectively.

Sustainable procurement, technology enabled care, low carbon healthcare environments, digital solutions as a driver for positive change and reducing the environmental footprint of medicines will all be subjects under discussion. 

“Climate change isn’t just about the fuels we burn and the way we travel. There are so many other elements to it where people can make a contribution. It’s important that they feel they can help.”

Precision Medicine Scotland is also involved in a pioneering programme alongside Glasgow University, which has been awarded £38 million by the UK government to create a Living Lab. Focused on translating cutting-edge science and innovation into a real-world clinical setting, it will become a global centre of excellence.

“I honestly believe that Scotland has the potential to be a global leader in this area,” Marian McNeil says. 

“Because every patient at birth here is given a unique community health index number, we have comprehensive electronic health records and the data is traceable.

“We are ahead of the game so much that I’ve heard this data called Scotland’s new oil. 

"It’s all massively exciting. We are doing something that makes a difference, and that’s what motivates me every day.”

-------------------------------------

Digital innovation is the driver of a fast-evolving revolution in care

Climate change isn’t just harming the planet: it’s damaging our bodies too. Pollutants and emissions in the air, microfibres in our clothes, plastic beads in our oceans – all these are well known and documented threats to our health and our futures.

However, we are now fighting back. Determined efforts are being made to address these high-profile, high-concern examples of how we are scarring and poisoning our global environment. 

Alongside this, though, we are seeing new thinking in challenging long-established patterns and procedures in healthcare, many of which are now outdated, inefficient and hindering common efforts to combat the climate emergency.

One Scottish organisation is acting as a leader in this exciting area. The Digital Health & Care Innovation Centre (DHI) is part of the country’s network of seven pioneering Innovation Centres, all of them working to bring business, academia, economic development agencies and the public sector together in order to drive change.

By creating collaborative links and so stimulating excellence and advances in technology, the centres aim to keep Scotland at the forefront of innovation, including in the critical area of climate change.

DHI will be hosting a session at the one-day online environmental conference on November 3. 

Professor George Crooks, who is the CEO of DHI, says his organisation is driven by the need to address societal challenges across Scotland, examining how to use digital tools and services to deliver safe, effective and sustainable healthcare services that are fit for the future.

It also aims to create economic benefit for Scotland by supporting businesses in developing innovative products that can be deployed in our NHS and then sold globally. Another of its functions is to entice global leaders in digital healthcare to invest here.

How, though, does this have an impact in the battle against climate change? The success of DHI, he explains, is related to how it engages with and empowers citizens in the way they access public services.

The NHS, he continues, is not currently shaped in a way that puts the environment at its heart. “It was built and designed for the way we used to live our lives 50 or even 100 years ago.

“People then were born into a local community and they lived and died there. That’s why when you register with a general practice, it’s still very close to your home. The interesting thing today, though is that most of us – excepting the current circumstances caused by Covid-19 – work from a distance away from where we live.

“So, you are in the situation where if you need a GP appointment, you often have to travel back from your workplace to your home for a 10-minute appointment. If you live in Glasgow and work in Edinburgh, that can be a near 100-mile return journey.”

The environmental damage of this outdated arrangement is clear. That journey, for a face-to-face appointment which may not even be necessary, is likely to emit CO2, particularly if it is made by car. It is also hugely unproductive in time terms.

This problem, Professor Crooks points out, is particularly acute in Scotland's remote rural areas. “People might have to make a four-hour round trip to access a hospital outpatient appointment or investigation lasting 15 or 20 minutes.”

The role of videoconferencing in replacing these face-to-face meetings has been transformational in alleviating climate damage, he adds. “The current pandemic has boosted the adoption of this in a really significant way.”

The statistics illustrate a huge surge over the last few months in the take-up of this more convenient technology. “In early February, there were about 300 video consultations happening across Scotland every week.

“Now, between primary and secondary care, that has gone up to more than 30,000. You can imagine the reduction in journeys that has brought and how much time it has given people back.”

Bold thinking and scientific innovation have led to other healthcare changes that cut down on the need to travel and on the production of carbon emissions.

“People also have to travel a distance to get blood or laboratory tests done. 

“Now, however, digitisation means that these can now be done in people’s homes or in local health centres. In other words, they can be carried out in communities instead of at a more distant hospital.”

George Crooks gives a particularly compelling example of this. “One example that we have been leading on at DHI has been in the area of bowel cancer. The gold standard investigation for this is a colonoscopy, with a fibre optic endoscope inserted. 

“Normally it is done in a hospital, and it’s invasive, uncomfortable and embarrassing. Now, though, it can be delivered at home while you’re undertaking your normal daily activities.

“It’s carried out using a camera pill that is swallowed and is no bigger than a large antibiotic capsule. It has a light source and two micro video cameras and as it passes through the bowel, it transmits more than 300,000 images to a receiver worn on the belt round the waist.

“These pictures are then sent to a central point in Inverness where they are analysed, and it can be determined if further investigation or treatment are required.”

Avoiding traditional colonoscopes has another environmental advantage: these are expensive pieces of equipment and require intensive washing after each individual procedure. Clearly the new approach avoids the need for this.

Professor Crooks stresses the need to empower citizens to become better aware of their environment and how it impacts on their health and wellbeing.

“Through the provision of information and knowledge, they are able to make better informed choices.

“We know the impact particulates in the air have, particularly on asthma and on chronic obstructive pulmonary disease (COPD), which are big problems in Scotland. 
“If we can blend medical measurements such as how you’re breathing with consumer generated data from sensors in cities, towns and even more rural areas, then you can use this information to calculate the time of your optimum journey to work – or, in some cases, work out if it’s simply safer to work from home.”

The Countdown to COP26 event will examine these health and care activities further. “Everyone understands that the environment and climate change can have a negative effect on health – heatwaves and severe cold snaps can result in increasing death rates among the elderly and vulnerable, for example.

“What people perhaps don’t realise, though, is that by transforming the way we deliver health and care services, we can benefit the climate in a positive way alongside improving our wellbeing.”

Among the guests at the Health & Wellbeing virtual session will be: Kathryn Dapré, Head of Energy & Sustainability, NHS National Services Scotland; Wendy Rayner, Sustainability Manager, NHS National Services Scotland and Caitlin Hamlett, Sustainability Manager, NHS National Services Scotland

• Join the conversation and take up the challenge by registering to join Scotland’s Countdown to COP26 at:hopin.to/events/scotland-s-countdown-tocop26. The event takes place on Tuesday, November 3, 2020, is free to attend, and will be accessible online.

This article was brought to you in association with the Scotland's Countdown to COP26 event.