151 15_021_RFL Barnet Lung biopsy 2508.jpg

Innovation in the NHS: Guest blog by Sam Hare

How a change in mindset and a simple, low-cost piece of kit can help revolutionise UK lung cancer management

Wednesday, June 8, 2016

An innovative method of carrying out lung biopsies at Barnet Hospital – part of the Royal Free London - could free up hundreds of hospital beds and provide earlier lung cancer diagnosis by increasing tenfold the number of potentially life-saving tests carried out each year.


Chest radiologist Dr Sam Hare explains why his team’s ambulatory lung biopsy method should be rolled out across the NHS.

Lung cancer is the world’s biggest cancer killer, causing more deaths each year than breast, colon and prostate cancer combined.

Worse still, despite advances in treatments the UK still lags behind our European and North American counterparts when it comes to lung cancer outcomes.

Many patients are not seeing the full benefit of the latest therapies because of delays in diagnosis caused by the sheer amount of time it takes to get someone in for a biopsy.

This is an area where the NHS urgently needs to improve. Reassuringly however, effective NHS innovation doesn’t always require a pioneering invention or new piece of technology. Sometimes a common sense solution that is truly patient focused is all that is needed.

In the UK I was trained to perform standard, uncomplicated lung biopsies. This is the pivotal lung cancer diagnostic test and usually involves four to six hours post-biopsy monitoring in a hospital bed, even in routine cases. If a lung biopsy patient developed a pneumothorax this would usually require a formal in-patient admission and treatment with a traditional bulky chest drain for a few days.

Heimlich valve
Heimlich valve

One of the biggest day-to-day challenges facing NHS organisations is bed and resource availability. Today nearly every standard NHS lung biopsy relies on the availability of a hospital bed for at least four to six hours.

Furthermore, the prospect of a patient being hospitalised for two to three days with a large, uncomfortable chest drain means that in the UK many patients, typically those who are older or have smaller cancers that are more complicated to biopsy, will often decline, or be declined, biopsy.

Is it any wonder that that we are missing opportunities to diagnose lung cancers at an early stage?

After a year-long thoracic radiology fellowship in Canada it soon became abundantly clear to me that achieving earlier lung cancer diagnosis didn’t actually require reinventing the wheel – rather a willingness to use simple but innovative techniques already being practiced elsewhere. I returned to the NHS with my eyes open and a steely determination to innovate lung biopsy practice here.

Since 2011 Barnet Hospital has performed lung biopsies on an entirely out-patient basis without the need for hospital beds.

This not only means that bed-related scheduling delays have been completely eliminated, but that the vast majority of patients can be discharged just 30 minutes after their biopsy.

Such creative thinking, using methodology with an international evidence-base, has permitted us to perform anywhere between 10-14 lung biopsies every week, in contrast to most other hospitals of equivalent size, where they might do only one or two.

Heimlich valve
The ambulatory lung biopsy method has won a BMJ award and the NHS Innovation Challenge Prize for Cancer

Crucially, even if patients do develop a pneumothorax, they are treated at home using a discreet, portable device called a Heimlich-valve chest drain (HVCD). The device is small enough to be concealed under the patient’s clothes and allows patients to engage in normal daily activities while it treats their collapsed lung. For some patients this has even included doing the weekly supermarket shop or being able to continue caring for a disabled partner at home.

So what is it that has finally changed to make people sit up and take notice in the UK?

Last year we were able to publish the results of our four-year study of nearly 500 lung biopsies using the ambulatory method in Thorax, the country’s leading respiratory journal.

Since 2011 we have performed close to 800 ambulatory lung biopsies and 99% of patients have been discharged within 30 to 60 minutes, including those patients who experienced lung collapse. Thanks to the Heimlich valve, pneumothorax has become a minor inconvenience for our patients, rather than a major upheaval.

Demonstrating that this approach actually works in the NHS, delivering improved patient experience as well as financial savings, in my opinion, makes wider rollout a no-brainer.

Due to our innovation, Royal Free London patients are being diagnosed more quickly. More patients are undergoing curative lung surgery and accessing the latest lung cancer treatments.

It’s now time for the wider NHS to give patients with lung cancer the best possible chance at beating the disease by making a firm commitment to early lung cancer diagnosis.

I firmly believe that the Barnet Hospital ambulatory lung biopsy model offers an NHS-wide scalable answer that could help achieve this. 


Read our innovation interview feature with Sam here.



Dr Sam Hare is a consultant chest radiologist at Barnet Hospital, which is part of the Royal Free London NHS Foundation Trust. He is also one of the lead radiologists for the London Cancer lung pathway board, responsible for improving regional lung cancer outcomes and patient experience.

Sam studied medicine at Fitzwilliam College, University of Cambridge and Imperial College School of Medicine, gaining a 1st class honours degree. After completing formal radiology training in the UK between 2004-2009 he undertook a thoracic radiology fellowship in North America (2009-2010). Sam was subsequently appointed to the position of consultant thoracic radiologist at The Ottawa Hospital in Canada specialising in: (i) complex lung biopsy techniques and (ii) lung cancer screening & diagnosis. He returned to the UK NHS in 2011 and currently runs the innovative ambulatory lung biopsy service at the Royal Free London NHS Trust. 

Dr Hare's technical lung biopsy expertise has been acknowledged as providing earlier lung cancer diagnosis in a wider range of patients. The novel ambulatory lung biopsy service was awarded the inaugural NHS Innovation Challenge Prize for Cancer Care in 2016 in addition to the 2016 BMJ Award for Cancer Care Team of the Year (sponsored by Macmillan Cancer). Sam's work has also gained national recognition in Thorax, one of the world's leading respiratory medicine journals, as well as in the Times newspaper and BBC news (August 2015). 

Sam is currently focused on leading wider NHS adoption of ‘ambulatory lung biopsy’ and is working closely with NHS England to achieve this. As part of this ambition, Dr Hare has established a national lung biopsy education course (POBAS) that will train clinicians from other hospitals to use the innovative technique. For more details please visit www.POBAS.co.uk