the vision, priorities & approach for ucl partners ahsn
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The Vision, priorities & approach for UCL Partners AHSNAmanda Begley | Director of Innovation and Implementation | UCL Partners AHSN
Academic Health Science Partnership Dr Amanda Begley, Director of Innovation & Implementation
13th June 2013
On the 20th of May 1747, I selected twelve patients in the scurvy, on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of their knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet common to all, viz. water-gruel sweetened with sugar in the morning; fresh mutton-broth often times for dinner; at other times light puddings, boiled biscuit with sugar, &c. and for supper, barley and raisins, rice and currants, sago and wine, or the like. Two of these were ordered each a quart of cyder a-day. Two others took twenty-five drops of elixir vitriol.
1795Routine adoption:
lemon juice to whole fleet
1747Lind’s Trial
1753Findings Published
1794Lemon juice issued on
non-stop voyage to India
Delayed adoption: wasted opportunities; lost lives
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Clinical Procedure Landmark Trial
Rate of Use study
Rate of Use %
Annual increase in Rate of Use %
Flu Vaccination 1968 1997 55 1.9
Thrombolytic therapy 1971 1989 20 1.1
Pneumococcal vaccination 1977 1997 35.6 1.8
Diabetic eye exam 1981 1997 38.4 2.4
Beta Blockers after MI 1982 1997 61.9 4.1
Mammography 1982 1997 70.4 4.7
Diabetic footcare 1983 1998 20 4.0
Cholesterol screening 1984 1995 65 5.9
Fecal occult blood test 1986 1993 17 2.4
Research into routine practice = 17 years Average annual rate of adoption = 3.2 %
Balas, E. A., & Boren, S. A. (2000). Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH.
How fast do useful new treatments get to patients?
The scale of the task
An average of 17 years for proven innovation to be rolled out into practice
“Brownian motion” diffusion along a pipeline
Organisational boundariesFunding silos
Vested interest
Lives lost
Resources wasted
The result
The barriers
The problem
UCLP spans a wide range of partners, collaborating to achieve measurable health gain for a population of six million
6m population across NE and NC London, Herts, Beds and Essex
• 19 Clinical Commissioning Groups
• 24 healthcare organisations (acute trusts, mental health trusts; community providers)
14 Higher Education Institutes and research networks
26 local authorities
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Including in London:- City of LondonLB Barking and DagenhamLB BarnetLB CamdenLB EnfieldLB HackneyLB Haringey
LB HaveringLB IslingtonLB NewhamLB RedbridgeLB Tower HamletsLB Waltham Forest
Discovery ImplementationClinical Trials Evaluation Capability
Academic Health Science
Centre
Local Clinical Research Network
Academic Health Science
Network
Applied Health Research(CLAHRC)
Local Education and Training
Boards
Improving patient and population health, supporting economic benefit for UK PLC
OUTCOMESValues Relationships AlignmentCo-creation
The AHSN will achieve its vision through five major programmes
‘Integration Programmes’
Collaborate to create and apply innovation at a system level
Cancer
Res
earc
h
Ed
uca
tio
n
1
8
Cardiovascular2
Mental health3
Co-morbidities4
Life course for women and children5
Together account for > 80% of
amenable premature
mortality and current healthcare
spend
Qu
alit
y &
Val
ue
Info
rmat
ics
Inn
ova
tio
n
System & Programme Enablers
Examples of Programme objectives
Integrated cancer
Integrated cardio-vascular
Integrated mental health
1
2
3
• Improve one year survival for all cancers, with 250 fewer patients dying per annum from 2016/7
• Offer every patient the opportunity to participate in a well-designed clinical study during their cancer care
• Identify and treat/tackle 25% more CV risk factors which will result in reduced major acute coronary events by 2017
• Develop a ‘First in Man’ devices centre, making the most of the Yale/UCL-QM/Anglia Ruskin Med Tech collaboration to assess and introduce novel cardiovascular devices
• Improve recovery rates in child and adolescent mental health with a stretching target of 50% by 2016
• Reduce long-term unemployment in mental health patients by 10% by 2016 through better integration with major employers and making employment a key focus of mental health services
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Co morbidities
Life Course
4
5
• Empower patients to self manage with access to personalised health records
• Embed enablers of care organised around patients – education, informatics, tariff etc.
• Establish paediatric chronic disease management networks to improve diagnosis and management of chronic conditions from childhood
• 400 more Health Visitors by 2015
• Create Schools Network bringing agencies together to address absenteeism and outcomes
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Examples of objectives under development for newer programmes
Lond
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ance
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Rar
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isea
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Imm
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rans
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Car
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Mat
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l, C
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ealth
Ora
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Neu
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Men
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ealth
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ell B
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Eye
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Personalised Medicine
Discovery - Academic Health Science Centre
Life-Long Health Neuroscience
Clinical Trials - Enhanced trials efficiency and recruitment
• 25% of all commercial studies on the NIHR portfolio led by Chief Investigators in UCLP
• >200,000 patients recruited in last five years from a population of 2.2 million (C&EL)
• 181 trials through Harmonisation pilot:
− Study wide review time from an average of 104 days to 7 days
− Local reviews from an average of 90 days to 10 days
• Developing relationships with Essex, Herts and Beds clinical research networks to
optimise synergies and combined delivery and maximise total recruitments
Focus support for partners with the greatest scope to increase recruitment
A B C D E F G H I J K L
M N O P Q R S T U V
0
50
100
150
200
250207
115 11597 83
57 46 45 43 34 33 29 26 24 23 21 17 15 11 10 4 3
Trust
Rec
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op
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Some examples of Joint Working with industry
Discovery Implementation
Ranked as first in the UK for academic-industry partnerships (Nature Biotech., 2013;31,383)
Early target area of rare diseases
Joint partnership with the GSK/ Stevenage Bioscience Catalyst and
University of Cambridge
Job Exchange: - UCLP & GSK,
- Moorfields & Novatis
NICE TAs: - Amgen & London Cancer
- NIC, GSK & Co morbidities- TBD & Cardiovascular
Service:Electronic discharge summaries
PREMs
AHSN collaborations for scale – trials, rare diseases, diffusion
• Improvement Science London• Joint collaboration with London Medicine• Scoping how to create a centre of excellence for
genomics
Pan London AHSCs
• Cancer: work on patient experience and A&E presentation, agreed a single holistic needs assessment tool and preferred referral pathway for suspected colorectal cancer, work programme started on chemotherapy,
• Mental health: supported by the Strategic Clinical Network, each AHSN will lead on different aspects of mental health. UCLP will lead on depression and the pan-London Clinical Commissioning Group network
• Frailty – London wide value based healthcare network established
Pan London AHSNs
• Eastern and UCLP (n = 11m). Collaboration to create a presence at Stevenage Bioscience Park
• Oxford and UCLP: collaboration to create Centre for the Advancement of Sustainable Medical Innovation (CASMI)
UCLP Boundaries
“Success depends on shared values, strong partnership working, local
leadership and energy, and clarity on operational delivery…rather than a single
system of control”
David Fish, Managing Director of UCLPartners, Lancet, June 27th 2012
Find out more: [email protected]
Clinical Commissioning Groups (CCG) Guidance on Promoting Innovation
Promoting Innovation to deliver better quality at less cost for your local
population
Guidance Note : 8 questions for CCGs
to consider
Checklist: 10 potential actions,
aligned with the commissioning cycle
Supplementary Guidance 1:
What is innovation?
Supplementary Guidance 2:
Leadership, culture & values
Supplementary Guidance 3: Engaging, networking, partnering
Supplementary Guidance 4:
Accountability
Endorsed by: