1. Understanding the economic and social
impact of academic clinical partnerships
Stephen Davies
Cambridge University Hospitals NHS Foundation Trust
NIHR Service Delivery and Organisation Programme
SQW Consulting (Associate)

2. • Why might we want to understand the
economic and social impact of academic
clinical partnerships?
• How might we understand this impact?

3. • Why might we want to understand the
economic and social impact of academic
clinical partnerships?
• How might we understand this impact?

4. Perspectives from the USA
• Social mission
• Social contract
• Economic contribution

5. Social Mission
‘ Why are academic health centers worth our
concern and our protection? …the rationale
rests on the observation that competitive
markets alone are unable to produce certain
types of socially valuable goods and
services…..applying this rationale to the work of
AHCs we identify activities – their ‘social
missions’ - that are likely to be undersupplied in
competitive markets’
Blumenthal, D et al ‘The Social Missions of Academic Health Centers’
NEJM 337(21) 1550-1553 (1997)

6. Social Contract
‘ as the millennium approached…the social
contract between society and medical education
had been bilaterally broken. Society was no
longer providing academic health centers
sufficient financial or political support. In turn,
medical faculties had grown inwardly focused’
Time to Heal – American Medical Education from the
Turn of the Century to the Era of Managed Care’
Kenneth M Ludmerer, OUP 1999

7. Articulating the social contract
• Underserved patients
• Rural and inner city
outreach
• Uncompensated care
• Care of the severely
ill
• Specialist and tertiary
services

8. Economic impact
‘A recent AAMC report on the economic impact
of medical schools and teaching hospitals
indicates that many of these institutions function
as engines of significant growth in their
communities, affecting not only their immediate
regions but also the economy of the entire
nation…. total impact on American economy
$326bn per annum….1 in 54 wage earners
receive part of their income from an AHC’
Association of American Medical Colleges (AAMC) Press Release
November 2004

10. Increasing scope for unintended
consequences for AHCs: England
• Choice
• Payment by results
• R&D funding reforms
• NMET funding changes
• ISTCs
• Research governance
• International competition – research, patients?

11. ‘The Cambridge Biomedical Campus’
2040 2020

12. The Glasgow Southern General ‘island’

13. • Why might we want to understand the
economic and social impact of academic
clinical partnerships?
• How might we understand this impact?

14. International
IMPACT National
Regional
Local
National Human Capital
Regional
Local training and development Local
education health care
procurement health promotion
ic
om
P l a ce
employment environmental
on
connectivity
Ec
innovation Clinical Medical
Partner/s School built environment
discovery
good governance
research and development equity and participation
social networks
social inclusion
Kn o w
le d g e ital
l Cap
Socia
Local
National
International IMPACT

15. Projects undertaken 2005-7
• Phase 1 – for AUKUH/CHMS - mainly
quantitative data complied from data in public
domain plus surveys. Chart book published
2006.
• Phase 2 – depth studies of specific centres, with
primary data collection.
– Manchester
– Norwich
– [Glasgow]

16. Quantifying economic impact
Economic Impact of an Academic Clinical Partnership
A. Employment B. Expenditure Impact
Impact
2. All income generated by the Trust and School of Medicine
1. Employment : 3. Expenditure on 4. Non-pay 5. Capital
Direct occupational salaries expenditure expenditure
impact groups workforce and wages on goods and services on buildings
by geography by geography and equipment
of ACP characteristics &
geography of by geography
partners (and estimated
employment Minus exclusions
employment)
(e.g. spend on partners)
Apply appropriate local, regional and national
Indirect and multipliers for indirect impact within model
induced impact of
multiplier effects 6. Estimated combined direct, indirect and induced impact
of ACP partners on sectors at a local, regional and national level
Other indirect 7. Estimated student 8. Estimated visitor impact of
impacts of ACP partners expenditure in the local economy non-local visitors to the region

17. Establishing other impacts
• Human capital
– Mainly secondary data to quantify main health care
and education outputs, some survey data.
• Knowledge
– Secondary data to quantify knowledge outputs plus
qualitative data on research impact.
• Social capital
– Qualitative data from interviews
• Place-making
– Qualitative data from interviews and published
sources

18. Profile across membership
External Funding by Trust 2004/5
£60
Millions
£50
£40
£30
£20
£10
£0
AH E AM AF C AB U J O G N AN AD X AQ Z L AK AA S AL H AI Q AP AC AE AO W D Y B T V I
External Funding External Income
Top 10 Trusts receive 63% of research funding

19. Comparative profiles of centres
‘Golden triangle’ partnership
London centre –single trust
New medical school partnership

20. Social capital
• Regarded as a key determinant of sustainable
economic and social development.
• No single definition – but usually regarded as
encompassing:
– Social networks
– Shared values and trust
– Behavioural norms
• Some evidence that also a strong determinant of
population health.

21. Place
• Growing importance of ‘place-making’ in UK
public policy – e.g. Lyons Report into future of
local government.
• ‘liveability’ – the extent to which localities have
the qualities that make them desirable, healthy
and safe places to live.
• AHC ‘place’ impact especially important in
context of redevelopment – includes built
environment, energy, travel, waste, contribution
to local governance.

22. Conclusions
• Why?
– National agenda – sector interest
– Local agenda – centre interest
• How?
– Multi-dimensional model using mixed
methods
– Yields evidence that can be used at both
national and local level.

23. Limitations/reservations
• Variable rigour of methodology
• Demonstration of added value of
partnership
• Reductionist?

24. ‘Understanding the economic and social
effects of academic clinical partnerships’
S M Davies and A Bennett
Academic Medicine, June 2008, 535-9
stephen.davies@addenbrookes.nhs.uk