to open the Prospectus and Business Plan

South West Peninsula Academic Health Science Network

Prospectus and Business Plan

1 October 2012

1

�� !� ��"�#�� #��$�� %�� &��&��

� �� '�� (��'�� )��

��& � ��*��+��#�� ,��-��$��#��-��+�� !� ��-�� -��!�� .�� .�-��/�� "��/�� .��!��0��.��.��!��&��.� ��1�2�!�&��3�

�� &��4�� !��!�� &��4�� 1�� /�� 1�2��/��3�� #��4��*��/�� "�� 2��/"��3��&��4��4�� !� ��&��!��*�� '�� 1 �� #��4��*��5��4�� $��5��&��

��0��56��7��48��7��4� �',��0��1 ��!��&��.��.�� -� ��,��&�� " ��4�� !��#�� *��9��.�� /�.�:��4�� !�� 0��&�*��4�� ,;�0��

�� *��& � ��*�� #��)�

!��" #�

��$�� %��&�'�� 4�� " ��4��!��4��$��#��&��&�� 4��&��-��2��&-3��*��<��

�� !�� "��

��#��!�� $��#��

!��(��)�*�� !��" #�

Figure 1 : Who We Are

Foreword ................................................................................................... 3

Introduction ................................................................................................ 5

1 How our AHSN will benefi t the South West Peninsula ...................... 7

2 Transforming Research Delivery ..................................................... 11

3 Spreading Innovation and Best Practice .......................................... 18

4 Creating Wealth ............................................................................... 26

5 Building our capacity: Education and Training ................................. 31

6 Building our Capacity: Information and informatics ......................... 35

7 Delivering the South West Peninsula AHSN ................................... 39

8 Measuring our Success ................................................................... 47

9 Way Forward and Next Steps .......................................................... 49

Appendix 1 South West Peninsula AHSN Business Plan ................... 51

Appendix 2 High Impact Innovations in the South West Peninsula .... 67

Appendix 3 NHS Change Model ......................................................... 70

Contents

South West Peninsula AHSN Prospectus and Business Plan

2

The South West Peninsula has a unique geography, a strong tradition of collaborative working and outstanding achievements in clinical care and research. The South West Peninsula partners aspire to create the most successful AHSN in the country, aligned to a shared, three-fold ambition:

• To become a UK and global exemplar of research participation and discovery.

• To spread innovation and best practice to make services the best they can be.

• To create a step change in wealth creation through enhanced commercial activity and employment opportunities.

The South West Peninsula AHSN (SWP AHSN) will be building on a strong track record. Our capacity for research delivery is outstanding, demonstrated by exceptional research network performance, dating back to the original Cancer Research Network. Peninsula’s Collaboration for Leadership in Applied Health Research (PenCLAHRC), Peninsula Clinical Trials Unit (PenCTU), our Comprehensive Local Research Network and Cancer Network are known for their prominent successes in catalysing innovation through successful partnership working, whilst our primary care partners have some of the best results in the country for recruiting to portfolio trials.

In 2011, the South West Peninsula became a Prime Site for the world’s biggest contract research organisation, Quintiles, making the South West prominent in promoting commercial research. We have a similarly strong record of achievement in service improvement, with further progress in this area has been stimulated by the PenCLAHRC, which has worked with partners to identify evidence to underpin decisions and design effective implementation strategies. Both the Universities and the local NHS have a history of effective commercialisation of innovation, with the Exeter Hip developed in the 1970s still being regarded as an exemplar of effective commercialisation of NHS-driven innovation, whilst K2, developed in Plymouth, is one of the world’s leading companies involved in fetal monitoring, training, visualisation and recording.

Collaboration isn’t always easy, with competing priorities across the Peninsula, but we have, over the past six months, emerged more united, stronger and better aligned. These signifi cant improvements have been cemented by the sustained close working and mutual respect that has been fostered during development of our Academic Health Science Network proposal. Our approach to establishing the South West Peninsula AHSN (SWP AHSN) will therefore be evolutionary not revolutionary. We believe transformation is achieved via small changes for a large number of people and this will be our underpinning principle.

‘Innovation, Health and Wealth’ provides a compelling vision of an NHS that is defi ned by its commitment to innovation, demonstrated through its support for research and its successes in rapidly adopting and diffusing the best, most innovative ideas, products and clinical practices. A commitment by members to jointly deliver agreed priorities, based on an explicit commitment to evidence-based implementation strategies, will ensure that we achieve this.

Foreword

3

Our AHSN AmbitionsGrowth is at the heart of our AHSN vision, and engagement with industry will be at the core of our priorities. We are ambitious to capitalise on existing R&D activity across our Network to maximise its contribution to economic growth. Whilst we cannot at this stage quantify it, we will seek to measure and demonstrate how the funding for the AHSN generates value for the NHS and academia, and most importantly creates economic growth, employment and job sustainability. We will use our AHSN to leverage additional commercial income streams, to fund innovation, implementation and evaluation, in order that the scale of our ambition is not limited solely to a centralised funding model.

We plan to build upon the successes of our business and science parks to generate gainful employment to attract and retain people in the area. We are committed to generating and sustaining local businesses, by increasing the ease with which products can be developed, trialled, taken to market, and procured at scale. But we are also committed to keeping and relocating wealth within priority local areas, directly linking wealth generation to our inequalities challenges, including wide variation in life expectancy and health outcomes, and marked pockets of urban and rural deprivation.

We are ambitious to achieve a transformation of health outcomes, linking in particular with the new commissioning groups and the full range of providers. We see the establishment of the SWP AHSN as an opportunity to use research evidence to drive rapid benefi t for patients, be they in hospital, out-patient clinic, general practice or their home. This ambition cannot be delivered centrally but can be delivered within self-regulating communities aligned to the needs of patients and the public within the geography of the South West Peninsula - it is up to us to make change happen.

Finally, we do not underestimate the challenge. We are ambitious to be the best in class. We want to harness and combine the unique capabilities of our region’s science and technology, commerce and service delivery partners to transform health and wealth outcomes. We want to lead by example, making a partnership pledge to spreading innovation locally and proving the impact of our approach. We have already invested signifi cant joint effort and resources to ensure our stakeholders fully understand the opportunities inherent within our AHSN. Within this Prospectus, we set out our guiding ambitions in terms of Governance and our engagement with industry and non-NHS providers. Over the forthcoming development phase we will seek to defi ne and strengthen these ambitions, to establish clear grounds for involving our industry and other partners. During the development phase, we will establish an active programme of Organisational Development to link our vision to clear strategic objectives, including defi ning and agreeing key performance indicators and a robust monitoring and management framework. We are committed, as a partnership, to developing a Network that will position us at the forefront of this powerful national agenda.

This is our collective pledge.

Angela Pedder

Chair of the South West PeninsulaAHSN Steering Group


4

The SWP AHSN will drive collaborative, cross-sector working to transform research delivery, advance adoption of innovation and best practice, and increase wealth creation locally and for UK Plc, by increasing commercial activity and generating new employment opportunities.

We will establish ourselves as a regional implementation framework for ‘Innovation, Health and Wealth’, building new relationships with commerce to attract investment; proactively supporting the life sciences industry; fostering Research and Development; and investing in our people and our system incentives to create a landscape that nurtures innovation and best practice.

In developing our AHSN Prospectus and Business Plan (see Appendix 1) we have engaged widely with cross-sector, cross-county organisations. We have held fi ve engagement events, with high levels of diverse attendance at each, and we have worked with patient and industry representatives to review and refi ne our proposals. This has enabled us to capture, align and incorporate widely-ranging perspectives, and has provided us with a prototype for the type of engagement, negotiation and joint decision making that our AHSN will provide.

Introduction

5

Isles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of ScillyIsles of Scilly

South West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaSouth West PeninsulaAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences NetworkAcademic Health Sciences Network

202020202020202020202020202020202020202020202020202020202020202020202020200000000000000000000000000000000000000

milesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmilesmiles

40404040404040404040404040404040404040404040404040404040404040404040404040

Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor Dartmoor National ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational Park

Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor Exmoor National ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational ParkNational Park

A388

A38

A30

A39

A30

A30

A39

A30

A377A386

A37

A361

M5

M5

TruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruroTruro

BarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstapleBarnstaple

YeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovilYeovil

CrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerneCrewkerne

TauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTauntonTaunton

PlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouthPlymouth

TivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTivertonTiverton

BamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBamptonBampton

ExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeterExeter

ChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChardChard

KingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridgeKingsbridge

AxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminsterAxminster

BidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBidefordBideford

BodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodminBodmin

BridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwaterBridgwater

BudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBudeBude

CheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddarCheddar

CreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCreditonCrediton

DartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouthDartmouth

DawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlishDawlish

FalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouthFalmouth

FromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFromeFrome

GlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonburyGlastonbury

HelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelstonHelston

IlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchesterIlchester

IlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombeIlfracombe

IlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminsterIlminster

LauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLauncestonLaunceston

LiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeardLiskeard

LyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLyntonLynton

MineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMineheadMinehead

NewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquayNewquay

Newton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton AbbotNewton Abbot

OkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehamptonOkehampton

PaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaigntonPaignton

PenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzancePenzance

RedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruthRedruth

SaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltashSaltash

Shepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton MalletShepton Mallet

St AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt AustellSt Austell

TavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistockTavistock

TeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouthTeignmouth

TorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquayTorquay

TotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnesTotnes

WellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWellsWells

WincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincantonWincanton

The South West Peninsula footprintOur proposed AHSN footprint will cover Somerset, Devon, Cornwall and the Isles of Scilly, with a population of circa 2.2 million (2011 census):

Figure 2: Infrastructure and population density

Persons per Km220,000 to 89,70010,000 to 20,0007,500 to 10,0005,000 to 7,5002,500 to 5,0001,000 to 2,500

500 to 1,000250 to 500100 to 250

0 to 100

Universities

General Hospitals

A review of clinical linkages, referral patterns, training fl ows, existing research communities, and geographical factors demonstrates that this is a coherent clinical and academic community, a view supported by dialogue with senior providers, commissioners and academics. Key factors include:

• The geography of the South West Peninsula is both rural and expansive. The travel distance between Land’s End and Axbridge is over 175 miles. Population density is consistently low, despite pockets of urban concentration.

• The universities within the South West Peninsula provide the full range of health and social care undergraduate education, and a broad range of postgraduate education and training opportunities.

• Strong clinical communities, clinical networks and clinical research networks have already developed within the AHSN footprint.

Local population health The population of the South West Peninsula has three defi ning features:

1. It is a mixture of urban and rural areas, with poor access to services in some remote rural areas: for example, Cornwall is one of the few counties in England with no motorways, and public transport is relatively limited. Our remote communities and poor infrastructure provide a compelling case for service innovation, including telecare and telehealth to enhance access and outcomes for patients who live remotely.

2. Despite pockets of affl uence, we have areas of marked deprivation: The South West Peninsula has urban and rural deprived communities, with up to 18 years difference in life expectancy for men between its most affl uent and most deprived areas. In addition to urban poverty, there are high levels of rural deprivation, exacerbated by problems of isolation and poor access to services. Cornwall has EU ‘Convergence’ status, identifi ed as having a relatively weak economy compared with the EU average.

3. It is ageing, in many places far quicker than the rest of the country: for example, the population of East Devon has an age structure that most parts of the country will not experience for another 20 years, with high proportions of the population aged 80+. These patterns place demands on age-relevant services and create a need to cope with growing numbers of frail elderly patients. By 2050, 20% of the world’s people will be over 60, compared to only 9% today. The great healthcare challenge for the future will be chronic disease resulting from increasingly ageing populations, and placing enormous burdens on care resources. Developing new treatments for these complex diseases is becoming increasingly more diffi cult and more expensive, with the greatest challenges in terms of population health and cost arising from dementia, diabetes and obesity. Our population is ahead of the national trend in terms of population ageing, making these challenges particularly urgent across our Network.


6

If dementia were a country, it would rank as the world’s 18th

biggest economy.

1.1 Case for ChangeOur case for change is strong. We need to improve population health and patient outcomes; to create an economically sustainable local health system; and to build a thriving, industry-led life sciences sector. Our Network will catalyse change, becoming the delivery mechanism for achieving IHW’s eight innovation priorities::

1. Reduce variation in the NHS and increase compliance with NICE guidance.

2. Work with industry to improve innovation uptake.

3. Improve delivery mechanisms for diffusion and collaboration within the NHS.

4. Align organisational, fi nancial and personal incentives to encourage innovation.

5. Improve arrangements for procurement to drive up quality and value.

6. Create a culture shift within the NHS by embedding innovation into training.

7. Strengthen NHS leadership in innovation and sharpen local accountabilities.

8. Identify and mandate the adoption of high impact innovations in the NHS.

We have a strong track record of achievement but recognise that we face some system-wide barriers to achieving these ambitions. Despite these challenges, we are making progress in implementing innovations such as the six High Impact Innovations identifi ed in IHW.

1.2 Our vision for the futureDriven by the needs of our population, the progress being made across our footprint and the opportunities identifi ed for spreading good practice further, we have developed with our partners a shared vision for the South West Peninsula. We are aiming to deliver ’an integrated health and social care system in the South West Peninsula, based upon uniform best practice in the implementation of clinical care commissioning and delivery. This will reduce variation in health outcomes, creating signifi cant improvements in population health and well-being, whilst stimulating the economy across the Peninsula to generate wealth’.

We will deliver our vision through six interdependent functions, supported by a lean governance structure, with specifi c priorities identifi ed and summarised in our SWP ASHN Strategic Framework (illustrated below), and Business Plan (see Appendix 1).

1. How our AHSN willbenefi t the South West Peninsula

7

We will work with industryto build greater trust and maximise

joint opportunities.

1. Hbenefit th

We will take each of these strategic objectives and develop them as themes over the forthcoming development period to translate them into specifi c objectives.


8

Spreading

Innovation &

Best Practice

• Identify priority

innovations relevant to needs.

• Understand value of innovations through

research.

• Align organisations

towards uptake or

cessation.

• Use of levers to

spread innovation.

• Achieve step change

in use of research to improve practice.

Transforming

Research

Delivery

• Partner with the

NIHR.

• Create a seamless

and active research

community.

• Enable easier

access to clinical trials and studies.

• Increase the pace of translating invention

and research into clinical practice.

Creating

Wealth

• Single point of

access for industry partners.

• Facilitate knowledge exchange with

industry.

• Stimulate innovation

and enable

successful commercialisation.

• Increase economic productivity and

create jobs

• Sell to international

markets.

Delivering the

SW Peninsula

AHSN

• Improve health and

patient outcomes.

• Create an

economically sustainable local

health system.

• Build a thriving,

industry-led life

sciences sector.

• Become the delivery

mechanism for the IHW priorities.

Education &

Training

• Develop levels of research literacy amongst staff

• Develop leadership skills for innovation

• Partner with LETB to develop innovative curricula

• Promote staff mobility – ‘training passport’

Information

• Share and transfer health information easily across

organisations.

• Improve the identification of research patients.

• Enable service improvement monitoring systems.

To bring together academic rigour and operational experience to enhance patient health and wellbeing. We will leverage the collective resources of NHS, academic, industrial and

government partners to transform health and social care services through innovation, adoption and wealth generation.

Our mission

Our vision

An integrated health and social care system in the South West Peninsula based upon uniform best practice in the implementation of clinical care, commissioning and delivery.

This will reduce variation in health outcomes, creating significant improvements in population health and well-being and stimulate the economy across the Peninsula to

generate wealth.

Figure 3 : SWP AHSN Strategic Framework

Innovation progress: HII and iTAPP

Members within the Network have already made measurable progress in adopting and spreading innovations that improve the quality and productivity of local healthcare. Network-wide work is underway to ensure rapid, sustainable delivery against the six High Impact Innovations (HII) set out in ‘Innovation, Health and Wealth’. However, our ambition is to progress beyond delivering ‘pockets of excellence’ which bring specifi cally local benefi ts, to create a Network-wide approach to innovation that delivers rapid change across larger populations.

Our AHSN model for dealing with innovations of proven effectiveness is presented in detail in Section 3. Within this model, HII and push technologies will be designated automatically as ‘Priority 1’ opportunities and will be fast tracked through our AHSN pipeline to drive service change at pace and scale. We will use the best evidence from improvement science to produce specifi c implementation strategies for each innovation, which will be designed to refl ect the barriers and facilitators to implementation operating at the level of system, organisation, team and individual. We will work enthusiastically with new commissioning bodies to promote seamless quality driven health care.

We understand that we must collectively demonstrate suffi cient progress on implementing the HIIs by March 2013, in order for providers to prove eligibility for 2013-14 CQUIN. In support of this, we have an existing commitment to our commissioners to defi ne all of our HII outcomes by December 2012, so that we can focus on further spread and sustained delivery from January 2013 onwards. In line with government mandate, we will develop a commissioner-based, local investment and improvement trajectory for each HII (with CQUINs agreed), to ensure that providers are fi nancially rewarded for successful delivery of HII. Development of and progress against this trajectory will be supported by our AHSN’s central remit to map each member’s progress against HII; develop local ambitions against each HII; co-ordinate and centralise implementation plans across the Network; and hold each organisation accountable for the delivery of these operational plans and agreed Network-wide outcomes. The following overview provides an indication of progress against the 6 HIIs across our Network, with further information available from our Trusts in their IHW pro formas and summarised in Appendix 2.

1. How our AHSN willbenefi t the South West Peninsula

9

“Innovation”: an idea, serviceor product, new to the NHS or

applied in a way that is new to the NHS, which signifi cantly improves

the quality of health and carewherever it is applied. (IHW)

“ “

Measurable progress against the 6 HII includes:

1. Assistive technologies: 3 million lives: 120 Plymouth patients with COPD and heart failure are managed with telehealth and telecare; 4,000 Somerset patients with COPD, heart failure and diabetes will be monitored by telehealth as part of a £1.2m, 3 year investment; Cornwall was one of the early adopters of telehealth and is now planning to expand its use to help patients self-manage their condition at home.

2. Oesophageal Doppler Monitoring: increasing numbers of high risk patients are undergoing ODM across all acute Trusts in the South West Peninsula, with KPIs being developed via commissioning functions and linked to CQUIN.

3. Child in a chair in a day: wheelchair services: Plymouth Community Healthcare now see 50% of current routine cases in a day and are reviewing skills, staffi ng and stock management to improve this further.

4. International and commercial activity: working with partners: We are a prime site for Quintiles Commercial research activity. Live or pending patents include patient care signs, a nursing acuity tool, rectus sheath catheters, a pain relieving device, episiotomy scissors, a total hip system, pleural catheter guidelines and a major C-Peptide innovation.

5. Digital First: Reducing unnecessary face-to-face contacts: Torbay and South Devon reduced outpatient appointments by 4,300 by use of a PSA tracker. A 38% reduction in paediatric outpatient appointments has been achieved by the use of advice & guidance.

6. Carers for people with Dementia: 1,700 short breaks for carers have been provided in Devon. The Enhanced Healing programme in Somerset is also re-designing ward environments with carers for patients.

Our AHSN will undertake a stock-take of push technology adoption and learning, using a centralised template to enable cross-comparison and sharing of learning between members. This would reduce duplication of trials and piloting activity by enabling members to share results from pre-existing trials, and thus to accelerate implementation. It would also enable members to draw on a pool of data and experience when developing organisation-specifi c business cases. We have made progress in adopting the ‘push technologies’ agreed by the Department of Health’s Innovative Technology Adoption Procurement Programme (iTAPP) Board, and have a similar ambition to move beyond pockets of excellence to deliver at scale. Whilst we understand that progress is being made across our footprint, we do not yet have a centralised view of individual or collective iTAPP activity across organisations.


10

Adopting iTAPP new technologies SWP AHSN members are working towards implementation of the push technologies, with some adopting iTAPP recommendations 6 (silver alloy coated catheter),11 (uterine fi broid embolisation,27 (faecal management), 34 (doppler guided intra-operative fl uid management), 126 (room sterilisation technology), 58 (implantable insulin pump), 78 (DVT testing using D-Dimer in primary care) and 83 (GP fi ngerprick test for HbA1c in diabetic patients). Studies are also in progress in relation to 98 (chronic wound care management), 104 (non-invasive device to diagnose lower urinary tract symptoms), 110 (pro NT BNP testing for improved drug management) and 119 (Suprabubic foley catheter inserted with guide wire using Seldinger technique). We have demonstrated clear benefi ts, linked to reductions in infections, improved outcomes for patients and effi ciency gains. To support this agenda, the ‘Peninsula Clinical Technology’ website (www.peninsulaclinicaltechnology.org.uk) provides an online portal for new technology ‘horizon scanning’ including iTAPP reviews, and now forms a standard element of strategic development and business planning.

2.1 Opportunities An effective partnership between the AHSN and the NIHR offers the opportunity to substantially increase the number of patients entering clinical trials and other well designed studies, and to ensure a step change improvement in delivery. To achieve this ambition we will:

• Create a seamless research community that removes the barriers to adoption and spread by providing easy access to the right people, for the right task, at the right time.

• Enhance the ease with which clinical trials and other high quality studies can happen, making it both quick and easy for researchers and industry to establish and run clinical trials and research projects.

• Increase the pace of translation from invention and research to clinical practice, thereby increasing the speed with which health outcomes are transformed and wealth is created locally.

2.2 BackgroundThe South West Peninsula has a strong reputation for research practice endeavour and delivery. However, there are system-wide barriers that the AHSN will specifi cally address to improve participation and outcomes. At present, the time taken to set up and approve research studies is not consistent across all Trusts and studies in the South West Peninsula. Although there are pockets of excellence, we do not meet the national expectation of 80% of studies delivering to time and target. The step change required is that we set up more quickly and deliver more studies within nationally set metrics, e.g. at least 80% achieve fi rst patient visit within 30 days and at least 80% of studies close to having recruited to target.

Under the NHS Constitution, patients have a right to be informed about opportunities to take part in NHS research for which they are eligible. However, application of this right is uneven and patients are sometimes unaware of research studies relevant to them, due to inconsistencies in patient engagement. Furthermore, levels of public trust in the pharmaceutical industry are low and this issue needs to be directly addressed, via targeted public awareness raising, if patients are to be active participants in clinical research. Scotland has taken the innovative step of pre-consenting its population at large, so that they agree to be contacted for appropriate research activities. We recognise that we need to be equally ambitious in working actively with our local populations to raise awareness of and support for research activity. Although all Trusts within our AHSN footprint are research active, there is therefore potential to increase the number of patients entering studies by setting up dedicated clinical areas to see patients in studies; raising the profi le of research; and resourcing this appropriately.

Commissioner approval is required to secure approval for additional treatment costs and hence for studies to proceed. To secure this approval, and recognising that commissioners are key to creating the evidence base upon which to build better outcomes for future populations, a strong focus on commissioner engagement is required. Furthermore, often there is a requirement for multiple approvals from different commissioners, which has been identifi ed as a barrier to studies progressing. For example, a study running at an acute Trust may currently require approval from four PCTs if patients are to be recruited from across the Peninsula, so a streamlining of the permissions process is also urgently needed.

2.Transforming ResearchDelivery

11

2.Tra

There is a national ambition to make the UK a competitive, vibrant place to undertake research, and to ensure that Research and Development stays within the UK to increase wealth generation and productivity. This must be supported by fast set up and recruitment to trials, and driven by the speed with which trials translate from bench to patient bedside.

We will combine our innovation experience with the academic rigour developed via PenCLAHRC and PenCTU. We will work with commissioners and providers to develop hypotheses which can be tested using PenCLRN resources and processes, producing research which is valuable and relevant to the NHS, important to patients, and properly project managed to guarantee cost-effective, timely delivery.


12

PenCLAHRC has:• Established mechanisms for working with

clinicians to identify challenges, leading to innovation.

• Expertise in developing complex interventions using the MRC framework, and links with national and international experts in the fi eld.

• Methods for convening a network to agree strategic priorities, using a system which is supported by all members that will be used to review innovations for adoption in the South West.

• Informal and systematic reviews to inform the development of priorities and to answer questions about the value of innovations - the PenCLAHRC Evidence Synthesis Team.

• Operational Research group (PenCHORD) already working with the NHS to innovate ways of organising resources for health gain and effi ciency, resulting in signifi cant change.

• Expertise in Evidence Based Practice through a series of nine and three day workshops to develop capacity to judge the value of innovations in the NHS.

• Experience developing innovations to the point where they are suitable for appropriate research evaluation to demonstrate their value to national and international audiences.

• Experience evaluating implementation of change based on research fi ndings.

• Nationally lauded expertise in patient and public involvement in research.

• Economic evaluation commissioning decision support (Peninsula Health Technology Commissioning Group).

• Signifi cant methodological expertise in a range of disciplines, as well as strong links into the CLAHRC’s partner universities.

• A team of researchers with skills in implementation science to evaluate the AHSN’s service improvement initiatives and inform their development locally and beyond.

PenCTU has:

• An exceptional track record in obtaining funding for multicentre clinical trials including NIHR Research for Patient Benefi t trials, closest to health care delivery.

• World-leading expertise in measurement science, particularly in Patient Reported Outcome Measures, many of which are now being used in trials and service evaluation across the world.

• Cutting edge information scientists able to write novel programmes for internet based data collection across numerous sites.

• Strong statistical support and ability to handle extensive datasets for evaluation across a number of fi elds.

We will capture the benefi ts from PenCLAHRC and PenCTU throughout our AHSN activity.

We will build on our our strong research foundations within PenCLAHRC and PenCTU. PenCLAHRC has a range of established mechanisms and experience

on which the AHSN will draw, including:

2.3 Key priorities The SWP AHSN will promote and support research in the NHS by achieving the 5 research priorities below. Fundamental to its success will be close collaboration between Trusts, Universities and other member organisations, with the highly successful NIHR Clinical Research Networks and with other components of the NIHR infrastructure. We will undertake service review and initiate service improvement across our research participation initiatives - a key principle to ensure we achieve the step change required.

Priority 1: An AHSN-wide system to manage research participation and performance effectively and effi ciently, consistent with national systems and approaches, delivering a step-change improvement in the initiation and delivery of clinical research on time and on target by constituent NHS providers

To achieve this goal the AHSN will:

1. Establish a single point of access for research in the SWP AHSN aligning closely with the Clinical Research Network.

To effectively manage research identifi ed by both ‘push’ and ‘pull’ mechanisms, we will establish a single point of access to AHSN members. This will be a joint Universities/ NHS offi ce, which will serve as the ‘front door’ for our AHSN. It will provide a more straight-forward entry and access mechanism; establish a centralised process for guiding researchers (especially commercial) towards relevant clinical groups, connect basic researchers and clinicians, and researchers and industry and promote early stage partnership more effectively. It will ensure that the interchange of ideas leads to harnessing basic innovation to solve clinical problems.

The NIHR Clinical Research Networks (NIHR CRNs) currently act as a single point of contact for commercial companies and non-commercial researchers wishing to run clinical studies. To harness existing expertise and build upon it, the single point of access for the SWP AHSN will be

provided by the Peninsula CRN (and successor organisation), with additional resources from the AHSN. The CRN offi ce will be strengthened by addition of experts who not only manage research but also have extensive knowledge to engage and connect the basic researchers, clinicians and life sciences industry, progress innovations and knowledge of the Universities. The CRN already has a successful track record of this way of working with the Quintiles prime site manager working in the CLRN offi ce ensuring maximum potential for collaboration with minimum duplication.

2. Establish across the region a Mutual Recognition Agreement (MRA) to streamline governance processes.

To remove barriers to research we will ensure systems and processes are aligned and effi cient across our Network, consistent with national requirements. The Peninsula CLRN working closely with Trusts has now gone live with a system of ‘one cost’ for commercial trials. Where trials are open at more than one site the trial is ‘costed’ once. These costs are then accepted by all Trusts. This process also includes elements of one contract review. We will build upon this initiative and establish a Mutual Recognition Agreement (MRA) covering all research governance requirements, to ensure a standardised and faster permissions process. This streamlined process will release time back to local Trusts and other AHSN members to enable them to concentrate on robust local feasibility and set-up, ensuring that when they agree to open studies at their site, they are achievable, can be delivered, and are well governed.

Within the AHSN footprint there are already good examples of cross organisational working. The CLRN has a joint NHS research offi ce for primary care, secondary care and mental health in Cornwall, and in Exeter and Plymouth local acute Trusts provide Research Management & Governance services to both acute and primary care Trusts. Early discussions with the emergent Clinical Commissioning Groups (CCGs) have demonstrated support for their involvement with this approach.


13

Inclusion of the university and other providers of NHS services (including social enterprises and private providers), in partnership with the NHS, will add complexity, but creates the opportunity for broader involvement and spread of good practice. Building on the current strength across these organisations, the goal will be to maximise high quality research across the partnership to ensure appropriate NIHR standards of research governance are achieved for non-NIHR as well as NIHR research, among all AHSN organisations. By demonstrating our excellent performance - in terms of time to initiate and the delivery of clinical research and support to teams developing research ideas - we know these newly research active organisations will seek out the AHSN to assist them in their research missions.

Priority 2: increase awareness in patients about the opportunities and benefi ts from participating in clinical research

Increased opportunities for patients to participate in clinical trials will be created by:

1. Increasing PPI group involvement in the trials process, with meaningful public and patient engagement embedded at the heart of all initiatives to ensure patients are ‘research ready’, with increased information sharing about research opportunities and outcomes. Through dedicated communications and linking with the public via the large network of Foundation Trust membership within the South West Peninsula our aim will be to enhance research transparency in the public domain by raising awareness and increasing patient and public understanding of research trials and involvement opportunities. This will, in part be achieved by providing training to engaged members of the public on topics such as searching for evidence and critically appraising research reports. The will draw on the successful training packages already developed by the Peninsula CLAHRC PPI team. This will also be aided by the naturally low levels of population migration across our footprint, which provides us with a stable base both for research activities and awareness-raising.

2. Engaging with patient groups to encourage patients to identify their important questions so that AHSN members can work with them to generate and run research projects. The South West already has a successful track record in this area, for example, working with parents of children with Cerebral Palsy to evaluate the effects of osteopathy for their children. PenCLAHRC currently has 7 research projects initiated by ideas from members of the public, six were initiated by service users and another originated from an idea generated jointly by service users and clinicians

3. Establishing a system to regularly update clinicians on all current NHS research taking place in the Peninsula, providing clinicians with information about their patients’ rights to be informed about opportunities to take part in NHS research, and ensuring research is included in discussions between Trusts and GPs and their own public and patient involvement groups.

4. Committing all AHSN members to embedding research as core business; patients will be recruited to clinical trials and other well designed studies within their own institution and also across the AHSN to facilitate recruitment to complex studies that cannot be opened at multiple sites.

5. An aspiration for all of our NHS providers to identify dedicated clinic space for research patients, to support clinical trials.

Increasing the number of clinical trials initiated and completed in the South West Peninsula by expanding PenCTU activities; linking with Research Design Services; increasing the number of Chief Investigators in the region through education, mentorship and coaching. In addition, we will increase engagement with industry, by adopting trials designed elsewhere, publication of our excellent governance statistics, and exploitation of our developing reputation as a Quintiles Prime Site in order to attract additional research organisations to the South West.


14

Priority 3: Increased recruitment of patients to non-commercial and commercially-funded clinical research by constituent NHS providers

The South West already has a strong track record of recruiting to NIHR clinical trials. Potential AHSN members are members of Peninsula and Western CLRN areas, both these CLRNs are within the top 10 of the 25 CLRNs for recruitment in 2011/12, with PenCLRN 5th when adjusted for population. Devon PCT was the highest recruiting PCT to NIHR trials in 2011/12 and all other PCTs in our AHSN performed in the top two thirds. In addition to the activities set out under Priority 2, we will also boost patient recruitment as follows:

1. To align processes and practice across the healthcare community, the SWP AHSN will work closely with the Primary Care Research Network SW to build on their successes and ensure that the systems and processes we develop refl ect the specifi c challenges and opportunities within Primary Care.

2. Increasing the use of existing bio-resources which enable patients with particular conditions, or their gifted tissues/samples, to be easily identifi ed for clinical research. Recruitment of patients via these cohorts has proved particularly useful for biomarker research with recruitment being completed well ahead of target. We will collate and publicise existing resources such as the NIHR Exeter Clinical Research Facility, ‘Exeter 10,000’; Diabetes Research Alliance for England, bio-resources of patients with diabetes, hypertension, cardiovascular disease and stroke; the University of Plymouth based South-West Impact of MS (SWIMs) database of 1,700 people with Multiple Sclerosis in Plymouth; the PRO-DeNDRoN database of people with Parkinson’s disease; and the Peninsula Tissue bank.

3. Informatics is fundamental and we recognise the opportunity already provided by the data we collect in each organisation and the potential we have to better support research participation and delivery. As set out in Section 6, ‘Building Our Capacity: Information and Informatics’, we will develop a Peninsula-wide information sharing solution, and will seek to create a single patient information system to enable researchers to connect rapidly and at scale with relevant patient cohorts. In advance of joined up Electronic Health Records, we will also develop our capabilities to use clinical data that are already stored electronically across the Network to facilitate ‘self-study’ and research. We will do this by pooling pseudo-anonymised data across the Network, and tapping into the most appropriate local expertise in order to analyse these data sets. The AHSN already has considerable expertise in this area with the Risk Assessment Tools for cancer diagnosis being generated from such data by Exeter University, and Plymouth University’s review of how to use routinely collected data to develop treatments for Alzheimer’s and Parkinson’s diseases. We will also develop further our pre-consent procedures and the establishment of disease cohorts as a means of approaching potential research participants.

Priority 4: Timely payment of treatment costs for patients who are taking part in research funded by Government, NIHR and Research Charity member organisations through the NHS commissioning system:

Peninsula Trusts and the CLRN have worked with commissioners on a standardised process for the payment of treatment costs over the past year. Going forward, we will build on this model recognising that incurred costs span a number of different organisations which will require different processes to be developed to ensure timely payment. For secondary care providers a model that offsets cost ‘savings’ made through increased research activity against any ‘excess’ treatment costs has been agreed in principle through dialogue with a number of stakeholders. This model has been discussed as a principle with CCG


15

representatives. It will be further discussed and the model refi ned with the newly formed CCGs once they are all established with the proposal that a local consortium of all CCGs within the AHSN area be established to pool risk across a number of organisations.

The outline of what is proposed is as follows:

Secondary Care providers:

• All studies will be reviewed and costs attributed, identifying if they are cost neutral, incur an Excess Treatment Cost (ETC) or are Treatments Saving (TS).

• Quarterly accounts will be produced by all Acute Trusts for the consortium including ETC and TS; information collated Peninsula-wide to provide regional evidence of research activity, that illustrates that the costs incurred by research do not outweigh cost savings generated through commercial and non-commercial research.

• Where the total cost incurred does not exceed a proportionate cap of the total annual cost savings, these are automatically approved without the need for further application. ETC above the proportionate cap will be approved by the consortia through a standardised process.

• A proportionate cap may also be set for any excess cost savings to be reinvested in research activity were it is demonstrated that cost savings greatly outweigh incurred ETC.

• Planned increases in commercial and non-commercial activity should continue to provide a trajectory of increased savings to support the model on an on-going basis.

Other providers:

Economies of scale and the nature of care do not provide the same opportunity to net off ETC and cost saving as most ‘saving’ is in the cancer drug budget and outside of the Acute Trust environment, thus most studies incur an ETC rather than achieve a saving. Therefore, Commissioners will provide a ‘ring-fenced’ allocation to which non-acute NHS providers will apply for their ETC to be administered by the CLRN. All studies will be reviewed and costs attributed.

Each will be identifi ed as cost neutral, excess treatment cost (ETC) or cost saving. Quarterly reconciliation will take place as patients enter the trial and the Commissioner will be provided with a quarterly fi nance update. If cost savings have been achieved these will be reinvested in research capacity and service improvement initiatives. This proposal will be refi ned in line with national guidance from the national commissioning board.

Exceptional services:

Different frameworks based on commissioning arrangements will need to be put in place for:

• Services commissioned by Public Health England.

• Specialist services commissioned nationally.

National guidance is anticipated on the payment of treatment costs incurred in organisations outside the NHS (e.g. Local Authorities). Much research commissioned by Public Health England falls into this category. Discussions with local authorities will be established to ensure that ETC will still be paid on a study by study basis utilising NHS consortia were required.


16

Translating research into practice: transforming the lives of children born with diabetesThe lives of most patients born with diabetes have been revolutionised by the medical research conducted by a University of Exeter team. Employing state-of-the-art molecular genetics, the team have identifi ed 8 genetic causes of neonatal diabetes, and proved that the two commonest types are better treated with sulphonylurea tablets rather than insulin injections. This work has meant that international guidelines for the diagnosis and care of these patients have now been rewritten. Patients from over 60 countries now have a normal life on tablets when they expected to be on insulin for the rest of their life.

Case study

Priority 5: Proactive support for life sciences industry research and development, including clear plans between University and NHS members to support recruitment to all phases of clinical research as part of the national effort.

For our AHSN to be truly innovative, we need to understand the expectations and priorities of industry. To fully maximise this potential, our objectives and metrics will need to align with those of existing NIHR research networks and current and potential industry partnerships for all commercial research. Progress has already been made in forming close strategic industry partnerships, and seven Trusts on the Peninsula are already part of the Quintiles Prime Site initiative. Both Plymouth and Exeter acute trusts are preferred research sites for a number of pharmaceutical companies, building on the long tradition of commercial trials research of hospitals in the region. By further streamlining our systems and processes, and to provide a single point of entry with quicker set-up and excellent delivery, we will seek to be the preferred region for multiple industry members building on our track record of active engagement with industry; in 2011/12 PenCLRN was ranked 3rd out of 25 CLRNs for NIHR commercial recruitment, with Western CLRN 1st.

The strategic capabilities within Primary Care will be enhanced and we will work with our NIHR partners to roll out the good models that already exist; for example, in Cornwall GP practices have combined in a hub and spoke model to deliver commercial trials. Maintaining the proportion of more complex interventional studies will also be prioritised as this will support a balanced portfolio, develop and demonstrate skills and track record and build confi dence to be a preferred site particularly for our life science members.

Within the SWP AHSN footprint we already benefi t from dedicated facilities which provide essential capacity to support patient recruitment and review for different types of clinical research. These include the Exeter NIHR Clinical Research Facility for experimental medicine; two areas for clinical trials facilities in Plymouth for phase 2 and 3 trials; and

the Jubilee Ward at South Devon Healthcare NHS Trust for NIHR clinical trials and other studies. We have an aspiration to develop a dedicated Peninsula Phase 1 trial facility and by ensuring all Trusts have dedicated out-patient clinic facilities for research.

Ensuring ‘delivery’ for commercial studies is critical for our industry partners. AHSN members will adopt innovative workforce initiatives to improve delivery to facilitate the step change required to deliver the studies we open.

Business engagement will be crucial if we are to be successful. Our Universities have a wealth of experience in this area and have successful innovation parks and industrial partners. As key AHSN members, they will ensure we learn from their experiences and adopt those which are most effective. Across the South West are a series of science parks, innovation centres and other mediparks with whom we will collaborate. We have examples of collaborations with Industry to bring potential new products to market (e.g. DTI funded work with Moor Instruments of Axminster and the NIHR Exeter clinical research facility) but there is capacity as yet untapped.



17

K2 Medical Systems provides a strong example of successful innovation. A joint project between Plymouth University computing department and Plymouth Hospitals Perinatal Unit, this moved from the design of computer software for use in the neonatal department to a multimillion pound business on the Tamar Science Park. Its products are used in >90% of all UK hospitals, by companies across the world, and it won a leading award for innovation of health technology last year.

Case study

18

3.1 Background The failure to rapidly adopt research fi ndings into practice is well described. The NHS is known for the development of innovative approaches but lateral spread within the service has been limited.

There is much in the Peninsula that is innovative. For example, local commissioners and providers have:

• Changed services for alcohol dependency in Devon (leading to marked changes in admission rates).

• Established effective telehealth in Cornwall (improving access and reducing costs).

• Transformed the acute stroke care pathway in Exeter (decreasing disability from stroke).

• Developed a paperless and fl exible information system in Somerset Partnership Trust (in collaboration with industry).

But, as elsewhere, such exemplars of excellence have often remained local and not been spread. We need a systematic, AHSN-wide approach to share the lessons and benefi ts of local innovation and ensure the value of innovations is understood and supported, where necessary, by research and development. The Peninsula Cancer Network has a history of achieving these aims and the AHSN will build on the experience of ensuring consistency in cancer care and promoting uptake of research in developing the AHSN.

Implementation work has had mixed success. PenCLAHRC successfully implemented the results of academic research – e.g. through use of tranexamic acid by ambulance staff in cases of trauma, prevention of venous thromboembolism in hospital, and development of patient-initiated clinics in rheumatology – but not all of such efforts have yet successfully spread. Similarly, trust-specifi c investment in improvement science has not involved cross-organisation co-ordination to roll out locally successful innovations. PenCLAHRC has been a valued focus for innovation and collaboration but the establishment of the AHSN will bring a step change in the commitment of NHS organisations to work

together to change practice based on research.

Mechanisms for dealing with NICE technology guidance exist but are fragmented. There is no single comprehensive system for auditing compliance with NICE guidance in secondary and primary / community care. Excellent local work in relation to NICE disinvestment approaches again needs to be made consistent across the region. The AHSN will develop a shared facility to monitor NICE technology guidance across all its constituent organisations.

3. Spreading Innovationand Best Practice

We will engage with NICE andestablish a formal relationship

to implement the agreed actions emerging from NICE’s review of

Innovation Health and Wealth. This will include structured engagement

between the NICE fi eld team of implementation consultants and the

ASHNs, to identify key NICE guidance in line with clinical domains for

implementation across the Network, and to support product uptake.

We will also agree a Memorandumof Understanding between NICE

and the SWP AHSN.

3. Spreand

3.2 Key priorities In order to achieve these benefi ts, we have identifi ed priorities on which we will focus over the next fi ve years. We consider service improvement and translating research and learning into practice as two sides of the same coin: the translation of research and learning into practice is not an end in itself but is worthwhile to the extent it permits and drives service improvement.

Priority 1 - establish high-trust relationships with partners including patients, commissioners, strategic clinical networks, providers of primary, secondary and community care.

Effective networks are built on trust and cooperation. The processes by which the Network identifi es, develops, considers and adopts innovation and supports its spread throughout the region must be trusted and supported by member organisations. The process of developing this prospectus has brought remarkable buy-in from stakeholders, refl ecting the enthusiasm in our health care community for increased collaboration but more needs to be done to develop the processes which are outlined in the delivery model set out in this section.

Priority 2 - create structure and processes for identifying and spreading innovations that is trusted, envied, and emulated.

Critical to the success of the SWP AHSN is putting in place structure and processes for identifying and implementing innovations that will transform patient care, a process laid out in the schematic in this section. It has its basis in three functions: the identifi cation and scoping of innovations; the implementation of innovations for service improvement and wealth creation; and monitoring and evaluation. This process will deliver more than one of the priorities described here and is thus central to the Service Improvement work of the AHSN.

19

Partnership working to improve service delivery - accelerating the delivery of Thrombolysis for acute ischaemic stroke The clot-busting drug Alteplase can greatly improve recovery if it is administered within 4.5 hours of a stroke. In collaboration between University of Exeter Medical School, the Royal Devon & Exeter NHS FT, South Western Ambulance Services NHS FT and the Peninsula Heart & Stroke Network, the acute stroke pathway has been reviewed, using 1,400 computer simulations to analyse all steps between patients arriving at hospital and receiving the drug. Improvements have been made to emergency care processes, which modelling suggests will increase the proportion of patients thrombolysed from 5% to over 15% (exceeding the NHS target of 10%), whilst reducing the time taken to deliver the treatment by up to 42 minutes. Results from a pilot scheme (introduced in 2011) show a doubling of the number of acute stroke patients receiving Alteplase, and could give a fi ve-fold increase in the number of people surviving stroke without disability. The project is now being extended across the South West Peninsula.

Case study



20

Priority 3 - create an environment where service improvement through innovating best practice is an essential part of the culture of all organisations.

We must foster a collaborative culture that encourages the identifi cation and development of effective innovations. Fostering such a culture is a central aim of the Peninsula AHSN.

We will take both general and specifi c approaches to developing an innovative culture across our health economy. Our general approach, as outlined in Section 5 (‘Building Our Capacity: Education and training’) will involve promoting research literacy in our workforce. We will develop our capacity for Knowledge Management, linking closely with work in the PenCLAHRC extending access to research-based knowledge on innovations and developing skills in use of evidence for practice amongst clinical staff, managers and patients.

We will rapidly establish a Network-wide understanding of our baseline position regarding existing Service Improvement Specialist capability and capacity, mapping service improvement posts across members, and conducting a wider skills audit. We will use this baseline to develop a tailored skills-development programme, including Network-wide support and training, and a targeted programme of development to ensure our AHSN teams of Innovation Strategists and Innovation Ambassadors (see below) are optimally resourced and matched to needs. Service Improvement roles and capacities are more developed in Acute and Partnership Trusts than in commissioning or primary care and other community settings, so an important early task will be to identify potential innovation leads in these settings.

We will develop a common strategic vision supported through the introduction of Network-wide mandatory practices where identifi ed innovations are adopted by AHSN members. Innovations not yet strong enough for roll-out may be passed to PenCLAHRC for evaluation or PenCTU for trialling, or may be supported and fostered by the SWP AHSN until a value assessment is made.

Priority 4 - build a marketing and communications functions that is responsive, dynamic, and effective in ensuring sharing of information within and beyond our Network of organisations.

Effective communication is fundamental to spreading and sustaining innovation and developing a collaborative culture across organisations. We will establish a shared communications function and will train and support our team of Innovation Ambassadors to proactively increase stakeholder involvement, awareness and support. We will emphasise public and patient engagement and will increase awareness and support for innovations and best practice through our dedicated PPI strategy, which builds on the nationally recognised Peninsula Patient Involvement Group (PenPIG). This will ensure that commitment to patient-centred care drives everything we do, and that public involvement and enhanced patient experience are central to our activity.

We will prioritise investment in communications to ensure key messages are understood in a timely and audience-appropriate manner. Since clear and compelling communication is essential at the initiation of spread we will seek to ensure that people across all implicated systems understand why a particular innovation has been selected for adoption.

High Impact Science: Adoption and Spread of Transformational Approach to Down’s Syndrome Screening A team of scientists at Plymouth University has revolutionised the way in which we screen for Down’s syndrome across the world. By using the latest statistical modelling techniques, they have reduced the need for amniocentesis with the potential risk of abortion. The team now has quality control responsibility for all screening labs across the UK, and are working to use these same methods in other diseases and clinical trials within the Plymouth University Institute of Translational and Stratifi ed Medicine.

Case study

Priority 5 - monitor, evaluate and improve by systematically recognising quantitative and qualitative changes in service quality and wealth creation.

Monitoring the effects of AHSN-led service improvements will be critical to understanding what we have achieved, what we have not yet achieved, and how we can move closer to our goals. Sometimes this can be done by capturing and analysing routinely recorded data, and the work of the information and informatics team will be a crucial contributor. Other approaches to evaluation may also be needed, often requiring considerable expertise. This function will be delivered in collaboration with PenCLAHRC, who will host the evaluation and monitoring staff needed to deliver this function.

Through a combination of the above priorities we will increase the success and spread of innovation and best practice, enabling us to increase the partnership’s ability to adopt the 6 High Impact Innovations, iTAPP, and NICE Technology Appraisal guidance. Our adoption and spread approach will cover hospital and secondary care provision as well as the wider service infrastructure spanning primary, community and social care.

3.3 Our delivery modelThe AHSN will link together the development and identifi cation of innovation with the implementation of academic research to achieve service change which will benefi t patients and lead to wealth creation. Our model for service improvement, illustrated below, has the NHS Change Model at its heart (see Appendix 3):

Figure 6 : SWP AHSN Delivery Model

21

Spreading innovation - implementing Tranexamic Acid for trauma patients Tranexamic acid (TXA) is a blood-clotting drug demonstrated in an NIHR-funded trial of 20,000 people to reduce risk of death in patients with severe bleeding by up to 30% if administered within three hours. Using TXA is routine practice for military trauma teams, but is seldom used in the NHS. PenCLAHRC worked with South Western Ambulance Service NHS Trust and local acute hospitals to introduce TXA for use by paramedics, nurses and doctors. TXA is cheap (an adult requires two 500mg ampoules at £1.55 each), yet it is estimated it could save 400 lives a year in the UK and reduce the burden of trauma-related disability.

Case study

1. INNOVATION

IDENTIFICATION

3. CONSIDER

5. SPREAD

1a.

PUSH 1c.

PULL

7. SUSTAIN 6. MONITOR &

EVALUATE

4. ADOPT or

STOP

2. SCOPE &

ASSESS

1b.

PICK

UP

ery Model



22

1. Innovations will be identifi ed through three routes:

(a) Push Innovations

Innovations which are already high priorities for the NHS. These are the High Impact Innovations identifi ed by the Department of Health, iTAPP priorities and technologies supported by NICE Technology Appraisal Guidance.

(b) “Pick up” of innovations by AHSN

We will pro-actively seek innovations for potential adoption - through a horizon scanning function by examining the results of local and national research; considering propositions from industry; local innovations developed within the NHS; and by networking with other AHSNs and AHSCs. In addition, where activities between stakeholders (e.g. “sandpit” meetings bringing together a diverse range of potential collaborators in relation to innovation development) generate promising innovations, the AHSN will nurture some of these to a point where they may become part of routine care.

Our AHSN will work closely with individuals from the South West innovation landscape, NICE (via a memorandum of understanding), and the wider AHSN community to ensure that emergent innovations and best practice are rapidly identifi ed and considered. In addition we will actively engage third sector organisations, and with the Councils for Voluntary Service, to seek emergent innovations from this sector. Engagement with the Third Sector will include building on established links through e.g. Mencap, Link Devon, Link Up Devon, Westbank

In some cases promising innovations will require further research and development to ensure that they hold suffi cient value to be spread widely. This may be achieved through partnerships leading to external funding (as has been successfully carried out in PenCLAHRC), by limited funding within the AHSN (e.g. to specify the precise components of complex interventions) or through operational research to explore the impact of organising resources within services in innovative ways.

(c) Pulling innovation out of problems - “Necessity is the mother of invention”

The AHSN will use a range of mechanisms to identify and defi ne local ‘problems’ relating to local population health and services. We will do this through:

• Review of the Network’s collective strategic priorities and ambitions.

• Coordinated communication between the AHSN and a range of networks including the emerging strategic clinical networks, existing networks of clinicians (arranged around conditions or professional groupings), and clinical commissioning groups to identify signifi cant problems.

• Coordinated communication between the AHSN and PenPIG (Peninsula Public Involvement Group), to identify problem areas via public and patient engagement. The PPI function will be properly resourced, with bespoke roles and a clear reimbursement structure for public participants in line with INVOLVE recommendations.

• Coordinated communication with Network-wide information teams and the Public Health Observatory to monitor variation in practice.

We will then bring together and resource the right people from across our Network to actively seek solutions to identifi ed challenges.

Problem solving with the third sector A Devonshire GP, stimulated by local Neighbourhood Watches, wondered if the ‘crime model’ might apply to health. Help was sought from Devon Partnership NHS Trust’s ‘Innovation Space’ to develop the idea and bid for Regional Innovation Funding. £150,000 was secured, enabling development of the ‘Neighbourhood Health Watch’ model and successful evaluation across eight sites in Devon.

Case study

2. Scope and Assess innovation ideas: ‘AHSN Review Team’

Once ideas for innovation and best practice have been identifi ed, we will specify exactly what each innovation is (scoping) and consider its potential value for the local health system (assessment). These functions are necessary to support the AHSN choice between candidate innovations so that the Network remains focused and can achieve and maintain real change in services.

A dedicated review team, will scope candidate innovations considering:

• Defi nition and clarifi cation of the proposed innovation or service change.

• Defi nition of the proposed population (characteristics and numbers), to whom the innovation applies.

• The innovation’s place within existing care pathways.

• Who would need to be involved in delivery and spread.

This early review may draw on academic and other literature, interviews with innovation developers and potential users (i.e. clinicians, managers and patients) and, in some cases, modelling of likely service activity using operational research methods and potential challenges for implementation. At this stage some proposals will be discarded, some guided into channels for further development and evaluation and the most promising passed to the “AHSN Consideration Panel” for further scrutiny and review.

3. Consider the expected value of innovation: ‘AHSN Consideration Panel’

Our AHSN model deliberately splits the process of ‘considering’ potential innovations from the process of aligning commitment among Network members to achieving spread at pace and scale i.e. adoption of AHSN innovations.

The details of the approach will need to be further developed early in the life of the AHSN, but will include the Consideration Panel examining potential innovations against explicit criteria, supported by information provided by the Review Team. Stakeholder membership of the Panel will be wide to ensure that potential impacts of innovation are carefully considered, and barriers to implementation are identifi ed.

In selection innovations to recommend for active spread, the Consideration Panel will review opportunities using the framework suggested below:

• Tractability / risks of implementing the innovation.

• Cost of implementing.

• Distance from current position.

• Scale of the problem being addressed by the innovation.

• Impact of the innovation - health gain, employment creation and economic outcomes.

• Certainty of expectation (strength of evidence).

• Alignment with stakeholder strategic priorities.

• Potential for wealth creation.

• Politics of implementation

We recognise that disinvestment can be as important as investment in innovation and a further key role will relate to activities and interventions which are regarded as being of limited value to the NHS. In part these opportunities will be identifi ed through our work with NICE, building on an existing local “disinvestment” partnership between NICE and PenCLAHRC.

23



24

4. Adopt or stop:

Formal decisions to adopt an innovation will be made at Board level, based on the material produced for the Consideration Panel. This step will confi rm, at the highest level, the commitment of Network members to working together to achieve spread of innovations at pace and scale and will commit the resources of Network members to this aim. The Board will reserve the right to require more information on highly ranked innovations, though it is expected that, by working closely with the Consideration Panel and being satisfi ed with the processes which are being undertaken, the Board will have trust in the AHSN’s prioritisation process.

5. Spread: ‘AHSN Innovation Strategists and Ambassadors’

Our team of innovation strategists and ambassadors will be a dispersed body of experts in service improvement, provided by AHSN members as a cross-Network, fl exible workforce, that is centrally coordinated and supported. The South West already has a small and expert workforce in service improvement, and this provides the bedrock for the Service Improvement Strategist Network (SISNet). The aims of the SISNet, which the AHSN will develop and extend, will include:

• Training and development of new Innovation Strategists (particularly in primary and community care) and Ambassadors.

• Sharing methods for achieving change across Trusts and sectors.

• Contributing to the AHSN Communications Strategy.

• Working with academic members to evaluate implementation efforts.

• Contributing to the development of a positive culture for innovation.

Innovation ambassadors will be responsible for implementing plans developed by the AHSN’s innovation strategists and to ensure that high impact local or national innovations and NICE guided innovations are spread widely and rapidly across the Network.

Implementation strategies will be built around the NHS Change Model, which provides a decisive framework for good change management practice, and whose precepts will ensure consistency and effectiveness of implementation across the Network. Appendix 3 sets out the detail regarding how we will embed the NHS Change Model throughout AHSN change processes. In addition, the Innovation Ambassadors will draw on the best evidence from implementation science to plan strategies appropriate to specifi c circumstances. An early and critical step in project development will be the specifi cation of potential barriers to implementation and identifi cation of the necessary resources and specifi c approaches to achieve change, as promoted in the NHS Change Model.

Their work will be underpinned by a commitment to develop the training, skills development and support they will need to act effectively.

6. Monitor and Evaluate: ‘AHSN Performance Team’

Each implementation project supported by the AHSN will be required to specify the necessary information that will be needed to monitor progress and to evaluate the consequences of change in practice.

Evaluation will be critical to inform the Board’s ongoing decisions to maintain implementation efforts in relation to the expected benefi ts of innovations. In some cases it is likely that the initial promise of innovations will not be fully realised, and the AHSN must reconsider its position in relation to innovations that do not signifi cantly impact on health gain, wealth creation and service effi ciency. Evaluation will be specifi ed at the outset of projects and supported, as far as possible, by the routine collection of necessary data.

7. Sustain: ‘AHSN Trouble Shooters’

Implementation can be considered complete when an innovation becomes routine in practice. This is the aim of the AHSN and once achieved the Network will reduce input so that its resources can be devoted to the next generation of projects.

The withdrawal of resources from Implementation Projects will be informed by demonstration of stable routine statistics on the outcomes of innovation and a steady state with implementation at a high level across the Network.


25

Our AHSN will drive innovation through collaboration between

stakeholders at all stages, including pro-actively identifying and developing

signifi cant innovations; aligning stakeholders in agreeing and

implementing change; and making AHSN innovations demonstrably routine practice for patients and

the public. The AHSN will develop capacity for innovation, drive research related to innovation and ensure that innovations are embedded in routine

practice.

26

4.1 Opportunities An effective partnership between industry, NHS and academics offers a number of opportunities to generate wealth for the region and the UK, not least by bringing our relationship with Quintiles into play as one of the world’s largest Clinical Research Organisations. To enhance the opportunities for wealth creation through the AHSN we will:

• Provide a single point of access for industry partners to the NHS and HEIs, which allows the development of productive partnerships across all stages of the innovation process from design, through research and evaluation to transparent procurement mechanisms and delivery.

• Work with the NIHR infrastructure to ensure that the research system across NHS and academic institutions delivers commercial as well as non-commercial research to time and target.

• Stimulate innovation through active promotion of interaction between scientists, clinicians, managers and industry and the deployment of ‘seedcorn’ funding.

• Facilitate cultural and knowledge exchange with industry to learn new and improved ways of working.

• Provide a streamlined, expert system to enable the commercialisation of innovations identifi ed within the Network and to exploit the NHS brand.

• Reduce the costs of service delivery through implementation of effective and effi cient best practice.

• Increase economic productivity, through improved management of long term conditions, and increased availability of fi t-for-work populations.

We will deliver a strong and effective partnership between industry, universities, and health that co-creates innovative solutions to healthcare challenges in the region, designed to transform the experience for patients, which then collaborates in ensuring the adoption and spread of the proven innovations to deliver measurable benefi t to patients, the population, members and partners.

4.2 Background Providing support to the life sciences industry is a key objective for the AHSN. Consultation with existing industry partners and their trade organisations reveals a picture of individually good relationships with NHS organisations and HEIs but a frustration at the diffi culty in engaging effectively with multiple organisations and in identifying appropriate collaborators at all stages of the innovation, research and procurement processes. It also reveals barriers to patient engagement in research relating to low levels of trust in pharmaceutical companies. In addition, industry partners express impatience with the delays and costs which commercial research can face. There is a need to develop an engaging and enabling environment to build relationships, foster collaborative work and procure project-based funding. There is also a need to provide a ‘welcoming front door’ for industry, the voluntary and community sectors.

Historically, some of our member organisations have not capitalised fully on the Intellectual Property (IP) they have generated. A step change is required to accelerate the commercialisation of NHS and university IP. Furthermore, healthcare is a growing international market and the NHS is a respected brand worldwide, but collaborative strategies to market and deliver NHS branded services are still in their infancy, representing a huge opportunity for growth.

4. Creating Wealth

“Good health is good forbusiness and good for the

economy” (IHW). We will build ‘delivery partnerships’ with SMEs

and larger pharmaceutical, IM&T and devices companies

by managing key account relationships. We will build

industrial links specifi cally to grow our life sciences industry.

4. C

There is a signifi cant track record within the Network both of constructive relationships with industry partners and of innovation and effective exploitation of IP. The universities in particular have been extremely active. Plymouth University, for instance, with Plymouth City Council founded the Growth Acceleration and Investment Network bringing together investors, academics and business and currently manages £120 million worth of business incubation and innovation centre assets, engaging with over 500 businesses. The University of Exeter works on over 1000 commercial and collaborative projects each year with business partners with an annual value of over £30m. It hosts 70 business clients within its Innovation Centre and is a member of the SETSquared partnership which has 5 innovation centres, 4 science parks hosting over 300 start-up businesses. Between them, the two universities added 46 patents to their portfolios last year and have increasingly active IP management services. Our intention is to take this experience and to build on it in order to promote job creation by expanding local commercial activity.

Numerous membership and representative organisations and Public Science Research Establishments exist within our footprint. For example, Medilink South West has been recently launched to support the regional healthcare industry, and in particular SMEs, and the South West Forum is a well established partner supporting the Voluntary and Community Sector. There are also multiple organisations dedicated to supporting local economic development, including Peninsula Enterprise and the Cornwall Development Company. The Industry Trade Associations collectively provide access to the £50b UK medical technology, biotechnology and pharmaceutical industries. However, there is no single reference point to support NHS organisations to engage with this landscape in order to generate wealth creation opportunities.

Improving healthcare services and general public health and well-being, offers signifi cant opportunities to increase the wealth of the country. Ineffective or ineffi cient health services incur opportunity costs, and better use of evidence to drive service

provision can affect substantial savings. In addition, provision of effective treatment and rehabilitation can directly increase productivity, as has been convincingly argued in the Layard report (‘The Depression Report: A New Deal for Depression and Anxiety Disorders’, 2006) with regard to the better management of depression. Finally, there is a signifi cant opportunity to increase revenue streams from clinical trials across our Network.

27

Saving £12-15 million: South West Peninsula Health Technology

Commissioning Group

The Peninsula’s four PCTs have collaborated to ensure there is a single, cost-effective, evidence-based approach

to commissioning drugs and health technologies prior to the introduction, or in the absence of NICE guidance. The Group comprises an evidence synthesis

team based at NHS Devon, which reviews existing clinical knowledge; and

decision analytic modellers from the NIHR PenCLAHRC, who calculate cost-

effectiveness. Recognising that new drugs and technologies do not always

represent the best treatment option (due to potential side effects, safety profi les or relative value for money versus absolute

cost), the Group provides information and takes coordinated commissioning

decisions, building on existing PCT systems and working with clinical staff to ensure that patients receive the best possible treatment for their condition. In the three years the Group has been running its work has led to cost savings within the Peninsula health economy of

£12-15 million.


28

4.3 Key priorities We have identifi ed four key areas for development on which we will focus over the next fi ve years:

Priority 1 - To provide a single point of access for industry partners to the NHS and Universities.

We will establish a welcoming AHSN front door for industry, supported via an online presence. Behind our front door, we will have a clear system covering the key needs that our industry partners have identifi ed as essential across the pathway from innovation to exploitation: easy access to the right clinicians, managers and academics to hone ideas or identify opportunities; access to academics to help with rigorous evaluation, particularly for smaller enterprises; the ability to identify appropriate clinicians and patients to participate in industry-led research; and an effi cient way of dealing with procurement where products have shown to be cost-effective. We also recognise a need to foster a positive attitude to engagement.

By better connecting industry with clinicians, service providers and academics we will enable companies to better understand what the NHS needs, to collaborate during the design process and hence to drive innovation. We understand that, to attract collaboration with industry, the NHS must be able to meet ethics approval requirements, deliver to commercial sector timelines, provide value for money, understand a clear IP position and publication strategy upfront, and deliver high quality data. We will ensure that our commercial pathway delivers these requirements.

To meet industry’s need for more effective exploitation of proven innovation we will use the delivery model outlined in Section 3 to drive rapid spread where they meet agreed criteria. We will also attempt to streamline access to procurement systems across the partnership for these products. Our ability to do this will be enhanced by ensuring that products are rigorously evaluated against accepted standards.

Our single point of access will enable us to broker relationships with potential industry partners, ranging from small family businesses to global pharmaceuticals - relationship management will be at the heart of what we do. This will be supported by a specifi c role in supporting local businesses to collaborate with the NHS, with potential engagement ideas including ‘expert workshops’, an AHSN information portal for business, and targeted support to develop SME-friendly practices with NHS Trusts. We recognise that numerous relationships already exist between industry, third sector organisations and our members. We will not seek to constrain existing relationships within this system or to discourage the development of new relationships which can come about through local or personal interactions. Instead the AHSN will offer support, providing a highly visible point of contact for advice and support on managing all aspects of the process.

To further enhance our working relationship with industry, we will align ourselves with the following 5 areas of opportunity as our AHSN develops:

1. Identifying cross-AHSN priorities and grouping industries around disease and service clusters.

2. An overarching compact between AHSNs and industry that would refl ect the ethical framework needed for effective partnership working.

3. Further work on metrics to measure both collaboration and the contribution of AHSNs to wealth creation and on information governance/ data sharing.

4. The pipeline of future innovations – ensuring an unambiguous case for spread and supporting the subtleties of local adoption.

5. Procurement – understanding and acting upon the implications of procurement reviews, when published.

4. Creating Wealth

Priority 2 - To stimulate innovation

We will aim to actively stimulate innovation and its exploitation within the NHS and University members. This requires a number of steps. The fi rst is the explicit provision of opportunities to bring together groups of clinicians, managers and scientists both to attempt to fi nd new ways of approaching specifi c problems and in formats which give the opportunity for connections to be made which could not have been predicted. There is already considerable activity of this type amongst the members. These include for instance “Bridging the Gap” events which have generated joint projects between Physicists and Urological cancer surgeons investigating new approaches to early diagnosis and between classicists and psychologists to develop preventive interventions for depression. We do not underestimate the capacity of NHS staff to innovate both in the development of new products and new ways of working. To capture this effectively requires an organisational culture that values and provides opportunities for innovation and accepts that these ideas may fail but values the process and the rich learning from this.

We recognise that adding participation by industry and third sector organisations in these interactions can bring new ideas not available within other organisations and help to develop amongst all members a clearer recognition of the potential for commercial exploitation. The European Centre for Environment and Human Health, based out of Royal Cornwall Hospitals NHS Trust, has partnerships with a wide range of organisations, from Outdoor Activity Centres developing interventions for obese children to the National Trust. A key role of our relationship management with industry will be an active attempt to understand how best to provide these opportunities and invest in staff to undertake this bridging role.

The ideas generated in these ways often need resources to develop them to the point where they can be formally evaluated. We will provide competitive access to ‘seedcorn’ funding, including where appropriate releasing people’s time. We will also ensure rapid access to advice about the design

of evaluation, including ways to access outside grant funding for later stages. SMEs in particular may lack the skills to evaluate innovative ideas in a way which meets requirements for evidence of cost effectiveness suffi cient to convince the NHS to purchase their products. We have positive experience of this approach (e.g. see “Brain in Hand”) and are keen to expand its reach.

Finally, we recognise that organisational culture can be an important barrier or facilitator for innovation. We will seek to build the promotion of innovation into all aspects of our work starting with education. All the member organisations are committed to ensuring that innovation and interaction with industry are positively recognised both publicly and within appraisal systems.

29

Achieving wealth creation: working with SMEs to commercialise innovation - Brain-in-Hand Brain-in-Hand Ltd is a commercial company that has developed smart phone technologies which work with existing therapies to help people with autism to live more independently. Via PenCLAHRC, the company has partnered with the Devon Partnership NHS Trust to test its technologies at scale. The trust has demonstrated the economic value of the system versus standard care. In addition, the trust has won its fi rst out-of-county AQP contract to provide Autism diagnostics and Brain-in-Hand in Wiltshire. As an ancillary benefi t, Brain-in-Hand has moved its head offi ce to Exeter and has recruited to its workforce, generating new employment opportunities and wealth locally. The University of Exeter has applied for NIHR Research for Patient Benefi t funding for the next phase of product development, and the company has attracted further commercial investment to allow development of an Android platform for the application.

Case study

4. Creating Wealth


30

Priority 3 - To create a streamlined, expert system for commercialisation of innovation.

As part of our AHSN infrastructure we aim to provide an Innovation Commercialisation Support Service. This will support the NHS, academic members and industry to commercialise innovations arising out of the NHS from collaborations with the NHS and from Universities. The service will not seek to replace the existing arrangements within member organisations many of whom are already extremely active in this area but to spread the expertise across the system. It is important to recognise the scale of existing activity in both NHS and universities. The universities manage these activities through integrated Research and Knowledge Transfer teams that support academic departments and individuals to engage effectively with business and commercial customers. Some of the larger NHS organisations have a history of commercialising innovation that stretches back more than 40 years. To avoid duplication of effort and spread learning from one another, we will set up partnering agreements between the Universities and Network NHS organisations and the AHSN.

We will also provide dedicated support for the management of IP, which will include establishing a baseline and aligning IP policies across the Network, in line with NIHR’s standard research contract (where appropriate). This will acknowledge the key role of the management of IP assets in driving innovation, and ensure that IP generated within the AHSN is secured within an appropriate legal, contractual environment to realise benefi ts for patients and create wealth for the Network. We will operate a process of periodic calls for new ideas across the Network which will therefore be cost-effective and will introduce a degree of standardisation. This will also enable projects to be referred and signposted.

Effective commercialisation also requires access to investment. We will seek to leverage funding opportunities and ensure that members have access to practical advice and assistance on securing funding for collaborative innovation projects, building on existing experience amongst members. We

recognise that we will need to attract investment from a range of sources. The active cultivation of relationships with industry partners by the AHSN will allow “match-making” between members and potential commercial partners.

Using our current extensive expertise, we will review possibilities for generating wealth and joint investment via the Technology Strategy Board and in line with regional innovation priorities managed through our Local Enterprise Partnerships. We will also build on our Universities’ established and successful mechanism for providing competitive small amounts of innovation funding in the form of soft loans. These loans would have minimal risk to successful recipients with no direct liability but a prior claim on any subsequent returns. In establishing this system, we will leverage industry experience in investment and disinvestment to ensure investment decisions are made on the basis of value based outcomes. An attendant role of the commercialisation support services will be to establish a common agreement for assessing and measuring value when commercialising innovations.

Priority 4 - To create cultural and knowledge exchange with industry and third sector organisations.

We recognise that the NHS and academia can learn from other organisations and that the benefi t of interchanges fl ows in both directions. Both member universities have experience through existing opportunities such as Knowledge Transfer Partnerships. These partnerships offer not merely the opportunity to learn specifi c skills and approaches to problem solving but can also have an impact on the culture of organisations and their attitudes to innovation.

We will seek to increase existing opportunities for exchange between industry and universities but seek to expand these to better include members within the NHS. We see particular opportunities in building these opportunities into relationships with those industry and third sector organisations which become affi liate members of the AHSN.

5.1 Opportunities Aligning education with clinical practice and research offers signifi cant opportunities to increase our capacity to promote the adoption and spread of innovation and best practice. To deliver this goal we will:

• Build the levels of research literacy amongst staff to increase their ability to use research evidence to drive service improvement and promote research participation. We also want to grow researchers from amongst under-represented groups of healthcare professionals, so that we diversify both our population of clinical researchers and also the types of research questions that they will ask.

• Develop leadership skills amongst all levels of staff to promote effective uptake of innovation and the adoption of best practice.

• Align AHSN and LETB education agendas to deliver highly skilled staff to support spread of innovation and best practice in priority areas.

• Develop innovative curricula to underpin specifi c service changes agreed by the partnership.

5.2 BackgroundEducation is a means not only of developing the skills we need in our workforce but also of driving a culture that values research and innovation. Our staff are our key asset, and developing staff capacity and capability is central to ensuring our ability to deliver the AHSN vision. Education and training within healthcare has traditionally focused on the preparation of individual professions, by developing the clinical and practice knowledge that is pertinent to each profession on a uni-professional basis. There is a strong opportunity to address this through the rich, multi-professional, trans-disciplinary potential held within the Peninsula and our members have been at the forefront of developing innovative approaches to teaching, using problem based learning to stimulate a lifelong ability to keep abreast of new developments, and develop research literacy across staff groups. Both of our Universities have a strong reputation for developing health and social care workforces, and for embedding of research literacy and leadership within pre- and post-registration training.

Recognition of the role of effective leadership, particularly clinical leadership, in driving service improvement has led to a number of initiatives, both nationally (e.g. NHS Top Leaders programme), and locally (e.g. NHS SW talent management programme) to develop leadership capacity and capability within the NHS workforce as a whole. However, a step-change is required to develop a workforce across all staff groups and levels that is able to both understand and implement research-based fi ndings, and innovate to improve care and outcomes.

5. Building our capacity:Education and Training

31

We need to create aworkforce that is research literate,

with a culture of innovation, in order to deliver the aims and ambitions of

the SW Peninsula AHSN.

Pre-registration students will benefi t from exposure to inter-disciplinary engagement, helping to prepare them for multi-agency working.

5. BEdu

5.3 Key priorities In order to achieve the benefi ts outlined above, we have identifi ed 4 specifi c priorities on which we will focus over the next fi ve years:

Priority 1 - Building research literacy

Understanding how research can help to improve clinical practice is often the fi rst step on the research escalator, particularly for clinicians. The ability to translate complex clinical and service problems into answerable questions, and then fi nd and assess existing research for its validity and relevance to the problem, is also key to effective innovation. To maximise the opportunities for staff and patients to take part in research, we will proactively expand our pool of research active staff and Principle Investigators, building research literacy across our members to drive the adoption and spread of best practice and innovation.

We will take active steps to develop research skills amongst under-represented staff groups, growing the number of Principal Investigators and Chief Investigators from those groups in order to diversify and enrich our pool of active researchers and develop a more rounded approach to research by bringing in different perspectives. Research literate staff are more likely to understand the gaps in our knowledge and hence to value, participate in and promote research activities and participation across our Network.

Our Universities’ undergraduate and postgraduate curricula for health professionals already offer a strong training in the promotion of evidence-based practice. Within PenCLAHRC, we have pioneered programmes where clinicians, managers and members of the public learn these skills together. This has borne substantial fruit, with programme participants acting as advocates, for instance, in driving the implementation of tranexamic acid in trauma, and gaining research grants including lay people as co-applicants alongside clinicians and academics. Nursing students on all branches of nursing programmes at Plymouth University have an option to undertake a placement within a research setting.

To ensure wide delivery of these research skills, we will identify the educational activities that are needed to support development of research literacy and will work with the LETB to support commissioning for appropriate pre- and post-registration training programmes. We will also facilitate the most fl exible use of our research literate workforce by seeking to develop a ‘skills passport’ that will enable staff to work across the healthcare community.


32

Developing Devon’s Skills PassportWe have commenced a process to establish ‘Skills Passports’ across Devon in both clinical and research areas, to enable transferability of skills between organisations and to prevent duplication of training activities. We will build on this experience during AHSN development.

Case study

Priority 2 - Develop leadership

We recognise the need for strong leadership at levels within member organisations to effectively promote the spread of proven innovation and best practice. We will work with the new Leadership Academy and with existing leadership programmes for the NHS, including those provided within the university business schools, to develop local approaches to delivering the leadership agenda.

We recognise particularly the importance of clinical leadership in facilitating service transformation. A joint initiative across the Devon Partnership Trust and the RD&E for instance used bespoke support for clinical leaders provided by the University of Exeter Business School to transform pathways for the acute care of the frail elderly - this was estimated to have generated savings of £250,000 in the fi rst 3 months of operation. We plan both to ensure through working with the LETB that the role of leadership development is considered across all programmes and that where appropriate we consider the use of bespoke training as a tool for specifi c service improvement initiatives.

Priority 3 - Aligning the AHSN and LETB

It is anticipated that there will be one LETB for the South West, which will serve as the overarching governance body, supported by 2 local committees. Our AHSN will work with the Local Education and Training Board (LETB), which will be established as the vehicle to agree local priorities for education and training, as well as planning, commissioning and managing the quality of education and training delivery. Our members have agreed that, where possible, we will share resources and skills with the LETB, including establishment of joint posts with responsibilities to both bodies where appropriate.

We will support the LETB in commissioning education programmes and workforce training, by developing evidence-based care pathways and identifying the training resource needed to skill staff to deliver best practice. We will work jointly with the LETB to establish what skills and competencies are required to deliver these pathways, to inform LETB’s commissioning of training and education programmes. We will also make recommendations to LETB about the roles that are required to deliver these pathways, again to inform commissioning. We will use this approach as a protocol for all best practice implementation work, so that the AHSN’s understanding of best practice delivery is used as a routine guide to inform and direct LETB commissioning of training and educational resource.

5. Building our capacity:Education and Training

33

Plymouth University has worked with Plymouth Hospitals NHS Trust to co-produce an e-learning Leadership Academy platform. This adapted the national leadership competence framework (tailored to the Trust’s strategic plan) and a series of resources to support clinical and non clinical leadership development.

Case study

Priority 4 - Developing innovative curricula to underpin service improvement

Although service improvement requires dealing with a wide range of barriers and facilitators, these inevitably include ensuring availability of the right skills and knowledge amongst staff. Organisations within the partnership have signifi cant skills in the design of innovative educational programmes. We plan to harness these skills within our service improvement planning, seeing education as a tool to help drive implementation of specifi c innovations prioritised within the AHSN.

We will establish partnerships with other sectors and agencies to support innovation through education and training, and building on the cross-sector nature of our Universities’ pre-registration activity. Two immediate priorities will be to formalise links with LETB to ensure effective communication and aligned working; and to establish a forum for service users and patient organisations to enable co-production of education and training programmes. We will also further develop formal education and training partnerships with industry, both to ensure that knowledge of NHS systems and priorities is embedded within the commercial sector and to make best use of their skills in areas such as trial delivery and training provision to support the uptake of new products and technologies. Partnership-building will be assisted by the degree to which our Universities’ existing programmes are recognised by service, regulatory bodies and professional bodies. It will also be underpinned by existing examples of training innovation, such as Plymouth University’s ‘Foundations of General Practice Nursing’ course - the fi rst such programme to be accredited by the Royal College of General Practitioners.


34

6.1 OpportunitiesBy creating an aligned, multi-sector approach to the collection, analysis and use of information (particularly clinical, patient and population outcomes), our AHSN will create opportunities for enhancing the identifi cation and evaluation of innovation, and hence accelerating spread. Our ambitions in relation to information and informatics are:

• To work with Public Health England, sharing information and intelligence about public and population health (including anonymised electronic patient record data) across organisations to develop a clear understanding of our region’s major challenges and Network-wide variation in practice. This will help to drive our prioritisation process and ensure we target resources accordingly.

• To enable easy identifi cation of eligible patients for participation in research studies. Swift access to appropriate patient cohorts is essential when recruiting to research studies, whether these are network adopted studies, commercial trials or early stage basic science. Easy identifi cation of apposite patient cohorts will increase the speed and accuracy of research delivery.

• To create an information system that allows us to quickly and cheaply evaluate the effects of service modifi cations and innovations across our Network. A better, cross-Network approach to collecting and sharing evaluation data will help us to catalyse change and roll out verifi ably effective innovations.

6.2 BackgroundAt present, there is no overarching infrastructure to support Network-wide access to anonymised patient data across the South West Peninsula. Similarly, data relating to research and evaluation outcomes sits within discrete information systems, across different sectors or organisations. These systems do not easily interface. Signifi cant opportunities therefore exist to improve access to Network-wide information, accelerating data analysis, facilitating recruitment to trials and enabling cross-sector identifi cation of key innovation and research priorities. Opportunities also exist for recycling research and innovation outcomes back into the Network-wide patient health record, to promote spread of innovations to the local and wider UK population.

Even with the technical capability to share data and information, it will be vital to address perceptions in both the population at large, and clinicians and managers, about the Information Governance issues associated with such data. Stakeholder events have identifi ed the importance of engaging clinicians, researchers and patients, in understanding what data can be used for and how. Clinicians are often the source of the data entry, through their clinical practice, and so data must be useful for clinical service delivery as well as for epidemiological and research purposes. Many patients and the general public expect that different parts of the NHS should be able to see the same clinical information about patients, and yet many professionals are anxious about handing over patient data.

6.3 Key priorities We have identifi ed three priorities over the next fi ve years.

6. Building Our Capacity:Information and informatics

35

Our Shared Data Repository will coordinate existing databases, providing easy access to outcomes research and cross-sector information to support AHSN prioritisation and problem-solving.

We need better andmore widely available

information (IHW)

6. BuInform

“

“

Priority 1: to develop a shared data repository

In order to enable robust identifi cation of key health challenges and practice variation, we will work across our Network, and with the sub-national structures within Public Health England, to develop a South West Peninsula Shared Data Repository. We will identify the specifi c data fl ows (including anonymised patient records) that are needed to support innovation-based service improvement, and will categorise the types of data that are required for identifying key problem areas.

Our fi rst task will be to conduct an audit of existing information systems across the South West Peninsula. We will review the data held within our members’ NHS, industrial and researcher (analytical) information systems, to assess the opportunity and feasibility of linking these systems together and enabling them to interface.

During the development phase, we will ensure that our Hub aligns with priorities set out in the Department of Health’s Information Strategy, including a new vision for shared integrated care information, a single web portal for health information and the creation of system standards. We will undertake due diligence to understand the opportunities and risks of co-developing our repository in line with the Department of Health’s evolving Clinical Practice Research Datalink (CPRD).

When designing our repository, we will work with our existing contacts in eHealth informatics, translational research, life science teams and MRC eHealth Informatics Research Centres. Where appropriate, we will also work with industry providers, such as Lightfoot Solutions and CSE Healthcare Systems, with whom we have established relationships. However, our data repository will be developed using ‘vendor neutral’ design principles (i.e. it will not be privately owned by one vendor), so that it will be able to integrate with the best new hardware and software as technology evolves.

We will adhere to industry standards for data compatibility and comply with best practice in protecting patient data and patient confi dentiality.

This will be supported through our engagement with members of the public in all aspects of AHSN activity.

Our shared data repository will be underpinned through the development of a central informatics strategy, setting out standardised AHSN systems for data collection, analysis and return to the patient’s longitudinal electronic record.

By establishing a cross-sector data sharing architecture, we will create an ‘information cycle’ between care, research and commerce, ensuring that information is continually fed back into the design, development and prioritisation loop:


36

Figure modified by Dr E Conley with permission from Profs J Wyatt (U Leeds) and F Sullivan (U Dundee)

Analysis

Insight

Access and

application Knowledge

assembly Knowledge

RESEARCHER

COMMUNITIES

Data capture Records

Patient care

CARER

COMMUNITIES

RESEARCH CONSENT & PRE-CONSENT

FRAMEWORK

Figure 7 : Care delivery, research and commercial information fl ow cycle

Commercial Partnership to Develop Electronic Patient Records Somerset Partnership Trust worked with CSE Healthcare Systems (the commercial developers of the RiO Electronic Patient Records system), long before RiO was rolled out nationally. This early partnership with CSE means that the Trust’s bespoke EPR system is better developed than the national one, to the extent that the Trust no longer uses any paper records.

Case study

Priority 2: to enhance patient participation in research through access to region-wide patient cohort data

Providing easy access to relevant patient cohorts will enable us to enhance research participation and delivery. Our AHSN ‘front door’ will play a vital role in signposting academic and commercial researchers towards study-appropriate patient cohorts, by connecting them with clinical subject experts. In addition to this overarching liaison function, we will develop information systems that help users to identify the right patient cohorts. This will include an ambition to develop electronic patient records across the Network.

The Wellcome Trust’s translational scheme project has already established a model for recruiting patients across multiple different sites. We will build on this model, creating standardised “Boolean-type” search terms which can be applied across our Networks’ databases to stratify local patients and recruit cohorts to trials in an open, standardised manner. This will enable us to offer a single interface to pharmaceutical companies, contract research organisations, life science SMEs and other industry representatives, and to offer them rapid, attribute-level matching of patients to research studies.

Our information strategy will be infl uenced by the increasing statutory emphasis on ‘patient ownership’ of data. We will develop a standard consent framework for healthcare and research uses, based upon the Wellcome Trust’s Sintero project (http://www.cs.cf.ac.uk/newsandevents/wellcome.html). This will involve signifi cant engagement with patients, the public, clinicians and managers to ensure all contribute to the sharing of appropriate information for clinical and research purposes. We will maximise the use of patient portals to provide cost-effi cient ‘pre-consenting’ points for recruitment to trials and ‘re-consenting’ points where research study protocols change. Our emphasis on patient empowerment will align us with the ambition set out in the Department of Health’s information strategy, to put patients in control of information sharing and re-use of information for research purposes. It will also be coupled to the development of ‘miConsent’ - a comprehensive, open standard patient consent framework for healthcare and research (www.miConsent.org).

6. Building Our Capacity:Information and informatics

37

Identifying Patient Cohorts for Depression-related Clinical TrialsMost trials for patients with depression recruit less than 10% of eligible participants and only 30% of trials for depression recruit to target and on time. Run from the centre for Mood Disorders Research at Exeter University, DiReCT is developing a new systematic method for recruiting participants with depression into clinical research for psychological disorders - the ‘Cohort Multiple RCT’ (cmRCT) system. DiReCT will use the cmRCT method to establish a longitudinal cohort of patients with depression using a research recruitment method which is closely aligned to the way treatments are offered to patients in routine clinical practice. This ground-breaking work will provide direct access to a defi ned cohort of research-ready patients, and if successful, cmRCT principles will be applied across the Network.

Case study

Priority 3: to align and share evaluation data and publicise results

As set out in Priority 1, our Shared Data Repository will provide a better, cross-Network approach to collecting and sharing evaluation data. This will enable Network-wide review of the relative effectiveness and value of different innovations, not only informing the AHSN’s selection of priority innovations, but also enabling different sites to adopt innovations without undertaking extensive piloting locally.

As most studies are conducted across different pathways and multiple organisations, we will develop standardised data units, formats and codes. This ‘common computability’ of routinely collected data will enable Network-wide review and comparison of information, such as patient-level intervention costs, drug side effects and personalised responses, net wealth benefi t and intervention outcomes. We will ensure that our data systems are compatible with the fi elds used for NHS Electronic Health Records (EHR), so that the variables used in modelling innovation outcomes can be co-computed with EHR data. One of the key roles of the national network of AHSNs will be to enable innovations identifi ed and proved in one AHSN to be shared and adopted rapidly in other AHSNs. With this in mind, we will work with other networks to develop common data protocols where possible.

In standardising and aligning evaluation processes, we will also link to the Department of Health’s ambition to create a high quality web portal for sharing innovation outcomes and successes.


38

In order to develop and manage the delivery of our priorities, and maximise the impact the SWP AHSN can have, we need robust, effective, and non-bureaucratic governance arrangements. In proposing the governance arrangements, a number of factors have been considered and taken into account.

• We will primarily be a mechanism for change, driving the delivery of change with member organisations, and therefore we will have a light touch organisational make-up, delivering our work through and with our members.

• We recognise that the members involved will vary in their size, complexity and legal standing, and therefore we need a membership process that is simple, fl exible and encourages active participation.

• The AHSN needs to be a structure which facilitates strong engagement of industry with the NHS, providing a framework for the delivery of the aims and ambitions set out Innovation, Health and Wealth, without creating additional complexity and associated bureaucracy.

• We are seeking to be as inclusive as possible, whilst balancing this with the need for good control and effective decision-making.

• We do not want the governance arrangements to stifl e innovation and creativity, but to harness and support these effectively for the benefi t of patients, the wider community we serve and members of the Network.

These arrangements will be refi ned as part of the ongoing development of the SWP AHSN, and a formal and structured process of Organisational Development will be implemented. This will include further debate and decision around our Governance model. What follows is therefore a summary of our work to date in this area.

7.1 Members and Affi liatesThe proposed AHSN footprint brings together a range of NHS provider and commissioning organisations, 2 Universities, 6 Local Authorities, and the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC). In addition, a number of existing networks and innovation bodies will be involved in the delivery of the AHSN’s objectives (as detailed in the Foreword), including:

• The South West Peninsula Education & Training Board.

• The NHS Leadership Academy.

• NHS Innovations South West.

• The Peninsula CLRN.

• 3rd sector organisations.

• Patient and public advocacy groups.

• Trade bodies such as the ABHI, EMIG and ABPI.

• Local Enterprise Partnerships.

• Chambers of Commerce.

• Other relevant commercial organisations.

In order to create a simple membership structure and encourage wide engagement with our work, we will establish the AHSN company (likely to be limited by guarantee) with two categories of members - voting members and non-voting affi liates.

Voting MembersThe specifi c details around voting membership will be developed further as we undertake development work to agree the company’s Memorandum and Articles of Association. In particular we will explore, in discussion with industry, the most appropriate way of including them which achieves the balance between full and active participation, whilst recognising potential confl icts of interest.

It is proposed that all NHS Trusts, Clinical Commissioning Groups and Universities within the SWP AHSN footprint are ‘voting members’ of the AHSN. This will entitle them to vote for the appointment of 6 representatives of this membership from their number to the AHSN Board of Directors.

7. Delivering theSouth West Peninsula AHSN

39

7South

The 18 member organisations will form the guarantors of the company, negligible potential liability. The conditions of membership will be specifi ed in a bespoke Members’ Agreement, to complement the company’s Memorandum and Articles of Association.

This wider group of voting members will hold the AHSN Board of Directors to account through a formal Members’ Council that will meet quarterly.

Non-voting Affi liatesIt is proposed that any other relevant organisations or networks that wish to join the AHSN will be offered ‘affi liate’ status. Whilst they will not vote on key aspects of governance of the AHSN (such as the appointment of Directors), they will be entitled to participate fully in the business of the AHSN and therefore be provided with easier access to the NHS, research and other organisations than has historically been the case.

Affi liate members may include Community Interest Companies (CICs) providing healthcare services, independent healthcare organisations, individual commercial organisations, trade bodies, voluntary, charitable and third sector organisations. Affi liate member status will be positively offered to a wide range of organisations and networks, as set out in the Appendices. Affi liate members will have the right to elect up to 6 of their number to join the Members Council and therefore play an important role in holding to account the Board of Directors for the performance of the AHSN.

A seat and voting membership on the AHSN’s Board of Directors will be offered to the South-West Peninsula Local Education and Training Board (LETB) and the National Institute of Health Research (NIHR) through its local representatives in recognition of the symbiotic nature of the role they perform in relation to the work of the AHSN.

7.2 AHSN Board of Directors and Members’ CouncilAccountability of the AHSNThe accountabilities of the senior staff are based on the accountabilities of the Network organisation, which in turn is primarily accountable to its members (including affi liates).

It has additional accountability to the NHS Commissioning Board through two different routes:

• The terms of the licence.

• The contracts (or quasi-contracts) from the NHSCB that the AHSN holds.

The SWP AHSN may have some additional accountability, through additional contracts or funding streams received for delivery of specifi c outcomes of that agreement.

Board of Directors of the AHSNThe AHSN will be governed by its Board of Directors, held to account by a Members’ Council. Membership of the Board of Directors, which will meet on a monthly basis. The specifi c membership of the Board is being developed, particularly in respect of industry and the private sector. However, based on current discussions, membership is likely to include:

• Independent Chair.• Independent Vice Chair.• Accountable Offi cer / Managing Director.• 4 members for NHS provider organisations.• 1 clinical commissioning nominated member.• 1 member for Primary Care or Community service providers.• 2 University nominees, one from Plymouth and one from Exeter.• 1 LETB nominee.• 1 NIHR nominee.The representatives of Trusts, Commissioners and Primary Care/ Community Care providers will be identifi ed through a nomination process, with the aim of selecting the best people for the role, to get a balance of skills and competencies, as well as achieving appropriate representation of members.


40

Terms of offi ce for those representatives will run for a fi xed period (to be agreed) with variation to allow for phased turnover of board membership. One university member will be nominated by each University and LETB and NIHR representatives will be nominated by their parent bodies.

Members’ CouncilThe Board will report quarterly through the Accountable Offi cer to a Members’ Council (comprising representatives of all members) on a wide range of issues. The full role of the Members Council, including Chair and support arrangements, will be established through discussion and agreement between voting members and affi liate members, as will the role and contribution of any potential non-Executive Board members. It is expected that the Chair of the Members’ Council will be a different person to the Independent Chair of the Board.

The Members’ Council will provide the opportunity for the wide range of affi liates to be involved in directing the priorities of the AHSN, holding to account delivery against those priorities, and be an opportunity for pan-AHSN networking and relationship building.

7.3 Key rolesChairThe South West Peninsula will look to appoint a non-executive independent Chair and Vice Chair, who between them will have excellent knowledge and experience of the needs of industry and of the voluntary and community sectors, ideally with strong links to patient advocacy and involvement groups. They will chair the AHSN Board and ensure that the AHSN has a clear strategy, sound governance and a leadership team with the necessary capacity and capability to deliver our vision. The Chair will be accountable to the Members. The post will not have a formal accountability outside the SWP AHSN.

It is anticipated this role will be part time and appointed for a fi xed term. The post is likely to be recruited through an executive search and selection process at a local level, against a person specifi cation which refl ects the competencies, skills and qualities required for a role of this nature.

The post holder will need to demonstrate the personal qualities required to lead the Board of a partnership organisation/network. He/she will be able to gain the confi dence of the three key sectors involved in the AHSN – industry, health care and higher education - and it will be benefi cial for the Chair to have a background in a relevant industry sector.

Managing DirectorThe SWP AHSN will need an Accountable Offi cer or Managing Director, capable of developing and leading a diverse, complex and entrepreneurial organisation. This is not a formal NHS Accountable Offi cer, but is the lead executive accountable for the performance of the AHSN. The Managing Director is accountable to the AHSN membership through his/her reporting to the Chair.

The Managing Director will have line management responsibility for the AHSN management team (including people on secondment from Members). The Steering Group is exploring the potential for joint senior management roles with the emerging South West Peninsula LETB. The post will be a substantive appointment in order to ensure sustained establishment and delivery of our AHSN’s objectives.

7.4 Local Education and Training BoardIn order for both the AHSN and the Local Education and Training Board (LETB) to be truly effective in the reformed NHS system, close links must be formed between the two bodies and ways of working in a coterminous nature need to be established. Collaboration between education and innovation at both strategic and operational levels will be essential.

In order for the LETB to carry out its function as a subcommittee of Health Education England (HEE), it is not proposed that any senior offi cer posts are shared between the two bodies, but that opportunities are sought to develop joint operational functional roles where it is appropriate, particularly as the LETB would have a local committee coterminous with the SWP AHSN and therefore avoid duplication of roles.


41

It is anticipated that the AHSN would be represented on the LETB as a reciprocal arrangement, ensuring cross-communication between the two bodies. Agreed procedures would be established between HEE and the AHSN to share pertinent information such as innovation linked to work with Higher Education Institutions.

7.5 Communication with members and affi liatesTo ensure the widest possible ownership of the AHSN and its work, a structured process of member communication and engagement will be put in place. This will include an Annual General Meeting, the four Members’ Council meetings referred to above and other meetings, engagement and seminars to canvass views and share learning. It is also intended that the wide range of affi liate members will play a full role in the work of the AHSN, through involvement and leadership in topic-specifi c programmes where their expertise and insight will be essential.

Engagement with other key external stakeholders and potential stakeholders, including private equity funds, providers of seed funding, business angel groups and other sources of capital will also be important. Such groups will be included amongst those that are targeted for affi liate AHSN membership.

7.6 Public and Patient InvolvementWe will embed meaningful patient and public involvement in all the activities of our AHSN. This is based on three main beliefs:• That the public has a right to infl uence our

research and implementation priorities. • That ensuring research and implementation

addresses patients’ needs and perceptions will increase the probability that research evidence and innovations will be used effectively in practice.

• That members of the public who understand the importance and relevance of health research can become an important driver for the adoption of effective and innovative practice by health care practitioners.

This approach means involving the public in the work of our AHSN as both producers and consumers of research.

PPI in the governance of the South West Peninsula AHSNThe Patients’ Association has agreed to become an Affi liate Member of the SWP AHSN, which will provide signifi cant strength and expertise to the governance mechanisms of our AHSN. The AHSN Patient Advisory Group will also have 2 representatives on the Members Council.

We will set up a patient led advisory group for the AHSN. This will be made up of approximately a dozen members of the public, service users and carers and will be supported by members of the SWP AHSN PPI team. Members of the group will have a wide range of appropriate experience, e.g. people with long term conditions such as diabetes, stroke and mental health problems, along with carers and members of the public with a more general interest in the work of the AHSN. As far as possible this will be a diverse group with respect to gender, age, cultural background and experience of primary and secondary care. Meetings will be chaired by a member of the public. The main remit of the group will be to advise the SWP AHSN on all aspects of the development and co-ordination of user involvement in the work of the AHSN and to act as a ‘critical friend’. Activities that the group will advise on will include: development of our performance impact and assessment framework, the recruitment of staff and the development of our website and our teaching activities.


42

My current level of involvement, as a patient with

long term chronic conditions, was fi rst triggered by attendance at a Research Information Day of the SWRN. So I know fi rst hand the importance of the identifi cation of

research patients and welcome the space devoted [in the Prospectus] to Informatics and respect evident for

data protection, (patient reviewer of

SWP ASHN Prospectus).

“

“

TrainingWe regard training for PPI members as a vital part of the involvement process and central to the facilitation of meaningful involvement. Appropriate training will be offered to members of our Public and Patient Advisory Group and those involved in specifi c projects. The training will cover topics such as an introduction to evidence based medicine, searching for evidence and critically appraising research reports. The aim of this training is two-fold.

• Training improves the ability and confi dence of service users and members of the public to participate in research and implementation activities, thus maximising the benefi ts of involvement.

• Actively engaged patients can act as an important catalyst for change, helping to drive the implementation of effective and innovative practice by professionals.

Training for Members and Affi liates We will provide support to members of the Network to encourage them to involve members of the public and/or patients in this work. Each project will be different and will require a different approach. We will adapt our approach to meet the differing needs of academics, NHS clinicians, managers and commissioners, health and social care providers and partner working in industry. This will give us the ability to support user involvement in research across the range of AHSN activities, e.g. research implementation, teaching and training and service improvement.

The PPI team will provide advice on designing an appropriate PPI strategy for specifi c projects, expenses and payments policies, the development of role descriptions, facilitated contact with appropriate groups of service users and carers and providing both specifi c and generic training to lay members, facilitating workshops and events and will act as co-applicants responsible for PPI within a project. This support will draw on the resources developed by PenCLAHRC (http://clahrc-peninsula.nihr.ac.uk/penpig-resources.php).

NetworkingWe will act as the hub around which to build links with a broad range of organisations which are already carrying out PPI both in research and service improvement. These will include the South West PPI forum which has involvement from all 7 local Clinical Research Networks and the South West Research Design Services. We will also develop links with the PPI groups already in existence in local managed clinical networks, health and social care service providers and LINks/Healthwatch.

The Patients Association already has a good track record of work in the South West, and with their Affi liate membership, will help ensure good quality PPI in the implementation side of our work. Projects undertaken include: Improving Dementia Care – Royal Cornwall Hospitals NHS Trust; Introduction of Patient Experience Tracker – Northern Devon Healthcare NHS Trust; Carers Survey – Plymouth Hospitals NHS Trust and Identifying Carers Needs – Plymouth Hospitals NHS Trust.

Our approach will ensure a joined up approach to PPI across the SWP AHSN. Co-ordination will increase access which will accelerate the spread of best practice, maximise the impact of our PPI and provide appropriate opportunities for involvement to patients and members of the public.

7.7 Partnerships and existing networksCommissioning infrastructureAcross the SWP AHSN footprint, four CCGs are in the process of applying for authorisation. These are Kernow CCG (Cornwall and the Isles of Scilly), South Devon and Torbay CCG, NEW Devon CCG, and Somerset CCG. Representation from all CCGs has been present at each of our fi ve engagement events across the region, and as CCGs appoint senior posts, we will seek to involve them in our business at all levels. All CCG Chairs have expressed support for this AHSN proposal.


43

NHS commissioners will want to know that they are commissioning services that refl ect state-of-the-art, proven innovations and best practice. Engaging actively in the AHSN will help CCGs to work with academics, providers and industry to identify, adopt and spread innovation and best practice. Participation in their local AHSN will also help CCGs provide assurance that they are meeting their duty to promote innovation. CCGs and the local area teams of the NHS Commissioning Board will want to discuss exactly how they contribute to their local AHSN and a range of models will develop across the country.

The services of PenCLAHRC and Pen CTU will continue to be used, commissioned by the SWP AHSN to conduct specifi c elements of work for which they have proven expertise and experience (e.g. systematic reviews. patient involvement, and clinical trials support).

The development of the Strategic Clinical Networks provides a clinical drive to the standardisation of care pathways and disease group diagnosis, treatment and management. We will seek to form strong links with the SCN as they develop, helping CCGs to link with the SCN in driving service change and improve quality and outcomes.

To support these aims formally, clinical commissioners will be represented on the Board and CCG’s priorities will be used to drive the focus of the AHSN work programmes. We will seek to involve Clinical Commissioners in setting the research agenda and will support good commissioning by making it easier for commissioners to have a common, agreed and supported set of best practice commissioning strategies. This is turn should help providers dealing with multiple CCGs to implement and delivery to a more universal set of service specifi cations.

In line with our strong commitment to the development of innovative patient centred care we will work to ensure that patients and the public have a strong voice in the new commissioning arrangements. Our approach will be based on the proposition that patients and members of the public who understand the relevance of research evidence

for health and social care practice, and who are able to access this evidence for themselves, will have more a more realistic understanding of the effectiveness of treatments; will have a better awareness about variation in practice; will be better able to participate in commissioning decision making; and will be able to promote the adoption of innovative evidence based treatments and services which address patient and carer concerns and needs. In order to achieve this aim we will work in partnership with CCGs, the Patients Association and members of the public, to develop an evidence based model of public involvement in CCGs. This will draw on the successful model of public engagement in research developed by PenCLAHRC and will consist in giving members of the public a basic understanding of the principles of Evidence Based Practice as well as an understanding of NHS commissioning.

Sunset ReviewAcross the South West Peninsula there are existing innovation bodies that are working within the proposed scope of the AHSN. The SW HIEC (Health Education and Innovation Cluster) and NHS Innovation South West bring together Clinical Commissioning Groups, providers of NHS funded services, universities and industry to focus on innovation. In line with the Sunset review, we will be working with these bodies to build upon the good work they have done. We will review whether the functions they currently perform could be built into the AHSN process, but this work cannot be completed until the outcome of the Sunset Review is known.


44

Academy of networks The SWP AHSN will border with Wessex AHSN and West of England AHSN. We will work with them and the emerging National Academy of networks to maximise the opportunities for wider knowledge transfer, sharing of priorities and ideas, to minimise the risks of unnecessary duplication of effort.

The SWP AHSN will be complemented by the West of England AHSN, covering Bristol, North Somerset, North-East Somerset, North Wiltshire and Gloucestershire. We will work closely with the West of England AHSN and, as part of the development of the SWP AHSN, will continue to have active engagement with the emergent West of England AHSN in order to agree how to maximise AHSN benefi ts for the populations we jointly serve.

Academic Health Science CentresAHSNs will play a crucial part in the translation of research into practice, which will complement the roles of the present and future Academic Health Science Centres (AHSCs). AHSNs will complement the AHSC’s translation function by focusing on the adoption and spread of innovative clinical practices that are of proven cost-effectiveness, across whole healthcare systems, linking back with the research and development community. The SWP AHSN has not identifi ed a preferred AHSC partner. We will seek to access learning from a range of partners including all the designated AHSCs and leading edge researchers in their locality.

7.8 Code of ConductThe delivery of the national licence conditions will be vital, and they are not yet fully known. At this stage, the AHSN is clear though on the need for a binding set of principles - a code of conduct - that will ensure adherence to the AHSN licence, and support the delivery of the Network’s objectives. In a similar way, many trade bodies have such codes of conduct, and it will be important for all members and affi liates to be aware of and respect each others’ codes of conduct, e.g. the NHS Constitution and CCG Constitutions. Initial ideas on the principles to be covered in the code are outlined below.

Each of the member organisations recognise the existing obligations that they and their own Boards have to their patients, the public and the NHS as a whole. As such, each member will continue to maintain sole accountability for meeting national and local quality standards and regulatory compliance for their own organisations, e.g. the Public Sector Equality Duty.

CollaborationDelivering our objectives will require strong leadership, co-operation and collaboration between all members and affi liates - across pathways; professional, organisational, and geographical boundaries - in ways which have not been achieved to date. This will necessitate different ways of working and will be in the form of:

• Respecting each organisation’s own codes of conduct.

• Sharing reliable, complete and timely information with each other and the AHSN.

• Co-operating and collaborating in key leadership appointments.

• Engaging openly with members to understand the impact of service changes being promoted, and to work together to understand and plan for the potential differential realisation of benefi ts between members.

• Adhering to the governance processes established.

• Being an active participant in developing the Network for all stakeholders.

Communication and EngagementCentral to sustaining service improvement and improving health and well-being outcomes is the involvement in planning and delivering change of service users, commissioners and other partners, as well as service providers.

The SWP AHSN and its members will:

• Create a centralised communications offi ce as part of the single point of access for researchers and industry.


45

• Ensure effective and ongoing patient, public and carer involvement and insight.

• Communicate effectively with all stakeholders, through a variety of media and mechanisms, building upon what is working well and learning from what is not.

• Listen, respond and adapt to stakeholder perspectives so that they infl uence clinical discussions and strengthen the options.

• Seek to consult and include as wide a representation of stakeholder groups wherever possible.

• Ensure that geographical, professional and sector representation is balanced with the need for tight and effective governance.

Brand reputationA key requirement for the SWP AHSN is to be seen as credible in endorsing good practice, and to promote evidence-based recommendations. Each member organisation will also wish to maintain their organisations’ reputation, and be part of a Network which enhances this. To build this reputation and create a trusted brand the AHSN and its members will:

• Act fi rst and foremost in the interest of the public, patients and carers;

• Keep information that is shared in confi dence, and adhere to information governance protocols;

• Report at the earliest opportunity to any organisation, any matter which may risk its reputation or that of the AHSN; and

• Act only on good evidence, and only when a full impact analysis has been undertaken and shared.

• Publicise and celebrate the achievements of the AHSN.

7.9 Funding fl owsNational FundingInitial indications are that the SWP AHSN will be in receipt of three types of income streams: national funding; voting member annual investments; and entrepreneurial and return on investment funding. It is expected that suppliers of professional and other services to the NHS will be invited to sponsor aspects of the AHSNs work in certain circumstances, and this will be a potential source of additional revenue. We also anticipate generating research funding leveraged from successful research activity, along with a revenue stream from the commercialisation of innovation across the Peninsula. At this stage we have not quantifi ed these or set specifi c targets, and thus have modelled the SWP AHSN fi nancial plan on c£11m per annum funding across all three streams. The fi nancial model is set out in more detail in the appendices, and will be developed in more detail once national funding becomes clearer during the development phase of the Network.

Voting Member InvestmentIt is proposed that each voting member of the AHSN makes an annual investment, or subscription, to support the legal and infrastructure preparation and ongoing delivery of the AHSN functions and deliverables.

It is not proposed to request subscriptions from affi liate members of the AHSN, since one of the primary aims of the AHSN is to encourage the participation of such members, be they commercial, charitable, voluntary or third sector organisations providing services and products to the NHS.


46

8.1 Variation to drive improvementInnovation, Health and Wealth set out a range of areas that drive innovation, two of which are specifi cally addressed within our approach to measuring and monitoring our performance.

• Reduce variation and increased compliance with NICE guidance.

• Working with industry, publish better innovation uptake metrics and more accessible information about new ideas.

Understanding variation in processes and outcomes is key in identifying opportunities for improvement and unlocking what drives success. It is an effective driver for change when variation in performance is communicated in an open, robust and inclusive fashion, but also it can de-motivate and disengage people if the chosen indicators do not align to values or agreed objectives.

The SWP AHSN will use variation in research participation, innovation adoption and spread, and in the delivery of health and well-being outcomes, to drive how we measure our success. We will make available better information about innovation uptake, and communicate widely about new ideas and problems being researched.

To ensure our approach is robust and effective, we are planning to use a fully inclusive approach to developing our performance measures, by adopting and adapting best practice. Continuing our approach to developing our application, we will take the time necessary to ensure we engage the right people in agreeing the right indicators of performance, and create ownership amongst the professions and organisations whose performance is being measured and reported.

8.2 NHS OutcomesIn addition to the NHS Outcomes Framework and existing national benchmarks, the opportunity afforded by working as a network across the South West Peninsula, provides us with the mandate to monitor and demonstrate regional variation in performance and patient outcomes. Together, these comparisons will provide a value tool for identifying areas for improvement.

8.3 Our performance management frameworkAn important part of the development of the AHSN will be the establishment of an effective Performance Management Framework (PMF). This will be a key element of our Organisational Development work, and will form a signifi cant focus of our attention during the forthcoming development phase. This section sets out the principles and process by which this PMF will be developed.

To bring together the requisite range of performance data to enable both baseline outcomes and the demonstration of success, we are developing an integrated and balanced PMF.

The PMF will provide the means for linking together population, organisations, service, and outcome measures for health, well-being and economic prosperity. We will integrate performance management of the SWP AHSN. As an organisation, with the health and wealth objectives we are trying to achieve, including measures of stakeholder perceptions, expectations and experience.

The PMF will provide clarity over four performance areas, or domains, as outlined in our strategic framework. Under each domain there are a range of metric types, to ensure a balanced view of performance is achieved.

As priority areas for improvement are identifi ed, such as Stroke or Dementia, service specifi c indicators will be chosen across the scope of the PMF, to provide a consistent dashboard or scorecard which can be used to compare improvement across different service areas. Wherever possible, we will use the NHS Outcomes Framework measures and improvement areas within clinical service areas, to ensure alignment with National priorities is achieved.

The PMF will promote the alignment of all AHSN staff with member organisations’ aims and objectives, and align the AHSN around common goals, incentivising the right behaviours and identifying areas for improvement.

It will be a tool we will all use for understanding and addressing variation in practice and performance. The metrics chosen will be aligned with National

8. Measuring Our Success

47

8. Me

Cancer Intelligence Network and International Cancer Benchmarking Partnership metrics in order to provide national and international comparisons where possible.

Informatics baselineAn informatics baseline review is needed to identify the range of metrics already available to measure the achievement of the AHSN objectives. However it is highly probably that we will need to develop new measures, and in doing so, our key principles will be:

• A centralised and consistent set of metrics, so all members and stakeholders have a ‘single source of the truth’.

• Wherever possible we will make the best use of existing metrics, data sources, data collection and reporting processes, to minimise the need for new work.

• The use of nationally agreed and available metrics and benchmarks to contextualise organisation and regional performance.

• Clinical teams and provider organisations will be engaged in the development process, so that all members can sign up to how performance is being measured.

• Clinical leaders will be engaged to help interpret performance variation, so that clinical performance reports come with a clinical narrative.

• A balanced set of metrics will be developed over time to ensure that all aspects of our aims and objectives can be measured - quality, activity, fi nance and workforce performance.

• We will judge performance using both leading (input and process) and lagging (outcome) indicators, and focus effort on understanding the causes and remedies for variation in performance as a key driver for continuous improvement.

Developing our PMFWe will develop our PMF using 10 steps critical to the successful design and implementation of robust reporting and performance management. These are summarised below, and form part of the business plan objectives.

1. Develop a clear organisational mission, vision and set of SMART strategic objectives, and explore the factors critical to achieving them (Critical Success Factors - CSFs).

2. Identify clear metrics for these objectives and CSFs, and defi ne performance indicators that measure what matters, with appropriate stakeholders, adhering to the key principles.

3. Agree accountabilities for the performance improvement for each objective and indicator, and owners for the development of the indicators. Develop and agree clear targets, improvement trajectories and thresholds for performance evaluation.

4. Develop the right performance monitoring and reporting processes and systems, ensuring that reports are geared towards users’ needs and ways of working, include interpretation and clinical narrative, and make good use of already available reports.

5. Design effective review meetings, ensuring the right people, reporting, frequency and resources support good performance conversations.

6. Consider opportunities for using IT to automate, streamline and reduce the resource overhead associated with performance management.

7. Ensure there are agreed and communicated consequences for performance, and that the right incentives and sanctions are in place.

8. Support individuals, teams and the organisations overall, to perform well, ensuring that development needs are identifi ed and resourced. Use a structured approach to diagnosing the root cause of poor performance.

9. Cascade the PMF across AHSN and obtain feedback.

10. Recognise and celebrate good performance and communicate success across the AHSN network.


48

9.1 Transitional arrangementsThere is a signifi cant organisational development requirement up to and beyond the proposed start date in April 2013 which will require leadership and resourcing, ahead of formal appointments being made.

The project team established to develop the South West Peninsula bid has been led by Angela Pedder, CEO Royal Devon and Exeter NHS Foundation Trust, with project support provided by Steering Group members’ organisations. The development of the detailed aims and objectives have been delivered by NHS and Academic staff from within existing resources, thus creating a ground-swell of staff who have enthusiasm and understanding of the aims and ambitions of the SWP AHSN.

When asked, all of the NHS Chief Executives and Universities have supported a continuation of Angela Pedder leading the work, with longer term leadership and project management support being developed by the Steering Group once the application has been submitted.

9.2 Organisational DevelopmentHaving set out the overarching vision for the SWP AHSN, and identifi ed the priority developments across each of the functional areas, we will now align these to the delivery of service-specifi c objectives, to create our Strategic Objectives. This will help us to defi ne further our key performance indicators (KPIs), as part of an ongoing programme to develop and implement a PMF. Further work is required to strengthen and defi ne our governance arrangements, including the defi nition of key roles and appointment of chairs and an Accountable Offi cer. Our fi nancial model, and the assumptions we have made, need to be tested further, and clarity around income streams achieved. Together these will enable us to actively start the process of organisational development.

We have benefi ted from signifi cant stakeholder engagement and input into the development of our AHSN application and will continue to involve key partners in refi ning and implementing our OD plan.

9. Way Forward andNext Steps

49

9.


50

Business Plan Section 1: IntroductionWe have developed a high-level business plan that supports our application to become an AHSN. The purpose of the business plan is to provide supporting material to the prospectus, and it is best read in conjunction with the main prospectus text.

The business plan gives a more quantifi ed perspective (in terms of both in time and resources) of the activities that we will carry out. It also explains our current thoughts on the performance management framework for the AHSN and the key risks and critical success factors for the AHSN.

The Business Plan is a live document and will continue to be refi ned and developed as we move forward to licensing in 2013 and beyond.

High-Level Milestone PlanWe have developed a high-level milestone plan that outlines the key objectives and outcomes for the AHSH by workstream. This gives an overview of the outcomes that we plan to achieve, and by when, from now to 2017/18.

The high-level milestone plan is included in Section 2 of the Business Plan.

High-Level Finance PlanWe have developed a high-level fi nance plan for the AHSN. This has been developed by workstream leads within the AHSN to give an estimate of the potential resource implications of the AHSN activities.

Appendix 1South West Peninsula AHSN Business Plan

51

A summary of the fi nance plan is included below. Further details of the fi nance plan can be found in section 3.

Table 1 : Summary of high-level fi nance plan 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

NHS CB/ Local income 200 * 11,000 10,843 10,686 10,530 10,530

Commercial income - - 157 314 470 470

Total income 200 11,000 11,000 11,000 11,000 11,000

Research delivery - (694) (725) (725) (725) (725)

Education and training - (204) (389) (609) (909) (909)

Service improvement - (2,339) (3,118) (3,118) (3,118) (3,118)

Information (10) (1,610) (880) (880) (880) (880)

Wealth creation - (2,180) (2,655) (2,735) (2,765) (2,735)

Projects yet to be determined - (3,331) (2,575) (2,275) (1,945) (1,975)

Operating costs (190) (643) (658) (658) (658) (658)

Total expenditure (200) (11,000) (11,000) (11,000) (11,000) (11,000)

Surplus/(defi cit) 0 0 0 0 0 0

* £200k assumed income from NHS Commissioning Board, which is in addition to £360k already committed by local partners.

South West Pe

The Finance plan is high-level and indicative at this stage. Funding levels from the centre have not yet determined, and the terms of the AHSN licence have not been agreed. The level of matched funding from local members of the AHSN has also not yet been determined. Finally, it is diffi cult to estimate the likely expenditure and potential commercial income for the later years of the AHNS’s fi ve year term, as there are many uncertain variables that will affect these fi gures.

The fi nance plan will be refi ned over the next six months as agreement is reached over the terms and conditions of the licence AHSN. It will then continue to be updated over the life of the AHSN.

Finance plan assumptionsA summary of the key assumptions used in developing the AHSN fi nance plan are listed below:

Income• Prospective members of the AHSN have already

invested £360k in 2012/13 to the development of the bid for AHSN status. These signifi cant levels of resources show the commitment of members to the AHSN and its goals. Members are all agreed to the need to provide local funding to support central funding as the AHSN develops. The exact level of funding from local organisations has not yet been determined, and will be subject to further work as the AHSN moves towards licensing.

• From October 2012 to March 2013 £200k of seed funding from the DH has been modelled. This is used to fund set-up costs, salaries of key personnel appointed prior to the AHSN go-live date, and to fund some functional activity (mainly around data collection).

• Total income for the AHSN has been modelled at £11m per annum in each year. This is made up of three sources: national funding, local funding and entrepreneurial funding from industry. This is a high-level assumption that will need to be refi ned as the AHSN moves towards licensing.

• It is anticipated that considerable income will be raised from commercial sources over the life of the AHSN to fund innovation and wealth creation projects. However, as this funding is likely to fl ow direct to SMEs and other organisations, rather than through the AHSN it has been excluded from the AHSN fi nance model.

• Research nurses carrying out research trials have been modelled to become fully self-funding by 2016/17. This funding is shown in the entrepreneurial income stream.

• Returns on investment, for example through international activity, have not been modelled at this stage, due to diffi culties in estimating the likely scale of such income.

Expenditure• The costs associated with the workstreams

have been estimated on a bottom up basis by workstream leads. These costs provide a fi rst view of the likely costs of the activities that will be carried out by the AHSN. However these fi gures are by necessity high-level, and will be subject to further refi nement as the exact scope and activities of the AHSN are clarifi ed, and as the terms of the license for the AHSN are agreed.

• Operating costs for the AHSN are estimated to be approximately £650k. This represents around 6% of anticipated income.

• Costs have been profi led by year to give an indication of the likely ramping up of expenditure and the effects of pump-priming. The effect of this profi ling is to reduce expenditure on costed projects in year 1, as time is taken to mobilise projects.

• Costs associated with costed workstream activity vary from £7m in year one to £8.4m in year fi ve. An allowance has therefore been made in the fi nancial model for projects that have yet to be determined to bring the income and expenditure position into balance. This allowance is £3.3m in year 1, dropping to £2.0m in year 5. The exact use of this funding and the recurrent and non-recurrent projects that it will be used to support will be determined as the AHSN plans are further developed.

• £1m per annum of prize money is modelled for an annual innovation funding competition. £150k per annum is available for the small grants scheme to support innovation.

• It has been assumed that excess treatment costs for research will net off to zero over the region. No funding is therefore required for this, apart from administrative time to administer the system.


52

• The exact scale of non-pay costs will be dependent on the exact governance and physical location for the AHSN. At this stage these have been estimated as a percentage of between 20% and 30% of pay costs.

• £640k per annum has been modelled to fund the secondment of 16 consultants to act as innovation strategists on a part time basis.

• £216k has been modelled for project managers to support the implementation of the six HIIs. An additional £216kis modelled for implementation of innovation project managers. £480k has been modelled for 16 innovation ambassadors.

Capital expenditure• Capital expenditure estimates are low. Currently

these amount to £150k on IT items over two years. It is currently expected that data hosting will be carried out using an external supplier, which will therefore mean that capital expenditure on this is not required. Offi ce accommodation is expected to be leased rather than purchased.

The fi nance plan is shows real terms income and expenditure at 2012/13 prices. Infl ation has been excluded. A detailed copy of the excel model for the Finance Plan is available separately.

Performance Management FrameworkWe have developed a high-level performance management framework for the AHSN. Further refi nement of this will take place as we move towards licensing.

It will bring together a range of performance data, to enable both baseline outcomes and the demonstration of success.

The PMF will provide the means for linking together population, organisations, service, and outcome measures for health, well-being and economic prosperity. We will integrate performance management of the South West Peninsula AHSN as organisation, with the health and wealth objectives we are trying to achieve, including measures of stakeholder perceptions, expectations and experience.

The PMF will provide clarity over four performance areas, or domains, as outlined in our strategic framework. Under each domain there are a range of metric types, to ensure a balanced view of performance is achieved.

As priority areas for improvement are identifi ed, such as Stroke or Dementia for example, service specifi c indicators will be chosen across the scope of the PMF, to provide a consistent dashboard or scorecard can be used to compare improvement across different service areas. Wherever possible, we will use the NHS Outcomes Framework measures and improvement areas within clinical service areas, to ensure alignment with National priorities is achieved.

The PMF will promote the alignment of all AHSN staff with member organisations’ aims and objectives, and align the AHSN around common goals, incentivising the right behaviours and identifying areas for improvement.

It will be a tool we will all use for understanding and addressing variation in practice and performance. The metrics chosen will be aligned with NCIN and ICBP metrics in order to provide national and international comparisons where possible.

A copy of the draft high-level performance management framework is included in section 4.

Appendix 1South West Peninsula AHSN Business Plan

53

In all, 36 risks have been identifi ed. Key risks categories include:

• Risks that stakeholder involvement (including industry involvement) is lower than expected.

• Patient participation in research and the wider activities of the AHSN is limited.

• Poor strategic alignment between the AHSN and other local and regional strategies.

• A failure to deliver the objectives and outcomes set for the AHSN.

• Duplication and excessive bureaucracy.

• Weak governance arrangements leading to poor decision making.

• Weak commercial arrangements leading to poor protection of intellectual property.

• To mitigate against this, risk mitigation strategies have been developed for risks, and these are outlines in the risk register.

The risk register is a live document and will continue to be updated throughout the life of the AHSN. A copy of the current risk register is included in section 5.

Critical Success Factors (CSFs)By defi nition, CSFs are the attributes essential to the successful delivery of the objectives of the AHSN. Successfully delivering the AHSN’s CSFs is essential to the overall success of the AHSN. A register of CSFs has been developed by workstream leads within the AHSN. This is a live document and will continue to be updated throughout the life of the AHSN.

The CSF register is included in section 6 of this business plan.


54

Risk RegisterA risk register for the AHSN has been developed. Risks have been assessed qualitatively, using the following scoring matrix.

Bus

ines

s P

lan

Sec

tion

2: H

igh-

Leve

l Mile

ston

e P

lan

55


56

Bus

ines

s P

lan

Sec

tion

2: H

igh-

Leve

l Mile

ston

e P

lan

57

Bus

ines

s P

lan

Sec

tion

2: H

igh-

Leve

l Mile

ston

e P

lan


58

Bus

ines

s P

lan

Sec

tion

2: H

igh-

Leve

l Mile

ston

e P

lan

59

Bus

ines

s P

lan

Sec

tion

2: H

igh-

Leve

l Mile

ston

e P

lan


60

Bus

ines

s P

lan

Sec

tion

2: H

igh-

Leve

l Mile

ston

e P

lan

App

endi

x 1

Bus

ines

s P

lan

Sec

tion

3: H

igh-

Leve

l Fin

ance

Pla

n

61


62

App

endi

x 1

Bus

ines

s P

lan

Sec

tion

3: H

igh-

Leve

l Fin

ance

Pla

n

Cap

ital a

nd C

ash

Sum

mar

y

63

Education &

Training

•Build research literate workforce

•Partner with LETB to develop curricula and commission education and training services

•Develop leadership capability and skills for improvement

•Partner with other providers to support service improvementtraining

Information •Design and develop a shared data repository

• Improve patient level information to enable easy identification of patient cohorts

•Enable spread through easieraccess to evaluation results

Our priority objectives

•Timely patient payment systems

•Attracting research money to the region

•NHS Outcomes Framework

•NHS Outcomes Framework

•Financial viability

•Patient participation and recruitment to clinical research

• Industry engagement

•Relationships with patients, providers, commissioners, industry and networks.

•Relationships with patients, providers, commissioners, industry and networks.

• Job creation

•Engagement of partners and patients

•Single point of access

•Mutual Recognition Agreement

•Effective process for identifying, adopting and spreading innovation, such as High Impact Innovations, iTAPP and NICE TAGs

•Effective learning and knowledge sharing

•Mechanisms to stimulate innovation

• Innovation commercialisation support

•Knowledge exchange with industry and third sector

• International growth of market

• Lean and effective delivery processes

•Effective and efficient governance

•Staff ‘research skills passport’

•Medical staff capacity

•Culture of improvement, delivery, innovation and learning

•Culture of sharing with external partners

•Competent and capable workforce

Spreading

Innovation &

Best Practice

Transforming

Research

Delivery

Creating

Wealth

Delivering the

South West

Peninsula

AHSN

Appendix 1Business Plan Section 4: Performance

Management Framework


64

Appendix 1Business Plan Section 4: Performance

Management Framework

Service Improvement

Innovation delivery • Improvement model delivery versus plan • Number of planned High Impact Innovation roll outs

achieved to plan

• Number of planned NICE TAG roll outs achieved to

plan

Innovation resourcing • Number of local innovators identified against target

• Delivery of all training identified to plan

• Number of formal engagements with partners against plan

Transforming Research

Delivery Efficient initiation and delivery of research

• Aligned NHS approval metrics with NIHR

• Number of studies achieving NHS permission to first patient first visit within 30 days, and closed study

recruitment to time and target.

Patient recruitment

• Number of patient recruits in NIHR/ non-NIHR trials

• Number of patient recruits to ‘complex studies’

Treatment costs

• % of Excess Treatment Costs agreed within 30 days for

all studies

Support for life sciences industry

• Number of commercial trials running

• Number of recruitments into commercial trials

• Number of NIHR/ non-NIHR commercial trials meeting

recruitment target by close of recruitment

Delivering the AHSN

Finance

• Measure(s) to be defined post MoU sign off

Engagement

• Number of strategic partnerships with patients,

industry, universities and NHS organisations versus plan

Internal processes

• Measure(s) to be defined

Learning and growth

• Number of staff in region with innovation skills (to be defined)

• Number of AHSN Innovation Leaders trained

Wealth Creation

Commercialisation • Number of NHS/TTU collaboration projects running • Number of innovations commercialised

Collaboration • Number of collaboration events delivered versus plan • Number of collaborative relationships in place

• Increase in job opportunities

Promoting Innovation • Number of IFDS bids supported

• Innovation funding secured £x per annum

• Number of Innovation Funding competition awards

• Number of Small Grant Scheme competition awards

International Markets • Number of contracts won

Information

IT systems • Audit delivery against plan

Shared infrastructure and repository • Number of AHSN partners sharing data openly

Innovation • Number of new technology projects identified • Number of new technology projects implemented

Education & Training

Building capacity and capability • Number of research studentships taken up • Number of research studentships in under-

represented staff groups

• Number of clinical academic programme studentships

in under-represented staff groups

• Number of Dip I&CM ‘leadership for innovation’ studentships

Delivery of AHSN priorities • Number of staff trained in delivery of specific HIIs • Number of staff trained in delivery of specific best

practice pathway improvements

Partnerships • Number of trials co-produced with patients

• Number of LETB/NICE opportunities realised

65

App

endi

x 1

Bus

ines

s P

lan

Sec

tion

5: R

isk

Reg

iste

r


66

P

App

endi

x 1

Bus

ines

s P

lan

Sec

tion

5: R

isk

Reg

iste

r

Appendix 2High Impact Innovations in the

South West Peninsula

67

Assistive Technologies- 3 Million Lives• 120 Plymouth patients with COPD and heart

failure are managed with telehealth and telecare; 4,000 Somerset patients with COPD, heart failure and diabetes will be monitored by telehealth as part of a £1.2m, 3 year investment; Cornwall was one of the early adopters of telehealth and is now planning to expand its use to help patients self-manage their condition at home.

• South Devon Healthcare NHS FT and Torbay & Southern Devon Health & Care NHS Trust are developing a system-wide vital signs solution across community and acute settings, to improve patient care through digital technology.

• South Western Ambulance Service’s Urgent Care service delivers a mobile response service to patients using Plymouth Council’s Telecare Service, and are seeking to expand this.

• Royal Devon & Exeter NHS FT uses tele-dermatology and will expand the range of services using non-face-to-face monitoring of longer term conditions. The Trust has piloted handheld tablet devices across inpatient areas and may roll this out.

• South Devon is adapting an existing online self-management service for pain management, to support COPD and diabetes. This focuses on setting up highly localised support communities and enabling patients to build their own networks of support to reduce dependency on services and unplanned admissions.

Oesophageal Doppler Monitoring (ODM) - intra-operative fl uid management monitoring technologies • North Devon Healthcare Trust is scoping the

implementation of ODM for all eligible patients, linked to CQUIN.

• South Devon Healthcare NHS Foundation Trust have fl uid management monitoring as an integral part of their enhanced recovery pathway, and have access to cardiac output monitoring to better assess fl uid requirements during major surgery, using ODM and LidCo as mechanisms for this.

• Royal Devon & Exeter NHS Foundation Trust have already implemented ODM in key procedures and specialties, and are reviewing plans to ensure full coverage.

Child in a chair in a day - wheelchair services• Plymouth Community Healthcare now sees 50%

of current routine cases in a day. They are now reviewing skills and staffi ng, as well as stock management, to improve this further in line with the HII ambition.

• Royal Devon & Exeter NHS Foundation Trust have been reducing waiting times for wheelchair services in recent years, and have short waits for simple chairs.

International and commercial activity - working with partners• Our trusts have a developing portfolio of national

and international offerings.

• Quintiles Clinical Research Organisation has established a formal partnership with the University of Exeter Medical School and seven participating provider trusts to develop international access to product development research across the pipeline.

• South Devon Healthcare NHS FT has an active commercial portfolio. Live or pending patents include patient care signs, a nursing acuity tool, rectus sheath catheters, a pain relieving device, episiotomy scissors, a total hip system, pleural catheter guidelines and C Peptide.


68

• Brain in Hand Ltd has engaged Devon Partnership NHS Trust in developing smart phone technology for people with High Functioning autism because of the relationship with PenCLAHRC to provide the research program.

• O2 Health is working with Devon Partnership NHS Trust to commercialize an SMS clinical support tool.

• Devon PCT won the contract from the Foreign & Commonwealth Offi ce to provide health services to St Helena in the South Atlantic, in place of previously contracted locum services from South Africa at a signifi cant cost saving. It is expected that St Helena becomes our ‘innovation lab’ for learning how to support healthcare in remote communities. The population of around 4000 is morbidly obese, has very high rates of diabetes (30% +) and hypertension, and is ageing. They have a resident medical offi cer and ancillary staff with a community hospital, and a very basic infrastructure. We have proposed a system of visits by Devon GPs and specialists; supported by telehealth consultation to the resident team and patients to improve the level of care they are given. This project is now up and running.

Digital First (formerly Digital by Default) - face to face contacts• The Right Care, Right Place, Right Time initiative

aims to support the NHS South West Strategic Framework ambition to reduce A&E attendances at acute hospitals by 10% per annum over fi ve years as people receive care in more appropriate local settings. South Western Ambulance Service NHS FT has been awarded the NHS 111 contract in Dorset with a service commencement date of the 19 March 2013. NHS 111 will be used to sign post members of the public to the most appropriate treatment pathways which will include telephone advice therefore reducing the need for face-to-face contacts.

• Torbay and South Devon have reduced outpatient appointments by 4,300 by use of a PSA tracker. A 38% reduction in paediatric outpatient appointments has been achieved by the use of advice & guidance. They are also exploring the development of (DOS) 111 services.

• Plymouth Community Healthcare is piloting wireless working within the Orthotics service clinical area to enable them to work remotely between clinic rooms, using portable technology. This has created a direct benefi t of reducing waiting times within the service in conjunction with changes in clinical practice. It will be rolled out to other clinical services. Their Portable Technology project involves the issue of portable devices to community based staff. Devices are being tested before selection of a preferred supplier, with full roll out in 2013/14.

• North Devon Healthcare Trust is exploring the use of e-discharge and implementation of CIDS/ ComPAS).

• South Devon Healthcare NHS Foundation Trust is exploring the development of 111 services, PSA trackers, DNA text service and a Telederm pilot.

• Devon Partnership Trust is implementing digital pens and paper into the Liaison Psychiatry Adult Service. Preliminary fi ndings indicate whole process time savings of 7-9 days.

• Digitising inpatient Therapist Working - Digital Tech - Yeovil: adoption and integration of an IT solution for inpatient based therapists. By providing accurate and up to date information such as inpatient details and live mobile bed states on small hand held devices the therapy teams we will be able to maximise their availability and accurately prioritise their workload. Anticipated Benefi ts: increased productivity in the therapy team; support to planned discharge dates and time; savings on staff cover.

69

Carers for people with Dementia • The Enhanced Healing programme in Somerset

is re-designing ward environments with carers for patients. 1,700 short breaks for carers have been provided in Devon.

• West Devon has a Dementia Support Worker based in the Memory Service who will meet everybody on diagnosis with dementia and their carer. They will develop a support plan that includes referring the carer to other support and advice. They have also started a Dementia Befriending Service which mostly focuses on people living on their own with dementia; and a Carers Buddying Service which will provide personalised support to the person the carer is caring for with dementia, either in their own home or during outings and activities in the community.

• Plymouth Community Healthcare provide several specialist health services for people with dementia and their carers through the memory clinic or community services, before and after diagnosis, as well as various support groups including telephone support.

• South Western Ambulance Service NHS FT will produce and undertake a Dementia Awareness Training Programme for Patient Transport Service staff to ensure they are trained to recognise the early stages of dementia and are better equipped to care for this group of patients.

• Royal Devon & Exeter NHS FT have implemented a ‘patient passport’ for dementia patients.


70

Appendix 3NHS Change Model

The NHS Change Model is a framework for change which provides advice on how to go about improvement aimed at delivering goals for quality and value.

It has been distilled from many years of experience of change in the NHS, and is effectively a collection of good change-management practice in a framework, with standard language to help improve consistency in application across the NHS. There were over 500 contributors to this model from across the NHS, all contributing to the knowledge share exercise.

The NHS Change Model is made up of eight components as shown below:

The principle of the model is that change is most effective in delivering benefi ts when an integrated approach, covering all eight components, is used.

It does not prescribe any particular improvement methodology such as Lean or Six Sigma, but instead provides the framework which NHS organisations can follow to implement successful change, using

methods they are familiar with or experienced using already. The focus here is about ensuring all eight components are integrated - and aligned to prevent adverse reactions to initiatives - when planning transformational change, for example improvements in pathways (spread of innovation) hampered by the way tariffs are structured (system drivers).

The importance of intrinsic motivation (people who join the NHS want to improve patients’ lives - shared values) is recognised in the Change Model through the shared purpose, engagement and leadership components; while that of extrinsic motivation is recognised through the other components such as measurement, payment systems and performance management.

For impactful change, the NHS Change Model recognises that all these components have to work together. Hence, any transformational change programme must include all components in the change planning process. It has been considered here in two ways; how it has been used in the AHSN formation process, and how it will be used in the ongoing work of the AHSN.

Application to AHSN formation processThe formation of the SW Peninsula AHSN itself could be considered as a large scale transformational change process; and hence the NHS Change Model is applicable to its creation. The eight elements are defi ned below in the context of the formation of the AHSN.

Our shared purpose: The purpose of this change is to create an organisational form to facilitate the effi cient and effective identifi cation, adoption and spread of innovation across the region; with this enabling real improvement in health and wellbeing outcomes for patients and service users.

Leadership for change: The leaders in the region who have come together to form the AHSN have been selected for their skills, knowledge and attitude towards creating a change process which will result in a forward looking organisation that will deliver its purpose and objectives.

Appendix 3NHS Change Model

71

Engagement to mobilise: A lot of effort has been put into engaging widely with health, social care, academic and industry leads across the region. This has been done through regional-wide engagement events, county events and one-to-one discussions. AHSN change leaders have consulted with opinion shapers and thought-leaders across the patch, to ensure that the planned changes are easier to mobilise when they are implemented. By ensuring the right people are involved at the onset, the chances of successful delivery of the AHSN purpose and objectives are greatly improved.

Spread of innovation: During the AHSN planning process, we have sought to learn from one another within the region, and ensure good practice is identifi ed and spread from the onset. These principles are being incorporated into the AHSN ‘delivery model’ which is described below.

Improvement methodology: During the wide consultation, the leaders have ensured good practice in improvement methodologies across the region are captured, so that learning can be retained in the AHSN. The involvement of thought-leaders from health, academia and industry in identifying an evidence-based approach to setting up the AHSN has resulted in a clear approach towards the initial goal of establishing the AHSN.

Rigorous delivery: The learning from the improvement methodology component has led to the defi nition of a project management approach to monitor delivery of the planned changes towards delivering the desired outcomes.

Transparent measurement: An open measurement system has been defi ned to ensure the short term AHSN application and formation objectives and timescales are met. These are reported at fortnightly board and project team reviews.

System drivers: In the AHSN formation stage the leaders have had to create an enabling environment to ensure those tasked with pulling together the AHSN application in the short term have the capacity, support and direction to deliver the change.

Application to ‘Delivery Model’ - how the AHSN will operateThe ‘delivery model’ has been defi ned, and continues to be refi ned, to capture an approach to the delivery of the AHSN purpose and objectives over the longer term. As managing large scale change will be inherent to the successful identifi cation, adoption and spread of innovation at a regional scale, the best practice contained in the NHS Change Model is again applicable to the way the AHSN will operate in future. The eight elements are defi ned below in the context of the operation of the AHSN.

Our shared purpose: The purpose of the changes planned by the AHSN will be to deliver, effi ciently and effectively, the spread of innovation across the region; with each enabling a real improvement in the health and wellbeing outcomes for patients and service users.

Leadership for change: The leadership and governance structure for the proposed AHSN is being designed to ensure that leaders have the appropriate skills, knowledge and experience to recognise that each innovation is a change intervention that requires them to set a clear vision at the onset, and demonstrate a style conducive to its effective delivery of objectives.

Engagement to mobilise: The engagement carried out in the formation stage of the AHSN is being harnessed through the creation of a governance structure for the AHSN which recognises the roles and relationships between partners, and defi nes a membership structure to ensure the right people are mobilised in making the change happen.

Spread of innovation: A core function of the AHSN is to deliver the spread of innovation to identifi ed ‘markets’. The mechanisms in which the AHSN will work to deliver this are based on the premise that learning and good practice are openly shared at all stages, so that the roll out and spread of innovation, regionally and nationally if applicable, is conducted as effi ciently as possible.

Improvement methodology: The AHSN will


72

not seek to impose any particular improvement methodology on partners, where existing ones are established and working well. It will instead aim to work on effi ciently designed processes already in place amongst partners, and share good practice amongst them, so that improvement methodologies used are evidence-based and proven to deliver successful outcomes.

Rigorous delivery: Each innovation cycle defi ned in the ‘delivery model’ will be subject to strict protocol-driven controls, so as to ensure innovations are subject to thorough scrutiny at each stage of the cycle, and ensure maximum chances of success when eventually rolled out.

Transparent measurement: A performance management framework is being design to measure the progress towards the delivery of the AHSN objectives over the long term are tracked and shared openly amongst members. This will also include regular reviews at different levels, and a challenge to ensure benefi ts are being delivered as planned, and improvement outcomes are being achieved.

System drivers: A critical success factor of the AHSN is the delivery of successful innovations to the ‘market’ in a rapid and thorough manner. To ensure that the barriers to this are identifi ed early, the AHSN will review how incentives from its members (eg commissioners) can be aligned to the successful delivery of innovations. Long-standing payment structures for services or pathways may need to be challenged, and by working closely with members upfront the importance of this can be understood and implemented for mutual benefi t of the partners involved.

to open the Prospectus and Business Plan

Documents

Transcript of to open the Prospectus and Business Plan