Characteristics of AHSCs
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Transcript of Characteristics of AHSCs
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