Integrating Care:Insights from Imperial AHSC

Professor Stephen SmithPro-Rector(Health) Imperial College LondonCEO, Imperial College Healthcare NHS Trust Trust

Four perspectives:

The

UK

’s fi

rst A

HS

C Integrating Service, Research and Education: Imperial College and Imperial College Healthcare NHS Trust

AH

SS Working

with other specialist providers IC

O p

ilot Integrated

Care across primary and secondary care Lo

ndon

AH

SCs Working

together for health & wealth in London

The Cooksey Gaps

INVENTION EVALUATION ADOPTION DIFFUSION

UK is a world leader in research but this is not translated into new innovations, products or healthcare practices. In 2006, Sir David Cooksey identified why – the 2 gaps in translation:- the translation of basic and clinical research into ideas and products- the introduction of those ideas and products into clinical practices

Wealth Creation

Expenditure

Health

United Kingdom6%>2%

Imperial College AHSC

Hillingdon

Harrow

Ealing

Brent

Barnet

Enfield

Haringey

Camden

Hounslow

Richmond Wandsworth

Kingston

Merton

Sutton Croydon

Bromley

Lewisham

Lambeth

Southwark

Greenwich

WestminsterKen.

& Chel.

CityTowerHamlets

Newham

HackneyIslington

Waltham Forest

Redbridge

Havering

Barking

Bexley

Hammersmith Hospital

Queen Charlotte’s & Chelsea Hospital

Charing Cross Hospital

Western Eye Hospital

St Mary’s Hospital

Imperial College LondonTwo leading organisations coming together as the first AHSC in the UK

Imperial AHSC – a closer look• AHSC partnership formed in 2007 - created largest

acute Trust in England – improved all Key Performance Indicators within 9mths

• Over 1,000,000 patient contacts a year - Serving a local population of 2 million

• 9,500 staff including 850 consultants, and over 200 clinical academics

• Hospital Budget of c £900M

Excellence in research

– 73% of all college research activity judged as world-leading or internationally excellent, highest in UK

– Times Higher Education Supplement 2010 World University Rankings rated the College 3rd in Europe and 9th in the world overall (in 2009 3rd/5th)...

– ... and 3rd in Europe and 5th in the World for pre-clinical, clinical and health

– One of the largest Medical Faculties in Europe with an annual research spend of over £162m (08/09)

University Tech Transfer Companies

– Imperial Innovations the first majority university-owned technology

transfer company to float in the UK

– £284M Market value, November 2010

– Profit of £5.5 million, 2009/10

Peptides to reduce obesity

N-Terminal

C-Terminal Octapeptide

HISSER

GLN GLY THR PHE THRSER ASP TYR

SER

LYS

TYRLEUASP

SERARGARG

ALA

GLNASP PHE

VALGLN

TRP

LEUMETASNTHRLYSARG

ASNARG

ASN

ASN

ILE

ALA

33

69

Therapeutics for cat, dust-mite, grass allergy

Developing stents and grafts

From AHSC to AHSS• Building on strong

relationship through the National Heart & Lung Institute

• Royal Brompton & Harefield Foundation Trust became first Associate in 2010

Integrated Care Pilot for North West London: driving collaboration across care providers

Pilot providers includes General Practice, Imperial College Healthcare Trust, Central London Community Healthcare, Local

Authorities, Mental Health Trusts and Third Sector

What are we going to do?

1) Inspire collaboration and integration of services

2) Decrease emergency admissions by 30% and nursing home admissions by 10% for diabetics and frail elderly

3) To overall reduce cost of these groups by 24% over 5 years

4) Significantly improve patient experience

Improvement to quality of patient care

Creation of a richer

professional experience

Improved Finances

1

Three core benefits:ICO Pilot

Group (50,000+)

Practice (~5,000)

Mental Health Specialist

Sub-Group (~10,000-30,000))

Acute Specialist

Regular meetings

Less frequent attendance

Regular additional calls

Social care Specialist

Community matron

Practice nurse

Social worker

District nurse

GP

Community Mental Health

worker

Clinicians will develop a more pro-active approach to managing care through more frequent interaction…

2

Preliminary modelling suggests that the pilot could significantly reduce emergency admissions across North West London

GP Practice Pilot

▪ Avoid 2,300 admissions across the

whole pilot pa assuming participation of 380,000 population

▪ Savings of ~£9m from reduced admissions

per annum

SOURCE: HES 2007/08 - 2008/09, ICO benefits and costs modelling

1 avoided admission per

month

4 avoided admissions per

month

190 avoided admissions per

month

3

Information sharing

- joint training and development- develop own team cultures

A mechanism for sharing that aggregates patient-level data -

Better analysisEasier access

Aligned incentives

Outcomes incentives aligned

Providers will share a pool of funding

Joint governance

Clinical enablers

Organisational development and culture

Joint governing, decision-making body that monitors and acts on

issues

Several enablers have been identified to support leaders and clinicians working across provider organisations within the IC pilot in this new way

4

A B

C D

London AHSCsWorking together for health & wealth in London• Integrated Care Pilots• With the Marsden/ICR

and SHA on cancer services for London

• On research infrastructure & programmes

• On wealth creation

London needs to be competitive globally

Tel Aviv

Shanghai

Singapore

Dubai

BostonSan

Diego

London ?

Bay Area

California • San Francisco and San Diego’s universities published ~7300 life sciences papers and were awarded 87 patents in 2007

• Home to over 1900 biotech companies and ‘lighthouse companies’ such as Genentech and Amgen

• Over 60,000 people are employed in biotechnology companies in California

• 2010: Pfizer’s first Global Center for Therapeutic Innovation with UCSF

What about London?

GMEC

NHS Reforms need to help not hinder

More needs to be done to encourage

collaborations with industry