The periodical of the Harley Street Health District Issue 15 / 2025
The eyes have it
Professor Paulo-Eduardo Stanga of The Retina Clinic London on the unique pleasures of working with the human eye
The Good Fight
Professor Teresa Lambe on how the global battle against Covid-19 changed the world of immunology
Tomorrow’s world
The drive to deliver novel solutions to modern healthcare challenges
Women first
How a women’s clinic is helping close the gender health gap
Prognosis is owned by The Howard de Walden Estate 23 Queen Anne Street London W1G 9DL 020 7580 3163 hdwe.co.uk
Howard de Walden contact Annette Shiel annette.shiel@hdwe.co.uk
Publisher Lusona Publishing and Media Limited lusonapub.co.uk
Editor Viel Richardson info@lusonapub.co.uk
Editorial consultant Mark Riddaway mark@lscpublishing.com
Contributers
Jonathan Browning, Ellie Costigan, Gerard Gilbert, Angela Holder, Vicki Power, Christopher L Proctor, James Rampton
Design and art direction Em-Project Limited mike@em-project.com
Women first Dr Orlanda Allen of HCA Healthcare UK on how a women’s clinic is helping close the gender health gap
04 Harley Street Health District
update
Mark Kildea, CEO of The Howard de Walden Estate, on the changing face of Harley Street
04 Home of unrivalled connections
News from The Howard de Walden’s Healthcare Conference
09 News
New arrivals, developments and events
10 Crystal ball
The evolution of treatments for tricuspid valve regurgitation
11 Harley Street hero
The life and times of Sir Harold Ridley
12 How does it work?
Selective neurectomy
14 Thinking aloud
The thoughts of Edward and Robert Ungar, co-founders of Pharmacierge
16 Profile of a pathogen
Helicobacter pylori
18 How to
Spot signs of breast cancer
20 A day in the life
Dr Simrat Marwah, medical director of OneWelbeck’s Health Assessment & Longevity Centre
24 Stem subjects
Dr Emma Nicholson, consultant haematologist at The Royal Marsden, on the work that goes into a stem cell transplant
26 Research party
Professor Rosalind Smyth on how the Academy of Medical Sciences plays a vital role in shaping the evolution of healthcare
30 The big interview
Professor Teresa Lambe on how the global battle against Covid-19 posed unprecedented challenges for the medical community and changed immunology forever
36 The eyes have it
Professor Paulo-Eduardo Stanga of The Retina Clinic London on the pleasures of working with the human eye
42 Tomorrow’s world
Dr Chris Laing of UCLPartners on the drive to deliver novel solutions to healthcare challenges
46 Q&A
Dr Leon Rozewicz of the Priory Group on transcranial magnetic stimulation
50 Patient experience
Philip Williams on how a knee replacement released him from decades of pain
54 Women first
Dr Orlanda Allen of HCA Healthcare UK on how a women’s clinic is helping close the gender health gap
60 My Marylebone
Dimitrios Mylonadis, founder of Hopscotch Children’s Therapy Centre
62 What’s on Cultural events near the Harley Street Health District
63 Five Places to see art in Marylebone
64 The guide
Pioneering Marylebone residents
Our healthcare system provides you with lots of different treatments for free when you need them, but we’re not really doing the preventative work to avoid those treatments being required in the first place.
Dr Simrat Marwah
20
Introducing the Harley Street Health District
Mark Kildea, chief executive of The Howard de Walden Estate, on the changing face of Harley Street
Welcome to the latest issue of Prognosis. As you will see from the new logo at the start of this issue, things are changing. Driven by advances in technology and changes to public attitudes, the healthcare landscape is rapidly evolving. And the key word in this change is ‘health’. It used to be that people didn’t think about their health much – or even at all – until they became ill and they looked to healthcare services for a cure. What we called ‘healthcare’ was in reality ‘sick care’.
There will, of course, always be a place for primary healthcare, as the place to go for people who fall ill. However, we are seeing a fast-growing interest in the maintenance of good health, driven by
in Harley Street. Our District is known
across the world for its 160-year medical heritage, but the evolving landscape
opportunities. We are looking to position the Harley Street Health District as a leading location in this new landscape.
The idea behind our new vision is to provide more than just facilities for healthcare providers – it’s about affirming Harley Street as the ‘home of health’. We aim to attract those organisations that are redefining healthcare, focusing on preventative and predictive solutions. By fostering an environment where pioneers can flourish, we want the district to become a magnet for organisations
addressing the most complex challenges in healthcare, while simultaneously retaining and improving the world-class care already available in the area.
One of the cornerstones of this transformation is an enhanced commitment from The Howard de Walden Estate to foster greater collaboration. Many clinics in the area engage in productive partnerships, but we are taking a more proactive approach to identifying new collaboration opportunities and strengthening existing ties. By connecting medical providers, researchers, technology innovators and financial partners more widely, our network offers far more than a prestigious address. This approach not only benefits individual businesses but also enhances the collective value of the District.
Strategically located between two major NHS Trusts, Harley Street boasts an exceptional concentration of healthcare expertise. From specialist hospitals to wellness providers, the District is evolving into an integrated healthcare ecosystem that spans prevention, treatment, and long-term care. This collaborative model reflects the future of healthcare – one that prioritises patients, partnerships and innovation.
For HealthTech startups and forward-thinking organisations, Harley Street offers an unparalleled opportunity. It’s not just a place to operate; it’s a place to thrive, with access to resources and networks designed to support their growth. By fostering connections and facilitating innovation, we are planning for Harley Street to remain at the forefront of healthcare’s evolution.
This change has already started with the launch of the Harley Street Health District. It is a transformation that is about much more than the change affecting real estate. It’s about creating a community where ideas flourish, collaboration is embedded and the future of healthcare is actively shaped. It is an ambitious vision but one that our society needs and will benefit from.
The Howard de Walden Estate’s Healthcare Conference gathered leading healthcare pioneers to explore improving patient pathways through innovation and collaboration
The home of unrivalled connections
The Howard de Walden Estate’s Healthcare Conference, held in the Harley Street Health District, gathered leading experts to explore the theme Revolutionising Patient Pathways Through Innovation. This pivotal event highlighted the intersection of technology, collaboration and systemic change in healthcare.
The RT Hon Lord Kakkar KG KBE opened the conference by emphasising the urgent need to address workforce shortages and fragmented systems. He advocated for innovation-driven solutions supported by investments in technology and prevention, while recognising broader societal determinants of health, such as housing and education. His remarks underscored the role of the Harley Street Health District as a hub for patient- centred care.
Key panels delved into the challenges and opportunities facing healthcare innovation. Michael Vrana from investment
management company Blackstone reaffirmed the UK’s status as a global investment destination, citing its robust talent base and leadership in life sciences.
Suzie Ali-Hassan from the Association of British HealthTech Industries (ABHI) urged the translation of the UK’s research and development strengths into global market success, particularly in medical exports. Ian Abbs of Guy’s and St Thomas’ NHS Foundation Trust stressed the need for scalable technological solutions to address systemic strain, with a focus on AI and social care integration.
The conference showcased practical examples of transformative innovation. Laura Wade-Gery of Moorfields Eye Hospital detailed a digital triage system that has halved outpatient appointments and reduced waiting times, offering a scalable model for other specialties.
Dr Sandy Chohan presented a digital platform that streamlines surgical
pathways, improving patient outcomes and reducing hospital readmissions while significantly cutting environmental impact.
Professor Patrick Maxwell highlighted Cambridge’s leading role in life sciences, where advances in genomics and AI are driving personalised medicine. However, he noted that the NHS’s fragmented structure hampers the widespread adoption of such breakthroughs, calling for better data integration and regulatory agility.
Dominic Dodd, chair of UCLPartners and UCL Health Alliance, challenged assumptions about NHS resistance to innovation and advocated for systemic, scalable solutions over isolated initiatives. He argued for reducing tolerance for risks in current practices and creating aligned funding and accountability to drive reform. Similarly, Alex Snow of Arcturis Data emphasised the transformative potential of healthcare data, underscoring the
need for seamless integration to support personalised treatments.
Professor Dame Molly Stevens delivered a compelling keynote showcasing innovations in regenerative medicine, drug delivery, and AI-driven diagnostics. Leading a team of 90 researchers, her work spans from the development of biomaterials for knee repair and retinal regeneration to the creation of cutting- edge diagnostic platforms combining CRISPR and nanotechnology. Prof Stevens emphasised the transformative potential of integrating AI with biological datasets, such as genetic, protein and metabolic information, to enable personalised medicine. She announced a quantum research hub for biomedical sensing, which will focus on leveraging cutting- edge quantum technologies to develop advanced diagnostic tools and improve the precision of disease detection and monitoring.
In closing, Lord Kakkar synthesised the discussions, calling for collaborative, technology-enabled solutions to improve patient pathways. He reiterated the importance of sustained investment and the integration of innovations across medicine, technology and infrastructure to achieve meaningful transformation.
The conference left attendees with a sense of cautious optimism. While challenges remain, the collective expertise and vision shared throughout the event underscored the belief that by fostering collaboration, embracing innovation and prioritising patients, transformative change is increasingly within reach.
Scan QR code for conference sessions
27 - 30 January 2025
ABHI hosts the largest and most visible group of UK companies at Arab Health. Our stand is home to a busy four-day programme of live surgical simulations and dedicated partnering events. Be sure to visit us to learn more about the best in UK healthcare and HealthTech. For more information, write to enquiries@abhi.org.uk.
3,450
110
180+ Countries Represented
Arab Health by numbers
NEWS
Re:Cognition Health, the pioneering brain and mind clinic, has unveiled a new state-of-the-art facility at 62-64 New Cavendish Street in the Harley Street Health District. The 7,765 sq ft cognitive and mental healthcare facility features advanced eco-lighting, purpose-built zones including child-friendly and low-sensory suites, and cutting-edge technology. Services span clinical trials, private practice care and medico-legal expertise. Dr Emer MacSweeney, CEO of Re:Cognition Health, said: “Our new home ensures patients can navigate treatments seamlessly in a personalised and innovative environment, reaffirming our commitment to world-class care.”
recognitionhealth.com
Optegra Eye Health Care’s flagship hospital on Queen Anne Street is now offering the first-ever treatment for dry age-related macular degeneration (AMD). This non-invasive procedure provides hope for the 700,000 individuals affected by AMD who were previously left without treatment options. By delivering specific wavelengths of light, Valeda light therapy reinvigorates malfunctioning cells at the back of the eye. Consultant ophthalmic surgeon Mr Sajjad Mahmood explains: “It allows us to stabilise vision, and in many cases, improve it, offering hope to patients who previously faced inevitable decline.” Treatment involves short outpatient sessions over a three-week cycle.
optegra.com
The Royal Marsden Private Care has been named Hospital of the Year at the prestigious LaingBuisson Awards. The accolade highlights the hospital’s pioneering work in genomics, which sets a benchmark for personalised cancer care and diagnostics. Judges praised The Royal Marsden’s innovative genomic laboratory, which uses next-generation sequencing panels to analyse entire gene alterations. Managing director Mark Hawken said: “This award reflects our commitment to innovation and excellence in cancer care. This recognition inspires us to continue raising the bar and ensuring we deliver world-class services to our patients and their families.”
royalmarsden.nhs.uk
The London Clinic, the UK’s largest independent charitable hospital, and Northwestern Medicine, a leading US-based academic healthcare organisation, have announced a wide-ranging collaboration. The strategic agreement will result in these two nonprofit organisations combining clinical expertise, amplifying their charitable impact, collaborating on research, and optimising their operational efficiency. Al Russell, CEO of The London Clinic, said: “Not only have we found a partner that shares the same not-for-profit values, but one with the scale that will give our charity access to the resources we need. We are determined to do as much as we can to support the health challenges our country faces charitable purpose.”
thelondonclinic.co.uk
In December, Isokinetic Medical Group hosted its first educational and networking event for patients in the Harley Street Health District. Dedicated to ACL injuries, the evening brought patients and team members together to discuss Isokinetic’s comprehensive rehabilitation pathway. Sports orthopaedics consultant Dr Jesús Olmo and physiotherapist Alessandro Compagnin delivered a presentation on the group’s step-by-step approach to recovery and former patient Mike Durie shared his personal journey of recovering from multiple ACL surgeries. isokinetic.com
Isokinetic
The Royal Marsden Private Care
CRYSTAL BALL
Tricuspid valve regurgitation
Dr Robert Smith on the evolving treatment of a common heart condition
State of play
Tricuspid valve regurgitation is a common heart condition where the leaflets in the tricuspid valve do not fully close when the right ventricle contracts. This allows blood to flow backwards from the right ventricle into the right atrium, which can cause several issues. Symptoms can include lethargy, breathlessness, enlargement of the heart chambers, fluid in the abdomen, and swelling of the ankles and legs. For a long time, cardiologists didn’t think treating this condition in isolation was appropriate as people usually presented late, which made open heart surgery, the most effective option, too risky. But recent technical advances are changing this view. Several new procedures have emerged, the most effective of which is called transcatheter edge-to-edge
repair (TEER). This involves a clip device being implanted into the valve to help it close. These devices work by attaching one leaflet to another where the valve is leaking. One, two or even three clips can be required. The key to this procedure is that you access the heart via a vein in the groin, avoiding the need for open heart surgery. When we started treating tricuspid valve regurgitation in isolation, it was unclear how patients would respond, as the leak was considered a secondary complication. But we soon realised that improvements to quality of life were so dramatic across the board that there is now a push to improve the available techniques.
On the horizon
There is a very new procedure called trans-catheter tricuspid valve replacement (TTVR) where you replace the valve completely. A number of devices are currently in trials, but one device called EVOQUE, which we have implanted at Royal Brompton and Harefield hospitals, is very promising. The procedure has only been done about 50 times in the UK so far. It is more involved than TEER, so there is an increased risk, but when successful it can completely stop the leak, unlike the other procedures which generally reduce it. Currently, TTVR is licensed for patients for whom TEER is not feasible. Another new procedure is an annuloplasty. With this you support or replace the valve’s annulus or ring, the structure to which the valve leaflets attach. Typically, annuloplasty is undertaken during open heart surgery, when a complete or semi-complete ring made of surgical-grade plastic is
Ventricle The lower chambers of the heart pump oxygenated or deoxygenated blood to the body or lungs, respectively.
Atrium The upper chambers of the heart receive blood from the body or lungs, initiating its passage through the heart.
Trans-catheter interventions Minimally invasive medical procedures use catheters to treat cardiovascular conditions, reducing the need for open-heart surgery.
implanted.. This is used to pull everything inwards and narrow the valve opening, which helps the leaflets operate more effectively. There are several on-surgical and open-heart devices in development and clinicians are working to make the procedure safer and more effective. It’s crucial that these partnerships continue.
In the distance
The most promising developments are in the sphere of trans-catheter tricuspid annulus interventions. This is where we access the tricuspid valve through the vein and strengthen or replace the annulus ring. As I mentioned, the TEER procedure can significantly reduce the leak but will almost never stop it completely, while TTVR can eradicate the leak but carries more risk, especially to older or frail patients. A repair of the annulus ring holds the promise of eradicating the leak with a very low-risk procedure. However, the most important change I see coming is a change of mindset. We need to be assessing and analysing our results to work out which patients would most benefit from these interventions and which may need more involved surgeries. This group of patients is enormous and we’re currently reaching only the very tip of the iceberg – about 1% of sufferers. With a safe, easy and effective procedure, we will be able to hugely improve the quality of life of many millions of people.
Guy’s and St Thomas Specialist Care 77-79 Wimpole Street
London W1G 9RU 020 3131 5130
guysandstthomasspecialistcare.co.uk
HARLEY STREET HERO
Sir Harold Ridley 1906-2001
Ophthalmologist
Words: James Rampton
From a very young age, Sir Harold Ridley, the surgeon who changed the face of modern ophthalmology, was perhaps fated to become a titan of modern medicine. As a small boy, he sat on the lap of one of his mother’s closest friends. Her name? Florence Nightingale.
Born in Leicestershire in 1906, Ridley attended Pembroke College, Cambridge from 1924 to 1927, before finishing his medical training at St Thomas’ Hospital in London in 1930. Eight years later, the ophthalmologist, who also had a practice at 53 Harley Street, was made a full surgeon and consultant at Moorfields Eye Hospital. A highly distinguished medical career was well underway.
But it was during the Second World War that Ridley really came into his own as a surgeon. While treating combat victims, he discovered a revolutionary treatment for cataracts. His groundbreaking work began during the Battle of Britain, when Ridley was tasked with tending to Royal Air Force pilots who had sustained serious eye injuries.
His most famous patient was Squadron Leader Gordon ‘Mouse’ Cleaver of 601 Squadron, a flying ace renowned for the derring-do with which he flew his Hawker Hurricane. On the morning of 15th August 1940, Cleaver went on a sortie that passed without incident. That lunchtime, his unit was suddenly called into action again. As he was scrambled in a rush, the pilot left his goggles at base.
Flying over the city of Winchester, Cleaver’s aircraft was strafed with machine-gun fire from a German
Junkers Ju 88. The Hurricane immediately went up in flames, firing out acrylic splinters from its canopy like tracer bullets, some of which shot into Cleaver’s eyes. Severely injured and suffering from catastrophic burns, the ace somehow managed to turn his Hurricane upside down so he could tumble out of the cockpit. At that point, the astoundingly skilful pilot opened his parachute and landed safely on the ground in Hampshire.
Unfortunately, Cleaver’s right eye was beyond repair and he had to endure 18 operations to patch up his facial wounds and attempt to save some vision in his left eye. Even then, he never lost his defiant sense of humour. When a colleague came to see him later, Cleaver’s first remark to him was: “Jack, tell them all to wear their goggles.”
Ridley was very involved in the pilot’s treatment and it was during his investigations that he came up with a completely counterintuitive diagnosis. He noticed that the plastic shards in Cleaver’s left eye had not impaired his sight. In addition, his body had not tried to reject them. Hitherto, the only treatment for cataracts, which cloud the lens of the eye and are the most frequent reason for blindness, was an extremely painful procedure. A method called “couching” had been employed for thousands of years. This entailed stabbing a needle into the eye in order to shove the cloudy lens away from the line of sight.
But the reaction of Cleaver’s eye to the acrylic splinter gave Ridley an inspired idea. It led the surgeon to believe that there might be a far easier
and much less excruciating solution to the issue of cataracts. He thought that he could employ a plastic lens as a replacement for the natural one. It was a groundbreaking theory.
The ophthalmologist asked the chemicals company ICI to make a plastic lens from the same material as the Hurricane canopy. On 29th November 1949 at St Thomas’ Hospital, Ridley accomplished the first ever implant of an intraocular lens (IOL). Regrettably, his fellow professionals sneered at the trailblazing concept and dismissed IOLs out of hand. Ridley had to wait until the 1980s for IOL implant surgery to become standard practice. Every year, 20 million of these operations are now carried out all over the world and Ridley’s game-changing discovery has transformed the eyesight and enhanced the lives of hundreds of millions of people.
There is a neat circularity to the story. In 1987, Cleaver had surgery to solve his cataract problem. His IOL implant was manufactured from a material just like the acrylic that was embedded in his eyes in the cockpit of his Hurricane.
Ridley, who died aged 94 in 2001, has justly been memorialised in a variety of different ways, including in a 2013 book by Andrew Lam called Saving Sight. Perhaps most memorably, in September 2010 the Royal Mail brought out a series of commemorative postage stamps to celebrate medical breakthroughs. The 67p stamp was captioned: “Artificial lens implant surgery pioneered by Sir Harold Ridley 1949.”
And so, quite rightly, Ridley belatedly received the stamp of national acclaim.
HOW DOES IT WORK?
Selective neurectomy
Mr William Townley, consultant plastic surgeon at the Phoenix Hospital Group, on a life-changing procedure used to treat facial palsy
Interview: Viel Richardson
Facial palsy is a condition that has the potential to profoundly impact a person’s appearance and quality of life. At its core, it refers to paralysis or weakness affecting the muscles of one side of the face, due to damage or dysfunction in the facial nerve. The facial nerve is one of the cranial nerves responsible for controlling facial expressions. If its operation is impaired in any way, this can lead to a variety of visible and functional challenges.
The best-known form of facial palsy is Bell’s palsy, a sudden and unexplained weakness in the facial nerve, often linked to stress, pregnancy or viral infections. While most Bell’s palsy cases resolve themselves within months, 30-40% of patients experience incomplete recovery, resulting in long-term issues. Other causes of facial palsy can include tumours, facial trauma or infections such as Ramsay Hunt syndrome (herpes zoster oticus), which occurs when a shingles outbreak affects the facial nerve near one of the ears. Congenital facial palsy, where people are born with facial weakness, is also an issue. Although this condition is widely recognised, misconceptions persist about the scope of available
treatments, even within the medical community.
The symptoms of facial palsy can vary depending on the cause and severity. In the acute phase, there can be a complete loss of movement and tone in the face. Patients might be unable to close their eyes, leading to dry eyes. At the same time, the tear ducts produce more tears, trying to lubricate the eye, but because the muscles around the eye don’t work effectively the tears just roll onto the cheek. Patients often have a loss of lip movement, resulting in difficulty with speech and a loss of oral continence. This can lead to drooling, difficulty chewing food or keeping food in the mouth, inability to move the lips normally during speech, and a loss of smile. For those who suffer an incomplete recovery, the long-term symptoms can evolve into frozen face syndrome, a condition characterised by stiffness and uncoordinated movements. This not only hinders physical function but can also cause significant emotional distress, underscoring the importance of early and effective intervention.
If the facial palsy does not resolve on its own, there are surgical procedures
we can turn to. One procedure I frequently perform is a selective neurectomy, primarily for patients with long-term facial paralysis or tight, uncoordinated facial muscles from conditions like Bell’s palsy. The goal is to carefully identify and address the specific nerve branches causing these issues, while preserving those essential for a natural smile.
Controls facial expression muscles, taste sensations and glandular secretions, influencing facial movement and sensory functions.
Bell’s palsy Sudden facial muscle weakness or paralysis caused by facial nerve inflammation, often resolving spontaneously within weeks or months.
Zygomaticus major A facial muscle that elevates the corners of the mouth, enabling smiling and expressions of happiness or amusement.
Botox A neurotoxin that temporarily blocks nerve signals to muscles, reducing wrinkles, treating spasms, or managing medical conditions like migraines.
Facial cranial nerve The seventh cranial nerve.
Under general anaesthesia, I make a series of precise incisions around the ear. These provide access to the facial nerve and its intricate web of branches. Using a nerve stimulator, I map each branch’s function, observing which muscles it controls. This step is crucial because it allows me to identify branches that are causing unwanted tightness or abnormal movements, such as muscles pulling against a smile or creating a frozen, asymmetric expression. By pinpointing these specific problem areas, I can ensure we only target the nerves that need some kind of intervention. This process requires real precision, as there are typically 20 or more nerve branches involved.
Once identified, the problematic nerve branches are carefully divided to stop the unwanted signals. I do this by removing a small segment of nerve – leaving a gap prevents regrowth. For some nerves, however, I take a more reconstructive approach. Instead of severing them entirely, I connect these branches to the zygomaticus major. Over time, this re-routing can help restore dynamic facial movements, enhancing the patient’s ability to smile naturally.
After addressing the nerves, I may perform additional procedures
to further improve the patient’s overall appearance and functionality, such as lifting the lower eyelid or correcting asymmetry with aesthetic adjustments. The incision is then closed with sutures, which are removed within a week. Social recovery –returning to work or restarting normal domestic activities – generally takes about two weeks, although some minor swelling or bruising may persist. Full physical recovery, including returning to exercise or strenuous activities, takes up to six weeks.
For re-routed nerves, the full benefits may take six months to a year to materialise. Physiotherapy plays a crucial role in recovery. This involves working with clinicians trained in facial physiotherapy, who can help the patient retrain the affected muscles. Not all patients are candidates for this operation. One of the key ways we can determine if it will work is a trial using carefully placed botox injections, which simulate the effects of cutting the problematic nerve branches. If these injections don’t reduce the tightness or asymmetry, it’s very unlikely that surgical intervention will be effective. Other factors, such as the presence of severe scar tissue or a lack of responsive
muscle, can also influence who this procedure would be suitable for. One of the biggest issues I find with patients is they have struggled to find accurate information about the condition, even when talking with their clinicians. It means many have suffered for years before getting help. One excellent charity I recommend is Facial Palsy UK – it provides valuable resources, from psychological counselling to guidance on rehabilitation.
Patients often describe the procedure as life changing. The ability to smile again, albeit sometimes momentarily at first, has a profound influence. As the results improve, they often regain lost confidence. While not every patient will achieve a completely natural appearance, for those who have lived with the daily challenges of facial palsy, surgical interventions like selective neurectomy offer not just physical relief, but a chance to reclaim a lost identity.
Edward and Robert Ungar, co-founders of Pharmacierge, on the new cutting-edge dispensary at the heart of their e-prescription healthtech
Interview: Ellie Costigan
Portrait: Christopher L Proctor
Robert: With our new dispensary on Wimpole Street, we’ve had the opportunity to design a modern pharmacy from the ground up, with greater efficiency from receipt of an e-prescription from the doctor, all the way to the patient’s front door.
Edward: It’s hard to imagine how we ever operated without the facility’s new robotic system. It has two arms which move up and down a 30-foot corridor of tightly packed, floor-to-ceiling shelving. When stock arrives, it sorts it out into individual packets and decides where to store them based on a lot of different variables: for example, the size, expiry date, and how often we’re going to use it. When we call a medicine off the robot shelves, it will pop it down a chute, spiralling down to one of our 14 dispenser stations – all within about 20 seconds.
Edward: We’ve also created a really lovely place for our staff to work, which is important. It’s calm and peaceful, with a lot of space to move around – it’s also incredibly efficient, all of which is evident when you visit us.
Edward: To appreciate how the robotics work, you have to abandon any notion of human logic and enter the realm of machine-learning, which is entirely abstracted from our understanding of space and classification such as alphabetical order. It’s evolved beyond that.
Edward: The robot doesn’t replace people; it enhances their role. They no longer need to stack shelves or struggle to find medications. Instead they can engage a higher level of their training.
Robert: In 2015, we created what was probably one of the first true electronic prescribing systems within UK private medicine. Our company was a pioneer in the field.
Edward: Clinicians love the ease of prescribing through our system – it’s quick, accurate and safe. There are lots of checks and balances throughout the process, which is of great reassurance to them.
Robert: Our service was designed to place clinicians and their patients at its core. Our ethos is, if clinicians ask us to jump, we reply how high.
Robert: We’ve taken lots of people round our premises and they’re always surprised – it reminds them of childhood films: Willy Wonka, Wallace and Gromit, or all those wonderful inventions of Mr Potts in Chitty Chitty Bang Bang. They always express how much fun it seems.
Robert: For patients, medication ‘automagically’ arrives at their door. But if they need to, they can call up someone friendly who will be able to reliably tell them where their medication is in the process: whether it’s in stock, who has dealt with their query and when it’s going to arrive. It alleviates uncertainty within a complex process with a lot of moving parts.
Edward: Like our father, a highly experienced pharmacist, we always try to make a difference and to say yes, even if that means going the extra mile to obtain rare or unusual medication.
Edward: The role of the pharmacy is changing nationally. Many are performing additional services that might previously have been within the purview of GP surgeries. In some ways, we’ve remained in the more traditional mould of dispensing and advising on prescription medicine. It’s a traditional role, executed in a modern way.
Edward and Robert Ungar
PROFILE OF A PATHOGEN
Helicobacter pylori
In the tempestuous battleground of the human stomach, few organisms have challenged medical understanding quite like Helicobacter pylori (H pylori), a tiny bacterium with an extraordinary survival strategy. Its discovery was a tale of scientific rebellion, in which two researchers staked their careers on a radical proposition that shocked – and ultimately transformed – the medical world.
H pylori, it turns out, is a marvel of evolutionary adaptation. A gramnegative, spiral-shaped organism equipped with multiple flagella, it developed a survival mechanism that defies the stomach’s notoriously hostile environment. Its secret weapon is an enzyme called urease that converts urea into ammonia and carbon dioxide, creating a much less acidic safe zone in which it can thrive.
In 1982, Australian researchers Barry Marshall and Robin Warren discovered this bacterial insurgent in the stomachs of patients with gastritis and ulcers and suggested they might be the cause. The medical establishment scoffed. Stomach ulcers were known to be caused by stress, diet and excess acid, not some hitherto unknown bacterium. Faced with widespread
scepticism, Marshall’s next step became the stuff of legend. Having determined he was free of these conditions, he deliberately infected himself with H pylori. Within days he developed gastritis, providing dramatic proof of the bacterium’s pathogenicity. It was an act that sent these maverick researchers on a path – to the sound of much less scoffing – to changing our understanding of gastrointestinal diseases, and eventually a Nobel Prize.
The bacterium’s virulence is sophisticated and complex. It releases two key proteins – CagA and VacA –that disrupt and damage cells. CagA can be injected directly into host cells, disrupting cellular functions and potentially promoting precancerous changes. VacA induces cell damage through the formation of tiny holes, creating microscopic destruction that can lead to significant complications.
Globally, H pylori is remarkably prevalent, with an estimated 50% of the world’s population carrying the bacterium. Yet not everyone develops symptoms – a testament to the complex interplay between bacterial strains and individual hosts. When symptoms do emerge, they range from dyspepsia and epigastric pain to more serious conditions like gastric adenocarcinoma.
Diagnosing H pylori is a complex investigative process, with clinicians deploying an array of tests, each with its own strengths and limitations. The urea breath test remains particularly elegant – patients consume urea labelled with a carbon isotope; when the bacterium’s urease enzyme breaks it down, it releases detectable carbon dioxide. Stool antigen tests offer a non-invasive
Gram-negative organism Bacteria with a thin peptidoglycan layer, outer membrane, and resistance to antibiotics, identifiable by pink Gram staining.
Flagella Whip-like structures that provide bacteria or other cells with mobility, allowing movement in response to environmental stimuli or host interactions.
CagA protein A virulence factor of Helicobacter pylori. Disrupts cell signalling, promotes inflammation, and increases gastric cancer risk after bacterial infection.
VacA protein A toxin from Helicobacter pylori. Creates holes in host cells, disrupts immunity, and contributes to ulcers and tissue damage.
Epigastric pain Discomfort or pain felt in the upper abdomen, often linked to digestive issues, gastritis or Helicobacter pylori infection.
alternative, directly detecting bacterial proteins. More invasive methods include endoscopic biopsies, which allow direct visualisation of the stomach lining and examination of tissue samples. Blood antibody tests can indicate previous exposure but struggle to distinguish between past and ongoing infections.
Treatment is essentially a multifaceted medical assault with most approaches involving intricate combinations of antibiotics designed to overwhelm the bacterial defences. Typically, these regimens include a proton pump inhibitor to reduce stomach acid, creating a less hospitable environment for the bacterium, combined with two to three antibiotics. However, the emergence of antibiotic resistance has turned treatment into a dynamic, evolving challenge. Some regions now see resistance rates approaching 30%, forcing clinicians to constantly adapt their therapeutic strategies and develop more complex treatment combinations.
The World Health Organisation has classified H pylori as a Group 1 carcinogen, acknowledging its role in gastric adenocarcinoma and MALT lymphoma. What was once considered a simple bacterial infection is now understood as a long-term health threat, capable of triggering chronic inflammation and cellular changes over decades. However, some researchers now speculate that H pylori may have played a positive role in human evolution, suggesting a relationship far more nuanced than simple ‘pathogen versus host’. It is a reminder that in the complex microscopic world, things are not always quite what they seem.
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HOW TO SPOT SIGNS OF BREAST CANCER
Mr Debashis Ghosh, breast consultant at The London Clinic
Interview: Gerard Gilbert
How common is breast cancer?
One in eight women will develop breast cancer, which amounts to 45,000 new breast cancers being diagnosed in the UK every year. This is the most common cancer in women in the UK and the number of cases in younger women is increasing. Mainly that’s down to lifestyle choices and the increased stresses of modern life.
What are the physical signs that should raise concerns?
Of course, any breast lump is a sign that there might be breast cancer. In addition, there are other clues: if there’s a sudden change in the shape of the breast; if there’s suddenly an in-drawing or a dimpling of the skin; if you notice the nipple, which was usually normal, has gone inwards or sunken; if there’s a lump under the armpit, or eczema, or changes over the nipple; if there’s a blood-stained discharge from the nipple. Sometimes, you might see skin changes similar to orange peel.
How often should women examine their breasts?
Women should really check themselves once a month – on a fixed day of the month so that you know how it feels on a particular day within each cycle. If you check it today and find something, then wait for another four weeks and it’s still there, you should see your GP. But if you’re concerned by your first
examination, don’t wait to get your referral done.
Would there be any cause for concern with a mole or lump in the breast area that has been there for several years without apparent ill effect?
If you’ve had it for years and it’s been checked and previously biopsied and declared benign, it should be fine. But if you find it’s grown in size or it suddenly becomes more prominent, you need to get it re-checked by your GP.
What would your advice be to someone who isn’t sure about something she sees or feels?
See your GP and a get a referral. I think leaving it alone is where things go wrong. For every 10 patients we see, only one person may have a breast cancer. Nine people go away having been reassured that their lump is completely benign
What about if she’s not confident in her ability to do the examination herself?
You can always ask your partner to check you out. And there’s always a nurse at a general practice who can help you. It’s worth looking up a YouTube video on how to examine yourself –there are plenty of sites on the web that show you how to examine breasts. I know many people are squeamish about checking their breasts, though. If they’re
very anxious, it’s always good to visit a specialist who can help them overcome these fears.
Should men be examining their breast area too?
Absolutely. As well as those 45,000 new instances in women, we also get 450 male breast cancers every year in the UK. So, it’s not uncommon for men to develop breast cancer and it’s therefore important for men to be checking their breasts as well. Men are often ignorant of this fact, and it has to be stressed on them as well.
What difference does early diagnosis make?
I have always stated that early pick-ups save lives. If you’re picked up in the early stages, 90% will be cured completely. On the other hand, if you’re picked up at a late stage, your survival rate goes down to 10%. And early pick-up doesn’t mean the size. You shouldn’t panic if you find a big lump – just come in the moment you find it so we can pick it up early before it has spread out of the breast. Early breast cancer means a cancer that is restricted to the breast and armpits, and these breast cancers are treatable and completely curable.
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A DAY IN THE LIFE
Dr Simrat Marwah, medical director of OneWelbeck’s Health Assessment & Longevity Centre
Interview: Gerard Gilbert
Portrait: Christopher L Proctor
Preventative medicine is not big in this country. We tend to be more reactive than proactive, something that became ever more apparent as I went through life as a GP. I’m from Yorkshire originally and after moving to London, I met a lot of people from places in the world where the health offering is rather different. My American patients would come in and say: “My children go for health screening” – a general check-up with a paediatrician – and that doesn’t happen here. I started thinking, why isn’t it happening here?
Our healthcare system provides you with lots of different treatments for free when you need them, but we’re not really doing the preventative work to avoid those treatments being required in the first place. That’s why I developed this service at OneWelbeck Health,
which is now in its second year. The idea was to put together a comprehensive head-to-toe health assessment and also use the expertise of the almost 300 leading consultants who I have access to through the practice.
Today I began my working day by speaking to two patients on the telephone about some test results. I then had meetings with the facilities that provide us with services for gut microbiome testing, to go through with them the intricacies of the tests before I present the results to a patient tomorrow. At 12.30pm, I had a consultation with a new patient that ended just after two o’clock. You really need to spend time with new patients, so the maximum number I would see on any given day is usually one.
I’ve
fallen into something where I look after whole families. I want to know the people really well and provide them with all the latest technology and knowledge.
follow-up with a patient who had come in for four different tests instead of doing the whole screen –we’d decided he didn’t need all of them done as he’d had several tests in the past.
In addition to my clinical work, I spent some time today working with the team on improving our patient reports and journey. I think it is important to continuously improve our service and supply the patient with the necessary information without overwhelming them, as the testing day and report information can often be long and very detailed.
People spend money on all sorts of things. This is your health.
If someone can’t afford a whole health screening, I would still suggest they sit with me and have a consultation. If anything comes up from that, we can refer them through their insurance or go back and highlight the symptoms to their NHS GP. Or we might suggest they take a close look at their family medical history, which can be very informative.
There are 12 different tests that need scheduling. We look at brain health, taking an MRI and an MRA of the brain. We check heart health, lung health, we do a baseline hearing test, we do an MRI scan of the abdomen and the pelvis, and we do 3D mole mapping. OneWelbeck Health has the only mole-mapping technology of this quality in the whole country. We also do blood tests and a testicular ultrasound in men. With our women, depending on their age, we would carry out a mammogram or an ultrasound for the breasts.
One of our admin team sees patients straight after the consultation – each patient has a dedicated liaison manager who looks after them, sending them emails and booking them in for the various tests.
After the consultation, I had a
I then had a remote chat with another new patient to go through their health history and decide what type of screening they should have. New patients are usually worried about something. This could be because of how they’re feeling or because an outwardly fit and healthy friend had a health screen and found something that was potentially life-changing but was caught early. The thing to remember, though, is that health screening would normally be for asymptomatic patients. If a patient, for example, had a change in bowel habit, they would not be coming in for a health screen – you’d want to refer them to a gastroenterologist.
A top-to-toe health assessment can be expensive, but once we’ve identified your health risks you don’t need to do the whole health assessment every single year. When you actually break it down to what it gives you in the long run – how it helps with your health planning – it’s a wise investment.
My working day usually ends with me going through some of the patients I saw the day before in my private practice. I’m still a working GP – that’s all I’ve ever wanted to be. I’ve fallen into something where I look after whole families. I want to know the people really well and provide them with all the latest technology and knowledge.
My day is a balancing act between seeing patients and administrative tasks. I loved my NHS work but I wish I’d had a bit more time to sit and get to know my patients. Back then, I was always that annoying doctor who would run over by an hour, which would continually get me into trouble. People would understand that once they’d come into the room – usually after telling me off for running late! That was why I started doing private practice and it’s why I’ve gone on to develop this health screening programme.
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STEM SUBJECTS
Dr Emma Nicholson, consultant haematologist at The Royal Marsden, on the work that goes into a stem cell transplant
Interview: Ellie Costigan
Portrait: Dominick
Tyler
I have been the lead for stem cell transplant and haematology at The Royal Marsden since 2020. Stem cell transplant is a treatment that’s used mostly in blood cancer patients who are at high risk of relapse, though sometimes it’s used as first line treatment in high-risk settings.
There are two main types of stem cell transplant: autologous and allogeneic. An autologous transplant uses cells that are collected from a patient’s own bloodstream, using a procedure called apheresis. We remove the cells from the blood, then use those cells in a high dose-intensity chemotherapy regime to destroy the cancer cells, before returning the cells to the patient.
The other type is called allogeneic, which uses stem cells taken from a donor. The cancerous cells are wiped out using high-dose chemotherapy, then replaced from bone marrow from another person. This brings more risk than using the patient’s own stem cells, so it’s only used for very high-risk blood cancers. The donor could be a parent, child or sibling, or a volunteer. We can also use stem cells collected from baby’s cord blood – this is used a lot in our hospital.
Finding a matched donor is a big part of our work. When looking for donors, we do a blood test called tissue typing, which looks at the genetics of that patient. In particular, we are looking at proteins on the surface cells of the body, called human leukocyte antigen (HLA) molecules. A fully matched donor has what we call a 10 out of 10 match, meaning that all the molecules are fully matched between patient and donor.
With a mismatched donor where one or more molecules don’t match up, you can still do the transplant, but it’s potentially higher risk. We can usually find a good enough mismatched donor for most patients, though for some patient groups and particular ethnic minorities it can be harder.
These treatments require large, complex infrastructure within the hospital. A big part of the department is the apheresis unit, which is where we collect stem or blood cells from the donor’s blood. We do this as an outpatient procedure. We take the blood from the patient via cannulas, which draw it into a machine that separates the blood into layers and takes the stem cells. We also have a cell therapy lab, where we store stem cells. Some of these will be frozen in liquid nitrogen, as they might not be infused back into the patient for a couple of months. Some of the donor transplants are collected elsewhere in the world, then flown to The Royal Marsden where they’re infused fresh into patients’ blood.
The other part of the department is the inpatient ward, where patients come for chemotherapy and radiotherapy. Usually, there will be a week of chemo and conditioning radiotherapy to clear out the bone marrow ahead of transplant. We also have positive pressure rooms –protective environments that minimise the risk of infection. Most transplants are carried out on the inpatient ward, but we are starting to do some of the chemotherapy in a patient setting called ambulatory care, which doesn’t require overnight admission. Finally, we have a minor procedure unit, where patients
are assessed, and an aseptic suite where chemo is made up ahead of the transplant.
There are lots of people working to make a transplant happen: specialist nurses and doctors, physiotherapists, pathologists, occupational therapists, psychological support staff, radiologists, intensive care staff. We work closely with clinical oncologists and haematology departments in other hospitals, too –the Royal Brompton provides a specialist cardio oncologist service for us. It’s a high-intensity treatment and requires a multidisciplinary approach.
I love working in a specialist hospital. It’s one of the major benefits for patients – all the care within The Royal Marsden is directed to cancer care. Everyone within the hospital is a cancer specialist, whatever kind of health professional they are. It’s a relatively small hospital and everyone knows each other, which means things happen quickly. We work brilliantly together and everyone is extremely dedicated. There’s a huge depth of knowledge, too, and it’s an amazing place to learn.
The treatment we can offer is often quite novel: there are world-class clinical studies being run within The Royal Marsden, which gives patients access to treatments they might not be able to get elsewhere. I’ve worked in many hospitals, most of them excellent, but I do think we go the extra mile here. We make a real difference for our patients.
The Royal Marsden Private Care 19A Cavendish Square London W1G 0PL 020 7811 8111
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I love working in a specialist hospital. It’s one of the major benefits for patients – all the care within The Royal Marsden is directed to cancer care. Everyone within the hospital is a cancer specialist, whatever kind of health professional they are.
RESEARCH PARTY
Professor Rosalind Smyth on how the Academy of Medical Sciences, the UK’s expert voice for biomedical and health research, plays a vital role in shaping the evolution of healthcare
Words: James Rampton
“Groundbreaking” is a word that is frequently overused by medical journalists. However, it really does apply to the work of Professor Rebecca Fitzgerald. A professor of cancer prevention at the University of Cambridge and director of the Early Cancer Institute, she has made an astounding medical breakthrough. Professor Rosalind Smyth, vice president (clinical) of the Academy of Medical Sciences, takes up the story: “Rebecca specialises in oesophageal cancer. With cancer of the gullet, the survival rate is not good.” The problem is that oesophageal cancer is particularly hard to identify. “A lot of people have heartburn or pain in their upper gastrointestinal tract,” say Prof Smyth. “So how does a GP sitting in their surgery, when they see 10 people with heartburn, know which ones might be at risk? What Rebecca and her colleagues did was develop this little sponge in a capsule that people can swallow. As it’s pulled back up through the gullet, it collects cells, and those can be looked at. If there’s an indication of any suspicious cells, they go on to have further investigation. But if there aren’t any suspicious cells, studies have shown that it’s quite safe not to proceed to an endoscopy.”
This is a trailblazing invention because, most importantly, it prolongs lives. But also, at a time when the NHS simply can’t cope with the number of endoscopies being requested, it ensures that those that are performed are absolutely necessary.
Why is Prof Smyth so invested in Prof Fitzgerald’s pioneering innovation, then? “Lots of people contributed to Rebecca’s fantastic career and fantastic successes. But she was an early participant in the mentorship programme at the Academy of Medical Sciences, and she became the first mentee to become an Academy fellow.”
Prof Smyth goes on to stress how central the mentorship programme is to the work of the Academy. “We do a lot of training and career development for scientists, including doctors, dentists, nurses, and allied health professionals. I love supporting talented early-career people – by mentorship, as I mentioned, but also by sitting on funding panels where we interview people who have applied for fellowships. That’s so important. Seeing just how able, enthusiastic and committed they are is a huge privilege. I’m a very lucky person.”
Prof Fitzgerald’s achievements highlight the often-unsung work
that the Academy of Medical Sciences undertakes. This is an institution whose work has informed the development of medicine in this country and in the process saved numerous lives. “The Academy of Medical Sciences is one of the four national academies in the UK, alongside the Royal Society, the British Academy and the Royal Academy of Engineering,” explains Prof Smyth. “It is
There are really very stark differences in life expectancy between children born in the lowest socio-economic groups and those in the highest groups. It’s an inequitable situation that we should strive to address. That’s what our report really flags up.
really the voice of academic medicine. It focuses on biomedical research. That is very important in transforming lives, discovering new treatments, addressing global emergencies such as the Covid pandemic and a great deal more.”
Founded in 1998, it is, she continues, a relatively young Academy, but its work carries significant weight. “We provide a voice on biomedical health and particularly research. We produce reports about issues that affect patients and issues that are relevant to health professionals, too. We also do a lot around public engagement with science and getting messages out that present the evidence. We’re politically neutral, but we believe decisions should be informed by the best available evidence.”
One of the most significant pieces of work the Academy has produced recently has been its child health report. The current government has emphasised “from sickness to prevention” as one of its key strategic shifts to accomplish its aim of constructing an NHS robust enough to deal with the nation’s health in the future. The Academy of Medical Sciences has backed this transition, supported by strong evidence that prevention is both cheaper and more beneficial than treating illness.
The Academy’s child health report concludes that early childhood intervention offers one of the best chances of improving the health of the nation. The first five years of life are critical in shaping lifelong health outcomes. However, early-years health is in need of more support to reduce the ever-widening health inequalities. The economic cost of delaying intervention
Professor Rosalind Smyth
is estimated at £16 billion annually.
Prof Smyth, a professor of child health at UCL, outlines why this report is so vital. “Some children’s diseases are inherited, but some children have shorter and more difficult lives not because of any innate susceptibility to illness, but simply because of the circumstances into which they’re born. There are really very stark differences in life expectancy between children born in the lowest socio-economic groups and those in the highest groups. It’s an inequitable situation that we should strive to address. That’s what this report really flags up.”
The report revealed some fairly dramatic figures around the prevalence of dental decay in the poorest groups, and childhood obesity and infant mortality were also shown to be much higher. “We’re not doing well compared to similar countries globally.” This underscores the crucial need for change. “The consequences of the chronic health conditions that begin in childhood but continue for many decades mean that it’s more cost-effective to try to intervene early than it is to treat people when they’re already ill and suffering those consequences.”
Another major report that the Academy has published lately concerns future-proofing UK health research. “It takes a helicopter view of the two different sectors – the NHS and the universities – and the intersection between them. The data opportunities that come from having one national health service are very powerful indeed when it comes to understanding health and disease. But because the two sectors are pretty cash-strapped, it’s been difficult sometimes to prosecute research
Research is part of patient care. If it’s integrated into patient care – engaging with patients, taking their advice, listening to them – then things will get better.
effectively in the NHS. Clinical academics are being pulled in different directions.”
She continues: “If delivery of clinical care takes priority – which, if you’ve got sick patients, it has to – then managers put more and more into that. But then doctors are not able to conduct the research they’re funded to do. So, it’s really about the university sector and the NHS understanding how important research is to improve patient care.”
Despite the challenges of the work, Prof Smyth remains hopeful about the future. “I tend to be a glass-half-full person. I think all forms of government listen to the Academy. I’m optimistic about the NHS 10-year plan, and that research will be seen as an absolutely integral part of that. Research is part of patient care. If it’s integrated into patient care – engaging with patients, taking their advice, listening to them – then things will get better.”
She adds: “We have seen a lot of that in the last 10 or 20 years. We have been engaging much more with patients, which has been hugely beneficial. It’s very important to understand really what their needs are because they are the best ones to tell us.”
She closes by summing up how essential the work of the Academy of Medical Sciences will remain over the coming decades. “Medical research is not the only way you improve patient care, but it is the future. The care tomorrow is the research today.”
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The good fight Professor Teresa Lambe, a professor of vaccinology & immunology and the Calleva head of vaccine immunology at the University of Oxford, on how the global battle against Covid-19 posed unprecedented challenges for the medical community and changed the world of immunology forever
Words: Viel Richardson
Portraits: Jonathan Browning
It was December 2019 when reports started emerging from Wuhan, the capital of Hubei Province in central China, about an unknown pneumonia-like illness circulating among the local population. The appearance of an unknown virus is not in itself a cause for alarm, but there were aspects of these reports that raised concerns within the medical community, particularly the epidemiologists whose role it would be to tackle the spread of a new pathogen.
The speed with which the virus was spreading suggested person-to-person infection. There was also an apparent association with the local live seafood market, an environment that holds the potential for cross-species infection, where an illness jumps from animals to humans. Finally, there was the fact that symptoms could shift from mild to severe, even fatal. Then health workers began to die and people other than epidemiologists started to take note.
Wuhan, a major national and international transportation hub, was experiencing an outbreak of an unknown virus that was spreading fast and killing people and worried Chinese authorities were working hard to identify the nature of the virus. Despite their traditional veil of secrecy, by the end of the month these officials began making a series of announcements. On 31st December 2019 they reported cases of a pneumonia of unknown cause to the World Health Organisation (WHO). On 7th January 2020 they announced the identification of a novel coronavirus as the cause of the outbreak, which
they called 2019-nCoV, which was important as it confirmed the virus’s relationship to the SARS coronavirus. On January 10th, they shared the first complete genetic sequence of the virus. On 11th February the International Committee on Taxonomy of Viruses (ICTV) officially named it SARS-CoV-2, and on the same day the WHO officially named the disease caused by SARS-CoV-2. For the first time, the world heard the name Covid-19.
For Professor Teresa Lambe and her colleague Professor Sarah Gilbert, both professors of vaccinology at the University of Oxford, the question was not if a vaccine could be developed, but whether they themselves should try. “When the first reports of the outbreak came in, Sarah and I talked about whether we should give it a go,” Prof Lambe recalls. The two friends had been working with viral vector technology for years, producing vaccines for diseases such as Middle Eastern respiratory syndrome (MERS) and the dreaded Ebola virus.
T wo vaccine technologies came to the fore in the drive to develop a Covid-19 vaccine: viral vector and mRNA platforms. Both operated on the principle that the immune system can be trained to recognise and then attack the virus if a person gets infected. Viral vector vaccines use a modified adenovirus as the delivery platform. This ‘Trojan horse’ carries the genetic recipe for the virus’s spike protein into cells, prompting the immune system to produce antibodies and activate T and
We had the platform ready and waiting for us to insert the spike protein sequence. People think of vaccine creation as starting from scratch every time. But it’s more like starting a building with a solid foundation already in place.
Academy of Medical Sciences
Professor Teresa Lambe is a Fellow of The Academy of Medical Sciences. The Academy, based on Portland Place, is an elected fellowship of medical researchers. It has over 1,300 fellows, about half of whom are clinically qualified, the other half being laboratory scientists in a range of disciplines. The Academy, which seeks to promote excellence in research,influence policy to improve health, promote careers in medical research, and foster links between academia, industry and government, is a registered charity that relies on philanthropic funding. To support its work and make a donation please visit: acmedsci.ac.uk/support
B cells. mRNA vaccines, in contrast, use lipid nanoparticles to deliver the genetic code directly into cells. While both technologies prompt immune responses, the body reacts differently to each one. mRNA vaccines produce rapid, high antibody production that tapers off relatively quickly while viral vector vaccines generate a lower spike of antibodies initially but produce a steadier, longer-lasting response.
“We wanted to see if our delivery platform, which was designed for speed and scalability, could meet this unprecedented challenge. Once the Chinese had published the genetic sequence, we had what we needed to begin,” Prof Lambe explains. She has spent years working to tackle emerging viruses in the global south, where infrastructure and funds can be limited. This meant developing a system for vaccine creation that was fast moving, allowing vaccines to be developed and deployed before a new virus has a chance to spread widely, all while ensuring the safety and efficacy of the medication produced.
Their decision was not without risk. Historically, vaccine development is a lengthy process, often spanning a decade or more with no guarantee of success. “It’s arrogant to assume you can make a vaccine for anything,” the professor tells me. “We don’t have vaccines for TB, HIV and other major killers despite years of research, but we had to try. It was clear that many lives would depend on a successful vaccine being developed.”
One of the most surprising aspects of vaccine development is the speed at which they can be designed. According
Vaccine Platform Comparison: Protective Efficacy against Lethal Marburg Virus Challenge in the Hamster Model. 2024
Immunogenicity and safety of beta variant COVID-19 vaccine AZD2816 and AZD1222 (ChAdOx1 nCoV-19) as primary-series vaccination for previously unvaccinated adults in Brazil, South Africa, Poland, and the UK: a randomised, partly double-blinded, phase 2/3 non-inferiority immunobridging study. 2024
Costa Clemens SA., Jepson B., Bhorat QE., Ahmad A., Akhund T., Aley PK., Bansal H., Bibi S., Kelly EJ., Khan M., Lambe T., Lombaard JJ., Matthews S., Pipolo Milan E., Olsson U., Ramasamy MN., Moura de Oliveira Paiva MS., Seegobin S., Shoemaker K., Szylak A., Villafana T., Pollard AJ., Green JA., AZD2816 Study Group None.
to Lambe, the design process itself took a single weekend. “It sounds almost boring,” she admits. Using computational tools such as basic local alignment search tool (BLAST) analysis, the team mapped parts of the SARS-CoV-2 genetic sequence against known coronaviruses. “This way we identified the spike protein as the most promising part of the virus to work with,” Prof Lambe explains. “The spike protein is a critical but harmless surface-based component that the virus uses to enter human cells This makes it the ideal candidate to train the immune system to recognise the virus.”
Once identified, this small segment of genetic code was cut and pasted into the adenovirus platform the team had been refining for years. “It’s like plug and play,” Prof Lambe says. “We had the platform ready and waiting for us to insert the spike protein sequence. People think of vaccine creation as starting from scratch every time. But it’s more like starting a building with a solid foundation already in place.”
This was of course not nearly as easy as she makes it sound. Once the segment of code has been identified, you need to isolate it very precisely, as you only want the information necessary to make this part of the virus. Any sloppiness and you could include instructions to make another, and possibly active, part of the virus you’re trying to protect against. Then you have to provide to your pharmaceutical partner the instructions needed to produce the sequence. Once you get this back and combine the two, there is of course testing, testing and more testing to
Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. 2021
Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, Angus B, Baillie VL, Barnabas SL, Bhorat QE, Bibi S, Briner C, Cicconi P, Collins AM, Colin-Jones R, Cutland CL, Darton TC, Dheda K, Duncan CJA, Emary KRW, Ewer KJ, Fairlie L, Faust SN, Feng S, Ferreira DM, Finn A, Goodman AL, Green CM, Green CA, Heath PT, Hill C, Hill H, Hirsch I, Hodgson SHC, Izu A, Jackson S, Jenkin D, Joe CCD, Kerridge S, Koen A, Kwatra G, Lazarus R, Lawrie AM, Lelliott A, Libri V, Lillie PJ, Mallory R, Mendes AVA, Milan EP, Minassian AM, McGregor A, Morrison H, Mujadidi YF, Nana A, O’Reilly PJ, Padayachee SD, Pittella A, Plested E, Pollock KM, Ramasamy MN, Rhead S, Schwarzbold AV, Singh N, Smith A, Song R, Snape MD, Sprinz E, Sutherland RK, Tarrant R, Thomson EC, Török ME, Toshner M, Turner DPJ, Vekemans J, Villafana TL, Watson MEE, Williams CJ, Douglas AD, Hill AVS, Lambe T, Gilbert SC, Pollard AJ; Oxford COVID Vaccine Trial Group.
ensure it does what you intend.
“Once the viral vector has delivered the instructions for producing the spike protein to the cells, the immune system, recognising this protein as a foreign and potentially dangerous object, kicks into gear and mounts a robust response, producing B cells and T cells whose job it is to destroy dangerous and unknown pathogens. This means that when a person then gets infected with the actual virus your immune system recognises and attacks it.”
This approach stands in contrast to traditional vaccines, which typically use inactivated viruses. This involves generating large batches of a virus or other pathogen then killing them using either chemicals, heat or radiation. The dead virus is then injected into a person so that the body learns to recognise it. The issue with this method is that it generally takes longer to complete and can be more expensive to produce.
Despite their expertise, Prof Lambe and her team faced a host of real challenges. One of the most significant being the accelerated timeline. Under normal circumstances, vaccine development follows a strict linear progression: vaccine design, preclinical testing to ensure it works and is safe, clinical trials in humans and finally manufacturing. It is possible for a vaccine to fall foul of failures at any one of these stages and never reach the point of being released. To save time, the Oxford team adopted a strategy known as ‘stacking’, which involves conducting multiple phases simultaneously.
“It is absolutely critical to emphasise that the only area of increased risk posed by stacking is monetary. At no point is the safety of those participating in the trials in any way compromised. Stacking simply means starting the next phase before we know if the vaccine will pass the current one. It is a financial gamble,” Prof Lambe explains earnestly. “So, for example, we began manufacturing doses of the final vaccine at scale before we were sure it would get approval. It was a calculated risk, but the urgency of the pandemic left us little choice.”
That calculated risk, however, was based on a very educated guess. Prof Lambe and her team are hugely experienced, and what they were seeing in the lab gave them confidence that the vaccine would be safe and effective. “Had there been any doubt about its safety or performance, any vaccine already manufactured would have been destroyed and we would have started again.”
Logistics were another obstacle. The adenovirus vector used in the vaccine required meticulous manufacturing processes to ensure consistency and safety. Scaling up production to meet global demand meant partnering with AstraZeneca, a move Prof Lambe describes as essential. “Creating the vaccine was only part of the battle,” she says. “The whole point of the process was to create something that could be delivered to billions of people – something that required an entirely different set of skills and resources and not a world we were familiar with.”
There were good days and bad days, some of the best being when
the team saw data confirming that the Oxford-AstraZeneca vaccine was safe, effective and protecting people. But there were dark days too. The team received hate mail, and verbally aggressive protesters gathering outside their lab. “You learn to compartmentalise and carry on,” she says, “but it’s hard not to take it personally.” Despite these challenges, Prof Lambe remains inspired by the collective effort to combat Covid-19. “The pandemic showed us what we’re capable of when we work together,” she says. “That’s a lesson I’ll carry with me forever.”
The pandemic has reshaped the field of immunology in profound ways. One of the most notable shifts was the speed and scale of collaboration.
What works best for one pathogen might not be ideal for another. It’s about using the right tools for the job – and we understand both our tools and ourselves so much better now.
“Researchers shared data like never before,” Prof Lambe says. “This openness, combined with huge amounts of real-world data from the vaccine roll-out, has accelerated discoveries about the immune system. We know so much more now about areas such as the longevity of vaccine-induced protection and identifying differences in immune responses across diverse populations.”
The professor also talked about hybrid immunity in the context of insights gained from Covid-19 vaccine research. She notes that studying individuals with hybrid immunity –those who have been both vaccinated and exposed to the virus – has been crucial for understanding immune responses over time. “Tracking responses from the initial vaccine dose ‘day zero’ through subsequent exposures has allowed scientists to map the dynamics of immune protection,” she explains. “Research has also highlighted the fact that protection against infection is not solely reliant on neutralising antibodies. While this plays a significant role, other immune system components are critical in maintaining health and preventing severe disease. Such findings are shaping the development of next-generation vaccines by helping researchers understand the combination of immune factors required for robust, long-lasting protection. Hybrid immunity serves as a valuable model for refining our vaccine strategies.”
This period really showcased the adaptability of modern platforms, such as mRNA and viral vectors, with each offering unique advantages.
“For example, we saw the difference in antibody response to the different platforms. Understanding these differences is key to tailoring vaccines for specific diseases,” she tells me. “These observations are shaping the next generation of vaccines, with researchers exploring how to combine technologies for optimal results.” There is a real gleam in her eye as part of her mind drifts away from our talk to imagine the lives that could be saved as a result of better vaccines. “What works best for one pathogen might not be ideal for another. It’s about using the right tools for the job – and we understand both our tools and ourselves so much better now.”
The pandemic also prompted a re-evaluation of research priorities. Diseases that were once overlooked are now receiving renewed attention, and the success of platforms like mRNA and viral vectors has opened doors to tackling a broader range of illnesses. “We’re not just learning about Covid-19,” Prof Lambe says. “We’re learning about ourselves – how our immune systems work and how we can protect more people.”
There was a truly global response to the pandemic. It led to a huge amount of funding being given to extremely bright people who were driven to do their best and share their results with the world. It has made the world of epidemiology a much more interesting place, with new research throwing up potentially paradigm-shifting possibilities. I ask if the world is better prepared for future pandemics. Prof Lambe is optimistic, but with caveats. “The tools are there,” she says, “but it
depends on political will and funding. Without sustained investment, we risk losing the progress we’ve made.”
Prof Lambe also emphasises the importance of combating misinformation. “Building public trust in science is critical,” she says. “We have to be effective communicators and engage people. If we can’t explain why vaccines matter, we’ve failed. There is a vast difference between the mind of the vaccine sceptic and that of the anti-vaxxer. We need to connect with people who have genuine questions. Not doing that can create a gap in which misinformation both accidental and deliberate can take hold.”
Unsurprisingly the experience has shifted Prof Lambe’s own priorities. Before Covid-19, she describes herself as a ‘geeky scientist’ who took joy in lab work and the excitement of analysing results. However, the pandemic experience broadened her perspective. “Now I place much greater emphasis on enabling scientific results to have a tangible impact on the wider world, beyond the confines of research,” she explains. “The experience has broadened my understanding of how scientific research can be a vehicle for meaningful change, particularly in addressing global health challenges.”
It also showed her the best of humanity. “The Covid pandemic offered an unprecedented opportunity to learn, collaborate, and innovate. The journey was far from straightforward, but what I found particularly inspiring was that unlike so many dystopian films we see, the pandemic saw societies coming together in the face of a global threat as opposed to falling apart.”
Oxford Vaccine Group ovg.ox.ac.uk
THE EYES HAVE IT
Professor Paulo-Eduardo Stanga of The Retina Clinic London on the unique characteristics of the human eye, the importance of empathy, and the race to keep up with technological changes
Words: James Rampton
“Life-changing” is an overused description, but it really does apply to the work of Paulo-Eduardo Stanga. The leading ophthalmic surgeon, who set up The Retina Clinic London in 2019, has the ability to transform the lives of his patients. It can be a very moving, even joyful experience.
Prof Stanga outlines the emotions he and his patients go through after a successful procedure. “The best thing about this job is seeing a positive response to treatment and the happiness that brings to the patients. We get wonderful feedback and thank-you letters from them.”
He explains that the transformation can be something as simple as removing vitreous floaters – very annoying specks that drift into your vision. “Vitreous floaters are a common problem. I remove the floaters surgically or with a laser, and we get complete resolution. The following day, I see the patient, and they say to me: ‘This is life changing. I never thought the change would be so dramatic.’ We’ve had patients with their eyes full of tears.”
Prof Stanga continues: “When we operate on a patient who has vision in only one eye, there’s great responsibility there because if you make a mistake, the patient could end up blind. But there’s also great reward because the following day, when you remove the patch, the patient can suddenly see again. There are few more rewarding things in life than that.”
The surgeon, who is also professor of ophthalmology at the Institute of Ophthalmology at University College London, has more than 30 years’ experience in his field. Talking in his clinic at 24 Queen Anne Street, he explains what inspired him to take up ophthalmology as his speciality. “I always wanted a niche – a ‘small’ but complex field.”
Prof Stanga goes on to make an intriguing comparison. “I see ophthalmology as like the work of a watchmaker or
The way we visualise the retina is changing on a daily basis. Technology becomes old within 12 months, and it’s essential to be constantly updating your technology.
a clock repairer. It’s very precise and well defined. There are also many toys. We use a lot of technology. It’s such a fascinating area.”
There’s more. “The eye is beautiful inside. The beauty of its anatomy was another factor that drew me to ophthalmology. Once you see the inside of the eye, you could stare at it for hours.”
This echoes what Charles Darwin wrote about the potentially divine qualities of the human eye in On the Origin of Species: “To suppose that the eye with all its inimitable contrivances for adjusting the focus to different distances, for admitting different amounts of light, and for the correction of spherical and chromatic aberration, could have been formed by natural selection, seems, I freely confess, absurd in the highest degree.”
Prof Stanga concurs wholeheartedly with Darwin’s thoughts on the possibly metaphysical properties of the human eye. “Those of us who believe in God couldn’t agree more. We have to remember that not only is the human eye beautiful, but it is also an extension of the brain. When the eye is developing, it’s part of the same tissue as the brain. So there’s a direct link between the eye and the brain. We are very fortunate because the eye is the only organ with a transparent medium. So, for example, you can look at the arteries and the veins in the eye of a diabetic, and if those blood vessels are damaged, they are going to be damaged in other organs as well. We have direct visualisation through the eye, and that’s unique.”
The Retina Clinic London offers a one-of-a-kind service, its founder and chief medical officer says. “We wanted to give patients a completely different experience, and we wanted
to give patients choice: choice of care, choice of how they are treated. We wanted them to be part of the decision-making process in reaching every diagnosis and treatment, rather than telling them:, ‘This is your diagnosis and this is how I’m going to treat you.’ For me, it’s very important for a patient to know what all the options are and not just be told what I think is best for them.”
Keeping the patients up to speed with their diagnosis and treatment is empowering for them. “Knowledge and information give you power,” Prof Stanga observes. “One of the difficulties that patients have is that they don’t receive enough information about their treatment. For instance, there is more than one drug which treats wet macular degeneration, and it’s important that the patient knows the difference between the drugs. Some drugs have different risks and different success rates. It’s crucial that all of this is discussed with the patient, so that they can choose which drug they want to go for.”
The aim is to arrive at a diagnosis during the first visit to the clinic. “Most, if not all, of our patients leave our first consultation with a diagnosis.” The patients at The Retina Clinic London also benefit from the fact that it is a one-stop shop. “We are a dedicated, self-contained clinic,” the surgeon says. “We have an on-site theatre, and we do all our diagnoses and treatments here.”
A nother aspect that motivated Prof Stanga to found the clinic was the continuity of care it could guarantee. “That is really important. I did 21 years in the NHS, and in some of the state-run systems there isn’t that continuity of care. A doctor sees the patient, then the patient comes back, and another doctor sees them. Yes, of course, there are medical records for the doctor to read, and in theory, it should be seamless.
However, sometimes there is a discrepancy amongst the doctors about what is the best way forward for a patient. Also, it’s always good for the patient to create a relationship with the doctor. That empathy is difficult to establish if the patient is in a conveyor system of 15-minute appointments, and every time they see a different doctor.”
A further benefit is that Prof Stanga doesn’t have to send patients to another department to get tested. “We do everything in-house. We see everybody the day after the surgery. It’s always the same team taking care of the patient.”
At The Retina Clinic London, the team work hard to establish a strong patient-doctor bond. Prof Stanga emphasises: “Every patient, whether they are paying, or whether they receive care free of charge because they’re on a clinical trial, is always greeted with the same smile. They all sit in the same waiting room, and they all receive the same quality of care and attention. It goes back to ancient medicine and the shamans; the first interaction between the physician and the patient is the beginning of the treatment. So it is essential that there is a healthy and empathic relationship between the doctor and the patient. It is critical to build trust with the patient – and always do it with a smile!”
That is only enhanced by the personalised service that patients receive at the clinic. “From the moment a patient asks for an appointment, we try to find a slot that’s convenient for them. It’s not unusual that we have to keep the clinic open longer to accommodate specific patients because of some special needs, or because they cannot make it at a time the clinic is normally open, or they want complete privacy. We can always accommodate that.”
The eye is beautiful inside. The beauty of its anatomy was one factor that drew me to ophthalmology. Once you start, you could stare at it for hours.
A nother attraction for patients is the excellent selection of clinical trials at The Retina Clinic London. “Something else that inspired me to set up the clinic,” says Prof Stanga, “was the possibility of doing research on site. We can offer patients participation in clinical trials outside of a teaching hospital. To the best of my knowledge, we are the first and only clinic that specialises in the retina that does this. For example, I’ve done the first gene therapy surgery in the field of the retina outside of the teaching hospital. The advantage to patients of participating in clinical trials is that they do not pay for treatment.”
Prof Stanga has also led the way in the use of cutting- edge technology. For instance, he has been a pioneer in the area of multi-modal testing. He details why it is so effective. “It is important to reach a diagnosis with information coming from different sources, so that one source validates the other or increases the amount of information that we are obtaining. We believe that it is essential for the patient to leave that first consultation understanding their diagnosis, even if it is something as simple as a cataract.”
The ophthalmologist has also done trailblazing work with optical coherence tomography (OCT) scans, another key diagnostic tool. He recalls: “I introduced OCT scans into the clinical setting in the UK back in 1998. It was a new technology at the time.” The method was initially treated with scepticism by the medical establishment. “At the beginning, I was being told: ‘Do you think we really need this? They are very pretty images, but do they change management?’ And I would say: ‘Yes, they do change management because we get all this extra cross-sectional information.’ We need that extra information in order to reach very specific diagnoses and also to plan treatment.”
Nowadays the use of OCT scans is universal; you cannot run a clinic or a high-street optometrist without them. Prof Stanga says: “When we show the pictures to patients with wet macular degeneration, for instance, they learn how to interpret their own images and become part of the decision making process. That’s just an example of how we are bespoke, and patients really appreciate that.”
The ophthalmologist has broken new ground in his employment of artificial intelligence (AI) as well. “Something that we’re doing on a routine basis now is using
artificial intelligence. For example, if you are a patient who suffers from dry age-related macular degeneration (AMD), we can objectively tell you whether you’re losing photoreceptors or not before we even see the changes in autofluorescence, which used to be the gold standard.”
He adds: “If you have wet AMD, we use artificial intelligence and can tell you within nanolitres whether the amount of fluid in the retina has gone up or down, and whether you are objectively responding to the treatment or not. This doesn’t replace the doctor; it empowers the doctor to reach a more accurate diagnosis.”
As he looks towards the future, Prof Stanga is very excited about the potential of gene therapy. “Gene therapy has recently been approved for the treatment of a disease called Leber congenital amaurosis. That’s been life changing. We are exploring other gene therapies for other conditions, like wet macular degeneration, dry macular degeneration and diabetic macular oedema. The aim of the gene therapy is to reduce the burden on the patient, as well as on the healthcare system.”
How else does the pharmacologist think his field will advance in the coming years? “I think artificial intelligence is going to become invisible. It’s going to be part of our mobile phones and of every imaging device that we use. We’re also going to be bringing robotic surgery into ophthalmology. It’s not going to replace the surgeon, but it’s certainly going to enhance our surgical techniques.”
In this area, you have to be running to stand still. “The way we visualise the retina is changing on a daily basis. Technology becomes old within 12 months, and it’s essential to be constantly updating your technology.”
A s you can see, Prof Stanga has an unquenchable passion for his work. What is it, then, that he loves most about his job? “Everything! That’s the problem! It’s constantly fascinating. Like everybody else, we have headaches, and we have good and bad days. But we really want to see the patients and we really want to come to work every morning.”
How many jobs can you say that about?
The Retina Clinic London 24 Queen Anne Street London W1G 9AX theretinacliniclondon.com
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Emilie, a student at Sanders Draper School in the Borough of Havering in east London, explains that until recently, her mental health “was really quite bad”. But then, she continues, she took part in a pioneering scheme called the Havering Youth Wellbeing Census.
Adapted from the #BeeWell survey, the purpose of the census was to collect data on the factors affecting the mental health of young people in Havering. Participating in the programme changed the game for Emilie. “It really helped me think. Maybe I should do this more, maybe I should do that more, maybe I should do some breathing techniques. Because of the questions – like, ‘Who should I go to?’ – it really helped me personally. Not a lot of people like coming out to teachers and friends and saying: ‘I’m not OK at the moment.’ So I think it’s really good that the school got people to take the test.”
T he census has been rolled out across 10 schools and 2,287 students in years 8, 9 and 10. Those schools are now formulating action plans. The findings of the census are available to the public and have been sent to young people’s services across the borough.
In the future, the council will be capable of organising the survey itself. Havering Youth Wellbeing Census represents a tremendous breakthrough in the assessment and treatment of mental health among young people in the area. The survey is one of the many excellent projects set up by a trailblazing medical innovations organisation called UCLPartners. Its CEO, Dr Chris Laing, lays out the mission statement of the organisation: “Our job is to deliver novel solutions to challenges in health and care.”
In addition to the field of adolescent mental health, UCLPartners is conducting groundbreaking work in the detection of cancer, cardiovascular health, dementia, respiratory disease and vision loss. Covering five million patients from north London to the Essex coast, this not-for-profit organisation boasts impressive stats. In the year 2023 to 2024, it raised £25 million to fund the implementation of solutions in the health and care system. It also helped 225 companies get their innovations adopted. This led to £5.8 million in sales and new investments.
TOMORROW’S WORLD
Dr Chris Laing, CEO of the non-profit innovation organisation UCLPartners, on the drive to deliver novel solutions to healthcare challenges
Words: James Rampton
UCLPartners, which employs 80 people, is funded by grants from NHS England and the Office for Life Sciences, as well as bespoke commissions. The team work with 17 partners, including several universities and three integrated care systems. “We are effectively an innovation agency,” says Dr Laing. “We work with the health and care system, and we help discover, develop and deploy innovative solutions that meet the healthcare needs in our wider partnerships. We also promote the growth of businesses in the NHS. We oversee something called the NHS Innovation Accelerator, which supports small and medium-sized enterprises, scaling solutions across the NHS in England.”
O ver the past year, 1.8 million patients were reached by innovations supported by the NHS Innovation Accelerator. At a time of ever-tighter budgets within the NHS, it is clear that UCLPartners plays a vital role in boosting revenue. The organisation is also critical when it comes to improving preventative care. Dr Laing explains: “We are focused on more proactive preventive care. We talk about the four Ps in medicine:
technology that predicts future illness, then proactively prevents it. The fourth P is personalising care and customizing it for patients.
T he NHS is currently concentrating on three shifts: analogue to digital, hospital to community, and treatment to prevention. “The development of new solutions is quite fertile ground here. The larger problem for the NHS is actually adopting those solutions. We’re a key part of that story.”
W hat sort of innovations have UCLPartners been responsible for, then? Dr Laing, who still works as a consultant nephrologist one and a half days a week, gives a good example. “We have developed a tool called CVDACTION. This is a cardiovascular disease (CVD) risk management tool that’s been deployed in GP databases. It allows GPs to very rapidly survey their patient cohorts for people who have got particularly high cardiovascular risk factors that may include high blood pressure, kidney disease or high lipids.”
T he consultant continues: “It helps the GPs find those patients and then supports them in delivering proper preventive care, which is usually with medicines that lower lipids or blood pressure. That tool has gone live, and it’s screening around a million patients across London at the moment. We get several hundred cases a week where patients have their cardiovascular risk adjusted. This reduces the risk of heart attacks, strokes or other adverse cardiovascular events.”
T he professionals who utilise CVDACTION are quick to sing its praises. Romil Mandvia, a pharmacist and cardiovascular disease lead, says: “By using CVDACTION we are trying to proactively prevent CVD, which might not have otherwise been done. The tool provides a helpful way to pick out patients who need care early on and offers a safety net for looking after patients.”
Another area of strong innovation at UCLPartners is the detection of potential vision loss. According to Dr Laing: “We’ve been supporting Moorfields Eye Hospital with their eye care pathway innovation. It’s their invention, but we are supporting them and doing modelling, analysis and evaluation. That particular pathway accelerates access to diagnostics through remote triage and the use of diagnostic hubs. As a result, we’ve seen a reduction in demand for
ophthalmology services of around 50% and a projected decrease in costs of around that magnitude.”
T he doctor continues: “Patients are having their care delivered in a more local way. It’s remote – there’s a telemedicine component to it. It’s delivered in community-based hubs, so the patients are getting the care more quickly and more reliably. But it also reduces costs by reducing demand on the hospital system, which is where the NHS is trying to head.”
L ooking forward, Dr Laing sees many advantages in the growing use of AI in medicine. “We’re already seeing benefits, and there are plenty more to come. AI has enormous potential to predict future illness and support doctors in making reliable diagnoses. There are certain tasks for which AI is very well suited, such as analysing complex data.”
A s an example: “We supported the implementation of a community diagnostic hub in Wood Green in northeast London. My team put a huge amount of effort into engaging with the local community in setting up that facility and developing the necessary clinical pathways. So that’s a good example of customisation.”
He adds: “With the artificial intelligence urgent care innovation that we’re working on in east London, the AI customises itself for the local population. It’s trained on the east London healthcare data set, so it delivers predictions that are quite specific to those communities. We’re also customising the clinical intervention that the predictive technology drives to ensure that it’s tailored to the needs of different communities. We hope the benefit will land most effectively on the most difficult-to-reach and deprived patients in that area.”
A I is also being employed to make clinicians’ lives easier. For instance, Dr Laing says: “There’s an innovation in Great Ormond Street Hospital that provides automated documentation and clinical notes. We hope this will provide clinicians with more time to actually spend talking to patients and less risk of burnout. So automation and, in certain domains, superhuman performance have huge potential and will continue to have a lot of impact in transforming healthcare.”
Despite the major challenges that face the healthcare system in this country, then, Dr Laing feels positive about the
future. “I’m very optimistic that we’re building capabilities, relationships and expertise and that we can land solutions which will help transform healthcare. I’m also very optimistic that we’re in the right place at the right time and that we will be able to make a contribution. The healthcare system in this country has got some fantastic staff. We’ve got some great institutions, and there’s a very rich supply of brilliant ideas and great new innovations and technologies.”
T he consultant adds: “I’m actually very optimistic that with focus and commitment we will be able to support the NHS on its journey to sustainability, while also promoting wealth creation and economic growth through life science and technology. There is a very promising supply of innovation with clear demand. I’m very hopeful that we can make a difference.”
Dr Laing sums up what he loves about his work. “I get to work with fantastic people, both among our team at UCLPartners, and among our healthcare partners, who include some great academics and innovators in industry.” It’s difficult work, “but we are trying to support positive change and transformation, so the rewards are very high.”
He also finds the societal aspect of his job very satisfying. “One of our missions is to try to reduce health inequalities and discover innovations which support that. In many of our projects, we are targeting some of our most deprived communities. So, for example, our cancer programme, where we’re providing early support for patients with a new cancer diagnosis, is active in our most deprived boroughs. There is great diversity in terms of the geography that we serve and the communities that we serve, and we are now able to adapt and customise the solutions to the needs of different communities. It’s very enjoyable, interesting work.”
A nd so, he concludes: “There are great rewards. I have the opportunity to have a positive impact. Helping to solve problems that benefit patients is the reason I do this work. I feel very privileged to be in this job.”
UCLPartners 32 Welbeck Street London W1G 8EU uclpartners.com
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Q+A
Transcranial magnetic stimulation
Dr Leon Rozewicz of the Priory Group on a minimally invasive neuromodulation treatment that offers hope to people with depression
Interview: Viel Richardson
What is repetitive transcranial magnetic stimulation (rRTMS)?
rTMS is a neuromodulation treatment. A rapidly alternating current is passed through an electric wire coil which induces a magnetic field on the scalp. The magnetic field then induces low amplitude electrical currents in the cerebral cortex of the brain.
How does it work in the treatment of depression?
When treating depression we target the left dorsolateral prefrontal cortex. Stimulation of this region increases blood flow and promotes nerve growth. This region is an important junction for pathways associated with depression. While the precise mechanisms underlying its therapeutic effects are not yet
fully understood, the rationale is that increasing blood flow and nerve growth alleviates symptoms of depression.
Electroconvulsive therapy (ECT) is another well-known neuromodulation technique. How does it differ from rTMS?
Both rTMS and ECT use electrical currents for treating depression, but they differ significantly in their approach and mechanisms. ECT uses a generalised seizure (convulsion) caused by electrical currents applied directly to the brain. It requires the patient to be under a general anaesthetic and temporary muscle paralysis. One of the side effects can be temporary short-term memory deficits. In contrast, rTMS uses
magnetic fields to stimulate specific brain regions, such as the prefrontal cortex, without inducing seizures or requiring anaesthesia. It does not impair cognitive function and has very few adverse effects, which are usually limited to temporary discomfort.
What criteria would make somebody suffering from depression suitable for rTMS treatment?
rTMS treatment is suitable for individuals with depression who meet one of two main criteria. Firstly, patients with treatment-resistant depression, meaning they have not responded to several antidepressant medications. Secondly, it is a very good option for individuals who cannot
tolerate antidepressant medication. It involves no chemicals and therefore avoids side effects like nausea, impotence or withdrawal symptoms. This also makes it a very safe treatment option for pregnant women suffering from depression as there is no risk of adverse effects on the unborn child.
What is the pathway to a patient receiving rTMS?
The usual treatment involves a combination of antidepressant medication and talking therapies. Patients typically begin with one or two antidepressants and their response is monitored. If a patient does not respond, other medications are tried. If the patient does not respond well to these either, or experiences intolerable adverse effects, rTMS is a good treatment option – a non-invasive, well-tolerated alternative. So, the pathway typically involves exhausting the standard pharmacological and therapeutic options and then proceeding to rTMS, positioning it as a specialist treatment for cases where conventional methods have proven insufficient.
Take us through a typical session. A typical session begins with a series of measurements needed to determine both the placement of the coil on the head and the strength of the magnetic field. The protocol is to generate the smallest possible current in the brain. The head is measured, and a cap is placed on the patient’s head and marked to guide the placement of the magnetic coil. Once these
measurements are complete, the first treatment session begins.
There are two types of session: standard and accelerated. A standard session lasts about 20 minutes with the coil on the left side of the brain. If we are treating anxiety as well, an additional 10 to 15 minutes is spent stimulating the right side of the brain. The standard course of treatment involves five sessions per week for six weeks. For accelerated rTMS, each session only lasts about eight minutes, using a different frequency and sequence of pulses. Patients can receive three to five sessions per day, condensing the treatment into just two weeks.
Can you expand on the measurements taken before the first treatment?
We need detailed cranial measurements to ensure accurate coil placement. This involves identifying key physical landmarks on the head. For example, measurements are taken from the nasion (the bridge of the nose) to the inion (the bump at the back of the skull) and across from one earlobe to the other. We measure the head circumference. These measurements help establish the exact location of specific brain areas. A formula is then used to calculate the precise coil positioning for the condition you want to treat.
That is the placement. What about the power level?
The strength of the magnetic field needed to get the correct level of nerve stimulation will differ for each
rTMS is a valuable treatment option and I think it very likely that it will play a larger role in mental health care in the coming years.
patient. A technician determines this by finding the ‘motor threshold’. This is done by applying the coil to the area of the brain that controls movement of the right thumb. We then generate the magnetic field and slowly increase it until it has reached the minimum power needed to produce a visible movement, such as the thumb twitching. This is the level we then use for the treatment.
What is the patient experiencing during the session?
The patient sits in a chair, similar to a dentist’s chair, and wears earplugs to protect against the noise generated by the magnetic coil, as this can be quite loud. The marked cap is placed on their head and the coil moved into position. When the session starts, the patient will feel a tapping sensation on the scalp, similar to tapping one’s fingers firmly against the temple. In fact, I tell them to do this before we start so they know what to expect. This tapping occurs at a frequency of about 10 to 20 times per second, depending on the protocol and is interspersed with breaks. While the sensation can be intense at first, most patients get used to it quite quickly.
What does the research say about rTMS’s efficacy in patients where medication has not worked?
For medication-resistant patients it can be very effective. Typically, about 50% of patients respond to their first antidepressant. For those who do not, switching to a second antidepressant offers a 25% response rate. A third medication has a 20% chance of
working. By the fourth medication, the likelihood of it working is just 12%. In contrast, rTMS has a 60% success rate when replacing the fourth medication. This significant improvement underscores its role as a treatment for those who have not found relief through conventional means.
How do you assess the progress of a patient?
Standardised patient-rated outcome measures (PROMS) such as the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 item scale (GAD-7), are used to evaluate levels of depression and anxiety throughout the course of treatment. These questionnaires provide measurable data on progress. The patients complete these assessments periodically, allowing clinicians to track progress and make adjustments if necessary. Additionally, direct communication with patients about their experiences and any changes observed by the clinician further inform the evaluation process. This combination of objective scoring and subjective feedback ensures a comprehensive understanding of the patient’s response.
Are there any side effects? They are minimal compared to ECT or medication. Patients may experience local discomfort at the treatment site or a mild headache, which can usually be managed with paracetamol. Overall, rTMS is safe and welltolerated with no significant cognitive or systemic side effects.
Is just a single series of sessions required or do patients need to return for further treatments? This varies for each patient. With some individuals, a single course of treatment can lead to lasting improvement, and they might not require further sessions for an extended period. However, if symptoms recur these patients can return for another course of treatment – if rTMS has worked once, it will work again. Some patients can also benefit from maintenance sessions to prevent relapse. In these cases, patients might come in once or twice a month as part of an ongoing treatment plan. Maintenance rTMS helps sustain the initial benefits and reduces the likelihood of symptom recurrence.
How you see rTMS developing over the next few years?
I expect it to become increasingly widely used for depression due to its effectiveness and minimal adverse effects. It is already gaining traction in several NHS trusts. Research could refine the treatment, including better targeting through advanced imaging techniques like MRI. I am not entirely sure how much improved targeting will improve outcomes, and it could make the treatment significantly more expensive, so for me the jury is out on this line of development. But rTMS is a valuable treatment option and I think it very likely that it will play a larger role in mental health care in the coming years.
How did you come across rTMS and
what were your first experiences with this treatment?
I first encountered it in 2016 after reading research highlighting its widespread use in North America. Given its success, I questioned why it was not more commonly employed here in the UK, so I persuaded the Priory Group to invest in an rTMS device. As soon as we started offering the treatment we observed significant improvements in patients where traditional treatments had failed. These initial experiences very quickly confirmed the treatment’s effectiveness.
What would you say to someone who was nervous about undergoing this treatment?
I would emphasise that it is a safe, effective and well-tolerated treatment with minimal side effects. Unlike ECT, it does not require anaesthesia, does not induce seizures and has no significant impact on memory or cognitive function. Patients remain awake throughout the procedure and can resume normal activities immediately afterwards. There are none of the side effects associated with medications, such as nausea, sexual dysfunction or withdrawal symptoms. Finally, and most importantly, it has shown real success with individuals who have struggled with other treatments.
Priory Wellbeing Centre Harley Street
41 Harley Street Marylebone, W1G 8QH 0207 079 0555 priorygroup.com
Patient experience Philip Williams on how a knee replacement released him from decades of pain
Interviews: Vicki Power
My right knee had been bothering me for 30 years. I snapped my anterior cruciate ligament (ACL) in my right knee in my early twenties when I was living abroad, but it was misdiagnosed at the time. I kept playing rugby and football, but would often put my knee out. It would swell up for days.
At the end of my twenties, I went to see someone who diagnosed it correctly. They said: “You have no ACL, but you’ve also been doing a lot of damage to your meniscus.” I was told I would need a knee replacement at some point, but to hold off as long as I could because the technology and results were improving all the time.
Since then, I’ve had a number of treatments to keep my knee as mobile as possible. These included an ACL reconstruction, which failed, and an
arthroscopy every few years to remove loose bodies that had built up inside.
Over the years I got used to the pain. I’d stopped playing contact sports and replaced them with cycling, swimming and going to the gym. When the pain started waking me up in the middle of the night towards the end of last year, I knew the time had finally come for a knee replacement.
I researched the different options available. Everything I’d read online from published hospital results showed that people have better results and recover faster from knee replacements carried out using the Mako robotic arm process. I asked a friend who is a knee and hip surgeon at the Fortius Clinic for a recommendation and he referred me to Mr David Houlihan-Burne, who uses the robotic process.
David advised me to prepare for surgery by continuing to go to the gym to make sure my leg was in the best possible condition. The stronger my muscles and ligaments were beforehand, the faster my recovery would be.
I had the surgery on 23rd April 2024 at Fortius Clinic London on Wigmore Street. I was pretty sanguine about the whole thing because I was confident I had found the right surgeon. The anaesthetist gave me an epidural to numb me from the waist down, then he sedated me and I drifted off listening to Pink Floyd’s Dark Side of the Moon.
W hen I woke up, I noticed that my right leg was straight instead of curving in from the knee. The pain meds had not worn off yet and they got me up that afternoon and the next day
Anterior cruciate ligament A key knee ligament that stabilises joint movements. Often injured during sports, requiring surgical repair or rehabilitation for recovery.
Meniscus C-shaped cartilage in the knee that acts as a shock absorber, providing cushioning and stability during movement or weight-bearing activities.
Arthroscopy A minimally invasive surgical procedure that uses a camera to diagnose or treat joint issues, enabling faster recovery and less pain. Flexion bending The movement that decreases the angle between bones at a joint, such as bending the knee or elbow during motion.
WHAT IS ROBOTIC ARM‑ASSISTED KNEE REPLACEMENT SURGERY?
Mr David Houlihan-Burne, consultant knee surgeon at Fortius Clinic
to get me on crutches and show me how much weight to put on the leg.
A fter two nights I went home with about two weeks’ worth of good drugs, which hit the pain hard. The first week you feel like you’ve been run over by a truck, but every day I did the exercises the hospital physio had given me. After two weeks I was quite mobile on the crutches and started going to a physio locally and building up the range of exercises from there. My physio said to work through the pain, and once I realised it was diminishing, it didn’t bother me anymore. The important thing was to build up the flexion bending in the knee a little more each day. My physio would add in more exercises for me to try.
I was on crutches for the first six weeks and then went down to one crutch. When I got back on the stationary bike at the gym at eight weeks, I was elated. After six months I got back on the rowing machine and was able to do all the weight machines – the abductors and adductors, leg press and hamstring curl. I can push more weight on my leg now than I could in living memory. I’m swimming and cycling again and I’ll go skiing this winter. The only activity David told me I should not do is running, which I’ve never been a fan of it anyway.
I’d recommend this operation to anyone. It’s important to acknowledge that, while the surgeon can give you the best possible replacement, it’s very much down to you to do the exercises. I’ve got more flexion now than I had before and hardly any pain at all. It’s been a great success.
When Philip first came to see me, his right knee was stiff, swollen and painful. His x-rays showed that he had advanced arthritis of the knee caused by post-traumatic sports injuries. There are various injections he could have tried, but when the arthritis is that advanced, they don’t tend to work very well and are only temporary. The arthritis was everywhere. The only realistic option for Philip was a total – rather than partial – knee replacement.
By the time he came to see me, he’d already had numerous operations on the knee to remove bits of cartilage or replace a ligament, just to keep him going. Often patients come to me before they require a knee replacement, but with Philip that was not the problem.
Since 2018 I’ve been exclusively using robotic arm-assisted knee replacement surgery. It’s assistive technology that allows us to plan the surgery before the patient even arrives in the operating theatre. We know exactly what to expect and can individualise the surgery for the patient before we start. During the surgery, we make adjustments to tailor the knee to the individual, rather than making the patient fit the knee.
By taking into account the shape of the patient’s legs, we can almost give them back the knee they had before they developed arthritis. In Philip’s case we recreated the shape of his arthritic bones on a computer. We then fine-tuned the model during the operation. The robotic arm ensures the accuracy of the cuts that we make so that instead of a 3mm accuracy, we can get down to 0.5mm. That translates to
a much better outcome for the patient and they can recover much quicker. Philip’s surgery was straightforward. Afterwards he stayed in for two nights, which is customary here, allowing him to have a bit more physiotherapy – an added benefit of the private sector. Philip was a very motivated patient. He had realistic expectations in terms of what he wanted to achieve from his knee replacement. I said to him – as I do to all my patients – that what I do is only part of the process: it’s up to them to really finish it off with their physiotherapist for about six weeks afterwards. And he certainly did that.
The new knee will allow Philip to do anything he wants, apart from becoming a marathon runner, because we worry that the impact of running might wear the knee out. But really, there is no other limitation.
In the old days I used to feel like a motivational psychologist with patients, saying: “Don’t worry; stay with me, it’s going to get better in the end. It takes time.” Sometimes these knees would take months to improve. But I only saw Philip once after surgery to say: “You’re doing great.” Now, patients walk into the clinic after two weeks and say: “It hurts, but it’s pretty good.” And I say: “Great! Off you go with your physio.” Then I get emails with pictures of them climbing mountains. It’s hugely satisfying.
Fortius Clinic London 66 Wigmore Street London W1U 2SB 020 3195 2442 fortiusclinic.com
Before After
Tibial component
Femur
Femur
Tibia
Fibula
Tibia
Damaged cartilage
Osteoarthritis
Meniscus
Tibial insert
Femoral component Patella component
Fibula
WOMEN FIRST
Dr Orlanda Allen, HCA Healthcare UK’s head of women’s services, on how a new Harley Street women’s clinic is helping to close the gender health gap
Words: Vicki Power
As the head of women’s services for HCA Healthcare UK, Dr Orlanda Allen is at the forefront of women’s healthcare provision in Harley Street. She’s been the driving force behind the arrival of the company’s new £13.5m Women’s Health Centre, a state-of-the-art outpatient centre that opened last August. “I feel very fortunate to be in the role,” says Dr Allen. “Every day there’s a new challenge and there are lots of problems to solve, but it’s been so exciting.”
Dr Allen trained and worked in the NHS as an anaesthetist, then ran a private aesthetics clinic before moving to HCA, where she worked as an anaesthetist in intensive care and also managed the resident doctor service at The Harley Street Clinic. She then undertook further training that focused specifically on women’s health issues.
“I did a management degree in medical leadership, and I’ve just finished an MBA in health at UCL Global Business School for Health,” she explains, “and as part of that, I did a primary research project on women’s health and the gender health gap and how you can design services strategically to better serve women. That’s what really sparked my interest.”
Moving away from hands-on patient care hasn’t dimmed Dr Allen’s desire to help. “Moving from clinical practice to managerial, that passion for helping people is still very much there,” she says. “But on the managerial side, you can help on a greater scale. Some of what we’re doing is really shifting the dial for women, and it’s just a privilege to be part of it.”
HCA’s investment in women’s health provision comes after the government published its Women’s Health Strategy for England policy paper in 2022. “That was a real driver for us, focusing on the gender health gap and seeing how, as a business, we can start to close that gap,” says Dr Allen. “We’re investing in women’s services to improve their access to care
and their experience of care as well as their outcomes.”
Statistics confirm it’s a much-needed approach. “We keep our fingers on the pulse of external news and what’s going on in the healthcare landscape,” she says. “It’s a very important part of healthcare that’s had underinvestment as a nation and globally, even. We wanted to invest in that by creating centres with the innovative care model designed to really push the agenda forward for women’s health and demonstrate that we can provide excellent quality care for women.”
Current data shows that women are living longer on average, but in poorer health, supporting the conclusion that their healthcare needs are not being met. “On a population level, there’s a real lack of research into conditions that affect women differently from men,” explains Dr Allen. “The most current issue to mention is probably cardiac care. A lot of women are misdiagnosed or underdiagnosed when having a heart attack, and that’s because they don’t present as a typical male would present with symptoms. It’s not crushing chest pain or left arm pain; it might be a bit of indigestion, fatigue, shortness of breath.” Also under-researched are conditions that affect women disproportionately, such as autoimmune diseases like rheumatoid arthritis.
A lack of education about women’s health issues causes untold distress, Dr Allen adds. “Another issue that people have been hearing about lately is endometriosis taking seven to 10 years to be diagnosed. Women feel they’re not heard so are being dismissed by a doctor, perhaps because the doctor doesn’t understand their symptoms or understand what the woman is presenting with.” It’s a global problem that needs addressing. “There’s a big knowledge gap among women themselves as well as practitioners and the healthcare
On a population level, there’s a real lack of research into conditions that affect women differently from men. A lot of women are misdiagnosed or underdiagnosed when having a heart attack, and that’s because they don’t present as a typical male would.
industry. I think we need more education in that space.”
The new HCA Women’s Health Centre is doing its bit to redress the balance by following the model of a women’s health hub, a concept championed by Professor Dame Lesley Regan, appointed the UK’s Women’s Health Ambassador in 2022. The centre contains a rapid-access triple assessment clinic, a full range of gynaecology and urogynaecology services, including oncology, plus fertility and reproductive medicine and menopause services. “It’s a very holistic approach to women’s health that isn’t really in evidence much, certainly in the NHS,” says Dr Allen. “We also have supportive services for women such as psychology and onward referral to physiotherapy and dietitians and the encompassing aspects of care that you might need to feel better.”
The centre, built over six floors, contains a full suite of imaging services including ultrasounds, mammography machines, an MRI scanner and a DEXA scanner. Primary care clinicians coordinate care within the centre, providing seamless care pathways. “So, say a patient has a mammogram that day and the medics see something,” begins Dr Allen. “The patient can then go into the one-stop breast clinic referral pathway, which means getting a biopsy on the same day and leaving the clinic either reassured or knowing that there’s something more significant there. It saves her time because she can do the consultant appointment and diagnostics all in one go and get reassurance most of the time as well.”
Similarly, multiple gynaecological services offered on site obviate the need for repeat appointments and referrals. “If you were a woman that needed to have a colposcopy [removal of cells from the cervix] because you’d had an abnormal smear or a hysteroscopy to look inside the womb, you can usually
have that as part of your appointment on the same day for the convenience factor,” says Dr Allen. Patients whose procedures require anaesthesia are referred to hospital.
Harley Street was chosen as the centre’s location because of the area’s pre-eminence as a district for private healthcare provision, as well as for its proximity to HCA’s other medical establishments. ‘We’re building a network so we can get women to the right service at the right time. We’ve got HCA’s Harley Street Clinic literally two minutes’ walk down the road,” she says, referring to HCA’s acute care hospital specialising in oncology, cardiology and neurosciences.
“Within that network as well we’ve got The Princess Grace Hospital, which has a robotic gynaecology surgery and does breast surgery, too. And also in the W1 postcode we’ve got the Portland Hospital, which is the flagship women and children’s hospital and serves a very important part of the women’s health journey as well. We have a fertility treatment centre and the obstetric centre there. In other words, we have care within that postcode for each part of a woman’s life.”
Dr Allen spends any spare time reading up on women’s healthcare, as well as consulting female patients, to ensure that HCA is in the vanguard of providers. “It’s the nature of my personality that I’m always reading about what the next step should be, where we should be going next, horizon-scanning,” she says. “I really enjoying learning about innovation and technology and how we can bring that to women’s health.”
“It’s collaboration that is going to move the dial on women’s health,” she continues. “That’s the key thing if we want to increase research about female-specific conditions and understand them better. I feel this signifies HCA’s commitment to improving outcomes and experiences for women when using the healthcare service. It’s exciting to be part of it.”
We wanted to create centres with an innovative care model designed to really push the agenda forward for women’s health and demonstrate quality care for women.
THE HARLEY STREET BUSINESS IMPROVEMENT DISTRICT
Harley Street BID will be supporting Arab Health 2024 with a presence in the UK Pavilion and at keynote events. We look forward to seeing you in Dubai.
The Harley Street BID has been established to promote the area and represent the exciting mix of businesses here.
In November 2021 the business community were invited to vote in the ballot to develop a business improvement district and there was an overwhelming “yes” for a BID to be established from the businesses. The BID term runs from April 2022 to March 2027. With the investment that will be made through the BID this provides opportunities to deliver projects across the key themes which are set out below.
STRATEGIC THEMES
We have implemented and devised projects across our themes, identifying key priorities and building our steering group membership with our partners. Our 4 steering groups are set out below and we have a specific Medical Board in place for our business community.
GET IN TOUCH
If you would like more information on the newly developed business improvement district please do not hesitate to contact Nicki Palmer. Email: nicki@harleystreetbid.com Telephone: 07944 386903
MY MARYLEBONE
Dimitrios Mylonadis, founder of Hopscotch Children’s Therapy Centre
Work
I’m CEO and owner of Hopscotch, a paediatric service established in 2002. The clinic takes a holistic approach to occupational therapy, helping children develop independence in their daily activities, such as using utensils, dressing and using the toilet. We also provide support for parents and schools, offering training and coaching. As CEO, I oversee the services, mentor therapists and manage the clinic’s growth, alongside the administrative and management team. I’m still a working paediatric occupational therapist specialising in neurodiversity. I work with children diagnosed with conditions such as autism, dyspraxia, dyslexia, dysgraphia and fragile X syndrome. My primary area of expertise is sensory processing disorder. I also have a background in occupational
therapy, paediatrics, child development and childhood anthropology, and I’m an educator in sensory integration, lecturing internationally.
Food
Marylebone is a great destination if you love food. Over the time I’ve been here I’ve really seen it grow in this regard. I like the mix of bars, bistros and restaurants that has developed. It gives you a great range of choice. Opso is a real favourite. I like the way they combine a modern culinary perspective with traditional Greek hospitality. You find some really wonderful dishes in a great atmosphere. Then there is The Ivy Café which you know will always be a good choice. A place that has recently opened, Carlotta, is a great Italian restaurant, and if you want traditional British food there is The Golden Hind, which sells the best fish and chips
Another shop I love is Bayley & Sage. It’s an artisan food shop but they also sell homewares and their displays, which combine food and flowers, are always beautiful.
Culture
in town. From there, you can stroll across the road to 108 Marylebone Lane, which has an excellent bar. This is also a great area for food shopping. One of my favourite places is La Fromagerie, the most wonderful cheesemongers, which has an incredible cheese room and a real variety of other foods as well. The Ginger Pig, a fabulous butchers shop, is great for meat, and they do really good hot food as well – it has to be one of the best butchers in London.
Shopping
I have to admit that I don’t spend a lot of time in the shops, but as someone who loves design there are some great places to window shop as you go about your day. The jewellery shops in particular catch my eye. Places like Cox & Power, Dinny Hall, 94YS and New Cavendish Jewellers have some beautiful creations.
There is a lot of culture here. Of course, there are world-famous music venues like Wigmore Hall and the Royal Academy of Music, and the Wallace Collection, which has an amazing range of art exhibitions. But my favourite cultural space is Clarendon Fine Art, a small gallery on the high street. I love art and design and really appreciate the gallery’s diverse range of artworks. You can find pieces by well-known names such as Mr. Brainwash and Damien Hirst, but they also champion emerging artists, so there is always a chance that you’ll discover someone new. Daunt Books is another absolute favourite. It’s a great place to relax, looking at new releases or limited editions. There is no sense of being rushed.
Community
I really value Marylebone’s unique atmosphere. I would describe it as having a blend of modern city life and a cosy, family-oriented feel. Despite being in the heart of London, it doesn’t feel like a bustling major city, which I find appealing. There is also a real multicultural flavour, which you can see reflected in the variety of shops, restaurants and cultural spaces. It’s is a real melting pot where you see can different trends in fashion, culture and attitudes coming together as you walk along the high street. It’s a unique place to be.
HOPSCOTCH CHILDREN’S THERAPY CENTRE
128 Harley Street
London W1G 7JT
020 74868168
hopscotchtherapy.co.uk
Daunt Books
Bayley & Sage
Carlotta
WHAT’S ON
MUSIC
MESSIAEN: QUARTET FOR THE END OF TIME
8 February
St Marylebone Parish Church 17 Marylebone Road, NW1 5LT stmarylebone.org
As part of the St Marylebone Festival, St Marylebone Parish Church presents Olivier Messiaen’s masterpiece Quartet for the End of Time, performed by Gabriella Jones (violin), Matthew Wilsher, (clarinet), Samuel Ng (cello) and Bertie Baigent (piano). Composed while interred as a prisoner of war in World War II, Messiaen’s work is a deeply personal composition that interweaves his intense faith, his fascination with birdsong and his profound respect for human life. This is a moving piece of music that feels as complex and relevant today as it was at its premiere in Stalag VIII-A, a German prisoner-of-war camp, in January 1941.
THEATRE
WHAT WE TALK ABOUT WHEN WE TALK ABOUT ANNE FRANK
20 January – 15 February
Marylebone Theatre
Rudolf Steiner House 35 Park Road, NW1 6XT marylebonetheatre.com
The recent sell-out show What We Talk About When We Talk About Anne Frank is returning to the Marylebone Theatre for a limited one-month run in 2025. In present-day Florida two Jewish couples, one secular the other ultraOrthodox, have the argument none of them meant to have.
In a provocative, hilarious, painful and honest play, Gaza, Israel, the holocaust, Nazis, marriage and sex all come under the spotlight in a wide-ranging discourse on identity, politics, parenthood and getting high.
What We Talk About When We Talk About Anne Frank, Marylebone Theatre
MUSIC
THE AFRICAN CONCERT SERIES
15 March Wigmore Hall
36 Wigmore Street, W1U 2BP wigmore-hall.org.uk
The African Concert Series at Wigmore Hall celebrates music and musicians from Africa and those of African heritage. Opening with Piano Music From Ethiopia, Girma Yifrashewa performs Emahoy Tsege Mariam Gebru’s blues-inflected works followed by his own impressionistic soundscapes. The series continues with Violin Music of the African Diaspora performed by Aisha Syed-Castro (violin) and Adam Heron (piano). The day concludes with Tunde Jegede and the African Classical Music Ensemble’s unique journey through African classical music and the griot tradition, from the ancient to the modern.
EXHIBITION
GRAYSON PERRY: DELUSIONS OF GRANDEUR
28 March – 26 October Wallace Collection Manchester Square, W1U 3BN wallacecollection.org
In celebration of Sir Grayson Perry’s 65th birthday, The Wallace Collection hosts its largest-ever contemporary exhibition. Curated by Perry and featuring over 40 new works inspired by the museum’s collection, the exhibition explores themes of gender, craftsmanship and art making, juxtaposing handcrafted objects with digital creations and a fictional narrative about Shirley Smith, an imagined heir to the collection. This landmark show examines Perry’s journey from outsider’ artist to national treasure, offering a unique perspective on art, collecting, and contemporary creativity.
St Marylebone Parish Church
EXHIBITION CATS!
8 April – 30 September
The Cartoon Museum 63 Wells Street, W1A 3AE cartoonmuseum.org
With its collection of over 6,000 original cartoons and 8,000 comics The Cartoon Museum champions comic art through exhibitions, education and events. For the first time, the museum is bringing together many of the greatest cats to grace our comics, newspapers and magazines to explore the enduring appeal of these feline characters. From the mischievous Garfield to the whimsical Bagpuss, the show features works by artists such as Louis Wain, Heath Robinson and Simon Tofield, among others, in a delightful journey through cartoon cat history.
personal memories. Her 2025 exhibition, ‘transiənt’, features two series that delve into themes of loss, grief and life abroad. Through monochromatic images, Ichida revisits and processes past experiences, examining how memories distort, repeat and regress when intertwined with the present.
JAGGEDART
28A Devonshire Street London W1G 6PS jaggedart.com
Five places to see art in Marylebone
DAIWA ANGLO-JAPANESE FOUNDATION
13/14 Cornwall Terrace London NW1 4QP dajf.org.uk
Hosting a wide range of visual arts, Daiwa Foundation Gallery offers British audiences an opportunity to see works from and influenced by Japan. Sayuri Ichida, a Japanese artist based in the UK, specialises in photography exploring self-identity and
Renowned for its unique style, jaggedart exhibits three-dimensional works made from ceramic, grasses, wood, books, maps and textiles. With a focus on the importance of time and craftsmanship, the gallery appeals both to new and experienced collectors. The first show of 2025 features a diverse array of artists including Batool Showghi, Jo McDonald, Monica Fierro and Thurle Wright. Bringing together ideas of history, identity, and storytelling to craft new narratives that redefine words and pages, the exhibition includes artworks ranging from jewellery made from book pages to textiles that incorporate storytelling.
67 YORK STREET GALLERY
67A York Street London W1H 1QB 67yorkstreetgallery.com
67 York Street Gallery offers a welcome alternative to traditional art spaces, presenting an exciting lineup of exhibitions. An early highlight of 2025 is Surface & Depth, featuring the works of Constance Regardsoe, Hannah Webber and Simone Russell along with special pieces from the James Baird Gallery, all of which explore the intricate relationship between surface appearances and deeper meanings. Later, in The Art of Edwin La Dell, the work of this influential
printmaker will be shown through a collection of prints, watercolours and oil paintings from the 1950s and 60s, drawn from his family’s personal collection.
CUBE GALLERY
16 Crawford Street London W1H 1BS cube-gallery.co.uk
A contemporary art gallery featuring a bespoke range of British and international artists who excel in craftsmanship and material mastery, Cube Gallery hosts a continuously rolling exhibition. In 2025, look out for Tay Bak Chiang’s paintings, blending traditional Chinese ink with contemporary techniques and vibrant pigments, Myung Nam An’s ceramics, with their highly reflective glazed surfaces and intense saturated colours, and, in a joint exhibition, Fired and Refracted, Hélène Morbu’s intriguing textural ceramics juxtaposed with Hildegard Pax’s playful dichroic glass artworks.
THE GALLERY OF EVERYTHING
4 Chiltern Street London W1U 7PS gallevery.com
The Gallery of Everything is dedicated to showcasing artists and makers outside the mainstream. The gallery focuses on self-taught, spiritualist and vernacular artists from the 19th century to the present, including creators of every colour, class, gender, race and neurology. With an ever-changing and varied programme, in 2024 the gallery celebrated Indian artist Nek Chand Saini, presented Wilson Bentley’s snowflake microphotographs at NOMAD in Switzerland and hosted Ningura Naparrula’s first solo exhibition in Europe. In 2025 the gallery will feature Janet Sobel, the first American artist to make drip paintings.
jaggedart
THE GUIDE
PIONEERING MARYLEBONE RESIDENTS
Frances M Buss
Frances Buss was a pioneer of girls’ education and the first person to use the self-appointed title of headmistress. She was an early pupil at the newly opened Queen’s College at 66 (now 43-49) Harley Street in 1848, where she attended evening lectures to gain certificates in French, German and Geography. Buss went on to found the North London Collegiate School for Girls in 1850 and the Camden School for Girls in 1871. Her tireless efforts in pursuit of girls’ education were instrumental in the expansion of rights for women, with alumni of her school themselves becoming pioneers in professions previously off-limits to women.
Florence Nightingale
Florence Nightingale was superintendent of The Establishment for Gentlewomen During Temporary Illness at the site
that is now 90 Harley Street from August 1853 to October 1854. Here, she put her administrative skills to good effect, instituting changes to improve conditions at the establishment. In October 1854 she left to treat wounded soldiers in the Crimea. Her reputation was cemented in a newspaper report on the conflict, provoking the iconic image of The Lady with the Lamp in the popular imagination. She went on to establish the world’s first professional nursing training school and is considered the founder of modern professional nursing.
Lilian Baylis
Lilian Baylis, pioneering theatrical producer and manager, was born in Marylebone in May 1874. Her family later moved to South Africa where she became a music teacher. In 1898 she returned to England to help her aunt Emma Cons manage the Royal Victoria Theatre. After Cons’s death in 1912, Baylis became the sole manager and transformed the venue into the Old Vic theatre. She achieved the feat of staging all of Shakespeare’s plays between 1914 and 1923, something no other playhouse had attempted. In 1931, she revitalised the Sadler’s Wells Theatre, making it a centre for opera and ballet.
Evelyn Mary Dove
Evelyn Mary Dove, a British singer, actress and jazz pioneer, trained at the Royal Academy of Music from 1917 until 1919. Dove was the first woman of African heritage to feature on BBC Radio in 1925, three years after its launch. She later appeared in numerous BBC productions between 1939 and the mid 1940s, including her own music series, Sweet and Lovely. Between 1945 and 1947 she hosted the show Serenade in Sepia with Trinidadian folk singer Edric Conner, which was
Florence Nightingale put her administrative skills to good effect, instituting changes to improve conditions.
so popular it transferred to television. Despite her early success as one of the most glamorous and charismatic entertainers of the jazz age, Dove ultimately faded into relative obscurity, passing away in 1987.
Jacqueline du Pré
Jacqueline du Pré, widely regarded as one of the greatest cellists of all time, lived at 27 Upper Montagu Street between 1967 and 1971. Among many notable achievements, Du Pré was the youngest person ever to be awarded the Queen’s Prize aged 15, and at 16 was the youngest cellist to make their professional debut at Wigmore Hall. In 1965 she recorded the definitive performance of Elgar’s Cello Concerto in E Minor, Op. 85, with the London Symphony Orchestra under the direction of Sir John Barbirolli. Tragically, only a few short years later she was diagnosed with multiple sclerosis and lost her ability to play. She died in 1987, aged 42.
Michael Faraday
Michael Faraday, pioneering scientist in electromagnetism and electrochemistry, began his career at 14 as an apprentice bookbinder to George Riebau at 48 Blandford Street from 1805 to 1812. Faraday’s passion for science was sparked by reading scientific books at the shop. After he attended lectures by Humphry Davy at the Royal Institution he was inspired to pursue a life in science, transforming his early intellectual curiosity into groundbreaking scientific achievements. From 1813 he held various positions at the Royal Institution and founded both the Friday Evening Discourses and the Christmas Lectures in the mid-1820s. Faraday notably declined the presidency of the Royal Society and declared he would not accept a knighthood, if offered one.
Michael Faraday
Florence Nightingale
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