Planning for a personalised future

Professor Dame Sue Hill @CSOsue

Chief Scientific Officer for England

SRO for Genomics, NHS EnglandSeptember 2018

Planning for the future

Oct 2014: Five Year Forward View provides cross-system vision for future development of the NHS given the pressing system challenges (the three ‘gaps’)

“…The NHS needs to adapt to take advantage of the opportunities that

science and technology offerpatients, carers and those who

serve them…”

Identified areas for action include:• Harnessing technology to reshape care delivery• A step change in prevention• The need to exploit the information revolution

Jun 2018: Government announces a £20bn funding boost for the NHS subject to a 10-year Long Term Plan for the NHS

2

• Ambitions for improvement• Plans for delivery over 5 years

Other initiatives inc HEE Topol Review looking to inform future planning

Speeding the innovation pathway

3

Creation

• new things

• new ideas

• new techniques

• new approaches

Assessment

• new things

• new ideas

• new techniques

• new approaches

Uptake

• new things

• new ideas

• new techniques

• new approaches

Spread

• new things

• new ideas

• new techniques

• new approaches

Basic Research Applied Research Commissioning Patient Care

INVENTION EVALUATION ADOPTION DIFFUSION

It still typically takes 17 years for a technology to move from initial discovery to widespread adoption across the NHS

Key emergent technologies need to be identified and supported to speed implementation for patient benefit

The power of personalisation

4

Prompt, precise

diagnosis

Personalised interventions,

care & treatment

Proactive participation of patients

Prevention & predisposition

Next Gen Diagnostics inc Genomics & transcriptomics

Mobilising Patient info for Analysiseg Digital Pathology

Computing power & Artificial Intelligence

eg Machine Learning

Personalisation

Personalisation is central to the shift from illnessto health needed across health systems

Emerging technologies and techniques are making personalisation much more deliverable in practice

Emergent technologies: delivering on the future

5

• PHG report provides detailed evidence synthesis on key emergent technologies

• Need to build on existing foundations – such as the NHS Genomic Medicine Service – to achieve the wholescale transformation needed for personalisation

• Underpinning this there must be a series of significant cultural changes:

‒ of professionals within services, as delivery models change

‒ recognising the immense value of capturing data throughout a patients’ life course

‒ greater engagement of citizens as partners in their health

Achieving the vision – working beyond the health sector

6

• Achieving the full potential requires a new and more collaborative approach across innovators, academia,industry and – most crucially – with patients & citizens

• More than just technology – social, ethical, legal and economic considerations will play a central role

• Radical improvements in patient outcomes & driving prevention are within our grasp – this needs a truly learning health system, that learns from every clinical encounter and directly from patients themselves.

The personalised medicine technology landscape

Dr Mark Kroese

Director, PHG Foundation

PHG Foundation - about us

Health policy unit focused on emerging technologies and how they can improve personalised healthcare, responsibly

• Part of the University of Cambridge

• Active since 1997

• Located within the heart of the Cambridge biomedical hub

• Funded by philanthropy, grants, and commissioned work

@PHGFoundation

Personalised medicine is not new - all medicine is personalised to some

extent. Drivers for the growing personalisation of medicine include:

▪ Scientific advances and innovations in biomedical and digital

technologies and growing knowledge

▪ Developments in genomic sequencing technologies

▪ Leaps in computing

▪ Wider evolving health/innovation ecosystem & strategies:

• FYFV

• NHS Genomic Medicine Service

• Life Sciences Industrial Strategy

• Accelerated Access Review

Personalised medicine

What are the range of technologies

that could contribute to personalised

medicine?

What are the near-term opportunities

(up to 2020) to advance and realise

the benefits of personalised

medicine?

What are the key considerations and challenges to implementation?

The technology landscape

Report:

Chapters 6

Technology overview 25 broad areas

Digital revolution 7 significant dimensions

Near-term opportunities 7 areas reviewed in detail

Evidence base 24 expert discussants

Near-term & long view 53 key considerations

The technology landscape

The technology landscape

For greater molecular

level characterisation

For personalised

therapeutic interventions

For personalised disease

and health monitoring

Underpinning and

enabling

Technologies for personalisation

Areas reviewed in greater detail

What?

• Detects and analyses fragments of tumour DNA in the circulation

Why?

• Blood sample instead of a more invasive tumour biopsy

• Testing is more accessible

• Can repeat tests

• Could better capture tumour genetic variation

ctDNA liquid biopsy

Current:

• Companion diagnostic testing in non-small cell lung cancer

Future:

• Further companion diagnostic testing

• Monitoring relapse after treatment or emergence of treatment

resistance

Realising the benefits:

• Liquid biopsy is a fast evolving area. Supporting current testing will

provide the foundations to ensure that future uses are realised for

patient benefit as the technology matures

ctDNA liquid biopsy

What?

• Study of RNA and how genes are expressed in a cell, tissue, or sample at

a specific point in time

Current:

• Growing number of targeted gene expression tests for early detection,

prognosis and therapy targeting particularly for cancer

Realising the benefits:

• Health system should prepare to respond to emerging evidence around

gene expression tests, and consider how elements of existing ‘omics

infrastructure could be used

Transcriptomics

What? • Treatments which seek to replace, repair or regenerate the body’s cells,

tissues and organs. Report - focus on gene therapies (including gene editing)

and stem cell therapies

Why?

• Can offer novel treatment options including in rare diseases

• Potential curative or long-term treatments (one-off or infrequent)

• Autologous treatments - reduced risk of tissue rejection

• New opportunities for personalised cancer therapeutics using patients own

immune cells

Regenerative medicine

Current:

• Diverse range of therapies under development – from oncology treatments to

small-scale, trial-based rare disease treatments

• Numerous trials underway

• Two NICE approved stem cell therapies e.g. Holoclar for corneal repair. FDA

and EMA approval for some CAR-T therapies

Future:

• Number / range of therapies likely to expand in the coming years

Realising the benefits:

• National coordinated approach, with designated leadership to fully address

near-term and longitudinal planning needs, including infrastructure, workforce

training, regulatory structures, and methods for reimbursement

Regenerative medicine

Cross-cutting considerations

Enormous growth in the volume of data relevant to personalised

medicine

Digital infrastructure and analytical solutions are key to harnessing

this data, including:

• Continued drive towards digitisation of health records

• Digitisation of processes where appropriate to support advanced analytics

e.g. AI in histopathology

• Robust, scalable, secure and safeguarded computing systems

• Agile and flexible underpinning informatics solutions that can respond

rapidly evolving capabilities of digital health tech

High-throughput

‘omics data

Portable, handheld,

wearable, & mobile

health devices

Digital innovation & infrastructure

AuthorsDr Sobia Raza

Dr Laura Blackburn

Dr Sowmiya Moorthie

Dr Sarah Cook

Dr Emma Johnson

Dr Louise Gaynor

Project consultees Pages 182 -183 of the report

NHS England For giving us this opportunity to undertake this work

Acknowledgements

@PHGFoundation