Anna Dominiczak: Health innovation requires the NHS, academia and the life sciences industry

St Andrew’s House, home to Scotland’s army of civil servants, acts as a metaphor for the transition Scotland has undergone during the last century. The turreted Governor’s House, the only remaining building from the old Calton Jail that stood on the ground before the government building was constructed, signifies a shift to permanent administration and governance from Edinburgh in the late 1930s, with it being the first purpose-built headquarters of the Scottish Office in Scotland. And of course, it marks the transition of devolution as it became the headquarters for the then-Scottish Executive, now Scottish Government, in 1999 and was even mooted as a potential home for the first minister of Scotland before a decision was taken to make that permanently Bute House.

It’s fitting then to meet Scotland’s chief scientist for health in this building that has played such a central role in Scotland’s past, as Professor Dame Anna Dominiczak, who took up the role in July 2022, pledged then to ensure “that health research, development and innovation takes a central role in the modernisation of the NHS in Scotland”.  

Dominiczak, a world-leading cardiovascular scientist, was born in Gdansk, Poland in 1954 into a medical household. Her parents Jakub Penson and Joanna Muszkowska-Penson were esteemed nephrologists and internal medicine specialists – a very different system of medicine from the one Dominiczak is used to. 

She laughs as she tells me that she was not immediately attracted to a career in medicine for reasons which become immediately clear.

“Both of my parents were renal physicians, and I wasn’t a great eater as a child. I explained to them that they always talked about urine at the dinner table, which really put me off. That’s why I didn’t grow, that’s why I am so small.” 

But she tells me more seriously that her parents did influence her, showing her medicine is not just a practice, it is a science. “My late father was the person who brought over treatment for chronic kidney failure. He introduced the so-called artificial kidney machine, bringing it from abroad during some very difficult times in central Europe.” 

Penson is remembered as one of the key figures in Polish nephrology and his contributions to the understanding of kidney function, infectious disease complications, and electrolyte balance remain significant in modern medicine. 

Dominiczak describes her mother as “a fighter of freedom”. She joined the resistance movement against the occupation of Poland during the Second World War and was captured by the Nazis and later deported to Ravensbrück concentration camp. After the war, she studied medicine. 

“She was a fighter of freedom for everybody through many stages of her life, first against the Germans during the Second World War, then during socialism, and as the doctor of Lech Walesa [Poland’s first democratically elected president], and she was imprisoned as quite a mature lady at that time.” 

There have been “lots of interesting influences” in her life. She studied for her medicine degree in Poland and says as a third year she was keenly reading the New England Journal of Medicine because she was interested in research. 

“The ambition was there, but not always the resources. At that time interactions with the Western world were pretty difficult, of course that has changed now.” 

In 1981, Dominiczak, and her husband Marek, a biochemist, left Poland for Malta and the following year relocated again to Glasgow. They were attracted by the “international esteem” Scotland has “in innovation, quality, patient care, as well as the National Health Service”. 

“We had offers to go to the United States,” she tells Holyrood. But she says she didn’t want to work in a country whose system has prevalent “inequality”. 

In contrast, she says: “The way I did my postgraduate training here, got my membership to the Royal College of Physicians and learned from the best in the west of Scotland was fantastic. The experience of fabulous medicine that aims for equality is the best here in Scotland.” 

With the country’s storied past in life sciences research and discovery, I ask how Scotland is planning to stay competitive globally in the future. She tells me that only that morning she attended the second roundtable on ‘Scotland’s triple helix’, which was chaired by health secretary Neil Gray. 

Strengthening the triple helix – the partnership between the NHS, academia, and industry – is what Dominiczak set out to do when appointed to the role almost three years ago. She wanted to help create a pipeline to adopt innovative ideas NHS-wide, not just in one or two health boards.

“It’s about working with the NHS, academia, and the life sciences industry. It is almost impossible to innovate without industry. And that industry, like all of us, is trying to make populations healthier. Both large businesses and SMEs bring essential dynamism into health innovation, and that’s hugely important. We want an approach that allows all three components to come together, without conflict of interest, for the benefit of our population.”

If the presidents and chief executives of big pharmaceutical companies, who were present at the roundtable, “see Scotland as a place to come”, that will benefit patients, communities and the economy, she says.  

Dominiczak played a key role in showing how the triple helix can work to benefit the population at scale during her time as director of the Lighthouse Laboratory, which was designed to process large volumes of PCR tests to detect Covid-19 at the beginning of the pandemic. At its peak, it collected and analysed over half a million Covid tests in a single day.  
In March 2020, she recalls receiving a phone call from the chief executive of Greater Glasgow and Clyde asking for help to rapidly scale up the health board’s ability to test for the virus. She describes that period as “frankly amazing”.

“I was told they needed 5,000 tests by the next day. They thought they could only do about 200 and with difficulty.”  

Dominiczak accepted the call and got to work. Based in a new small laboratory facility at the University of Glasgow, the team called the architects back in to figure out how they could expand the lab to better meet the demand. 

“The architects and builders came in at the start of the lockdown, to take down walls and expand our space. While local universities, mainly the University of Glasgow, started sending molecular equipment.  

“All the PCR and other molecular equipment was carried in by porters, the army and the navy. Our colleagues from BioAscent [an SME based in Motherwell] came in to help run the laboratory as they were used to high throughput in industrial-style laboratories.  

“But then most importantly, we had 800 volunteers in two days. They were PhD students and postdocs living in and around the Glasgow area. We could only take 100 people, it was incredible.” 

She reflects on that time, a period where the need was most dire and academia, the NHS and industry were able to come together and deliver widespread testing from nearly a standing start. I can see the mixed emotions on her face before she answers how she feels about that time. 

“It was scary, people were dying, and it was terrible. People were next door dying in the A&E, and yet it was absolutely uplifting to see we were not afraid to come together and do things for others.” 

It is a period that government has received warranted criticism for some of its actions during the pandemic, however, the Lighthouse Laboratory’s success is undeniable. Within three weeks it was doing more testing than the rest of Scotland and was later scaled up to a further nine labs across the UK, doing the same vital work that Dominiczak and her colleagues started in Glasgow.  

Now working in government, Dominiczak wants to see more examples of the close work between academia and industry rolled out at scale across Scotland. She points to the Scottish Government’s £6m package of health innovation funding, which was announced last month, and will in part support programmes like the secondary prevention of type 2 diabetes. A total of 3,000 Scots recently diagnosed with the illness will take part in the programme which is expected to help around 40 per cent achieve remission from the condition by the end of their first year. 

It is part of the Scottish Government’s commitments to the Accelerated National Innovations Adoption (ANIA) pathway, which is aimed at rapidly integrating proven technological innovations into NHS Scotland to enhance patient outcomes and streamline healthcare delivery. 

Dominiczak describes the programme as “extremely interesting”.

“This is a chronic disease that in the history of medicine has been extremely difficult to reverse; it is normally progressive and goes from bad to worse. However, several years ago scientists from Glasgow and Newcastle published a study that showed that you can reverse it. 

“We want to adopt that at scale across all 14 of Scotland’s health boards. This kind of secondary prevention is crucial if you’re thinking long-term. We know type two diabetes leads to cardiovascular diseases, strokes and heart attacks, so, if we can truly achieve remission in 30 to 40 per cent of people that would be a huge gain for not just patients but the NHS and the economy.” 

She acknowledges that there are “multiple challenges” to driving innovation into the health service. “Change is difficult,” she says. Despite near-constant news of innovations from Scotland’s universities, “very few are adopted at scale”. 

“Adoption is the most difficult part of the innovation pathway, and that’s why we have a team of Scottish Government and NHS colleagues working together as the Innovation Design Authority and in ANIA. This will allow us to have a thoughtful, well-validated way to achieve greater adoption.” 

As well as funding pathways like ANIA, the Chief Scientist Office is funding three innovation hubs in Scotland, which bring together health boards and universities from all over the country. Artificial intelligence (AI) is being suggested by some as a game-changer for the NHS, and the hubs are currently looking at three AI projects that could be translated into useful clinical tools to be used in the NHS. If they can find a translatable use, they will be brought to ANIA. But Dominiczak stresses that this will only happen when “they are ready”.

“The worst thing you can do is take an innovation that is not ready and discover once it is adopted that something doesn’t work, and a patient could potentially suffer as a result. So, it’s crucial we are rigorous in our evaluation.” 

She adds: “AI will take time, but I don’t think we should be afraid of it. The suggestion that it will completely replace doctors is a nonsense, you can’t replace a thinking human being, at least not yet. It’s more likely it will be used as a second observer for things like mammograms or chest X-rays.  

“It will allow savings for the NHS, but also the patient will receive faster treatment.”