The specialist fields in which I work, tissue pathology and molecular diagnostics, have undergone extraordinary transformations in recent years. Yes, we're still looking through microscopes in the way that many people might be familiar with. But in Ireland we're also using technology in evermore innovative ways, analysing DNA for mutations to both protect people from contracting disease and treating them more effectively when they are diagnosed.
In particular, with molecular pathology we are able to personalise medicine and offer the kinds of precision treatments – especially for cancer where we can sequence patients’ tumours – that would have been unthinkable just a few years ago.
But we can do better. Indeed, for future Irish generations we must do better and that means taking tough decisions now about how we can improve access to the best medical care. Benchmarking ourselves against other European nations is one way to achieve this and it's why Futureproofing Healthcare: The Sustainability Index, for which I have been a consultant, is such a vital project.
By compiling vast amounts of data from across the EU, the Index enables us to measure accurately how certain nations are performing in terms of diagnostics. And the data shows that whilst our abilities in this field have been transformed, this has not always been matched by the systemic changes which are required to utilise that technology more fully. Only a few nations are able to say that these new diagnostic techniques are reaching the right people at speed, regardless of where people live, their age or status.
Integration
What is apparent for all of us who work in these specialisms – in Ireland and elsewhere – is that there has to be seamless integration of research and clinical activity. If treatment and research is carried out together, in the same place and at the same time, and always in relation to patients, it can become truly transformative. That means that we need to create specialist cancer institutes where high level activity is performed concurrently.
We have to offer patients those abilities. In doing so, we will be able to offer them something else – the opportunity to take part in the latest trials for the newest treatments. Because you don’t get on one of those clinical trials unless you have had advanced diagnostics. And you don’t receive the advanced diagnostics unless you live in certain parts of the country, close to a centre of excellence.
Not all of those trials will be successful but all trials certainly take us one step closer to cures for future patients and generations. What we do today will not always result in immediate benefits but, like a stone thrown in a pond, the ripples always lead elsewhere.
That is another way of looking at futureproofing. We are not only trying to find ways of creating more sustainable health systems for a future in which our various needs will be greater. We are also trying to trial novel therapies today that may only be perfected in the future.
Translational research
Such seamless integration can work in Ireland. We have designated cancer centres and while the majority are associated with university research facilities and clinical trial activity, much more needs to be done to support translational research and to attract and support major global clinical trials in a way that happens in some other countries. Data from the Index shows that some nations are ahead of us in that respect. We can learn from them.
And that is why the Index is so important. It can persuade policymakers that there are healthcare shifts that are not just vital for the future of Ireland but that are already proving successful amongst our European neighbours. Where integration of research, diagnostics and testing is leading to huge benefits for patients.
Data of the type that the Index has amassed will not directly lead to a diagnostics revolution in Ireland. But the intelligent analysis of this data will make clear to stakeholders, politicians and decision-makers that transformation is not just possible but essential.
The pace of disruption within the Irish healthcare system is more rapid than it has ever been. And that’s especially true within the field of diagnostics, where there continues to be a fundamental shift from purely traditional to a combination of integrated traditional and molecular approaches.
‘Futureproof’
By looking at what other countries have achieved through seamlessly integrating their research and activity – particularly in the field of oncology – we can ‘futureproof’ our own healthcare system. Disrupt it now and prepare properly for future disruptions.
The Index encourages us to look for solutions by collaborating with each other. And as molecular diagnostics continues to expand – through emerging areas such as germline and somatic next generation sequencing, gene expression profiling and pharmacogenomics – we need to start making those shifts towards sustainability today.
Measuring ourselves against our European cousins by using the data can show us where the gaps lie in our own provision of care and how we can learn from others to correct these discrepancies.
The Index should not be about who’s better than who. It should provide an opportunity to learn from each other and to have discussions that lead towards changes that must be made if we are to create sustainable healthcare for future generations.
Dr Stephen Finn is consultant pathologist at St James’s Hospital in Dublin