Many innovations have improved the COVID-19 response and could be key for future-proofing against pandemics. What are the governance and privacy concerns?
Overview of change
Public health is ”the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society”.1 Early detection of diseases (such as chronic inflammatory diseases, cancer or dementia) improves health outcomes, reduces costs for health and social care systems, and is a key component of public health programmes.2–7 Similarly, disease prediction can inform targeted interventions, reaching those individuals most at risk (while avoiding unnecessary testing for individuals at low risk), improving outcomes, and reducing time and treatment costs.6,7
There is increasing focus on developing better diagnostic technologies and disease prediction tools. Examples include minimally invasive technologies (such as ingestible sensors, or diagnostics that use hair or breath as a sample), artificial intelligence-based tools and portable diagnostic kits.8–16 Many of these technologies require further development and adequate funding before being widely deployed.
Patient trust, adequate staff training, consideration of the ethical aspects of these new technologies (especially those involving AI or genetic testing) and equity of access are required for widespread adoption of new diagnostic technologies and disease prediction tools.
Challenges and opportunities
The Research and Development (R&D) landscape in the UK is mainly driven by the private sector, but the public sector has a key role in supporting innovation in a variety of fields, including health (see The Future of UK Research). Health innovation can be encouraged through allocated research funding, targeted technology development programmes such as the NHS Innovation Accelerator (NIA), and better alignment among different stakeholders, including academia, regulators, industry and the health service.17–20 The NHS Accelerated Access Collaborative, set up following the 2016 Accelerated Access Review, is a partnership between patient groups, government bodies, industry and NHS bodies to promote the adoption of new technologies in the NHS.21,22 It has highlighted that engagement with patients, charities and clinicians is key to the prioritisation and adoption of technologies in the NHS.
Disease diagnosis and prediction technologies continue to be developed for a wide range of applications. Examples include minimally invasive techniques for the detection of specific cancers or hormone levels in women seeking fertility treatment.8,10 Blood tests are being developed to detect early markers for certain neurological conditions in newborns (such as severe disability following difficulties at birth) or older adults (such as Alzheimer’s disease).37,38 Genetic testing can detect certain cancers or can be used to screen embryos.39–41 AI-based diagnostic tools have been used to examine stool samples, monitor heart function, or analyse scans and pathology from biopsies.11,42 And finally, point of care kits are being developed to diagnose cancers (by analysing biopsies obtained by needle aspiration) or infectious diseases (from example, from a blood sample).12,13
Issues related to the adoption of these new technologies include facilitating commercialisation and industry access to the NHS, ensuring sufficient test accuracy to minimise the rate of false test results, and confirming that datasets can be shared appropriately to develop future disease diagnosis and prediction tools. Patients need to be engaged to properly inform them about new technologies and foster trust in the testing of new technologies within the NHS.
Finally, widely embedding innovation in the NHS, regardless of differences between local trusts, is a key challenge in the UK. In February 2021, the UK Government published ‘Integration and innovation: working together to improve health and social care for all’, a white paper setting out legislative proposals for a Health and Care Bill. One of the key aspects of this document is to reduce bureaucracy, with the potential to facilitate the embedding of innovation in the NHS.43,44 The House of Commons Health and Social Care Committee has started an inquiry to analyse the white paper proposals.45
It is unclear how and when these tools will be widely available. Further research, safety assessments, regulatory approval and staff training are needed. There is also a need to ensure that services can cope with the consequences of more proactive testing, including follow on tests and treatments.
In August 2020, the UK Government announced the creation of, a new public health body (originally called the National Institute for Health Protection) to replace Public Health England (PHE)46–48 PHE has been responsible for the coordination of NHS-led screening programmes so far and it is currently unknown how its role in disease prevention will change with the establishment of the new institute.49 On 24 March 2021, the Government published a white paper describing the aims of the new agency (now titled ‘UK Health Security Agency’), where it is stated that “options for the placement of expert advice on screening […] and the national screening programme quality assurance functions (currently provided by PHE)” are currently being considered.50
Key questions for Parliament
- Is there adequate funding for the development of better disease prevention and diagnostic tools?
- Will the changes proposed in the UK Government’s Health and Social Care white paper be adequate to support innovation within the NHS?
- How can we streamline and accelerate the implementation of new tools and pathways for early diagnosis in the NHS?
- How easy and equitable is patient access to innovative medicines and diagnostics?
- Are the ethical implications (including patient privacy and right of choice) of new innovations being adequately considered?
- Is enough being done to support public engagement with the development and use of these technologies?
Likelihood and impact
Better disease prevention and diagnostic tools have the potential to reduce NHS spending and improve population-wide health outcomes. Overall: high impact, impact felt within the next 5 years.
- Acheson, E. D. (1988). Public health in England: the report of the Committee of Inquiry into the future development of the public health function. HMSO.
- Department of Health and Social Care Prevention is better than cure. 2018,
- Cancer Research UK. (2015). Why is early diagnosis important?
- Rasmussen, J. et al. (2019). Alzheimer’s Disease – Why We Need Early Diagnosis. Degener Neurol Neuromuscul Dis, Vol 9, 123–130.
- Population Health Screenings for the Prevention of Chronic Disease Progression. AJMC.
- Crosby, D. et al. (2020). A roadmap for the early detection and diagnosis of cancer. The Lancet Oncology, Vol 21, 1397–1399. Elsevier.
- CRUK (2020) Early Detection and Diagnosis of Cancer – A Roadmap to the future.
- Fitzgerald, R. C. et al. (2020). Cytosponge-trefoil factor 3 versus usual care to identify Barrett’s oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. The Lancet, Vol 396, 333–344. Elsevier.
- Wilson, C. Hair sample tests may give women more accurate fertility predictions. New Scientist.
- Crisci, A. K. et al. (2020). QUANTITATIVE DETECTION OF BIOLOGICALLY RELEVANT ANTI-MULLERIAN HORMONE (AMH) AND PROGESTERONE IN HUMAN HAIR SAMPLES. Fertility and Sterility, Vol 114, e531. Elsevier.
- Moxie – Poop scanner [online]. Accessed on 23/3/21
- CytoPAN—Portable cellular analyses for rapid point-of-care cancer diagnosis | Science Translational Medicine.
- Mutreja, A. et al. Antibiotic resistance: cheap diagnostic test could be a saviour. The Conversation.
- Hanna, G. B. et al. (2019). Accuracy and Methodologic Challenges of Volatile Organic Compound–Based Exhaled Breath Tests for Cancer Diagnosis: A Systematic Review and Meta-analysis. JAMA Oncol, Vol 5, e182815.
- Peters, Y. et al. (2020). Detection of Barrett’s oesophagus through exhaled breath using an electronic nose device. Gut, Vol 69, 1169–1172.
- Assessment of a Noninvasive Exhaled Breath Test for the Diagnosis of Oesophagogastric Cancer | Cancer Screening, Prevention, Control | JAMA Oncology | JAMA Network.
- SBRI – AI supporting early detection and diagnosis in heart failure management – UKRI.
- Innovative Diagnostics. Oxford University Innovation.
- Healthcare Innovator Awards – Grant Funding | Wellcome. [online] Accesses on 23/3/21
- Welcome to the NHS Innovation Accelerator. NIA.
- Accelerated Access Review: final report. 70.
- NHS Accelerated Access Collaborative.
- Build Back Better: our plan for growth (HTML). GOV.UK.
- Competition overview – Digital health technology catalyst round 4: collaborative R&D – Innovation Funding Service.
- £9m awarded to breakthrough digital health technologies. GOV.UK.
- Competition overview – Biomedical Catalyst 2020: round 1, early and late stage awards – Innovation Funding Service.
- ISCF – Innovate UK.
- Accelerating detection of disease challenge – UKRI. [online] Accesses on 23/3/21
- From data to early diagnosis and precision medicine challenge – UKRI. [online] Accesses on 23/3/21
- Accelerating detection of disease challenge – UKRI. [online] Accesses on 23/3/21
- Healthy ageing challenge – UKRI. [online] Accesses on 23/3/21
- ClinSpec Dx: Diagnostics for Cancer. [online] Accesses on 23/3/21.
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- Development and demonstration of clinical potential for a multi-biomarker-based, low-cost, point of care, lateral flow blood test for active tuberculosis.
- binx Health – Homepage. [online] Accesses on 23/3/21.
- HartleyJul. 29, C. et al. (2020). Blood test could identify early stage Alzheimer’s disease. Science | AAAS.
- Montaldo, P. et al. (2020). Transcriptomic profile of adverse neurodevelopmental outcomes after neonatal encephalopathy. Scientific Reports, Vol 10, 13100. Nature Publishing Group.
- (2020). Genetic tool can identify Asian women at higher risk of breast cancer. University of Cambridge.
- The role of exome sequencing in newborn screening for inborn errors of metabolism | Nature Medicine.
- Human Fertilisation and Embryology Authority (2020) New technologies in embryo testing.
- AI tracks a beating heart’s function over time.
- Department of Health & Social Care (2021). Integration and Innovation: working together to improve health and social care for all.
- Blueprint launched for NHS and social care reform following pandemic. GOV.UK.
- Health and Social Care Select Commitee Department’s White Paper on health and social care.
- The future of public health: the National Institute for Health Protection and other public health functions. GOV.UK.
- Government creates new National Institute for Health Protection. GOV.UK.
- Rough, E. et al. (2021). Establishing the National Institute for Health Protection.
- Statement UIN HCWS606 (2021).
- Department of Health and Social Care (2021) Securing our health: the UK Health Security Agency
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