Presented by Professor Ed Byrne AO

1. Presented by Professor Ed Byrne AO New Directions in University Health Provider Partnerships Presented at Southern Health Research Week 2010 Tuesday May 11,2010

2. Key Issues A shared Vision with dual governance Or Two tenants in a shared building

3. Shared Issues • Undergraduate and Postgraduate education in Nursing, psychology, allied health, medicine and dentistry. • Clinical research and innovation.

4. Current Situation in Many Health Care Facilities • Health provider recognises shared responsibility for education and research but: • not high in priority of organisation • Inadequate budget line • University regarded as a tenant that should meet it’s own costs • Formal budgetting for education inadequate

5. Current Situation • Research and innovation regarded as peripheral to main mission. • Many aspects of education regarded as only university’s responsibility.

6. Current Situation Inadequate budgetary lines leads to stresses between partners with either no or inadequate budget stream for significant aspects of clinical training. At its most destructive, this leads to unbundling of costs with attempts to move the total cost of training to the university.

7. Current Situation • Little respect to excellence in education and research in Senior Health Systems funded clinical appointments. • Patchy recognition of these activities in job descriptions. • Inadequate weighting in senior clinical promotions.

8. A New Model • Joint ownership of clinical research and education with single vision of these activities as enhancing clinical outcomes and community health. • R&D central to ethos rather than optimal add on. • Robust governance models to support this.

9. Academic Health (Science) Centres • An old model in the USA • A new model in most parts of Europe and Asia. • A non existent model in Australia

10. Key Issues in Clinical Science Clinical Research – Enhances patient care by Latest technologies and treatments supported by innovations Attractive to many of the most able staff Supports best practise in care pathways and quality In an open market, leads to a virtual cycle where manifest excellence attracts patients.

11. A full engagement in the health professions The best care available Constant improvement Training of others “The triple mission”

12. Evolution of Teaching Hospitals 1 Engrafted University Departments in large general hospitals Considerable separation Academics of variable influence Town versus gown Most staff engage in teaching few in research

13. Evolution of Teaching Hospitals 2 Larger vibrant Academic departments Many health staff doing doctorates Appointment committees value academic credentials Solid research in many hospital departments carried out by a minority of staff

14. Evolution of Teaching Hospitals 3 High level academic clinical integration No differentiation between university and health trust staff Single employer or agreed dual control Expertise in teaching and research on appointment panels. Teaching and research component in all consultant job descriptions Many research active staff Departments with national and international reputation Poor community links

15. Evolution of Teaching Hospitals 4 Academic health system Incorporating all in 3 and in addition Effective links with community services in - chronic illness management - hospital in the home Population and family medicine KPI’s reflect health across the community

16. Academic Health Science Centres and Health Systems Triple mission Virtuous cycle Best care possible Integrated with the community

17. UCL Partners A Culture of Excellence An Ethos of Collaboration A Commitment to Improving Lives

18. UCL UCLH Royal Free GOSH Moorfields 18

19. EXCELLENCE DH Highly Cited Publications Review 2006 Highly Cited Publications Oxford UCL P Imperial Manchester Cambridge Kings Birmingham 19

20. A fundamental change in the basis of interactions at all levels in our organisations • Span disciplines • Cross sites • Link institutions • Encourage Innovation • Patient focused ethos EXCELLENCE IN EDUCATION CLINICAL QUALITY RESEARCH INNOVATION IMPACT Locally / Nationally / Worldwide

21. Delivering & Measuring Health Impact UCLP Programmes & Leadership UCLP Industry Engagement Powerful Networks UCLH UCL Educating Outstanding Individuals Driving & Streamlining Research UCLP Innovation Research Initiatives Moorfields Clinical Need

22. UCLP Programmes & Leadership Industry Engagement Driving & Streamlining Research UCLP Powerful Networks Delivering & Measuring Hlth Impact Educating Outstanding Individuals Educating Outstanding Individuals

23. APPROVAL UCLP BOARD INTEGRATED STRATEGIC PLANNING IMPLEMENTATION UCLP Programmes Cardiovascular Child Health Eyes & Vision Immunol/Transplant Infection Neuroscience Women’s Health UCL Royal Free Moorfields Great Ormond Street UCLH Programme Director Education Deanery Linking across disciplines, sites + institutions Research Deanery Cancer Mental Health Population Health Clinical Deanery

24. UCLP Programmes & Leadership Industry Engagement Driving & Streamlining Research UCLP Powerful Networks Delivering & Measuring Hlth Impact Educating Outstanding Individuals Educating Outstanding Individuals

25. Middlesex Hospital Eastman Dental NHNN Queen Sq Institute of Neurology Institute of Opthalmol Wolfson Institute Faculty of Biomedical Sciences Heart Hospital Institute of Child Hlth Faculty of Life Sciences Eastman Dental EGA Women’s UCL School of Life & Medical Sciences UCL UCLH Tropical Diseases Faculty of ClinSci UCLP RNTNE Moorfields

26. LSHTM City Univ LS Pharm UCL UCLH PCT’s Whittington UCLP Moorfields North Middx MHT’s

27. BENEFITING PATIENTS IN THE COMMUNITY Population + Mental Health Programmes Primary Care Trusts Mental Health Trusts General Practice Other Hospital Trusts London School Hygiene + Tropical Medicine UCL Population Health UCL Mental Health UCL Core members • New Initiatives • A Focus on PREVENTION • Reduction of HEALTH INEQUALITIES • Prevention of OBESITY • Early Intervention in DEPRESSION • Early Detection of DEMENTIA • Severe CHRONIC MENTAL DISORDER

28. UCLP Programmes & Leadership Industry Engagement Driving & Streamlining Research UCLP Powerful Networks Delivering & Measuring Hlth Impact Educating Outstanding Individuals Educating Outstanding Individuals

29. INVESTMENT IN WORLD CLASS FACILITIES UCLH Tower Opened 2006 Moorfields, Richard Desmond Eye Centre, Opened 2007 UCLH EGA Wing Opened 2008 GOSH Plans

30. UCLP Clinical Quality Deanery To ensure that all patients receive safe, effective care and an optimal experience Safety National Centre for Risk adjusted Condition Specific Outcome Measures Patient Experience Development of Real Time Patient Experience Feedback Systems Outcomes Develop International comparators for Benchmarking The Clinical Quality Deanery will work with UCLP Programmes and CORU (Clinical Outcomes Research Unit)

31. UCLP Programmes & Leadership Industry Engagement Driving & Streamlining Research UCLP Powerful Networks Delivering & Measuring Hlth Impact Educating Outstanding Individuals Educating Outstanding Individuals

32. EDUCATING OUTSTANDING INDIVIDUALS Education/Teaching/Training/CPD/Recruitment/Retention Opportunities of Scale 2000 Medical Students Undergraduates 87 Taught Masters Programmes MSc Programmes 1148 PhD Students PhD Programmes Largest Cohort ACF’s + HEFCE SL’s Postgrad / CPD Research Courses Nursing and AHP’s

33. EDUCATING OUTSTANDING INDIVIDUALS Education/Teaching/Training/CPD/Recruitment/Retention Opportunities for Innovation Research Training Programme UK’s 1st Translational Science MSc Undergraduates MSc Programmes Regulation, Ethics, Methodology Programme PhD Programmes E - Learning Initiative Nursing and AHP’s Postgraduate Training/ CPD Cross Disciplinary + PhD program MBPhD Programme (only 2 in UK) ‘Bench to Bedside’ PhD program

34. UCLP Programmes & Leadership Industry Engagement Driving & Streamlining Research UCLP Powerful Networks Delivering & Measuring Hlth Impact Educating Outstanding Individuals Educating Outstanding Individuals

35. UKCMRI UKCMRI 1500 Scientists £600m St Pancras British Library Sainsbury/ Wellcome Centre 150 Scientists £70m

36. STREAMLINING RESEARCH UCLP RESEARCH DEANERY + JOINT R&D OFFICE GMP vector facility GLP Toxicology Research Translators Drug Discovery Pathway Computational medicine / Informatics Biobanks + well phenotyped cohorts Platform Technologies + Methodologies One stop regulatory approval Clinical Research Facilities Clinical Trials Units Clinical Research Network 36

37. 51 Senior Academic Appointments 2009/10 Including 28 Professorial appointments Cardiovascular Pharmacology Cardiothoracic Surgery Endovascular Surgery Cardiovascular Science • ENT • Colorectal Surgery • Urological Cancer Obstetrics Fetal Medicine Neonatology Translational Neuroscience Neurosurgery Macular Degeneration Diabetic eye Disease Opthalmic Epidemiology • Psychology • Health Economics • Public Health • Health Informatics • Systems Medicine • Nursing + Midwifery • Computational Medicine • Paediatric Cancer Biology • Paediatrics • Metabolic Chemistry • Paediatric Neurology

38. UCLP Programmes & Leadership Industry Engagement Driving & Streamlining Research UCLP Powerful Networks Educating Outstanding Individuals Delivering & Measuring Hlth Impact

39. Single UCLP Commercial Office & an IP Vehicle for each Programme Devices Diagnostics Therapies Data INDUSTRY UCLP COMMERCIAL OFFICE Cardiovascular Child Health Eyes & Vision Immunol/Transplant Neuroscience Women’s Health Infection IP £ Spin Outs Research Contracts & Collaborations Implementation

40. UCLP Programmes & Leadership Industry Engagement Driving & Streamlining Research UCLP Powerful Networks Educating Outstanding Individuals Delivering & Measuring Hlth Impact Innovation Research Initiatives Clinical Need

41. A fundamental change in the basis of interactions at all levels in our organisations • Span disciplines • Cross sites • Link institutions • Encourage Innovation • Patient focused ethos EXCELLENCE IN EDUCATION CLINICAL QUALITY RESEARCH INNOVATION IMPACT Locally / Nationally / Worldwide

42. Lessons for Australia Governance relationships between Universities and Healthcare organisations Scale necessitates collaboration Need to look at whole of health and not large hospitals alone. Systems versus centres Identify clear funding streams Triple mission adopted by both parties Identify KPI’s and strategic structure that supports constant improvement

43. Academic Health (Science) CentresPartnership or Splinter Advantages: • Easier to get Buy in • Develop more ambitious and broadly based consortia • Governance advantages • Can be true partnerships

44. Academic Health (Science) CentresPartnership or Splinter Disadvantages: • May lack strategic authority • Partners have to seed genuine “authority” to a common process

45. Academic Health (Science) CentresMerged or Fused Model Advantages: • Clear line management authority linked to a single governance • Nimble • Major changes more easily made

46. Academic Health (Science) CentresMerged or Fused Model Disadvantages: • University only viable owner • Financial risks/misalignments • Limited scale • Very difficult to achieve

47. Academic Health (Science) CentresFused Model Imperial College London • Most ambitious project in UK • Major cultural and governance issues to be overcome • Dynamic leadership Many American Models • University owns hospitals • Dean is always supported by a senior health care executive

48. Academic Health (Science) CentresSplinter Models Harvard Partners • Unique in historical development • Hospitals major partner • Academic input by “control” of hiring and promotion

49. Academic Health (Science) CentresSplinter Models Pittsburgh Model • True partnership • Whole of community role • Shared governance with high level of respect • Financial dividend to University

50. Academic Health (Science) CentresSplinter Models UCLP/Kings Health Partners • Closer to Australian Scene Karolinska • Carefully developed dual management structure