Bellevue Healthcare Trust

📢 Are all of the solutions to the healthcare cost crisis arising from chronic medical conditions complex and expensive? Our portfolio has significant exposure in to ‘closed loop’ insulin delivery systems for managing insulin dependent diabetes. These investments provide high tech solutions for treating this serious disease. Insulin usage is rising, as poorly controlled Type 2 diabetics inevitably progress to insulin. Almost one in ten people in the UK are impacted by diabetes, and closed loop is now the ‘go to’ for newly diagnosed Type 1 patients.   These systems have revolutionised their users lives. Amazing as they are, there is still a risk of hypoglycaemia (very low blood glucose). If glucose drops too low, the brain shuts down and you can fall into a coma. Over time, patients learn to sense the early signs of hypoglycaemia, and the devices also have alarms to warn them blood sugar is trending low, so they can hopefully avoid a dangerous episode. Using a continuous glucose monitoring (‘CGM’) device like those made by Dexcom reduces hypoglycaemia risk by more than 70%. There is a further benefit from using pump delivery (e.g. Tandem). This is life-saving stuff, and improved glucose control reduces the vascular and nerve damage that tend to afflict diabetics long-term.   What happens if you are deep asleep though? Nocturnal hypoglycaemic episodes can be serious and, if you sleep alone, don’t hear the alarm on your device and wake up, you cannot take preventative action. Nocturnal hypoglycaemia might result in a trip to hospital via the ambulance, costing the NHS upwards of £2,000 per episode. If no-one finds you, then it could even prove fatal: the longer you are hypoglycaemic, the more long-term complications that can arise. Dexcom allows data from its device to be shared with third party products. A little US company, Custom One, makes an alarm called Sugar Pixel which retails for about $100. It is essentially a very loud digital alarm clock that links to your Dexcom data feed and displays your blood sugar data and directional trend. It could wake even the most errant teenager off at University. Similarly, an Amazon app called Sugarmate connects Dexcom to Alexa. There are probably many other examples, but they are mostly off of the radar of investors like ourselves and probably do not garner the attention they deserve. The cost of SugarPixel is so low compared to the cost of treating one hypo that arguably all insulin users should be gifted such a device by their healthcare provider.   Sometimes, incremental improvements to care quality are neither expensive nor complex; merely creative. So, cheers to all the homespun innovators helping make healthcare better. Even when we cannot invest, we nonetheless recognise the contribution to the wider objective. If you know anyone who is an insulin-dependent diabetic, tell them these things are out there. They could, quite literally, be life-saving. Find out more ➡️ https://lnkd.in/eZPXV54w

🔬 📢 Here in a cold and wet UK, the damp squib that was the Labour Party’s first post-election victory conference has drawn to a close. There was little substance to add to any of the commentary up to and through the election itself. On the subject of healthcare, we have the “big report” from Lord Darzi and PM Starmer gave a speech about this some weeks ago at the King’s Fund. Save for the (welcome) change in language to finally describe the NHS as we have long done – i.e. broken, there was a surprising lack of substance to this big reveal.   What do we mean? As a reminder, the NHS laid out a 10-year plan for its own transformation back in January 2019 (many, many prime ministers ago). This wittily titled “Long Term Plan” can be found online. Its implementation was of course set back by the pandemic, but the ambition of the plan itself is worth remembering.   Here is what Starmer said in his bold ‘new’ vision for the NHS:   “This plan will be framed around three big shifts, Three fundamental reforms: First, moving from an analogue to a digital NHS. Second, we’ve got to shift more care from hospitals to communities. And third in terms of the shifts, we’ve got to be much bolder in moving from sickness to prevention.”   And here is what the NHS itself decided was needed more than five years ago, excerpted from the executive summary of the Long-Term Plan:   “Over the next ten years [changes] will result in an NHS where digital access to services is widespread, where patients and their carers can better manage their health and condition. Where clinicians can access and interact with patient records and care plans wherever they are… without the administrative hassle of today.” “New expanded community health teams will be required under new national standards to provide fast support to people in their own homes as an alternative to hospitalisation.” “The NHS will take to strengthen its contribution to prevention and health inequalities. Wider action on prevention will help people stay healthy and also moderate demand on the NHS.”   Given these changes are already well underway, one supposed that we can already look forward to a positive, and doubtless self-congratulatory progress report ahead of the next election. Whilst original thinking is lacking, I suppose we could commend the environmentalist chops of the new government - this is an impressive level of recycling…   In reality, what people care about is being able to see their doctor in a timely fashion and access care easily when needed. These hard endpoints will be more challenging to shift in a parliamentary term.   Find out more about our approach ➡️ https://lnkd.in/eZPXV54w #labour #nhs #healthcarereform Paul Major

🔬 𝗪𝗵𝗮𝘁 𝗶𝘀 𝘁𝗵𝗲 𝗯𝗶𝗴𝗴𝗲𝘀𝘁 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝗰𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲 𝘁𝗵𝗮𝘁 𝘄𝗲 𝗳𝗮𝗰𝗲 𝗶𝗻 𝘁𝗵𝗲 𝟮𝟭𝘀𝘁 𝗖𝗲𝗻𝘁𝘂𝗿𝘆? This is not an easy question to answer, but we can begin by looking at a sad and unarguable fact. The gap between ‘healthspan’ (i.e the number of years lived in good health) and lifespan is widening in many countries, and very noticeably here in the UK.   Part of this pattern is a positive – people are living longer and not succumbing to acute coronary or infectious disease as they did in decades past. By doing so, their bodies last longer and wear out more; there is much work to do on combating decrepitude.   On the other hand, we must also recognise that obesity and metabolic diseases are making people sicker and worrisome life limiting conditions such as cancer are becoming more prevalent. Men born in 1960 have a 15% higher lifetime risk of cancer than men born in 1930 and men born in 1980 are estimated to have a higher risk again (note – this is an estimate as most of those in the 1980 cohort are yet to succumb to serious diseases) and this is expected to rise yet again for the 1990 cohort.   Worse, the typical age of onset for many cancers is getting younger. There are countless studies that show this, most recently we would cite the keynote lecture at the recent ESMO cancer conference “the epidemic of young-age onset cancer”. The most interesting aspect to our mind here is the gap between the broader rise in non-smoking related cancers in general since the 1950s (inevitably increasing incidence as people live longer) and the much more sudden and rapid increase in the incidence of colorectal cancers since the 1990s (in lock step with rising obesity and type 2 diabetes). It would seem that you really are what you eat. Obesity treatments will help, but they are not enough on their own as even people with ‘healthy’ BMIs are seeing increased risk over time.   What does this mean in practical terms? Firstly, we need to ramp up cancer screening at earlier ages, especially for colorectal. This will be challenging to do in any other way apart from cost-effective non-invasive genetic tests, such as those offered by portfolio holding Exact Sciences (sadly but predictably, this test is not available in the UK). Secondly, we need to educate people about the importance of a healthy diet; it’s not just obesity and diabetes that results from poor diet. We also need to understand what factors drive this risk increase – is it the nature of the food (e.g. lower fibre), certain food additives that have become common in recent years, or is it changes to the gut microbiome. The latter is increasingly understood to play a role in all manner of chronic maladies, including degenerative brain conditions. Find out more about our approach ➡️ https://lnkd.in/eZPXV54w #healthcare #futurehealthcare #cancer #diagnostics #exactsciences Paul Major

🎙️ The science of ageing is a captivating field. Researchers are exploring the roles of senescent cells, their signalling pathways, and drugs like metformin and rapamycin in extending lifespans - at least in animals. Yet, when it comes to humans, clinical evidence is scarce. Discover more in the podcast with Portfolio Manager Paul Major. https://lnkd.in/ezSRNKQJ #healthcaretrust #marketingcommunication Funds Europe

📢 𝗜𝘀 𝘁𝗵𝗲 𝗙𝗖𝗔’𝘀 𝗻𝗲𝘄 𝗲𝘅𝗲𝗺𝗽𝘁𝗶𝗼𝗻 𝘁𝗵𝗲 𝗯𝗼𝗼𝘀𝘁 𝗨𝗞 𝗜𝗻𝘃𝗲𝘀𝘁𝗺𝗲𝗻𝘁 𝗧𝗿𝘂𝘀𝘁𝘀 𝗵𝗮𝘃𝗲 𝗯𝗲𝗲𝗻 𝘄𝗮𝗶𝘁𝗶𝗻𝗴 𝗳𝗼𝗿? Today saw some positive news for the benighted UK Investment Trust sector. Firstly some background: the expansion of the sector-average discount to NAV since late 2021 has been attributed to a number of different factors, but it is undeniable that incremental demand for Trust products from the wealth management sector has played a role. Why do they seem to have been less positive on these products in recent years? Many point to the unintended consequences of EU rules under Mifid-2 that that require funds investing in investment trusts to aggregate their ‘look through’ PRIIPs costs with its own fees, making these products appear much more expensive to end clients, as compared to more typical UCITS funds.   This is an unfair comparison though, since the disclosed NAVs of these Trusts are already net of any such fees. Whilst the wealth management industry has become used to explaining this to clients over the past five years, it nonetheless adds a further level of complexity to client discussions. With so much focus on fees in a world with increased competition from low-cost robo-advisor products, we can understand why some WMs have voted with their feet and elected to put new money to work in other product types.   What happened today? The FCA has announced (as an interim measure pending final legislation to formally address the issue) that investment trusts have been temporarily exempted from PRIIPs and associated EU Law. What this means in practical terms is that providers can alter the numbers in PRIIP/KID documents to aggregate such costs and the FCA will not pursue enforcement action against any providers choosing to do this. Time will tell, but this may shore up incremental demand for Trust products from one of their key historical supporters. #Healthcaretrust #marketingcommunication Paul Major

Watch the latest video from Proactive with our portfolio manager Paul Major. ⬇️ #healthcareinvestments #trust #marketingcommunication

Trust in Focus: Listen to Kepler's in depth analysis of Bellevue Healthcare Trust   #bellevuehealthcaretrust #maketingmaterial 

📖 The half-yearly report of the Bellevue Healthcare Trust was published this morning! Read the full report here ⬇️ https://lnkd.in/dZqHNkK4

📖 Read the latest #blog post from Paul and Brett: «A tale of three elections – Part 1: Our sceptred isle united?» ⬇️ https://lnkd.in/eb-Attug #Trust

«Protection is the word du jour as manifestos fall short on #healthcare» Article from Paul Major, Portfolio Manager, Bellevue Healthcare Trust on FT Adviser. ⬇️ https://lnkd.in/e7B8BDgE #Trust