In the Spotlight: Dr Bruno Holthof, CEO of the Oxford University Hospitals NHS Foundation Trust

  • April 8, 2022

In this feature of our monthly newsletter we present an inspirational person who has crossed our paths or has a professional link with Flanders . This month, we had the pleasure to talk to:

Dr Bruno Holthof, CEO of the Oxford University Hospitals NHS Foundation Trust

 

Dr Holthof, thank you very much for talking to us. How did you end up in Oxford and your position at the Trust?

You may know that I was the CEO of Ziekenhuis Netwerk Antwerpen (ZNA). About 7 years ago now, just before Christmas, I received a phone call from a headhunter, asking whether I would be interested in a position in Oxford. Initially I said no, but they called again, and so I ended up visiting Oxford where I had a most fascinating chat with Sir John Bell, an authority in the field of Life Sciences and the Regius Professor of Medicine at Oxford University. The aim was to put Oxford on the map in the field of Life Sciences and to develop the interaction between the university, the health care system (of which the hospital is an important element) and private partners. 

I can sincerely say that 7 years on, we succeeded. Oxford is now an authority in the field of Life Sciences and the interaction between the university, the health care system and private partners has led to innovations that are being used worldwide. The best-known example is of course the development of the COVID-vaccine in cooperation with AstraZeneca. 

Lesser-known examples are the worldwide use of Oxford-developed technology for the genomic data analysis used for the disease surveillance of pathogens, and the methodology of the COVID-recovery trials: these trials use data that come straight from the clinical care records, which allows for quick analysis of which medicines have an impact on a treatment and which don’t. 

Does Oxford work together with Flemish institutions? 

Certainly: a good example is that part of the technology of Oxford Nanopore (an important player in genome sequencing) comes from Belgium. There are also a lot of academic collaborations between researchers, who apply for grants together, for example. 

Brexit has doubtlessly had a big impact on Oxford University. Are you hopeful that participation in programs like Horizon Europe will remain possible? 

There has always been an understanding that the UK’s participation in such programs should continue; I am hopeful it will be resolved, because it is too important for both the EU and the UK.

To anticipate the impact of Brexit, Oxford has entered into a partnership with Berlin, which allows us to apply for grants within the EU. And of course, the cooperation with universities on other continents, such as North America, Asia, and Africa continues.  Our connections with the Commonwealth (Australia, Canada, New-Zealand, …) are very important to us.

What are, according to you, the big differences between health care in Belgium/Flanders and in the UK? What are Flanders’ strengths and where can we learn from the UK?

Flanders is at the top worldwide on the dimension of access to health care. During and after COVID this changed a bit: people now complain about the fact they must wait to get an appointment.
It is essential in health care that there is quick access, because the sooner you have a diagnosis, the sooner you can receive treatment and the better your chances of healing. Flanders is still way ahead in terms of accessibility, something that people who have travelled or lived abroad will recognise. 

The UK puts a big emphasis on research: they want to involve all patients in the National Health Service (NHS) in research, which is rather unique. This approach should strengthen the evidence base (what works, what doesn’t work, which treatment is cost effective…?). British institutes such as NICE are copied by other countries, for example the Knowledge Centre in Belgium. The UK really leads the way in the integration of research into their health care provision and the development and evaluation of new technologies. 

Another advantage of the NHS is that central coordination is very quick. This was a real asset during the pandemic! Take the vaccination campaign for example: this all happened very quickly and was very well organised. I received daily instructions from the government about what Oxford University Hospitals should do. For example, we had to vaccinate the employees at Oxford Biomedica as soon as possible, to safeguard the production of the vaccines in the UK. But the system not only works in times of crisis. It is also possible to launch a prevention campaign very quickly. For example, we know that when the NHS launches a campaign to highlight screening for prostate cancer, we’ll have to increase our capacity to treat prostate cancers a few months down the line. 

How should we look at the social debate about privatisation? 

There are two sides to this: who pays and who provides. In my opinion, it is good when the government pays (such as in the UK), as otherwise this becomes too fragmented (such as in the USA). In health care provision, private initiative is good, because autonomy and initiative lead to innovation and efficiency. At ZNA, I saved a public provider from bankruptcy: I altered the public structure into a social profit structure. When I left ZNA, it was the most profitable hospital in Belgium.

The big question is what kind of privatisation you allow. Flanders only allows social profit: there are no shareholders and all profits are retained in the organisation. This is good because this allows a government to step in in times of crisis. In the UK, many private providers made large profits from the pandemic. The question is whether this is good. 

The last two years, the pandemic has put immense pressure on our health care. What do you think are the greatest challenges in the coming years? Also, technology and innovation keep evolving, especially in health care. What does the health care of the future look like? 

I think the challenges we face have been highlighted by COVID. Health care has claimed a lot of the resources of society and this will only increase. We will reach the boundary of what we want or can pay for health care. We will have to makes choices about which innovations really contribute to health care and which don’t. One of the big challenges is the cost of new technologies, and we should ask the question how we can create value for money.  

Another question, which is really important to me, is how we can develop technologies that will benefit the whole world, and not only the ‘select few’. A hopeful sign is the investment in development and production capacity in places such as Asia, South America and Africa. This will lower the cost of new technology and as such have a positive influence on the accessibility.

Do you think that new technologies and personalised health care will allow us to get to 120 years of age?

We already added 10 years to the average life expectancy, especially through cardiovascular medicines and surgery. If we want to add an extra 10 years, we need to focus on cancer treatments. 

A longer life should go hand in hand with a good quality of life. Mobility, for which there are already many innovations in development, and brain function are very important . We’re still waiting for the big breakthrough regarding the prevention and treatment of dementia and other CNS (Central Nervous System-) diseases. The brain remains the greatest mystery of the human body. 

In June your tenure as CEO of the Oxford University Hospitals NHS Trust comes to an end. What are your professional plans ?

I will continue to live and work in Oxford, at the university and the hospital, but in a different role. I will be busy with two things: on the one hand I will help develop Global Health at Oxford University, more specifically how to develop technology and innovation in low resource settings and how to improve the rollout. I will also extend my teaching assignment at Global Health. I will concentrate especially on the supervision of Master and PhD students. Two of my students for example are working on a low-cost MRI scanner and an affordable digital electronic patient record. This really is my passion: the affordability of new technologies. If we can lower the cost of new technologies, it will immediately increase access in low- as well as high-income countries. 

On the other hand, I will be working part time for an investment firm, where I will work with 2 funds. One is a venture capital fund, where investment should have a good return but also lead to better treatment results for patients and a lower cost for the payer. The second fund pursues sustainability. We want to show you can work for profit, but also benefit society. Everybody realises by now that the planet has her limits and we need to take those into account, because otherwise we will cause a worldwide crisis (the climate crisis has, in fact, already begun!). It really is time to change to green energy, to change our consumer behaviour and to switch to sustainable goods and services. Also the gap between the haves and the have-nots is becoming too big, which will lead to tensions everywhere. So, we must look at how big companies and investment funds can contribute to resolve these challenges. 

Finally, the question we ask everybody: where would you spend 48 hours in Flanders? 

Since I was born in Antwerp, I can’t say anywhere else but Antwerp! I am really looking forward to visiting the Museum of Fine Arts, when it re-opens in September. 
One of my last achievements in Antwerp was signing the contract for the building of the new ZNA Cadix hospital. The new site will open in March 2023 and I am really proud of the hospital: it has totally altered the skyline of Antwerp! The view from the terrace of the cafeteria is unique. 

Dr Holtholf, thank you again for this fascinating conversation!