Chief Scientific Adviser Lucy Chappell: "You have to be thoughtful about how you describe uncertainty"
Lucy Chappell (Credit: Department of Health and Social Care)
Lucy Chappell, chief scientific adviser to the Department of Health and Social Care, was in the trenches at the start of the Covid-19 pandemic, before she took up her government role in August 2021. Two years on, she speaks to Sophie Church about the role of advisers during that time, the next pandemic, and tackling problems in the NHS
“We shouldn’t have empowered the scientists in the way we did”. So said former chancellor – now Prime Minister – Rishi Sunak to The Spectator in 2022, in a swipe aimed at the Scientific Advisory Group for Emergencies (SAGE). He continued: “Whoever wrote the minutes for the SAGE meetings – condensing its discussions into guidance for government – would set the policy of the nation”, and that “no one, not even Cabinet members, would know how these decisions were reached”.
A year on Lucy Chappell, chief scientific adviser to the Department of Health and Social Care, in her early fifties, seems amused by the suggestion that scientists acted as the government’s puppeteers.
“I would say we had a group saying that, and we had another group saying we weren’t in their ear enough,” she says. “I think walking that tightrope is challenging as a scientific adviser. But to some extent our training is very much to weigh up, present the pros and the cons, and then ensure that the advice is as strong as it can be, but also being clear where we’ve still got gaps in our knowledge.”
It is essential that we look at embedding research within the health service at a time when they are tackling the backlog
The Covid-19 pandemic presented scientists with a familiar question, says Chappell: would the public want them to say when they do not know the answer, or would they rather them pretend they do know? “I happen to think the former,” she says. “But you have to be thoughtful about how you describe uncertainty.”
Chappell has been a scientist for over 30 years now, naturally informing a sense of thoughtfulness. During the course of our interview, she asks around 40 rhetorical questions: “How does science inform policy?” “How do we look at emerging technologies and then use them for maximum benefit?” “How do you make sure those lessons [from wider pandemic research] are learned and transferred?”
However, she is quick to opine on The House’s own question: will we see another pandemic in our lifetimes?
“I think there is a very real possibility,” she replies. But says, “There is an opportunity for us… to say: how do we stand up an approach – that isn’t a sort of on off switch when a new pandemic starts, but both funds the underpinning science and the mechanisms by which we would look at the risks, whether it’s surveillance or research – that would make us better prepared?”
In Chappell’s mind, research should act as a dam – addressing healthcare problems before they flow downstream to collect in the NHS waiting list pool.
“It is essential that we look at embedding research within the health service at a time when they are tackling the backlog,” she says firmly. “Think about it from the patient’s point of view: through our research office, they have access to treatments… in cancer trials or to new vaccines, faster than if we just said, ‘oh, well, we haven’t got time for that’.”
Chappell adds that addressing health inequalities sooner can help shift the NHS backlog.
“I’m not convinced that we are going to get out of our backlog just by doing things as we have always done, and allowing the inequalities to persist,” she says. “We’re going to get out of it by saying: we can work better, [by being] better evidence-based, [and by] tackling the inequalities upfront rather than as an afterthought, when it will take more activation and energy to narrow those gaps.”
Research active hospitals have also improved at recruiting and retaining workforce, she says: “So again, what looks like an upfront investment repays itself very quickly both for the patients and the workforce.”
In her call to tackle problems “upstream”, does Chappell think the government suffers from short-term thinking? It is “easy to see why that is the case”, responds Chappell, “and particularly at certain points of the election cycle”.
With the NHS celebrating its 75th birthday this month, Chappell is clear we must plan for its future. “We shouldn’t just be saying, ‘well, looking backwards, what have we got to?’ It should be saying, ‘well, what does the NHS look like for the next 75 years?’ And what [do] we need to keep on ensuring is woven in to the fabric of the NHS so that we do keep improving and evolving?”
Perhaps artificial intelligence (AI) is the thread Chappell is looking for. Already, she says, AI is being used in clinical settings: reading images from stroke patients to assess whether they should go for certain treatments, or by analysing the content of cognitive behavioural therapy sessions to see which specific interactions are proving successful.
Chappell is however, cognisant of the risks. “It is really obvious that if you train your AI algorithm on a very selected data set, then your AI algorithm will perform better when it sees new data from that training data set… So we have really got to be thoughtful about how we ensure that we don’t build bias into AI algorithms.”
While AI can be a daunting prospect for workers, Chappell is clear that it be seen as an enabler in healthcare. “We run on a vacancy rate in the NHS and in social care, which is part of our remit,” she says, “[and] I don’t think it’s going to be taking away jobs. I think it’s going to be freeing up people to do the bit of the job that really needs that face-to-face and that personal interaction.”
Discussions around moving to a two-tiered health system have also been swirling – but Chappell does not think we can expect a “major shift” in the way our healthcare is structured.
Certain areas, like the care of young people, “should clearly be free”, she explains. “I, for example, know about my particular area, which is hypertension in pregnancy, where we saw that the advent of free antenatal care over the 50s and 60s… was associated with a massive reduction in our maternal mortality.” Despite this, she thinks “it is very likely that we will always have private healthcare” along the lines that currently exist.
In March 2023 Sir Paul Nurse, chief executive officer of the Francis Crick Institute, published his Independent Review of the UK’s Research, Development and Innovation Organisational Landscape, cautioning against universities cross-subsidising research with income from international students. He writes, “care is needed as such sources are not always reliable and sustainable”.
I think you have to be thoughtful about how you describe uncertainty
Changing the current research funding model would require a cross-government agreement, Chappell says, to empower funders to grant more money to fewer studies without the need to top up with international student fees.
Would Chappell be willing to move to such a model?
“It’s something I would be open to,” she says. “I think there is active discussion going on right now in government about how we respond. And I’m seeing a move… towards saying, let’s reopen this.”
While Chappell works closely within government – only just returning from an event with minister for science, innovation and technology George Freeman – she wants to see greater engagement with research in Parliament.
“[Parliamentarians] will know what their local trusts are, and I would really welcome the opportunity to say, ‘how do we get that dialogue?’ We have got some really interested MPs, but also more broadly, how do we make this relevant to them? Because it’s happening on their doorstep.”
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