Artificial Intelligence (Select Committee Report)

Lord Kakkar Excerpts

Monday 19th November 2018 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join in thanking the noble Lord, Lord Clement-Jones, for the thoughtful way in which he introduced this report. I also congratulate the noble Lord and his committee, as it is an excellent report. In so doing, I confine my remarks to Chapter 7, which deals with the potential impact of artificial intelligence on healthcare, and I declare my own interest as professor of surgery at University College London and chairman of UCLPartners.

This excellent report identifies that healthcare and its delivery are particularly sensitive to the tremendous opportunities that the application of artificial intelligence will provide. It also represents all the challenges that the adoption of artificial intelligence will present to society, government, individual professionals and the public more generally.

We have already seen the adoption of artificial intelligence in the application of clinical practice. Two of the most important applications have been in the area of diagnostics. The first regards the interpretation of retinal scans to help diagnose retinal pathology more rapidly. That application, developed at Moorfields Eye Hospital in conjunction with DeepMind, shows particular promise; it allows for broad application across large communities, reducing the time and resources necessary to make appropriate diagnosis of eye pathology and therefore providing the opportunity for earlier intervention and for interfering with the natural history of diseases in the eye to improve clinical outcome. Equally, there have been recent reports of the application of artificial intelligence to the interpretation of lung scans to help the earlier diagnosis of pathology in the lung, particularly pulmonary fibrosis; this is an important condition which, if identified early, allows the opportunity for earlier intervention and therefore, again, “for improving” clinical outcome.

However, these are rather simple applications. As we move forward in our broader development of the life sciences and biomedical sciences, so with reference to the opportunity for genomic medicine—the proper evaluation of the genome under individual disease conditions—combined with better characterisation of the phenotype, better monitoring and characterisation of clinical outcomes and the combination of all those data will provide tremendous opportunities for solutions through artificial intelligence, deep learning and machine learning, which will transform clinical practice.

This transformation will first come in the area of early and more accurate diagnosis; it will soon be applied to the identification of new targets for the management of diseases, with new therapeutic targets for the development of potential new drug entities. This will be done more efficiently and more rapidly, and, of course, in such a way as to deliver on the promise of personalised medicine—precision medicine—through analysis of the characteristics of an individual disease and how that disease behaves, both in individual patients and among many individual patients. One can then predict how the natural history will progress and therefore how we should intervene more effectively.

All this promise is attended by a number of very serious challenges, as identified in this excellent report. How do Her Majesty’s Government propose to deal with seven particular challenges regarding the application of artificial intelligence in healthcare? Without clarity of purpose and of strategy in addressing these challenges, it will not be possible for our country, uniquely positioned as it is with the National Health Service, to bring the benefits of artificial intelligence and the attendant improvement in the delivery of healthcare and clinical outcomes to our fellow citizens.

The first of those benefits relates to data scientists—invaluable experts in a developing field that brings together mathematics, statistics and computational science. These individuals are at the heart of the development of the algorithms that inform artificial intelligence. How do Her Majesty’s Government propose to ensure that the National Health Service can compete in attracting these vital individuals with this particular skill set whom we do not currently have in sufficient numbers in the NHS so as to provide opportunities for artificial intelligence in healthcare?

Equally, a huge amount of data is generated on a daily basis through routine tests, investigations and the follow-up of patients in all healthcare environments. Those data, although vast in quantity, represent a meaningless resource unless they can be curated appropriately and their quality can be secured. They can then be brought to bear to provide opportunity in artificial intelligence application for the benefit of the individual patient. How do Her Majesty’s Government propose to ensure the curation of high-quality data across the widely varying range of institutions and environments where NHS care is delivered to ensure that the value of those data, both for the individual and for society more generally, can be secured?

In that regard, there will also be a need to train current and future healthcare professionals so that they will be able to take advantage of the opportunities that artificial intelligence as applied to healthcare will provide. What moves have Her Majesty’s Government made with regard to, for instance, Health Education England to ensure that curricula are now being developed to ensure both lifetime learning for current professionals and the development of future healthcare professionals so that they can take advantage of the opportunities that are provided? All this will of course require substantial funding. Her Majesty’s Government have committed substantially to increase the NHS budget between now and 2022, but what proportion of that additional funding will be applied specifically to data in the NHS and to the opportunity to adopt innovations associated with artificial intelligence at scale and pace across the entire health economy?

There are then questions relating to the adoption and application of artificial intelligence that attend to other areas, establishing both the social licence that will give the public and patients confidence in the state collecting and keeping secure very sensitive data—far beyond the data that we currently collect, moving to genetic information and beyond—and social licence regarding the sharing of those data, frequently with commercial third parties which have the expertise and experience to exploit them appropriately to provide opportunities to improve healthcare outcomes.

Ethical and legal questions will also need to be answered when clinicians start to rely increasingly on information generated as a result of artificial intelligence applications in making clinical decisions and driving forward patient care. How is that ethical framework to be delivered? How are legal questions around liability to be addressed when decisions are taken on the basis of AI applications for individual patients? Then there are important questions about how NHS institutions will be supported in negotiating access to data both for research and for the development of patient applications. Some institutions are well positioned to do that; others are not. How will Her Majesty’s Government ensure that all that is brought together so that the important opportunities provided by artificial intelligence application for the delivery of healthcare in the NHS can be taken for the benefit of all our fellow citizens?

Industrial Strategy

Lord Kakkar Excerpts

Monday 8th January 2018 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I thank the Minister for the thoughtful way in which he introduced the debate and Her Majesty’s Government’s industrial strategy. I remind noble Lords of my interests as professor of surgery at University College London, chair of University College London Partners, business ambassador for healthcare and life sciences, and a member of your Lordships’ Science and Technology Committee, which is undertaking an inquiry on the life sciences industrial strategy.

It is quite right that there is a very acute focus on the question of life sciences, because they have played, and will continue to play in future, a vital role for our country and its economy. After financial services, the life sciences sector is one of the most important, and it is built on a substantial and impressive ecosystem that has been developed over many decades. We have four of the top 10 biomedical universities in the world; the published output from the research activity in those universities accounts annually for some 10% of citations globally and some 15% of the most highly cited papers published. Much of that research is undertaken with impressive collaboration with institutions in the United States, the European Union and the rest of the world.

We have two of the top 10 pharmaceutical companies based here in the United Kingdom. They represent a vital part of our economy, providing some £21 billion a year in exports. Consistently over the last 15 years, every year, they have contributed more than £1 billion in surpluses to the economy. The impressive large pharma sector is supported by more than 3,500 small and medium-sized enterprises in the medtech and biotech spheres; of those 3,500 companies, some 500 are actively exporting. They have seen substantial growth in the period 2009-14. For the medtech sector it is a 5.8% growth in revenue per annum; in the biotechnology sector it is 4% per annum in that period.

All that demonstrates that we have a fundamental and strong base but, in addition, we have something quite unique—the National Health Service, which provides care free at the point of delivery to all our citizens, and a wide range of care, and which has provided a unique opportunity over many decades to develop the base for our medical research, which in many areas leads the world.

What is striking is how the opportunities and the needs will grow, needs that will have to be addressed by the life sciences sector. The global value of the life sciences industries is some $1.6 trillion; by 2023, that will grow to over $2 trillion. With regard to healthcare expenditure and revenue, in the period between 2014 and 2027 it is estimated that expenditure on healthcare globally will grow by 5.8% per annum, but in certain markets, where we already have a very strong relationship and affinity, it will grow at an even greater rate—in India by some 15% per annum over that period, in China by 12% and in the Middle East and the Gulf by 8% per annum. So there are very big opportunities for the life sciences industrial base to make important contributions to our own economy. At the moment, some 300,000 people are employed in the science and technology sectors, in highly skilled jobs. The potential for that to grow over time to provide economic benefit and employment is quite obvious.

It is for that reason that there is so much focus on the life sciences strategy authored by Sir John Bell and presented along with its first set of sector deals before the Christmas Recess. In that strategy there is a focus on five important areas: to ensure that the science base in our country, to drive the innovation and discovery essential for life sciences, is properly invested in and maintained, not only in the public sector but through private sector investment through the sector deals; to ensure that the innovative companies that result from that discovery can grow in our country; and to ensure that the patient capital essential to allow them to grow over time to become substantial entities is provided in our own country, rather than those small enterprises having to look abroad and, potentially, move abroad, when they require greater investment. We need to provide the opportunity for an appropriate manufacturing base, with the skills required for those highly innovative industries to prosper and succeed in our country.

There are two elements that are vitally dependent on the National Health Service. The first is the adoption of these innovations at scale and pace within the NHS. This is critically important for a number of reasons. First, the delivery of healthcare in our country is not going to be sustainable unless we are able not only to adopt innovation to make the delivery of healthcare more effective in improving clinical outcomes but to use in the most efficient fashion the vital and valuable resource that the state makes available for the delivery of healthcare, providing true value for each of the health economies and institutions where that delivery takes place. Secondly, as we have heard from the noble Lord, Lord Mandelson, there is the need to harness the ability to use the unique data generated in the National Health Service through the care of countless millions of patients, day after day, month after month and year after year. This longitudinal database is unique in the delivery of healthcare anywhere in the world. It can inform research, development and innovation to develop new therapies and technologies and improve the way that we deliver care. All this has huge value in improving the health of our nation and in providing a remarkable opportunity to generate wealth. As the House has already heard, using the technologies that we develop, and the companies that have developed as a result of them, to export globally will transform healthcare throughout the world and, therefore, also ensure and enhance the standing of our country as a leader in healthcare and life sciences.

The life sciences industrial strategy makes a number of important proposals. One is the health advanced research programme, developed to mirror the very impressive programme established some decades ago by the Department of Defense in the United States to ensure that high-risk proposals—the so-called moonshot strategies—can be properly invested, developing transformational technologies and innovations that will have a profound impact, in this case on human health. It has worked so well in the area of defence in the United States because that department has such a huge expenditure budget. This brings me to the question of the vital role that the life sciences strategy envisages for the National Health Service. It must be able to adopt innovation at scale and pace and to provide confidence to those who are going to invest in high-risk strategies that if they are successful there is the opportunity for the home market—the remarkable National Health Service—to adopt those innovations for the benefit of patients and our fellow citizens.

In this regard, there is some concern. The strategy is excellent, but it is unclear how the Government are going to secure the role that the NHS must play in ensuring that the life sciences strategy can be a success. I have three questions for the Minister. First, how do the Government envisage securing the critical role which the National Health Service must play in the broader life sciences industrial strategy? How will funding be made available to ensure the adoption of innovation at a local level, which is vitally important to support the industries that are envisaged as part of the life sciences strategy? How can the Government aid in transforming the culture in the National Health Service, to ensure that what needs to be done by way of adoption of innovation, beyond its funding, will be practicable and possible in terms of developing the remarkable staff who work in the service, ensuring they have the skills to interact with the innovations that are going to be available and overcoming the culture which is sometimes resistant to adopting innovation?

Finally, how will they ensure that lessons are learned from previous attempts at a life sciences strategy? Will the important lessons from the 2011 announcement of a life sciences strategy by the Prime Minister of the time and the subsequent innovation, health and wealth strategy, announced by Sir David Nicholson when he was leading the NHS, be properly adopted to ensure the success of this strategy?

Queen’s Speech

Lord Kakkar Excerpts

Monday 26th June 2017 Lords Chamber

[Lord Kakkar (CB)]

My Lords, it is a very great privilege to follow the noble Lord, Lord Mountevans, and to be the first in your Lordships’ House to be able to congratulate him on his magnificent maiden speech, so clearly informed by the wisdom, experience and insight he has developed through his distinguished career in the City, which culminated, as we have heard, in serving as the 688th Lord Mayor of the City of London. I had the opportunity to speak to the Lord Chief Justice this morning, who indicated to me that the noble Lord was a most successful Lord Mayor of the City of London. He is highly regarded throughout the City and beyond, and your Lordships’ House will benefit from his future contributions to the important work that we have the responsibility of discharging on behalf of our nation.

I also congratulate the Minister on the thoughtful way in which he introduced this debate and declare my interests as professor of surgery at University College London, chairman of UCLPartners and UK business ambassador for healthcare and life sciences. I shall concentrate my contribution in this debate on the area of life sciences.

We heard from the noble Lord, Lord Mountevans, that financial services represent the most important part of our economy, but beyond financial services the life sciences are the second. They are an industry and a sector predicated on the development over many decades of a very finely balanced ecosystem. At the heart of that ecosystem is the National Health Service. Four of the 10 leading universities of the world, three of the 10 universities leading specifically in the field of life sciences, and two of the top 10 pharma companies in the world are based here in the United Kingdom, between them employing some 200,000 people in more than 180 countries around the world and providing a surplus in excess of £20 billion a year to the UK economy. There are some 1,300 companies in our country manufacturing in the medical area. There are 3,500 small and medium-sized enterprises, 500 of which are exporting actively, and the life sciences industries employ some 235,000 people, which is just under 1% of total private sector employment in our country. Those are important statistics, because the life sciences sector not only makes an important contribution to the economy and to generating wealth but has the vital purpose of ensuring that we can improve healthcare and the outcomes we can achieve for our patients through the application of innovation and technology that has transformed life prospects over recent decades.

A recent UK Trade & Investment report, Strength and Opportunity in 2014, which looked at the life sciences sector in 2014, established that it was a true world leader. Since 2011, the sector has attracted some £7.5 billion of inward investment into our country, which has resulted in the creation of some 18,000 jobs. The medtech sector grew at some 5.8% per annum in the period 2009 to 2014, and the biotech sector some 4% per annum. Those are very impressive figures when one looks at the general pace of economic activity during that period, and something that cannot be neglected.

The Conservative Party manifesto at the last election committed to ensuring that the United Kingdom was the most innovative country in the world. Clearly, the gracious Speech has identified certain areas of innovation—we heard in the Minister’s introductory comments a particular focus on driverless cars and travel into space—but I hope that the Minister can confirm a continued emphasis on the area of life sciences. This important area of activity, which is so bound up with the public sector, our universities and the delivery of healthcare, will not thrive unless there continues to be a determined focus on ensuring that it can compete globally. It is a sector, beyond many others. that is exquisitely dependent on collaboration—across universities, across industries and between Governments. Any loss of focus in that area will result in our country paying a heavy price.

In that regard, would the Minister be able to address two or three questions? First, is he content that there will be the opportunity for sufficient focus on the life sciences sector so that it can continue to deliver as required without any further legislation to deal with some anomalies with regard to the environment in which it has to operate? In particular, is he content that UK Research and Innovation will be able to drive the kind of collaborations and co-operation among scientists and innovators, not only in our own country but across the European Union, and potentially in other fundamentally innovative economies such as the United States and the emerging innovative economies in the east, such as China and India?

Is the Minister content that the vital role that the National Health Service has to play with regard to innovation in the life sciences sector can be delivered, particularly with the adoption of innovation at scale and pace—innovation established in our own country and applied for the benefit of the patients in our National Health Service but also using the fundamental opportunities of the NHS to demonstrate to the rest of the world the value of what we can bring to drive improvements in global healthcare?

Finally, is the Minister content that the life sciences sector can be properly supported in the negotiations attending our exit from the European Union?

[Lord Davies of Stamford (Lab)]

Before the noble Lord sits down, I have been listening to him—