AHSC not what your country can do for you: Early lessons from the

Academic Health Science Centre models in England

Prof Alastair M Buchan Head, Medical Sciences

World class AMCs deliver against the three missions …

Talent

Operatingprocesses

Financialstrength

Externalpartnerships

Infrastructure

Brand… through strength in core capabilities …

… founded on an aligned partnership

Patientcare

Teaching Research

ACADEMIC HOSPITAL

Characteristics of AHSCs

The “unlinked partners” model of medical school-clinical enterprise relationships in England

Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

UK health care expenditure as % GDP

£4bn-£40bngap with Wanless recommen-dations

Source: Appleby J, Crawford R, Emmerson C. How Cold Will It Be? Prospects for NHS Funding: 2011–2017. London: King’s Fund; 2009.

Industry productivity gap – new drug approvals have not kept pace with rising R&D spend

Source: Tufts Centre for the Study of Drug Development; Morgan Stanley Research: Pharmaceuticals, 20 January, 2010.

Source : Centre for Medicines Research

North America

41% > 36%

LatinAmerica3% > 7%

Asia Pacific2% > 10%

EU Non-Core8% > 21%

EU Accession4% > 8%

Middle East &Africa

2% > 3%

United Kingdom6% > 2%

EU Core21% > 12%

Percentage of subjects randomized by region for industry cohort, 2000 vs. 2007

UK policy context

Walport Report National Strategy Cooksey Review

Best Research for Best Health Goals -- delivered through the creation of NIHR

INVENTION EVALUATION ADOPTION

Creation• new things• new ideas• new techniques• new approaches

The Innovation Pathway

Assessment• new things• new ideas• new techniques• new approaches

Uptake• new things• new ideas• new techniques• new approaches

DIFFUSION

Spread• new things• new ideas• new techniques• new approaches

Basic ResearchApplied

Research

NIHR

Commissioning Patient Care

PCTs & SHAsMRC, Wellcome NHS Providers

Biomedical Research Centres

Manchester

Cambridge

ImperialLiverpool

Oxford

Newcastle

NIHR Biomedical Research Centres

University College

Guy’s & St Thomas’

Great Ormond St

Marsden Maudsley

Moorfields

Leeds• Musculoskeletal

Oxford• Musculoskeletal

Brompton• Cardiovascular• Respiratory

Sheffield• Cardiovascular• Musculoskeletal

Birmingham• Gastrointestinal

Bristol• Cardiovascular

Nottingham• Hearing• Respiratory• Gastrointestinal

NIHR Biomedical Research Units

Liverpool• Gastrointestinal

Barts & London• Cardiovascular

Leicester• Cardiovascular

Southampton• Nutrition, Diet, Lifestyle• Respiratory

Oxford AHSC enabled by NIHR BRC & BRU

Oxford Radcliffe Hospitals and Nuffield Orthopaedic Centre NHS Trusts

University of Oxford

South Parks RoadSouth Parks RoadCampusCampus

John RadcliffeJohn RadcliffeCampusCampus

NOC & NOC & Old RoadOld RoadCampusCampus

The Radcliffe The Radcliffe InfirmaryInfirmary

Science based platforms

Oxford Medicine’s external research income by sponsor type, FY 2008/09

Cross-cutting platforms

Hospital embedded research space

New Translational Laboratory (7)

Institute of Experimental Medicine

Radiology

Emergency Department

Acute Vascular Imaging Centre

Cardiac Unit

Imm

unity

Infe

ction

Vacc

ines

Hea

rt

Dia

bete

s

Stro

ke

Bloo

d

Brai

n

Wom

en’s

H

ealth

Canc

er

Genetics and Pathology

Imaging

Bioengineering

Tissue Banking & Cohorts

NIHR Oxford Biomedical Research Centre

Academic Health Science Centres

Integrated governance; internationally-recognized

excellence in research and clinical practice;

clear integrated funding streams for research and teaching;

integrated leadership and career paths;

joint programs which combine research and clinical work;

commercial expertise to market research developments and benefit the UK’s economy.

Medical schools & clinical academic staffing related to population by region of England

Sources: Medical Schools Council: Staffing levels of medical clinical academics in UK Medical Schools, 2010; PCT Expositions Book 2009/10 – 2010/11

NHS Next Stage Review: Roles and expectations for AHSCs

AHSCs: a range of governance models

Healthcare System Governance

JV or SharedGovernance

University Governance

Composed of Imperial College & HammersmithNHS Trusts with 5 hospitals: Charing Cross Queen Charlotte’s and Chelsea Hammersmith St. Mary’s Western Eye Hospital In total support 9,700 scientists, researchers and

consultants Combined annual clinical turnover of approx

£760 million Offers 50 clinical specialties

Types of activity performed

 Circulation sciences and renal medicine  Clinical and investigative services  Medicine  Preventative interventional public health  Specialist services Surgery and cancer Women’s and children

First UK AHSC initiative announced August 2007

Imperial led AHSC; Principal is CEO

The “joint leadership and management” organizational model of Imperial College Healthcare

Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

Composed of leading research centres and 3FTs: University of Cambridge Cambridge University Hospitals NHS FT –

Addenbrooke’s Hospital Cambridgeshire and Peterborough NHS FT Papworth Hospital NHS FT Comprehensive BRC CLARC

Types of activity performedFocus on proven research strengths in:•Cancer Research•Cardio-Vascular Medicine•Diabetes, Endocrinology and Metabolism•Epidemiology, Public Health and Primary Care•Genetics and Genetic Medicine•Infection and Immunity•Neurosciences and Mental Health•Stem Cells and Regenerative MedicineHaematological and Transplantation Medicine

Cambridge NHS has catchment area of 1.5m population

Cambridge AHSC as a company: Head of Clinical School as CEO

The “joint partnership board” organizational model of Cambridge University Health Partners

Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

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Composed of 7 leading research centres and specialist hospitals: University College London Great Ormond Street Hospital for Children Moorfields Eye Hospital FT Royal Free Hampstead NHS Trust University College London Hospital NHS FT as anchor In total support 3,500 scientists, researchers and consultants Combined annual turnover of approx £2 billion

Types of activity to be performed Nervous System Children’s Health Heart Disease Transplantation Immunology Ophthalmology Deafness and hearing impairment Dental and oral disease Cancer Women’s health

Service over 1.5 million patients

UCL Partners.org: cluster of hospitals

Composed of 4 leading research centres: King’s College London as anchor Guy’s and St. Thomas’ NHS FT King's College Hospital NHS FT South London and Maudsley NHS FT In total support 3,500 scientists, researchers and consultants Combined annual turnover of approx £2 billion

Types of activity to be performed Neuroscience and Mental Health Inflammation and immunity Cancer Cardiovascular Dental Dermatology Diabetes Stem cell Reproductive health Allergy allied disciplines including public health

Service 5 million people (60% of London)

King’s HP: confederation of 4-5 FTs

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Composed of 7 leading hospitals and Manchester Medical School:

Central Manchester and Manchester Children’s University Hospitals NHS Trust

Christie Hospital NHS Foundation Trust Manchester Mental Health and Social Care Trust Salford Primary Care Trust Salford Royal NHS Foundation Trust University Hospital of South Manchester NHS

Foundation Trust

Types of activity performedFocus on proven research strengths in: Cancer Child health Mental health Primary care Neurosciences Respiratory disease

Manchester: SHA, PCTs, University and cluster of 6 FTs

Organizational model of CLUSTERS or University Hospital Partners.org . Is this a big city, big hospital, cluster solution that does not, perhaps really create a centre?

Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

Oxford Radcliffe Hospitals NHS Trust Nuffield Orthopaedic Centre Primary Care TrustUnderpinned by the link to the Wellcome (Gene Centre) MRC (Weatherall Institute of Molecular Medicine) CRUK (Cancer Centre) BHF (Centre of Excellence)

Types of activity performedIntegrated clinical innovation units as 7 “centres” would include: Acute Care Centre Cardiovascular Centre Cancer & Surgery Centre Conservative Medicine Pavilions Neuroscience Centre Women’s & Children’s Health Centre Bone and Joint at NOCCross cutting Platforms for Pathology, Imaging etc

Services approx. 0.5 million patients

Oxford Medicine: federation of 7 devolved but integrated centres as OUHP

Osler on academic-clinical integration

“We need an active invasion of the hospitals by the universities... In the United States and the Dominions these changes are rapidly progressing...”, 1911

Neuroscience

3-person Academic Department Senior Management Group

Oncology

Director of Clinical Service

5-person Academic Department Executive

Clinical

Oncology/NIHR BRC Theme

Surgery

Renal, Transplant, Urology

Academic

Cancer Therapeutics

Radiobiology

Surgical Oncology

Medical Oncology

Clinical Oncology

Head of Academic Department

Orthopaedics, Rheumatology and Musculoskeletal Sciences

11-person Hospital Board

5-person Academic Department Senior Management Group

Clinical

Musculoskeletal

Enablement

NIHR Biomedical Research Unit

Academic

Osteoarticular Pathology

Bone Oncology

Cell Signalling

Musculoskeletal Sciences

Orthopaedic Engineering

Head of Academic Department/ NIHR BRU

Director/ Non-Exec

Institute of Rheumatology

Laboratory Sciences

Clinical Trials Unit

Epidemiology & Biobank

Trauma Research Centre

The Committee of Five presenting their work to the Congress on June 28, 1776, a “split solution” required to allay sum of all fears

University Departments merging with Hospital Divisions to create devolved centres a policy experiment of 7 laboratories…

"It is one of the happy incidents of the federal system, that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.“

U.S. Supreme Court Justice Louis D. Brandeis, 1932

Next steps

AHSC vs. confederation of “AHSC’s”

• Tripartite mission comes together in topic specific themes each with own distinct brand;

• Multi-disciplinary learning (with embedded academic post graduate schools);

• devolved resources, fund raising, leadership and accountability but also each owns their brand;

• Underpinning by institutions to ensure tertiary income, safe discovery, and a culture of change;

• Community inclusiveness, strong links to Public Health, Primary Care, Mental HT, PCT, Oxford Brookes U (allied health sciences) and SHA;

Summary, questions