As we approach the 75th anniversary of the NHS, it is important to consider how research has shaped our current care and practice, but also what the future will hold. Professor Melanie Davies CBE, Director of the NIHR Leicester Biomedical Research Centre and NIHR Patient Recruitment Centre: Leicester and Professor Nigel Brunskill, Director of Research and Innovation at Leicester’s Hospitals and NIHR Leicester Clinical Research Facility, share their thoughts
Professor Melanie Davies said: “In the area that I work in, which is diabetes, I have witnessed incredible changes in clinical management largely driven by research and innovation.
“Although insulin was discovered 2 decades before the NHS was established, since 1948 we have moved through cycles of improvement of the purity of insulin and insulin formulations, making them much more convenient for administration.
“The first insulin pumps were developed in the 1970s, and much better basal insulin in the early 2000s, reduced the risk of hypoglycaemia (low blood sugar) and made insulin administration more convenient.
“In the last 20 years we have seen a technological revolution with continuous monitoring of glucose, delivery of insulin by continuous subcutaneous pumps, and now closed loop systems, where we are almost able to mimic the physiological delivery of insulin by the pancreas.
“Similar amazing changes have been driven through research in Type 2 diabetes, particularly with the advent of new pharmacotherapy which is not only to improve the long term outcomes of diabetes – reducing the risk of cardiovascular events and renal disease progression – but also now smart pharmacotherapy where we have just published exciting data in the Lancet showing mean weight loss of 25%. As these medicines enter the market, they have the potential to transform weight management, and gets close to what we have seen with metabolic surgery.
“In the future, research will continue to transform possibilities: we are likely to fully harness the potential for Artificial Intelligence, and increase our use of technology in both facilitating different models of care for patients and delivering life-saving treatments. We will continue to see the concept of precision medicine, with its emphasis on matching patients to the most effective treatments for them based on their genetic make-up, move beyond cancer care to many other aspects of clinical management, and will increasingly harness the use of routine healthcare data to better plan and deliver efficient and innovative care at pace and scale.”
Professor Nigel Brunskill said: “Research in genomic medicine and ‘multi-omics’ will grow and herald a new era of personalised medicine for all. This is a step-change from the using the same medicine at the same dose for all people and expecting the same results.
“There will be new targets for advanced therapies and more gene therapies for rare diseases and cancer, giving hope to many families with rare or inherited conditions. We will also use genomics to predict to a greater extent those that may be at higher risks of developing health conditions before they have any symptoms and use preventative medicine to reduce or even remove that risk.
“We are starting to see the benefits of using large scale data to facilitate research into which treatments and care pathways bring about the greatest improvements to people’s health, and just as importantly, what does not work and can be phased out.
“During COVID we saw wider uses of new clinical trial designs, such as digital and remote trials, developed to overcome the constraints of geography and limited access to hospitals at that time. We will see more trials like this, which will increase the number of people who can take part in research – no matter where they are located – and help to answer more health questions.
“As we work to integrate health and social care through partnership, I expect there to be many research-enabled changes to the way care is delivered to help people live longer, healthier lives.”