Characteristics of AHSCs

1. AHSC not what your country can do for you: Early lessons from the Academic Health Science Centre models in England Prof Alastair M Buchan Head, Medical Sciences

3. Characteristics of AHSCs Patient care World class AMCs deliver against the three missions … Teaching Research Talent External partnerships Brand … through strength in core capabilities … Financial strength Infrastructure Operating processes … founded on an aligned partnership ACADEMIC HOSPITAL

4. The “unlinked partners” model of medical school-clinical enterprise relationships in England Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

5. UK health care expenditure as % GDP £4bn-£40bn gap with Wanless recommen-dations Source: Appleby J, Crawford R, Emmerson C. How Cold Will It Be? Prospects for NHS Funding: 2011–2017. London: King’s Fund; 2009.

6. Industry productivity gap – new drug approvals have not kept pace with rising R&D spend Source: Tufts Centre for the Study of Drug Development; Morgan Stanley Research: Pharmaceuticals, 20 January, 2010.

7. United Kingdom 6% > 2% Percentage of subjects randomized by region for industry cohort, 2000 vs. 2007 EU Non-Core 8% > 21% EU Accession 4% > 8% EU Core 21% > 12% North America 41% > 36% Asia Pacific 2% > 10% Latin America 3% > 7% Middle East & Africa 2% > 3% Source : Centre for Medicines Research

8. UK policy context Walport Report National Strategy Cooksey Review

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

10. Biomedical Research Centres The Innovation Pathway DIFFUSION INVENTION EVALUATION ADOPTION • Spread • new things • new ideas • new techniques • new approaches • Creation • new things • new ideas • new techniques • new approaches • Assessment • new things • new ideas • new techniques • new approaches • Uptake • new things • new ideas • new techniques • new approaches Basic Research Applied Research Commissioning Patient Care MRC, Wellcome NIHR PCTs & SHAs NHS Providers

11. NIHR Biomedical Research Units NIHR Biomedical Research Centres • Leeds • Musculoskeletal Newcastle • Nottingham • Hearing • Respiratory • Gastrointestinal • Liverpool • Gastrointestinal Manchester • Leicester • Cardiovascular Cambridge • Sheffield • Cardiovascular • Musculoskeletal Liverpool • Oxford • Musculoskeletal Imperial University College • Birmingham • Gastrointestinal Oxford Great Ormond St • Brompton • Cardiovascular • Respiratory • Bristol • Cardiovascular Moorfields Guy’s & St Thomas’ • Barts & London • Cardiovascular • Southampton • Nutrition, Diet, Lifestyle • Respiratory Maudsley Marsden

12. Oxford AHSC enabled by NIHR BRC & BRU Oxford Radcliffe Hospitals and Nuffield Orthopaedic Centre NHS Trusts University of Oxford

13. John Radcliffe Campus South Parks Road Campus The Radcliffe Infirmary NOC & Old Road Campus

14. Science based platforms

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

16. Cross-cutting platforms

17. Hospital embedded research space New Translational Laboratory (7) Institute of Experimental Medicine Radiology Emergency Department Acute Vascular Imaging Centre Cardiac Unit

18. Vaccines Heart Diabetes Blood Cancer Infection Stroke Immunity Brain NIHR Oxford Biomedical Research Centre Tissue Banking & Cohorts Genetics and Pathology Imaging Bioengineering Women’s Health

19. Academic Health Science Centres • Integrated governance; • internationally-recognized excellence in research and clinical practice; • clear integrated funding streams for research and teaching; • integrated leadership and career paths; • joint programs which combine research and clinical work; • commercial expertise to market research developments and benefit the UK’s economy.

20. Medical schools & clinical academic staffing related to population by region of England Sources: Medical Schools Council: Staffing levels of medical clinical academics in UK Medical Schools, 2010; PCT Expositions Book 2009/10 – 2010/11

21. NHS Next Stage Review: Roles and expectations for AHSCs

22. AHSCs: a range of governance models Healthcare System Governance JV or Shared Governance University Governance Foundation Trusts (Cambridge, Kings, UCL, Manchester Birmingham) Hopkins McGill/MGH Partners/HMS Stanford System U.Penn, U of Washington Duke, UNC NHS Trusts Oxford RHT Imperial

23. Imperial led AHSC; Principal is CEO • First UK AHSC initiative announced August 2007 Composed of Imperial College & Hammersmith NHS Trusts with 5 hospitals: • Charing Cross • Queen Charlotte’s and Chelsea • Hammersmith • St. Mary’s • Western Eye Hospital • In total support 9,700 scientists, researchers and consultants • Combined annual clinical turnover of approx £760 million • Offers 50 clinical specialties • Types of activity performed •  Circulation sciences and renal medicine •  Clinical and investigative services •  Medicine •  Preventative interventional public health •  Specialist services • Surgery and cancer • Women’s and children

24. The “joint leadership and management” organizational model of Imperial College Healthcare Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

25. Cambridge AHSC as a company: Head of Clinical School as CEO • Cambridge NHS has catchment area of 1.5m population Composed of leading research centres and 3FTs: • University of Cambridge • Cambridge University Hospitals NHS FT – Addenbrooke’s Hospital • Cambridgeshire and Peterborough NHS FT • Papworth Hospital NHS FT • Comprehensive BRC • CLARC • Types of activity performed • Focus on proven research strengths in: • Cancer Research • Cardio-Vascular Medicine • Diabetes, Endocrinology and Metabolism • Epidemiology, Public Health and Primary Care • Genetics and Genetic Medicine • Infection and Immunity • Neurosciences and Mental Health • Stem Cells and Regenerative Medicine • Haematological and Transplantation Medicine

26. The “joint partnership board” organizational model of Cambridge University Health Partners Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

27. UCL Partners.org: cluster of hospitals • Service over 1.5 million patients Composed of 7 leading research centres and specialist hospitals: • University College London • Great Ormond Street Hospital for Children • Moorfields Eye Hospital FT • Royal Free Hampstead NHS Trust • University College London Hospital NHS FT as anchor • In total support 3,500 scientists, researchers and consultants • Combined annual turnover of approx £2 billion • Types of activity to be performed • Nervous System • Children’s Health • Heart Disease • Transplantation • Immunology • Ophthalmology • Deafness and hearing impairment • Dental and oral disease • Cancer • Women’s health 27

28. King’s HP: confederation of 4-5 FTs Service 5 million people (60% of London) Composed of 4 leading research centres: • King’s College London as anchor • Guy’s and St. Thomas’ NHS FT • King's College Hospital NHS FT • South London and Maudsley NHS FT • In total support 3,500 scientists, researchers and consultants • Combined annual turnover of approx £2 billion • Types of activity to be performed • Neuroscience and Mental Health • Inflammation and immunity • Cancer • Cardiovascular • Dental • Dermatology • Diabetes • Stem cell • Reproductive health • Allergy • allied disciplines including public health

29. Manchester: SHA, PCTs, University and cluster of 6 FTs Composed of 7 leading hospitals and Manchester Medical School: • Central Manchester and Manchester Children’s University Hospitals NHS Trust • Christie Hospital NHS Foundation Trust • Manchester Mental Health and Social Care Trust • Salford Primary Care Trust • Salford Royal NHS Foundation Trust • University Hospital of South Manchester NHS Foundation Trust • Types of activity performed • Focus on proven research strengths in: • Cancer • Child health • Mental health • Primary care • Neurosciences • Respiratory disease 29

30. Organizational model of CLUSTERS or University Hospital Partners.org . Is this a big city, big hospital, cluster solution that does not, perhaps really create a centre? Source: Ovseiko, P, Davies S, Buchan A. Organizational Models of Emerging Academic Health Science Centers in England, Academic Medicine, 85/8, 2010.

31. Oxford Medicine: federation of 7 devolved but integrated centres as OUHP • Services approx. 0.5 million patients • Oxford Radcliffe Hospitals NHS Trust • Nuffield Orthopaedic Centre • Primary Care Trust Underpinned by the link to the • Wellcome (Gene Centre) • MRC (Weatherall Institute of Molecular Medicine) • CRUK (Cancer Centre) • BHF (Centre of Excellence) • Types of activity performed • Integrated clinical innovation units as 7 “centres” would include: • Acute Care Centre • Cardiovascular Centre • Cancer & Surgery Centre • Conservative Medicine Pavilions • Neuroscience Centre • Women’s & Children’s Health Centre • Bone and Joint at NOC Cross cutting Platforms for Pathology, Imaging etc

32. Osler on academic-clinical integration “We need an active invasion of the hospitals by the universities... In the United States and the Dominions these changes are rapidly progressing...”, 1911

33. Neuroscience 3-person Academic Department Senior Management Group

34. Oncology 5-person Academic Department Executive Director of Clinical Service Head of Academic Department Clinical Academic Oncology/NIHR BRC Theme Cancer Therapeutics Surgery Radiobiology Renal, Transplant, Urology Surgical Oncology Medical Oncology Clinical Oncology

35. Orthopaedics, Rheumatology and Musculoskeletal Sciences 11-person Hospital Board 5-person Academic Department Senior Management Group Head of Academic Department/ NIHR BRU Director/ Non-Exec Clinical Academic Musculoskeletal Osteoarticular Pathology Institute of Rheumatology Enablement Bone Oncology Laboratory Sciences NIHR Biomedical Research Unit Cell Signalling Epidemiology & Biobank Musculoskeletal Sciences Clinical Trials Unit Orthopaedic Engineering Trauma Research Centre

36. The Committee of Five presenting their work to the Congress on June 28, 1776, a “split solution” required to allay sum of all fears This morning is assigned the greatest debate of all… A declaration, that these colonies are free and independent states,…May heaven prosper the newborn republic. John Adams

37. University Departments merging with Hospital Divisions to create devolved centres a policy experiment of 7 laboratories… "It is one of the happy incidents of the federal system, that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.“ U.S. Supreme Court Justice Louis D. Brandeis, 1932

38. Next steps

39. AHSC vs. confederation of “AHSC’s” Tripartite mission comes together in topic specific themes each with own distinct brand; Multi-disciplinary learning (with embedded academic post graduate schools); devolved resources, fund raising, leadership and accountability but also each owns their brand; Underpinning by institutions to ensure tertiary income, safe discovery, and a culture of change; Community inclusiveness, strong links to Public Health, Primary Care, Mental HT, PCT, Oxford Brookes U (allied health sciences) and SHA;

40. Summary, questions