The Topol Review, led by cardiologist, geneticist, and digital medicine researcher Dr Eric Topol and facilitated by Health Education England, was published this week. As an independent review, commissioned by the Secretary of State for Health as part of the development of a new healthcare workforce strategy for England, it has spent the past year exploring how the NHS may be able to utilise new digital technologies to improve its services, and how it can ensure that its staff have the relevant skills and training to be able to exploit these approaches.
Genomics has been one of the key technologies investigated by the Review, alongside digital medicine, AI and robotics. In a rapidly developing healthcare environment, there is little point in investing in the latest technology if there isn’t a workforce with the right skills to make full use of it, also in place. With initiatives such as the 100K Genomes Project already delivering tangible benefits to patients and their families, genomic science has the capacity to radically alter how both rare and common diseases are diagnosed and treated. However there a number of challenges that need to be addressed, in order for this potential to be realised. Our Head of Society and Ethics Research, Dr Anna Middleton, has been deeply involved in the Topol review, providing expert opinion on both the ethics which underpin regulatory frameworks and patient trust, and the skills gap in the current healthcare workforce.
We are pleased to see that the Review has placed people at the centre of its findings and recommendations in relation to genomics.
“Citizens need to be empowered to understand how genomics may affect their health, to make informed decisions about their care, and to recognise the personal and family wide implications of the findings that genomics may bring.” Topol Review, 2019
How to bring about this type of ‘empowerment’ is a question in itself, but it is heartening to see Genomics England’s ‘Genomics Conversations’ referenced in this context. Anna led the Socialising the Genome project as part of this strand of work, to explore the sort of language about genes and genomics that best resonated with different audiences, so that we can all participate in these types of conversations. And we completely agree that a robust ethical framework for genomics should include collaboration with patients and healthcare professionals, in order to maintain public trust in relation to their genomic data.
“Genetic counselling and clinical genetic services will require sufficient capacity to fulfil both their existing specialist roles and to diffuse their expertise across the NHS.” Topol Review, 2019
We also support the recommendations in relation to healthcare professionals and genomic literacy, lifelong learning, and capacity building in the field of genetic counselling. Many of these areas resonate with our own work around communication in the clinic, online training, and developing and supporting the genetic counselling community. We’re pleased to see the insights we contributed to this Review translated into recommendations for training, education and workforce development, which we fully endorse.
With over 1.2 million NHS staff in a wide variety of both clinical and support roles in England alone, this workforce will play a key part in ensuring that patients experience the benefits of new healthcare-related technologies. The Topol Review provides a clear starting point for ensuring that these benefits can be realised. But moving these recommendations forward, within the NHS in England and beyond, will only be possible through collaborative working with a range of patient and professional stakeholders. And this is a process that the Society and Ethics Research group, and indeed the wider Connecting Science programme are looking forward to being a part of.
Anna Middleton is Head of Society and Ethics Research, part of Wellcome Genome Campus Connecting Science. Anna is also the Chair of the UK Association of Genetic Nurses and Counsellors. Anna was a member of the Expert Advisory Panel for the Topol Review.