My Lords, I join in thanking the noble Lord, Lord Clement-Jones, for the thoughtful way in which he has 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 to 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 improve 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 solution 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?