The vision, priorities & approach for ucl partners AHSN
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  • The first trial of the modern era promoted by the huge numbers of deaths due to scurvy As the serving Surgeon on HMS Salisbury, in 1747 Lind’s trial consisted of just 12 men, grouped into pairs and given a variety of dietary supplements from cider to oranges and lemons.The trial only lasted six days but, within that time, there was a noticeable improvement in the group eating the fruit. It took 6 years to publish the trialAlthough the importance of Lind's findings on scurvy were recognised at the time, it took more than 40 years for the official Admiralty to issues an order on the supply of lemon juice to ships. Scale was cracked by Admiral Gardner who did an n=1 study of a whole ship on a long voyage - mixed the lemon juice daily with rum and had full compliance and no scurvy -then adopted in every ship in the fleet- a moral for us all about patient pull!With this, scurvy disappeared almost completely from the Royal Navy.
  • AndQuarterly AHSC Executive and Forum meetingsSharing representation on cross London structures e.g., Clinical Senate

The vision, priorities & approach for ucl partners AHSN The vision, priorities & approach for ucl partners AHSN Presentation Transcript

  • The Vision, priorities &approach for UCL PartnersAHSNAmanda Begley | Director of Innovation and Implementation | UCLPartners AHSN
  • Academic Health Science PartnershipDr Amanda Begley, Director of Innovation & Implementation13th June 2013
  • On the 20th of May 1747, I selectedtwelve patients in the scurvy, on boarthe Salisbury at sea. Their cases wereas similar as I could have them. Theyall in general had putrid gums, thespots and lassitude, with weakness oftheir knees. They lay together in oneplace, being a proper apartment forthe sick in the fore-hold; and had onediet common to all, viz. water-gruel1795Routine adoption:lemon juice towhole fleet1747Lind‟s Trial1753Findings Published1794Lemon juice issued onnon-stop voyage to IndiaDelayed adoption: wasted opportunities; lost lives
  • 4Clinical Procedure LandmarkTrialRate ofUse studyRate ofUse %Annual increasein Rate of Use %Flu Vaccination 1968 1997 55 1.9Thrombolytic therapy 1971 1989 20 1.1Pneumococcal vaccination 1977 1997 35.6 1.8Diabetic eye exam 1981 1997 38.4 2.4Beta Blockers after MI 1982 1997 61.9 4.1Mammography 1982 1997 70.4 4.7Diabetic footcare 1983 1998 20 4.0Cholesterol screening 1984 1995 65 5.9Fecal occult blood test 1986 1993 17 2.4Research into routine practice = 17 yearsAverage annual rate of adoption = 3.2 %Balas, E. A., & Boren, S. A. (2000). Yearbook of Medical Informatics: Managing Clinical Knowledge for Health CareImprovement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH.How fast do useful new treatments get to patients?
  • The scale of the taskAn average of 17 years forproven innovation to berolled out into practice“Brownian motion”diffusion along a pipelineOrganisational boundariesFunding silosVested interestLives lostResources wastedThe resultThe barriersThe problem
  • UCLP spans a wide range of partners, collaborating to achievemeasurable health gain for a population of six million6m populationacross NE andNC London,Herts, Beds andEssex• 19 ClinicalCommissioningGroups• 24 healthcareorganisations(acute trusts, mentalhealth trusts;communityproviders)14 HigherEducationInstitutes andresearch networks26 local authorities6Including in London:- City of LondonLB Barking and DagenhamLB BarnetLB CamdenLB EnfieldLB HackneyLB HaringeyLB HaveringLB IslingtonLB NewhamLB RedbridgeLB Tower HamletsLB Waltham Forest
  • Discovery ImplementationClinical Trials Evaluation CapabilityAcademicHealth ScienceCentreLocal ClinicalResearchNetworkAcademicHealth ScienceNetworkApplied HealthResearch(CLAHRC)Local Educationand TrainingBoardsImproving patient and population health, supporting economic benefitfor UK PLCOUTCOMESValues Relationships AlignmentCo-creation
  • The AHSN will achieve its vision through five major programmes‘IntegrationProgrammes’Collaborate tocreate and applyinnovation at asystem levelCancerResearchEducation18Cardiovascular2Mental health3Co-morbidities4Life course for women and children5Together accountfor > 80% ofamenableprematuremortality andcurrent healthcarespendQuality&ValueInformaticsInnovationSystem & Programme Enablers
  • Examples of Programme objectivesIntegratedcancerIntegratedcardio-vascularIntegratedmentalhealth123• Improve one year survival for all cancers, with 250 fewer patientsdying per annum from 2016/7• Offer every patient the opportunity to participate in a well-designedclinical study during their cancer care• Identify and treat/tackle 25% more CV risk factors which will result inreduced major acute coronary events by 2017• Develop a „First in Man‟ devices centre, making the most of theYale/UCL-QM/Anglia Ruskin Med Tech collaboration to assess andintroduce novel cardiovascular devices• Improve recovery rates in child and adolescent mental health witha 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 makingemployment a key focus of mental health services9
  • ComorbiditiesLife Course45• Empower patients to self manage with access to personalised healthrecords• Embed enablers of care organised around patients – education,informatics, tariff etc.• Establish paediatric chronic disease management networks to improvediagnosis and management of chronic conditions from childhood• 400 more Health Visitors by 2015• Create Schools Network bringing agencies together to addressabsenteeism and outcomes10Examples of objectives under development for newer programmes
  • LondonCancerInfectiousdiseasesRareDiseasesImmunology&TransplantationCardiovascularMaternal,Child&AdolescentHealthOralHealthNeurosciencesMentalHealth&WellBeingENTEyes&VisionPersonalisedMedicineDiscovery - Academic Health Science CentreLife-Long Health Neuroscience
  • Some examples of Joint Working with industryDiscovery ImplementationRanked as first in the UK foracademic-industry partnerships(Nature Biotech., 2013;31,383)Early target area of rare diseasesJoint partnership with the GSK/Stevenage Bioscience Catalyst andUniversity of CambridgeJob Exchange:- UCLP & GSK,- Moorfields & NovatisNICE TAs:- Amgen & London Cancer- NIC, GSK & Co morbidities- TBD & CardiovascularService:Electronic discharge summariesPREMs
  • 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 genomicsPanLondonAHSCs• Cancer: work on patient experience and A&E presentation, agreed asingle holistic needs assessment tool and preferred referral pathway forsuspected colorectal cancer, work programme started on chemotherapy,• Mental health: supported by the Strategic Clinical Network, each AHSNwill lead on different aspects of mental health. UCLP will lead ondepression and the pan-London Clinical Commissioning Group network• Frailty – London wide value based healthcare network establishedPanLondonAHSNs• Eastern and UCLP (n = 11m). Collaboration to create a presence atStevenage Bioscience Park• Oxford and UCLP: collaboration to create Centre for the Advancement ofSustainable Medical Innovation (CASMI)UCLPBoundaries
  • “Success depends on shared values,strong partnership working, localleadership and energy, and clarity onoperational delivery…rather than a singlesystem of control”David Fish,Managing Director of UCLPartners,Lancet, June 27th 2012Find out more: www.uclpartners.comamanda.begley@uclpartners.com
  • Clinical Commissioning Groups (CCG) Guidance onPromoting InnovationPromotingInnovation todeliver betterquality at less costfor your localpopulationGuidance Note :8 questions forCCGs toconsiderChecklist:10 potentialactions, alignedwith thecommissioningcycleSupplementaryGuidance 1:What isinnovation?SupplementaryGuidance 2:Leadership,culture &valuesSupplementaryGuidance 3:Engaging,networking,partneringSupplementaryGuidance 4:AccountabilityEndorsed by: