Virtual City-Wide Medical Grand Rounds: Barnet Berris Lecture

Changing the Paradigm for Healthcare Systems

Professor Sir John Bell, CH, GBE, FRS

OVERVIEW:

All healthcare systems globally are under considerable pressure and there is a serious question about whether they are sustainable in their current form. Many of these in developed economies are based on the healthcare requirements and services developed in the 1950s and 1960s, essentially a health system targeting acute episodes of care in late-stage symptomatic disease.  This approach has worked very successfully and, indeed, life expectancy has extended dramatically over the past forty years, but often without equivalent increases in healthy life expectancy.  It is increasingly clear that demographic shifts and the pressure emerging from chronic diseases, often those not looked after well in existing healthcare systems, is creating an enormous burden on society and on health services.  
 
In order to approach this problem, it is necessary to reconsider what the major causes of the chronic disease epidemics we are seeing arise from.  It is clear that most of these diseases are prevalent in asymptomatic populations and, indeed, 80% of the natural history of these diseases is present without acute or active symptoms.  However, they are associated with a clear set of risk factors that can be relatively well-defined and, thanks to innovation in healthcare, these factors are now increasingly addressable.
 
The NHS in England is an example of a healthcare system under considerable pressure.  The rise in incidence of chronic diseases and co-morbidities is not only producing direct pressure on the NHS, but also on the labour force. The number of people who have left the workforce because of chronic ill health has doubled over the last two-and-a-half years and this is largely due to the major chronic diseases which are not well managed within the NHS.
 
We have been developing a strategy to test and evaluate how one could pivot a healthcare system to one associated with early diagnosis, risk factor detection, increasing focus on prevention and early intervention.  Based on the success of UK Biobank and Genomics England, Our Future Health has been created as a large-scale cohort focusing on early detection of and early intervention in the treatment of the major chronic diseases.  It is a community-based study that is recruiting participants at the rate of a million per year, with the end-goal being five million people recruited, consented, and participating in the project.  We believe that there will be early successes in preventing and controlling the chronic disease epidemic, but it will require significant change in focus of almost all elements of healthcare.  Without this, current health systems are unlikely to be sustainable.

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