European Models of Academic Health Centres

2. European Models of Academic Health Centres David Gordon University of Manchester

3. Thesis • 1. There are multiple stresses and potential conflicts in the relationship between the two sides in the Academic Health Centre • 2. There are many experiments and models across Europe • 3. Personal and political factors are important for success

4. Stresses and conflicts? – • Money • Time-scale • Regulatory framework • Control

5. Money – healthcare >>> medical school • never underestimate the power of money • Timescale • health care – minutes, days and weeks • medical school – years and decades • Regulatory framework? • also the political framework – the gap between what governments say and what they do • Control – an open question?

6. If books are written about problems then the problems must be big ones

7. If books are written about problems then the problems must be big ones

9. Flexner, apropos Cincinnati, 1910 …to have a first-rate medical school, the faculty must have a controlling role in appointments at the…hospital.

10. History – maybe 200 years ago • Medical schools as part of hospitals • Medicine as a university discipline?

11. History – maybe 10 or 20 years ago • Many factors, particularly • Structural changes to healthcare delivery (e.g. NHS reforms in the UK) • Economic pressures on both healthcare and on the medical school (e.g. major changes in the economics of healthcare in Eastern Europe)

12. Three examples • UK – reports, reforms and experiments • Netherlands • Germany, particularly Berlin

13. UK - reports

14. UK – the “Richards report” • “…to conceive of a new kind of completely integrated medical teaching and research hospital” • “…more work should be done to explore the concept of the University – Hospital NHS Trust”

15. UK – reforms and experiments • The concept of the “Foundation Trust” (i.e. semi-independent hospital) • A hospital with a primarily academic leadership? • The Imperial College experiment…

16. Connects services, teaching agenda and research - to bring the very latest treatments to patient bedsides and to students Improvement through academic enquiry A magnet for the world’s best healthcare professionals and researchers Attracts investment and new companies Staff development in multi-disciplinary teams The benefits of an Academic Health Science Centre (AHSC)?

17. Merger of Hammersmith Hospitals NHS Trust and St Mary’s NHS Trust and integration with Imperial College London to create an Academic Health Science Centre Integrated board and management team Our proposal

18. …on page 3 of 38… • “…the new Trust … will be an NHS body…” • Do we want to give our medical schools to the healthcare system?

19. Netherlands – the Dutch Federation of University Medical Centres • Eight UMCs • 60,000 staff • 30,000 students • €4,300,000,000 • www.nfu.nl

20. Netherlands – the Dutch Federation of University Medical Centres - personalities

21. Berlin – the Charité “…flourishing…”

22. Berlin – the Charité • Is the success because of this - ?

23. Berlin – the Charité – success? • - or because “…flexible attitude…work [clinically] part-time…”

24. Conclusion • 1. There are multiple stresses – money, timescale and control particularly - and potential conflicts in the relationship between the two sides in the Academic Health Centre • 2. There are many experiments and models across Europe • 3. Personal and political factors are important for success

25. References • 1. Governance of Teaching Hospitals: Turmoil at Penn and Hopkins John A Kastor 2004 The Johns Hopkins University Press ISBN 0-8018-7420-3 • 2. Iconoclast: Abraham Flexner and life in learning Thomas Neville Bonner 2002 The Johns Hopkins University Press ISBN 0-8018-7124-7 • 3. Slide 10 The images are of Joseph Jordan and Thomas Turner, founders of medical schools associated with the Manchester Royal Infirmary • 4. Clinical Academic Careers: Report of an Independent Task Force 1997 CVCP ISBN 1-869835-93-X • 5. Slides 16 and 17 I am grateful to Professor Stephen Smith of Imperial College, and to Don Neame of the Hammersmith Hospitals NHS Trust, for these slides. The consultation document referred to is available from ahscprogrammeoffice@hhnt.nhs.uk • 6. www.nfu.nl • 7. http://www.charite.de/start/ • 8. Nature 447 (2007) pp 630 - 633