Written Statement: Precision Medicine

We are living in an era of rapid technological innovation, which is permeating every area of our lives. Increasingly this will include the management of our health and care. This technological revolution is opening up new areas in our understanding, detection and treatment of disease. Through these innovations we are entering into a new era of healthcare called ‘precision medicine’ which holds the promise of more personalised health and care.  Advances in DNA analysis for the diagnosis and targeted treatment of diseases, such as cancer; point of care testing for infection control and the use of Artificial Intelligence to support clinical decision making together with digitally connected health records are just a few examples of how technology will support the provision of personalised care.

In Wales, our journey towards precision medicine is well underway and I am confident that we can be a front runner in the global race to harness the potential of precision medicine. It is vital that we have a connected and collaborative approach towards precision medicine and that our story is heard both in and outside Wales as an example of good practice and of working together towards a common set of goals.

NHS Wales is on the cusp of realising the significant benefits that can be delivered from providing the right test or treatment to the right patient at the right time.  The continuing evolution of precision medicine will help us to mitigate the escalating costs we face from providing excellent healthcare to an ageing population whilst providing more care closer to home. Our long term plan “A Healthier Wales” recognises the importance of moving towards earlier detection and intervention which is designed to prevent illness and prolong independence.  

The integration of diagnostics and personalised therapies with big data (e.g. machine learning) are the vital components for expanding precision medicine and the enhanced delivery of high value care. We already have strong foundations in place to widen the options for prevention, diagnosis and more effective treatment.  

My vision for precision medicine has two elements, which are integrated diagnostics and advanced targeted therapeutics. For both elements we have a clear national vision that sets out how we will transform our services to create sustainable, high quality, future-facing care pathways that have space for increased research, innovation and strategic partnerships.

In the NHS, diagnostics must be firmly positioned at the forefront of patient care. If we can know earlier what the diagnosis is, we can be more effective with our decisions and provision of care and support. Accurate and appropriate diagnosis provides the bridge for decision making between the clinician and the patient that will lead to better patient outcomes and experiences.  We must strive to improve the prediction and prevention of disease. There are already a wide range of advanced technologies that can yield higher quality laboratory and imaging results than were previously available only a few years ago. For hundreds of years the examination of tissue sections and blood samples has been carried out using a microscope and glass slides. Since 2019, we have had digital microscopy for pathology tissue samples in all University Health Boards (UHBs). Building on the successful work in Betsi Cadwaladr UHB, the digitalisation of pathology workflows will be a vital first step to harness the potential for computational approaches for pathology image analysis. Here, I want to be clear that we are transforming accepted clinical practice that has been in place well before the creation of the NHS and embracing new technologies for the betterment of patient care and our service.

Today, I have published a Statement of Intent setting out plans for a national programme to transform pathology services, like digital pathology, across Wales. This provides the strategic framework for working with NHS Wales and partners to develop an implementation plan that will be presented for my consideration later in the year.

Last year, I published a strategic framework setting out a national vision for transforming imaging services across NHS Wales. An early priority was to establish the National Imaging Academy (Pencoed), which I opened last month. We are also working with NHS Wales on plans for an all-Wales approach to investment in positron emission tomography scanners that provide highly accurate images of disease and guide subsequent treatment decisions. Last year, through Welsh Health Specialised Services, we commissioned a wider range of PET scans in Wales and this year we are broadening the number of conditions that we scan to meet the emerging evidence base. These are just two examples of us doing what we say, more will follow and will include new ways of multi-professional working, improved image sharing across Wales and the analysis and accurate detection of disease through artificial intelligence.

Human and pathogen genomics are important components of the personalised medicine journey and will refine the diagnosis, treatment and prevention of disease in Wales.  Building on the Genomics for Precision Medicine Strategy that I published in July 2017, Genomics Partnership Wales will provide the foundation for the infrastructure needed to develop world class genomic services for the people of Wales.  The pace of change in the field of genomics is startling. I am committed to making sure that people have access to the latest genomic tests and pleased to say that £5.9m has been allocated in 2019-20 to continue to take forward the Strategy and this includes an additional £2.3m to support the delivery of new genetic tests. We will continue to work with our UK colleagues to make sure people have access to the right test when needed and ensure there is mutual benefit from UK research and innovation funding for genomics.

On an almost weekly basis, we hear of new disease treatments through cell and gene therapies. Our understanding of disease and our ability to manipulate human tissue is ushering a new era of advanced therapeutics. Regenerative medicine (stem cell therapies, gene editing and gene therapies) are treatments which seek to replace, repair or regenerate the body’s cells, tissues and organs. A number of the emerging regenerative medicine treatments offer potentially curative or long-term treatments for chronic diseases, as well as new opportunities for personalised cancer therapeutics using the patient’s own immune cells. Given the need to ensure health system readiness for implementing these therapies as their number and range expand over the coming years, I have also today published our Statement of Intent for Advanced Therapeutic Medicinal Products.  This sets out our intention to develop and deliver a national approach for precision therapeutics in Wales. We will build upon the successful UK Industrial Strategy Challenge Fund bid to support an Advanced Therapies Treatment Centre, to work with NHS Wales, industry and academic partners to prepare an implementation plan that will report back to me later this year.

In keeping with precision therapies, I visited today the Rutherford Cancer Centre in Newport where they will provide proton beam therapy for some adult cancer cases. Proton Beam Therapy is a highly targeted radiotherapy technique which will support the treatment of patients with otherwise difficult to treat cancers. The relationship with the Centre is new and illustrates how we are working collaboratively for the betterment of patients in Wales so that they can access this treatment locally.

There are huge opportunities to support patient care by the use of digital data and our ability to interpret the information in a meaningful and valuable way. The quantity, quality and relevance of patient information being collected today, with the promise of more tomorrow, will be critical to improving precision in medical diagnoses and treatment. We already safely and securely collect, collate and care for significant amounts of patient data through the electronic patient record and Welsh Government supported Secure Anonymised Information Linkage Databank (SAIL). We will also be able to capture and store large amounts of quantitative data from high-resolution medical images and there are big strides to be made by analysing the results of the visual images using diagnostic algorithms which will help to reduce variability in diagnosis. Over time, the application of deep learning and artificial intelligence techniques to anonymised clinical data sets will give clinicians and medical researchers the ability to establish connections and patterns that would not be apparent if data sets were smaller and involved human interpretation alone. 

One of the most pressing cross-cutting requirements is the need for improved informatics infrastructure to be able to collect, store, share, integrate and analyse the vast amounts of patient data. Without the underpinning investment in informatics platforms and software solutions progress towards greater personalisation will stall. In a fast evolving era of data and machine learning it will be crucial that our health system’s informatics solutions are sufficiently agile and flexible to respond to the evolving capabilities of these new biomedical and digital health technologies.  Welsh Government are supporting this drive through our digital strategy and investing in the development of the National Data Resource.

Unlocking the real opportunities from precision medicine and artificial intelligence will require even greater collaboration with innovators from industry and academia, as well as meaningful engagement with both the patient and public, to support joint decision making and patient empowerment. With everyone committing to this journey, we can foster a culture of trust that will permeate healthcare and ensure that new technologies are integrated swiftly for the benefit of patients.

We are fortunate that we already have a strong cluster of life science companies and the Life Sciences Hub who can help to support our journey into the precision medicine era. We have strength, depth and close working relationships with our academic partners in Wales, many of which already have both national and international reputations in precision medicine.  I am keen that we should build on our strong foundation and international reputation of excellence in clinical research and industry activity and look to further strengthen our national and international position in precision medicine.

We will fully explore opportunities like the Cardiff City Region Deal and those emerging from the UK Government through the Industrial Strategy and Life Sciences Sector deal to benefit businesses in our life sciences sector as well as the people of Wales. We will use ‘national collaboration’ and a ‘system-level approach’ to create an axis of precision medicine progress, encouraging and creating opportunities for others to work with us on this journey so that we can play our part in this global revolution.  

My ambition to expand precision medicine and to put diagnostics at the forefront of care will lead to higher value patient care. Our ability to capture and harness the significant benefits from future advances in diagnostics and personalised therapies, together with powerful artificial intelligence, are vital if we are to improve patient outcomes and help to mitigate the significant financial pressures our health system faces on a daily basis. Collaboration between all our partners involved in these initiatives is vital to ensure that precision medicine will create the foundations for a learning health system that will drive ongoing improvement, research and innovation in healthcare practice.

This statement is being issued during recess in order to keep members informed. Should members wish me to make a further statement or to answer questions on this when the Assembly returns I would be happy to do so.