Who are NHS scientists?
Biomedical scientists, a subset of healthcare scientists, comprise the biggest scientific workforce in the health service and specialise in diagnosing and monitoring disease. Thanks to genomics, they’re also beginning to play an increasingly important role in directing treatment.
“Between 70 and 80% of all patient pathways rely upon a diagnostic test at some point – anything from a blood test to a swab to excising a piece of tissue,” Wells explains. “Biomedical scientists or pathologists deal with these tests, so they’re fundamentally vital for healthcare in general and cancer care in particular.
“But where biomedical scientists really add value is in working out the type and grade of a cancer and identifying which genes and mutations might be driving it. That’s crucial for ensuring not only that patients get the most appropriate diagnosis, but also that oncologists can offer them any personalised medicines that could make the difference in their treatment.”
Biomedical scientists are clearly instrumental in cancer diagnosis and care today, but, with innovations like liquid biopsies and multi-cancer tests on the horizon, we’re just beginning to scratch the surface of what they can do. Wells is quick to highlight some of the ways advances in genomics could fundamentally change NHS scientists’ day-to-day.
“In the future, we could dive into people’s genomes to understand more about the drivers of cancer, and we could use what we find to help direct risk-stratified screening,” he says. “Then, as liquid biopsy technology keeps improving, we could use blood tests to find cancer mutations in high-risk groups like people with a history of smoking before tumours present. In some cases, we could match those mutations to personalised medicines right at the start of the diagnostic process, so people can start receiving effective treatments much sooner. And, if we can connect biomedical scientists to primary care, we can match all these advances to the specific needs of different populations.”
A workforce to bridge the gap between science and medicine
As our understanding of genomics grows, having a workforce that can bridge the gap between science and medicine will be vital. The UK Government and NHS England recognised this in the NHS Long Term Workforce Plan, which includes commitments to increase healthcare sciences training places by more than 30% to over 1,000 places by 2031/32. However, this covered all healthcare scientists and was not broken down into the many specialisms that sit underneath this catch-all category. Wells stresses that, with ever more complex treatments, rising cancer incidence and more people with multiple conditions, the NHS is likely to need more healthcare scientists than current plans propose, and biomedical scientists are a good pool of talent to draw from.
“Uniquely in the healthcare workforce, expanding the training posts for biomedical scientists would mean you could just give these people one-year contracts to train, and you’d suddenly have a lot more qualified scientists,” he says. “Unlike other healthcare professionals, undergraduates in biomedical sciences do not receive funding from government. And their degree means these graduates are useful members of the lab team from the very start. Through the one-year training posts, you’re getting a qualified health workforce for, effectively, one year’s salary, on which they are also working and contributing to the NHS.”
It’s essential that the UK finds long-term solutions to expand the healthcare sciences workforce to meet growing demand for more complex tests, like those used in genomic medicine. But with shortages across almost all the professions involved in diagnosing and caring for people with cancer, the health service must also find ways to make the best use of the skills and experience it already has. Wells is an advocate for taking an innovative skill mix approach, using consultant scientists to support clinical teams in the prevention, diagnosis and treatment of illness.
“We need more medical consultant-equivalent scientists to support clinicians,” he stresses. “We can’t close the gaps in the medical workforce quickly enough without them. Having these roles handling diagnostics in healthcare teams means the medics can focus their time and effort where it’s needed most and where they add the most value. Plus, the consultant-level scientist qualification costs roughly as much as a Masters. I don’t know any other workforce where that level of expertise and utility is achievable at that price.”
A pivotal moment
This is a pivotal moment for the health service. The UK Government has committed to making long-term changes to deliver three strategic shifts: hospital to community, analogue to digital, and sickness to prevention. Genomics can play a crucial role in achieving these ambitions, and David believes there are some key things that the health service and government should consider as they develop their plans.
“The Government and the NHS need to give the experts in diagnostic labs a voice in the innovation agenda alongside GPs and other groups,” he says.
“Almost in their entirety, biomedical scientists sit in secondary care. But imagine a community of scientists working with a community of GPs to manage their approach to testing and match their testing regimen to a particular population. Testing really isn’t one size fits all – and this would mean we’re using our tools in the way that makes the biggest difference to people’s health.
“Diagnostics should be seen as part of a continuum of care, from cancer diagnoses to long-term condition management. Biomedical science can play a part in identifying patients, tracking them, and stratifying them earlier.”
Many of these proposals might seem like a long way from the reality of today. But by continuing to invest in high-quality research, and combining that with evidence from frontline insights and sustainable workforce planning, we can unlock the potential of genomic medicine to deliver better outcomes for people affected by cancer.