UCLPartners Annual Report 2015/16

Contents

Chair’s statement 06 Managing director’s statement 07 Directors’ report 08 • Business review 09 • Introducing UCLPartners – An Academic Health Science Partnership 10 • UCLPartners Academic Health Science Centre 12 • North Thames NHS Genomic Medicine Centre 15 • NIHR Clinical Research Network North Thames 16 • UCLPartners Academic Health Science Network 18 • Improvement, quality and leadership development 26 • System transformation and population health 30 • NIHR Collaboration for Leadership in Applied Health Research and Care North Thames 36 • Education Lead Provider 39 • Corporate governance 40 • Financial report 44 • Auditor’s statement 48

Appendix 1 – Details of partnership members 49 Appendix 2 – Financial statements 50

The information contained in this report was correct at the time of publishing (April 2016)

UCLPartners Annual Report 2015/16 • Contents 03 2015/16 Achievements through partnership

Discovery science

1. Dementia research: 2. Proposed Institute 3. The London Project 4. The Zayed Centre 5. Institute of created a partnership of Mental Health: to Cure Blindness: for Research into Immunity and with the retail industry supported a proposal first embryonic stem Rare Disease in Transplantation: to provide funding for to create new joint cell surgery was Children: supporting developing new dementia research. institutes for mental conducted to reverse the development of diagnostic tools and Join Dementia health and for eyes vision loss caused by the largest centre therapies for immune- Research is increasing and vision, co-located age-related macular for paediatric health related diseases the number of people within a single degeneration research in Europe Partners: Universities, participating in campus Partners: Universities, Partners: Universities, NHS, charity, industry dementia research Partners: Universities, NHS, industry NHS, charity, industry studies NHS, industry Partners: Universities, NHS, industry, philanthropy, AHSN Network, charities

Innovation into practice

1. NHS Innovation 2. Care City: 3. DigitalHealth. 4. Genomic Medicine 5. Improving Accelerator: supporting the London: building the Centre: at the current outcomes for patients created a national creation of a centre ecosystem, market rate, the North with atrial fibrillation: platform supporting for healthy ageing, and evidence base for Thames NHS Genomic driven improvement entrepreneurs to innovation, research digital health across Medicine Centre is and research across accelerate the use and education London recruiting over one the atrial fibrillation of high impact Partners: NHS Partners: London quarter of all rare pathway including innovations across the (acute, primary care, AHSNs and AHSCs, disease genomes in the increased detection, NHS for patient benefit community), industry, MedCity, Greater country anticoagulation, and Partners: NHS England, councils, voluntary London Authority, NHS Partners: NHS (acute), medicines optimisation Health Foundation, sector, innovators, England, industry, NHS universities, National Partners: Pan-London AHSNs, industry universities Institute for Health AHSNs, NHS industry, (global), universities Research (NIHR) policy makers, (global) universities

Population health and place-based care

1. Essex Success 2. The Newham 3. i-THRIVE: 4. National digital 5. Barts Heart Regime: supporting partnership: supporting a major maturity assessment: Centre: developing whole health system supporting service transformation commissioned by system leadership for and social care partnership solutions for child and NHS England to cardiovascular care transformation in to a range of health adolescent mental deliver a national and research south and mid Essex issues in Newham health services digital maturity scan, Partners: NHS Partners: NHS (acute, Partners: Voluntary Partners: Charities, completed by 99% of England, NHS, primary care, out-of- sector, NHS (acute, NHS (acute, mental the NHS universities, charity hospital care) across mental health, health, primary Partners: NHS (acute, south and mid Essex, primary care), schools, care, NHS England), community, mental councils, regulators, universities CLAHRC, universities health, ambulance patient groups (UK and USA) services, NHS England), industry

UCLPartners Annual Report 2015/16 • Achievements through partnership 04 These pages provide a snapshot of achievements delivered in partnership, highlighting the range of partners involved. Every area that supports healthcare delivery works in partnership with patients and/or patient groups and this is fundamental to UCLPartners’ approach.

6. Bloomsbury 7. Africa Centre: 8. Cardiovascular 9. Cancer Academic 10. Cancer Research Research Institute: submitted major Academic Medical Medical Centre: UK Major Centre: planning permission funding bid for Centre: delivering a building on scientific developed a granted for a new research into joint cardiovascular breakthroughs and partnership proposal research institute infectious disease devices centre to supporting spin- to deliver world- to undertake world- and antimicrobial focus on prevention out companies in leading research, leading research into resistance and novel therapies immunotherapy improved patient infectious disease Partners: Universities, Partners: Universities, Partners: Universities, care and greater local Partners: Universities, charity, industry NHS, industry NHS, industry engagement NHS, industry Partners: Universities, NHS, charity, industry

6. Increasing 7. Quintiles Prime Site: 8. Neuroresponse: 9. Multiple sclerosis: 10. Proton Beam improvement UCLPartners has the adapting and scaling supporting the Therapy: partnership capability: created a highest recruitment of a nurse led, 24/7 new introduction of new support has enabled cohort of improvement patients to Quintiles model of care for long pharmacological and approval of a new fellows to embed trials in the world, term neurological digital therapies for a world-class facility at improvement across increasing patient conditions population of 10,000 UCLH for the treatment the partnership to access to innovative Partners: NHS (acute, patients with multiple of complex and hard- delivering better treatments and clinical mental health, 111), sclerosis to-treat cancers in results for patients and trials voluntary sector, Partners: Universities, children and adults populations. Partners: Industry, NHS industry, Yorkshire and NHS, industry, NIHR, Partners: Universities, Partners: Universities, (acute), NIHR Humber AHSN charities NHS NHS (acute, community, mental health), councils

6. National Cancer 7. Dementia 8. Supporting 9. London devolution 10. Host pan-London Vanguard: supporting awareness training: sustainability and pilots: supporting neonatal operational national initiatives helping to reduce transformation plans: new ways of working delivery network: to improve early the variation in care sharing knowledge in partnership to supporting improved diagnosis and provided for people across UCLPartners to transform health and outcomes for prevention of cancer with dementia by reduce costs, increase social care premature babies through forming part training more than pace and scale of Partners: NHS (acute Partners: NHS (London of the national cancer 40,000 staff change and primary care), acute and ambulance vanguard Partners: NHS (acute, Partners: NHS councils trusts, NHS England) Partners: NHS (local community, mental England, STPs across and national partners), health) UCLPartners universities

UCLPartners Annual Report 2015/16 • Achievements through partnership 05 Chair’s statement

UCLPartners has continued this year to make an important contribution to transforming the health of our population, both within the local partnership and through our national connections and influence.

The changing and challenging environment in the delivery of health and social care has not altered the company’s determination to deliver outstanding results on behalf of the partners.

During the year, UCLPartners has reviewed its model, and rather than focusing on patient pathways for specific diseases, the company has adopted an approach to place-based care, building on existing expertise to support improvements for whole populations across the partnership. This approach - linking up organisations in the health and care system to ensure that high quality care is delivered effectively and efficiently - is wholeheartedly supported by the Board and endorsed by national leaders.

Championing innovation and its translation into practice continues to be a key role for UCLPartners, and we have been privileged to host and lead the NHS Innovation Accelerator in partnership with NHS England, the Health Foundation and the country’s Academic Health Science Networks. Following a rigorous recruitment process, 17 top innovators from across the UK and overseas are now supported by the programme to introduce their innovations into the NHS at scale and pace. In just the first nine months, these innovative new products and services have benefited over three million patients across 14% of the NHS and have generated over £8m in additional external income. This is an outstanding achievement and demonstrates UCLPartners’ expertise and knowledge in this field. We will build on this programme as a key part of our ongoing commitment to innovation.

This year we have had success in broadening our engagement strategy to involve more colleagues from the social care sector, whilst continuing to engage with and support partners across healthcare and academia. Our role in DigitalHealth. London will enable us to further connect and support industry partners, and the establishment of our Improvement Fellows Programme enables us to create wider networks for professional quality improvement.

I am grateful to my colleagues on the Board, who continue to supervise the evolution of UCLPartners’ strategic direction, provide expert insight into the company model and approach, and serve as custodians of our values.

On behalf of the Board, I would like to thank every member of staff for their commitment to our mission and for continuing to deliver at such a high level in times of change and uncertainty for the health and care system. I would also like to thank our partners for continuing to involve us in their work. Through the Board, Executive Group and other groups, they have helped shape our priorities and enabled us to focus on what matters most to patients and the population. We will continue to do all that we can to add the greatest possible value to these exceptional organisations.

Rt Hon Professor the Lord Kakkar Chair, UCLPartners

UCLPartners Annual Report 2015/16 • Chair’s statement 06 Managing Director’s statement

When UCLPartners was first created in 2009 the founding partners recognised the need and challenge to learn and apply partnership skills for the overall benefit of the populations served. This continues to be the sustaining foundation on which our work is built and today, partnership approaches to health and care challenges and the need for every partner to develop and utilise these skills are at the forefront of the national and global agenda in discovery science, innovation into practice and population health.

As this report exemplifies we have all made a contribution to real and sustainable value to the partnership, beyond the individual projects.

Partners in our region are already considered leaders in the development of transformation plans, including London’s evolving devolution pilots and the Mid and South Essex Success Regime. In London, four out of the five devolution pilots are in the UCLPartners region and we have engaged with all four, including providing director-level advice and guidance, and encouraging knowledge sharing within and beyond the partnership. In mid and south Essex, it has been a privilege to personally support the transformation across one of the most challenged health economies in the country that is at the forefront of radical change to deliver sustainable healthcare for 1.5million people while closing a funding gap of more than £200million out of a £2.1billion spend over three years.

Having been personally involved in the work to support the reconfiguration of specialist heart and cancer services in region, I congratulate all the staff in the partnership who have worked so hard to make such a marked difference for people living with these prevalent diseases. Almost one year on from opening the new dedicated specialist centre at Barts the results speak for themselves: the standardised hospital mortality index at Barts is 0.535 (equivalent to 340 lives saved every year); faster inter-hospital transfers (target now exceeded by one day); full seven-day emergency and specialist cover for patients with serious acute heart conditions; cancellations reduced by half; and savings worth over £45m to the NHS over five years. For people with cancer, more are now able to have surgery that spares their kidneys (20% more than the national average); and over half of patients with small mass kidney/urological cancers avoid the need for any surgery at all. This makes a huge difference to the experience and the long-term outcomes for patients. These achievements have only been possible through the commitment and collaboration of the clinical teams in the region who saw solutions over the long-term and made this happen.

In discovery science, UCLPartners is supporting the potential redevelopment of the new academic medical campus at St Pancras for mental health and ophthalmology. This is a great example of partners in health and local government working together to add even greater value for patients.

There are many other examples outlined in this report that reflect our achievements and challenges through the year, and it is a credit to all the staff at UCLPartners that we have demonstrated such progress and resilience.

As a company, we have remained true to our values of patient and population focus, developed in partnership and delivered at pace. We have reviewed our ways of working to ensure the company is best positioned and agile to respond quickly to the evolving needs of our partners in the coming years.

Professor Sir David Fish Managing Director, UCLPartners

UCLPartners Annual Report 2015/16 • Managing Director’s statement 07 ondon Directors’ Report L sity of niver U y ar M ueen Q ©

UCLPartners Annual Report 2015/16 • Director’s Report 08 Business Review

Introducing UCLPartners

UCLPartners is a leading academic health science partnership that brings together people and organisations to transform the health and wellbeing of the population. It was created in 2009 as a small partnership that has grown to one that now serves a population of over six million people through more than 40 partner organisations across the NHS, higher education and local authorities.

UCLPartners’ commitment How do we achieve this?

UCLPartners exists for three key reasons: In partnership: UCLPartners’ fundamental role is to support and facilitate an ethos of sustainable partnership working in 1. To give patients access to the most effective medical areas that add value for partner organisations, patients and discoveries and innovation. We work with partners populations, and to catalyse improvements in health and to speed up the pathway from scientific discovery and care at greater scale and pace than individual partners can medical innovation to clinical application in health achieve alone. and care. Breaking down barriers: UCLPartners breaks down the 2. To transform the health of the local population. barriers that exist along the pathway of scientific discovery We support and facilitate measurable improvements and innovation and along patient pathways from prevention, in the health and care systems and apply academic diagnosis, treatment and after care to end of life care. This rigour to improve the patient journey from diagnosis is achieved by bringing together people and organisations, to treatment and after care. applying academic rigour and supporting delivery of a portfolio of research, health and social care programmes 3. To support a sustainable health and care system in that address the needs of the population and the long-term England. We work with partners and support system sustainability of the health and care system. transformation that aims to close gaps in health and wellbeing; care and quality; and finance and efficiency. Adaptability: The company’s business model is flexible to respond to the evolving needs of partners and the population. A guiding principle is that delivery and outcomes are attributed to partner organisations rather than the company itself.

Values driven: UCLPartners sets direction, employs staff and works with colleagues based on core values that ensure its work is: patient-led, population-focused, developed in partnership and delivered at pace.

Focus on delivery of solutions: UCLPartners offers a range of support determined by partners’ needs, ranging from workforce development; leadership support and advice; research and evaluation.

Above all else, UCLPartners has an unrelenting focus on challenging the status quo for the benefit of patients and the population.

UCLPartners Annual Report 2015/16 • Introducing UCLPartners 09 Partnership roles

As an academic health science partnership, UCLPartners is In line with our values, UCLPartners takes a patient-centred unique in bringing together a wide set of roles to improve approach to improving quality of care across the system. health of the local population. These roles help our We link improvement in quality to better use of resources colleagues to collaborate more easily, and to bring about across the health system to support organisations and greater improvements to the entire healthcare pathway; individuals to develop capability and infrastructure to from early research, through implementation, to evaluation. improve quality, patient safety and experience. The These roles cover: improvement programme encourages all services involved to be open in sharing learning, to take joint accountability • Early research and discovery: The UCLPartners for addressing gaps in care and focussing efforts to improve Academic Health Science Centre (AHSC) harnesses on what matters most to patients and the population. world-class academic and clinical specialty expertise to speed up the development of new treatments, The detail of this annual report is structured around these diagnostics and prevention strategies. partnership roles.

• Clinical trials: UCLPartners works closely with the National Institute for Health Research (NIHR) Clinical UCLPartners strategic priorities in 2015/16 Research Network (CRN) North Thames, which provides support for clinical trials and other well designed studies Following the publication of the Five Year Forward View in in all areas of disease and clinical need. October 2014, the NHS spent much of this year focusing on delivering the priorities set out for the system. To support • High science into practice: UCLPartners helped to the partners in delivering on the national priorities, establish the North Thames NHS Genomic Medicine UCLPartners’ strategy in 2015/16 focused on: Centre, which aims to help researchers and clinicians better understand, and ultimately treat, rare and • Improving health outcomes for patients and the inherited diseases as well as common cancers. population through supporting the system to implement and evaluate integrated pathways and • Implementation: The UCLPartners Academic Health new models of care Science Network (AHSN) improves health and creates wealth by enabling the NHS and academia to work • Supporting organisations and individuals to develop collaboratively with industry to identify, adopt and capability and infrastructure to improve quality, spread innovation, improvement and best practice. patient safety and experience and reduce costs

• Evaluation: UCLPartners’ work aligns with the NIHR • Embedding innovation to drive change at scale and pace Collaboration for Leadership in Applied Health Research and Care North Thames, which conducts • Ensuring UCLPartners is a sustainable organisation to research into the quality of healthcare and public maximise the benefits to partners, patients and the health to investigate its effectiveness, value for money, population. appropriateness and fairness. Updates against each of these areas are provided • Education: UCLPartners also leverages other roles for throughout this report. the benefit of the partnership, to support the system with the quality of education and capability of staff.

UCLPartners also works to transform systems of care based on patient and population needs. The system transformation team works to improve health outcomes for patients and the population through supporting the system to implement and evaluate integrated pathways and new models of care.

UCLPartners Annual Report 2015/16 • Introducing UCLPartners 10 Looking to the future

Over the coming years, it is clear that UCLPartners needs to continue to support discovery science and innovation into practice, but the greatest national challenge by far is supporting the partners to close the health, quality and financial gaps in the NHS. The scale of the national challenge in the NHS is unprecedented, with deficit projections consistently above £20bn by 2020. Only by closing this gap will there be a sustainable health and care system for the country’s patients and populations.

As a result, through discussions with the UCLPartners Executive and Board, the company has committed to supporting the partners in delivering a sustainable health and care system for patients and the population.

To achieve this, UCLPartners is evolving its approach to focus on three key areas that will achieve the most positive impact on the system. The partnership will harness the power of the Academic Health Science Centre and Academic Health Science Network to drive system-wide, population health improvements, in a new programme called Population Health. The three programmes will feed into each other as outlined below:

Discovery science harnesses world-class academic and clinical expertise to speed up the development of new treatments, diagnostics and prevention strategies

Innovation into practice enables academics, healthcare professionals, industry and patients to work together to speed up innovation into routine practice in the NHS and social care.

Population health and place-based care will lead UCLPartners in supporting population-based transformation for the six million people served by the partnership and those further afield. This will include providing a platform of support for organisations that are connecting across the system to deliver sustainable population-based (or place-based) care.

These areas of focus will be further developed in 2016/17 in discussion with the Executive Group and Board, with direction driven by stakeholders across the partnership and their patients and populations.

In line with these three areas, UCLPartners will continue to ensure it is a sustainable organisation that provides value for money and continues to build on the achievements through partnership.

UCLPartners Annual Report 2015/16 • Introducing UCLPartners 11 UCLPartners Academic Health Science Centre

UCLPartners is one of six accredited Academic Health Science Centres (AHSCs) in England. As an AHSC, UCLPartners aims to ensure that discovery science and medical breakthroughs lead to direct clinical benefits for patients. The AHSC harnesses the expertise of its eight partner organisations to set a new benchmark in what can be achieved through academic and clinical partnership.

UCLPartners’ AHSC sits within the wider academic health Personalised medicine science partnership to ensure diffusion of innovation and This domain is a cross-disciplinary community that best practice across the region, and to ensure that the focus harnesses the breadth and depth of relevant research of our academic efforts is grounded in those health issues of across UCLPartners, and supports the delivery of greatest concern to our clinical services and citizens. innovative patient-targeted medicines and therapies. This year, the domain has supported the AHSC’s During 2015/16 Professor David Lomas became the successful participation in the North Thames NHS Academic Director of UCLPartners, leading the AHSC, as well Genomic Medicine Centre and Genomics England as Vice-Provost Health of UCL. He assumed the role on 1 Clinical Interpretation Partnership domains (GeCIPs), August 2015, succeeding Professor Sir John Tooke. seven of which are led by researchers in UCLPartners. Recognising the importance of training and The UCLPartners AHSC has six Academic Medical Centres development, the domain launched an Early Careers (AMCs): Network (ECN) in December 2015, which provides • Cancer a platform for mentoring, careers advice and the • Cardiovascular disease dissemination of information about training, funding • Child health and job opportunities. • Eyes and vision • Infection, immunology and inflammation Populations and lifelong health • Neuroscience This year, progress in this domain includes the development of a cohort research strategy to improve Progress for the AMCs is highlighted in the following pages. synergy across the population and clinical cohorts in The AMCs align with the NIHR-funded Biomedical Research UCLPartners. UCL and the London School of Hygiene and Centres (BRCs) within the partnership. The BRCs provide Tropical Medicine have worked in partnership to submit critical mass and resource from which to enable the AMC an application for renewal of the Wellcome Trust Major translational strategies. Overseas Programme funding for the Africa Centre for Health and Population Studies, which carries out The AMCs are supported by two cross-cutting domains research on population and health issues affecting the within the AHSC, which are integrated into all the rural population in KwaZulu-Natal, South Africa. programmes: TRUST

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UCLPartners Annual Report 2015/16 • Introducing UCLPartners 12 Programmes and progress

The AHSC is actively involved in a wide range of projects, Child health: which support increasing alignment between NHS and university partners to benefit patients. Some highlights of • The new Zayed Centre for Research into Rare Disease progress during 2015/16 are outlined below: in Children, was officially named at a ceremony held in September 2015. The Zayed Centre for Research Cancer: is a partnership between Great Ormond Street Hospital (GOSH), UCL and the Great Ormond Street • The AMC has developed a proposal for a Cancer Hospital Children’s Charity. It will bring hundreds of Research UK (CRUK) Major Centre award, involving clinicians and researchers together under one roof to engagement with CRUK, across UCLPartners, and with drive forward new treatments and cures for children external academic partners, including the Francis Crick with rare diseases. Once completed, it will welcome Institute. CRUK Centres form a national framework to approximately 400 academics and clinical staff and deliver world-leading research, improved patient care feature over 150 laboratory bench positions. The and greater local engagement. They drive a united outpatient facility will accommodate more than 200 strategy to accelerate the translation of research into patients and accompanying family members at any one the clinic. If successful, funding is provided for clinical time. The new facility is scheduled to open in 2018. and non-clinical training, research infrastructure (research nurses, technicians, equipment) and to • Three child health programmes have gained funding provide seed-funding for new projects. from EU Horizon 2020. One such project, SCIDNET, is focused on severe combined immunodeficiency (SCID), • A paediatric cancer strategy has been developed in which is a devastating rare disorder of immune system collaboration with Great Ormond Street Hospital, which development affecting infants. The project aims to includes facilitating cancer patient recruitment to the address the unmet need in SCID by developing curative 100,000 Genomes Project via the North Thames NHS gene therapy treatments from early clinical trials Genomic Medicine Centre. through to a licensed medicinal product.

Cardiovascular: Eyes and vision:

• Following the successful opening of the Barts Heart • As part of the London Project to Cure Blindness, the first Centre in May 2015, the National Institute for embryonic stem cell surgery was conducted to reverse Cardiovascular Outcomes Research (NICOR) has more vision loss caused by age-related macular degeneration. closely aligned to clinical services by relocating to Barts. The first patient was recruited at Moorfields Eye NICOR helps the NHS, the government and regulatory Hospital for the Phase I/II study within the national bodies improve quality of care by checking that the care benchmark of 70-days. received by heart disease patients meets good practice standards. Being located at Barts Heart Centre will • A collaboration was established with Google DeepMind ensure closer alignment with cardiovascular clinicians to analyse over one million optical coherence and access to more data. tomography (OCT) images, which are cross-section pictures of the retina within the eye. Google DeepMind • The partners have developed a joint academic strategy Health collaborates directly with frontline clinicians to to work across thematic areas where the most impact develop technology that helps improve patient care, and patient benefit is predicted. The intention is to by providing an artificial intelligence platform that uses create a translational institute with a one-stop device algorithms capable of learning from data for themselves. innovation institute - the Joint Queen Mary University of London/UCL Cardiovascular Device Innovation Centre for Integrated Biomedical and Bioengineering. A site has st Moorfields Eye Hospital been identified for the facility and a bid for £10.2m has conducted the first been submitted to support this, match-funded by the Barts Charity. embryonic stem cell surgery to reverse vision loss caused by age-related macular degeneration

UCLPartners Annual Report 2015/16 • Introducing UCLPartners 13 Infection, immunology and inflammation: • UCL launched a new massive open online course (MOOC) in dementia, entitled ‘The Many Faces of Dementia’, in • The AMC has progressed the Institute of Immunity and January 2016, which received over 10,000 registrations. Transplantation, a new facility for an international centre The free online course covers some of the key issues in of excellence in immunology transplantation research at dementia care and research through the eyes of people the Royal Free London. The institute is being developed affected by the condition, and world-leading experts at in partnership between UCL, Royal Free London NHS UCL. It also reveals how research into the signs, stages, Foundation Trust and the Royal Free Charity. symptoms and causes of less common forms can bring us closer to the aim of defeating dementia. • Camden Council has granted planning permission for the Bloomsbury Research Institute, a new facility being developed in partnership between UCL and the London Contributing to economic growth School of Hygiene and Tropical Medicine to undertake world-leading research into infectious disease. The The AHSC’s focus on wealth generation has enabled several institute will bring together more than 200 scientists significant successes during 2015/16: to find new treatments, vaccines and diagnostics for prevention and control of infectious diseases. • A £40 million Apollo Therapeutics Fund was launched this year to significantly improve the speed and potential of • The AMC has established a new tuberculosis university research being translated into novel medicines. network, which has secured NIHR Health Informatics The initiative is a collaboration between AstraZeneca, Collaborative (HIC) commitment and funding for GlaxoSmithKline, Johnson & Johnson Innovation and the initial roll out to standardise TB data collection across technology transfer offices of Imperial College London, UCLPartners trusts (Royal Free London NHS Foundation UCL and the University of Cambridge Trust, Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust). • Two Syncona Immunotherapy companies have been successfully spun out (Freeline Therapeutics and Autolus). Syncona is an independent subsidiary of the Neuroscience: Wellcome Trust and has invested £55m into Series A financing for the companies. Freeline Therapeutics • The AMC has progressed the development of the will develop and commercialise gene therapies for Alzheimer’s Research UK (ARUK)-UCL Drug Discovery bleeding and other debilitating disorders, while Autolus Institute, which was awarded £10m by ARUK in early will focus on the development and commercialisation 2015. The institute is one of three within the ARUK Drug of next-generation engineered T-cell therapies for Discovery Alliance, working alongside institutes at the haematological and solid tumours. University of Cambridge and University of Oxford to accelerate the discovery of novel, effective therapeutics • Athena Vision has been established, a new company for Alzheimer’s disease and other neurodegenerative focused on developing gene therapies for eye diseases diseases. The institute is looking for targets that have based on research conducted at UCL. Athena has been unexplored by the pharmaceutical industry, entered into a global partnership with MeiraGTx Ltd. broadening the focus to novel proteins and pathways to develop and commercialise Athena’s ocular gene implicated in neurodegenerative diseases and drawing therapy programmes arising from research conducted at on academic expertise to find these. the UCL Institute of Ophthalmology.

• To support world-class dementia research at UCL, the AMC has also secured a major philanthropic agreement with UK retailers Iceland, Asda, Morrisons, Waitrose, WHSmith, Boots, Poundland and HSS Hire in a unique coalition, pledging funds from the new levy on single- use carrier bags.

UCLPartners Annual Report 2015/16 • Introducing UCLPartners 14 North Thames NHS Genomic Medicine Centre

The 100,000 Genomes Project was launched by the government as part of its ambitious vision to sequence 100,000 whole human genomes by the end of 2017. The project focuses on people living in England with rare diseases and cancer and through 13 designated NHS genomic medicine centres began to invite patients to participate in 2015. The aims are to help medical teams provide better diagnosis or treatment for patients, create a comprehensive medical research resource, stimulate the development of new therapies and support a new era of personalised medicine.

The North Thames NHS Genomic Medicine Centre Overcoming challenges (NTGMC) builds on existing and successful collaboration through UCLPartners and covers a population of over six As with the other GMCs around the country, our local million people with a proven delivery of genetic samples centre has faced a number of challenges in its first year, in and established consent protocols. Led by Great Ormond particular relating to patient recruitment. Recruiting and Street Hospital NHS Foundation Trust, the partners include: consenting patients to the programme is complex due to • Barts Health NHS Trust the wide range of criteria to meet, and engagement with • London North West Healthcare NHS Trust clinicians in all specialities will be crucial to overall success. • Moorfields Eye Hospital NHS Foundation Trust Despite a slow start, recruitment for patients and their • Royal Free London NHS Foundation Trust families with rare diseases is progressing well, however • University College London Hospitals NHS Foundation Trust there are still some obstacles to overcome for involving • Royal National Orthopaedic Hospital NHS Trust. patients with cancer. This will be resolved through continued partnership working, local engagement with trusts and The NTGMC was established to gain a better understanding ongoing conversations with patients and their families. of the genetic causes of cancer, rare disorders and infectious diseases and to contribute to 10,000 rare disease genomes and 5,000 cancer genomes – a significant proportion of the overall project. “What we hope to understand through genomic sequencing is Progress highlights in 2015/16 what is causing the problem and • All six inaugural partners are recruiting patients and their how we might begin to tackle it..” families to the project. The Royal National Orthopaedic Hospital joined the initiative in February 2016 Professor Maria Bitner-Glindzicz, Academic Clinician, Great Ormond Street Hospital NHS Foundation Trust • There is strong engagement at executive level through the partner organisations, creating a partnership approach to the initiative

• In terms of scale, the NTGMC is expected to recruit more patients with rare diseases than any other centre in the country. As of the end of March 2016, the centre TRUST had recruited over 27% of the national total.

• The first patients to receive a genetic diagnosis through FOUNDATION

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NTGMC. The results stand to have a major impact on many areas of their lives including future treatment HOSPITAL options, social support and family planning. They also EYE have the potential to help many more children with undiagnosed conditions who may be tested for these genetic mutations early on and be offered a diagnosis MOORFIELDS to help manage their condition most effectively. ©

UCLPartners Annual Report 2015/16 • North Thames NHS Genomic Medicine Centre 15 Clinical Research Network The National Institute for Health Research North Thames Clinical Research: North Thames

The National Institute of Health Research Clinical Research Network (NIHR CRN) is the clinical research delivery arm for the NHS. Over the last year, as one of 15 Local Clinical Research Networks, CRN North Thames has increased opportunities for patients to take part in clinical research.

Progress in 2015/16 • In 2015/16, the network has increased recruitment to studies in conditions such as cancer, renal and The CRN North Thames has faced a challenging year musculoskeletal disease, as well as increasing recruitment but has also seen some real achievements in improving activity to the health services portfolio and primary care both patient access to innovative treatments and patient setting. In 2015/16, improved recruitment in the cancer outcomes through clinical trials. and paediatric portfolios meant that North Thames was the highest recruiting CRN in the country for these Highlights include: important areas and maintained this important top recruiting position in a number of other key specialties • Since April 2014, when the CRN was established, over (anaesthesia, haematology and neurological disorders). 117,000 people have been recruited to participate in NIHR research within the region. This is approximately • The network’s excellent recruitment record in 2014/15 55,000 participants in 2015/16. resulted in an increase in funding, which has enabled it to develop initiatives to expand recruitment further in • The CRN North Thames has opened more studies in 2015/16. These have included establishing ‘champion’ multiple sites in the last 12 months than ever before. roles for research nurses in midwifery and cancer to work The commercial portfolio opened over 700 study/site across the whole of the North Thames region to help combinations and recruited 2,359 people to studies establish new recruiting sites and inspire more nursing during 2015/16. and midwifery staff to engage in research. Another initiative has been to appoint GP champions to help more patients who are treated in the community to participate in research studies.

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UCLPartners Annual Report 2015/16 • NIHR Clinical Research Network North Thames 16 TRUST

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Overcoming challenges In focus: This year has seen many challenges for the CRN and the Increasing clinical research in primary care partnership as the general financial pressures on the NHS distract from research. In the coming year, the network With most people accessing the health system through plans to increase engagement with trusts and GP practices, primary care and GP services, increasing GP involvement in and will focus on embedding research into clinical practice, research was a particular focus for the network in 2015/16. including developing plans to fund new consultants and clinical fellows to have dedicated research time, and In 2015/16, the network has increased delivery in the extend our champion roles to other specialties. community setting, doubling the activity by recruiting almost 5,000 more people than in the previous year. The network also supported the delivery of a locally-led study – the East London Genes and Health Study – linking DNA sequencing to health records of people of British- Bangladeshi and British-Pakistani origin to characterise genetic variation between these two groups, and scope how some people respond differently to certain medicines. The study that aims to recruit 20,000 patients in the next three years. The CRN has provided funding for several local researchers who speak a number of south Asian languages to support the recruitment in GP practices in East London as well as at The Royal London Hospital (Barts Health NHS Trust). This has proved very successful and this year the study has recruited more than 9,000 people.

UCLPartners Annual Report 2015/16 • NIHR Clinical Research Network North Thames 17 UCLPartners Annual Report 2015/16 • NIHR Clinical Research Network North Thames 18 UCLPartners Academic Health Science Network

Spreading innovation, improving health, generating economic growth

UCLPartners is one of 15 Academic Health Science Progress highlights for 2015/16 Networks (AHSNs) in England, which were established by NHS England in 2013. Promoting economic growth - fostering opportunities for industry to work effectively with the NHS As the only bodies that connect NHS and academic organisations, local authorities, the third sector and • UCLPartners has hosted the NHS Innovation industry, AHSNs are catalysts that create the right Accelerator, which has helped 17 innovators to attract conditions to facilitate change across whole health and over £8.3m in investment and benefited approximately social care economies, with a clear focus on improving three million patients (Find out more on page 24) outcomes for patients. • UCLPartners has supported four successful bids in AHSNs are uniquely placed to identify and spread health excess of £3 million through SBRI innovation at pace and scale; driving the adoption and spread of innovative ideas and technologies across large • Trusts recruiting patients to clinical studies through the populations and generate economic wealth. UCLPartners Quintiles Prime Site receive approximately £1m per 100 patients, and save an average £6m in The impact of AHSNs rests in the ability to bring people, costs. (Find out more on page 23) resources and organisations together quickly, delivering benefits that could not be achieved alone. Diffusing innovation - creating the environment to All AHSNs share the following priorities: identify and spread innovation at pace and scale, and • Promoting economic growth supporting collaboration across boundaries to adopt and • Diffusing innovation spread innovation at pace and scale • Optimising medicine use • Improving quality and reducing variation DigitalHealth.London • Putting research into practice This joint initiative between the three London AHSNs, • Improving patient safety. MedCity, Greater London Authority and NHS England was formally launched at City Hall by George Freeman in It is also a focus of AHSNs to collaborate on a national February 2016. DigitalHealth.London includes a 12-month scale, where possible, in order to best spread innovation accelerator programme (£2.2m funding over three years across the health and care system. Success in this area from the European Regional Development Fund) to support can be seen in the contribution the AHSNs have made to up to 30 small and medium digital health businesses per the Accelerated Access Review, led by the Office for Life year for the next three years to work with the NHS and Sciences; cross-boundary working to support the NHS wider healthcare system. There is also an active support Innovation Accelerator programme outlined below and the network to bring together stakeholders across the digital partnership working between Patient Safety Collaboratives. health spectrum with frequent educational events.

UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 19 Optimising medicine use - ensuring that medication is Improving outcomes for newborns used to its maximum benefit – improving safety and making efficient use of NHS resources During 2015/16, UCLPartners continued to be commissioned by NHS England to host the pan-London Supporting adoption of primary care interventions to Neonatal Operational Delivery Network. The network helps manage atrial fibrillation to improve outcomes through the development of single- operating policies and improved cost efficiency. In 2015/16, • UCLPartners has supported the development of the network in north central London has achieved the the national bleeding registry (ORANGE) to build highest survival rates nationally for babies born at ≤31+6 understanding of the risks of major bleeds associated weeks gestation. with oral anticoagulants. In 2015/16, seven additional hospitals enrolled (taking the total to 32) and 1,200 patients were added to the registry (making a total Enhancing the skills and knowledge of the workforce of 1,700). The target is to recruit 2,000 patients by to provide the best care for patients October 2016. UCLPartners was commissioned by Health Education • The three London AHSNs and the London Strategic England to work with partners in north central and east Clinical Network have established ways of working and London to develop materials and deliver education engaged with Atrial Fibrillation Association (AFA) as a programmes to help reduce the variation in the partner for a pan-London atrial fibrillation programme. standard of care on three core areas: dementia, mental The programme has started work on developing toolkits health and end of life care. to support commissioners, clinicians and managers to implement local priorities across the AF pathway. The • Raising staff awareness of dementia in the acute aim of the programme is to prevent 1,777 strokes and and community settings. UCLPartners has trained save 350-450 lives over a five year period. almost 40,000 clinical and non-clinical staff in the basic principles of dementia awareness (almost 11,000 trained during 2015/16), and successfully Improving quality and reducing variation - spreading best piloted a programme practice to increase productivity and reduce variation, of more practical thereby improving patient outcomes knowledge of dementia with 1,200 staff. A 11,000 staff trained in dementia Neuroscience dementia awareness pilot was delivered to awareness in 2015/16 • UCLPartners worked with researchers, clinicians and 252 staff in 12 Haringey patients across eight countries to development of care homes. The dementia awareness training whole pathway patient-centred outcome measures programme was a finalist in the 2015 national in stroke. This work as part of the International Dementia Friends Awards for Best dementia Consortium for Health Outcome Measures (ICHOM) friendly educational initiative. has been published in the highly regarded peer • Breaking down the barriers between the physical reviewed journal, Stroke. and mental health needs of patients. UCLPartners has created and successfully piloted a range of • UCLPartners supported the evaluation of novel free, best practice, core training packages to be hyperacute neurology models in two London embedded in the training of professionals in the Neuroscience centres (Kings College Hospital and acute, mental health and community settings. University College London Hospital). This work, funded by NHS England London region, has demonstrated • The end of life care programme addresses reduction in re-admission rates and improved patient improving care in acute hospitals and the and staff experience following the introduction of a community. The team has identified and trained 59 seven day consultant led service at both sites. acute care staff as trainers and over 400 staff have been trained in the acute and community setting. • Working with NIHR Clinical Research Network North Funding has been secured to evaluate and embed Thames, UCLPartners helped open seven sites for the training in 2016/17. recruitment to a multiple sclerosis register, which will link patients to research studies across the UK. We All three programmes will continue throughout 2016/17. exceeded our recruitment target for the year (500) by an additional 147 patients in 2015/16.

UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 20 Supporting the translation of research into clinical practice Progress highlights in 2015/16:

• UCLPartners remains the highest global recruitment • UCLPartners worked with trust safety leads to site for Quintiles. In 2015/16, 619 patients were support and ensure alignment of priorities and future recruited across the UCLPartners geography. 13% of sustainability of improvement these were recruited into real world late phase (RWLP) studies. (Find out more on page 23) • 13 partners are participating in the sepsis work stream and 9 partners are participating in the AKI • UCLPartners is a founding partner in MedCity, work stream, with over 150 people involved from which aims to attract life science organisations to organisations across the UCLPartners geography London and the south east of England. UCLPartners participated in the production of a report into the way • Trusts are sharing data and learning from each other businesses undertake their research and development. through four face-to-face learning workshops, 18 Findings suggest that locations that can offer the best online webinars and regular social media interactions opportunity for businesses to work with a strong research base and each other are expected to see • Evaluation of the programme is underway with a the greatest demand in the future. The Southeast, researcher in residence working with all involved London and East of England collectively contain 60% teams of pharmaceutical employment in the UK, and 50% of medical biotechnology employment. Spin-outs • A dedicated patient involvement and engagement emerging from the research space typically want facilitator is working with partners to ensure patient to remain close to their originating faculty and at involvement and engagement in the collaborative. times are not finding this space readily available. There is also evidence of multi-national companies UCLPartners is also actively involved in the national patient wanting to work closely with the research base who safety clusters of AKI and sepsis sharing learning from would find this type of space appealing. There is a across NHS England. need for >250,000ft2 oof space t meet demand. As such, UCLPartners is working with industry partners to develop this offering further and has identified adequate facilities to house this initiative. “The network and support provided for ideas and shared learning is

Improving patient safety invaluable. Our sepsis champions have enjoyed being part of a larger The UCLPartners Patient Safety Programme aims to improve the safety of patients through working with network and can see how their role partners to both tackle the leading causes of avoidable is vital to the sepsis improvement harm to patients, and by supporting the development of a patient safety learning culture. Incorporating the Patient journey. The learning sets have Safety Collaborative, our programme empowers local provided time away to reflect on patients and healthcare staff to work together to identify safety priorities and develop solutions to be implemented our data, storyboards have been across the partnership. great in hearing the approach other

The Patient Safety Programme established two significant organisations have taken and also work streams during 2015/16 using the Institute for Health an opportunity to be in the loop with Improvement (IHI) Breakthrough Series Methodology; one focusing on acute kidney injury (AKI) and the other national/evidence based changes.” on sepsis. These conditions were selected as the focus for Catriona Stapleton, Patient safety programme manager, UCLPartners because they represent areas where most the Royal Free London NHS Foundation Trust lives can be saved (together AKI and sepsis are responsible for two thirds of avoidable deaths in England).

The programme also aims to build quality improvement capability in local teams, the methodology of which can be then used by the teams going forwards.

UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 21 UNIVERSITY

MIDDLESEX

© UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 26 IN FOCUS Partnering with industry to increase patient access to innovative treatments and clinical trials

The challenge: “It is well recognised that there is Historically the UK - and specifically London - has had significant pressure to speed the a poor reputation with the pharmaceutical industry drug development process in order because of its slow approvals processes for clinical trials. As pharmaceutical companies were able to engage to develop treatments that enable more participants in other countries, they did not focus people to live healthier lives. We on opportunities for trials in London, and patients in the region had poor access to innovative potential new are proud to be working with the treatments. team at UCLPartners to further enhance our ability to recruit patients Addressing the challenge: and investigators who are critical Through UCLPartners and the local Clinical Research to an efficient and effective drug Network, hospital trusts in north central and east London development process. We have gone harmonised the approvals process for trials, reducing average approval time from 104 to 17 days. The success of from strength to strength since this this work led to UCLPartners partnering with the world’s relationship began and we are proud biggest clinical research organisation, Quintiles, to become a Quintiles Prime Site in May 2013. of what we have achieved together, for the benefit of London as a whole.” Prime Sites receive first notification of all Quintiles trials taking place in Europe, providing opportunities Lindy Jones, Chair, European, Middle East and Africa to researchers and patients to lead and participate in Board, Quintiles national trials. In addition, Quintiles provides considerable infrastructure contributions that support study initiation and recruitment and a commercial management input Impacts and outcomes: that helps the trust to plan for growth and the company to attract more trials to the UK. • An additional one million people have better access to clinical trials since the Prime Site was expanded to Since the establishment of the Prime Site, UCLPartners has Essex in 2015 become the highest recruiting Quintiles site in the world. • UCLPartners is the highest performing Prime Site in the world (in all categories measured, including: Expanding the reach: recruitment numbers, recruiting the right patient, quality and low rates of non-enrolees) In 2015, UCLPartners worked with local trusts and Quintiles to expand the Prime Site beyond north central and east • Between April 2015 and Feb 2016, 619 patients in the London to include Essex. This means that an additional one UCLPartners region took part in Quintiles trials, more million people will have access to clinical trials in a way than doubling the target set by the clinical research that they did not before. organisation

The Prime Site is increasing patient access to innovative • For every 100 patients recruited, a trust receives an treatment and supporting research capabilities in our average of £1m hospitals. • For every 100 patients recruited, a trust also saves approximately £6m in costs of treatment if those patients were not on trials and were accessing normal care

Expanding the reach:

The model has been so successful that UCLPartners has been approached by other industry companies to replicate the model for them in the region.

UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 23 IN FOCUS NHS Innovation Accelerator: bringing innovative technologies and services to over three million patients

The challenge: Impacts and outcomes:

Although the NHS has a history of innovation, the Five Within the first nine months of the programme, the Year Forward View recognised the need to better embrace Fellows have made a considerable impact: innovation in order to address the pressures the health and social care system is facing. State-of-the-art development, • Over three million patients are benefitting from access cost-effective solutions and new ways of delivering care to the innovations, including: apps, safety devices and are essential to improving patient outcomes and the health on-line networks of the nation, but it is often difficult for innovations to be implemented at scale and pace in such a huge system. • An additional 68 NHS organisations are using one or more of the 17 new innovations

Addressing the challenge: • More than £8m in funding has been secured from external sources, an eight fold increase of the Accelerator’s initial investment of £1m At the beginning of 2015, NHS England, UCLPartners and the Health Foundation launched a call for applications to A selection of NIA achievements include: the NHS Innovation Accelerator. This new programme aims to create the conditions and cultural change necessary • Join Dementia Research - a national service matching for proven innovations to be adopted faster and more people interested in participating in dementia research systematically through the NHS, and to deliver examples into with suitable studies - enrolled 4,938 dementia practice for demonstrable patient and population benefit. patients in 62 studies across 115 sites, and has over 17,000 people interested in dementia studies In July 2015, 17 Fellows from the UK and abroad were registered on the website announced as the first cohort of innovators who would receive support to take their innovative technologies and • NeuroResponse - a specialist electronic care plan to be services to the wider NHS. The UCLPartners programme accessible across primary, secondary and urgent care team provides the Fellows with: for patients with long term neurological conditions - is now integrated with NHS 111. • Mentorship from international healthcare leaders • Pairing with an AHSN lead • Nervecentre - a whole hospital digital platform that • Quarterly learning events enables doctors and nurses to carry out patient • Peer-to-peer support observations, handovers and clinical assessments • Ad hoc specialist information sessions, as required (eg: electronically - is now used in over 30 trusts in the procurement, NHS commissioning, health economics, UK. Independent research identified a 70% reduction business case development etc.) in clinical incidents such as patients deteriorating • Navigation to existing innovation initiatives locally within because of a delay in finding the right doctor and a AHSNs (eg: SETsquared) and nationally (eg: vanguards) 100% reduction in avoidable deaths out-of-hours. • Access to a bursary to support delivery • Option to continue within the programme beyond the • HealthUnlocked - a social network that allows patients, initial 12 months. caregivers and health advocates to connect to others living with similar conditions and having similar Since the beginning of the programme, UCLPartners has experiences - has grown to more than 500 user- worked with the Fellows to understand the barriers and generated specialised communities, and has over 3.5 enablers experienced in implementing innovations; NHS million visits per month globally. England has helped to unblock systemic barriers, and the country’s 15 Academic Health Science Networks have • MyCOPD - an online 24-hour self-management, assisted in achieving adoption into clinical practice. education, expert advice and pulmonary rehabilitation platform for patients with chronic obstructive pulmonary disorder (COPD) - has been implemented by a number of CCGs. Over 3 million Expanding the reach: patients are benefiting from A second wave of the programme launches in June 2016, access to new innovations which aims to recruit a further eight fellows.

UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 24 “I have used myCOPD for 9 months, I use it every day. Last year, before using myCOPD I had 12 exacerbations, this year I have had just 2. I now know when and how to take my medication, when to use my rescue pack and perform my rehab exercises most days.”

Paul, myCOPD user

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Improvement, quality and leadership development

UCLPartners focuses on four key areas of work to support Patient engagement and involvement organisations and individuals to develop capability and infrastructure to improve quality, patient safety and The patient engagement and involvement programme experience, alongside increasing efficiency. These are: aims to embed the involvement of patients, carers and the public in the work of the partnership. This year has focused 1. Support the local health system and individuals to on significantly improving collaboration and co-ordination improve quality and increase efficiency and to support across member organisations, and understanding the leadership that enables transformation in line with the health expectations and challenges facing our population. Five Year Forward View Progress highlights for 2015/16:

2. Support our partners, through the Patient Safety • 3,000 patients and carers were engaged through Programme, to improve the safety of patients and UCLPartners programmes, collaborating with partners develop a patient safety learning culture as well as in the development of new systems of health and care improve efficiency (Find out more on page 21) • UCLPartners developed an Involvement Leads Network 3. Develop a deeper understanding of health needs and that provides peer support, guidance and strategic expectations for our population by continuing to build collaboration to involvement and engagement staff stronger partnership with, and leadership by, patient, across the partnership, with an 84% increase in partners’ carer, community networks and organisations Involvement Leads engaged - totalling 160 people - during the year 4. Support the system to maximise the use of informatics as an enabler and driver of high quality care both • Working in partnership with patients and staff, forum within organisation and across health economies. events and masterclasses were held on improving patient experience and methods for better patient involvement, bringing 300 attendees together to share learning.

UCLPartners Annual Report 2015/16 • Improvement, quality and leadership development 26 t rus T

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Developing capability within and beyond the partnership Supporting the development of informatics to drive high quality care UCLPartners is working to support the local health system and individuals to improve quality and increase efficiency With a national focus on joining up health and care and to support leadership that enables transformation in services for the benefit of patients and populations the line with the Five Year Forward View. sustainability of the NHS, connectivity of data sources and information exchange between care providers is vital. By Progress highlights: working in partnership and understanding the strengths of individual and groups of organisations, UCLPartners • Launched, recruited and commenced delivery of is facilitating knowledge sharing that will help to drive the inaugural UCLPartners Improvement Fellows improvements across the region. Programme during 2015/16 – the first programme run by UCLPartners to build improvement capability of individuals across the partnership. Through a rigorous Progress highlights: recruitment process, 22 people from the partnership received a place on the programme, which provides the • Sharing learning from a partnership-wide environment opportunity for open dialogue in a safe environment, scan led to UCLPartners helping NHS England to away from the usual workplace. It offers time and develop its national Digital Maturity Programme. space to reflect and plan improvement work, and learn from top improvement experts. • UCLPartners’ support expanded into leading NHS England’s model development in consultation with • Supported the Health Foundation and NHS England in other AHSNs, a market scan on suitable tools for the the development of the Q Initiative – both in relation assessment, then delivering the survey and analytics to having 10 Q participants across UCLPartners but also build, whilst providing end user support throughout through involvement in a number of different design groups • The Digital Maturity Index survey was launched nationally in November 2015, and an unprecedented • Provided bespoke support for a number of challenged >99% completion rate was achieved by February trusts in a variety of ways – from leading board 2016 across all acute, community, mental health and development sessions, to conducting diagnostics of ambulance services in England. certain services and functions For further information, please see page 29. • The Model for Improvement Training has been a great success with sessions being fully booked and organisations enquiring about bespoke quality improvement training and support – our aim is to build on the success of this next year.

UCLPartners Annual Report 2015/16 • Improvement, quality and leadership development 27 IN FOCUS Care City

Care City is a ground breaking new initiative to improve care for older people while also helping to regenerate one of London’s most deprived communities. Launched in January 2016 by North East London NHS Foundation Trust and the London Borough of Barking and Dagenham, Care City is a centre for healthy ageing, innovation, research and education based in Barking. Today it represents a system-wide partnership of north east London’s health and social care organisations, academia and the community.

Care City has two focus areas: In March 2016, Care City became one of ten NHS England Healthy New Town sites in England. It will 1. Healthy ageing: Frail older populations are a growing ensure the 10,800 new homes planned for the Barking proportion of society, with complex and multiple Riverside area not only provide an environment that needs, and a group with whom the whole system of promotes health and wellbeing, but will also ensure care interacts. Havering has the distinction of being they support healthy ageing. Homes will be easily London’s oldest population and has the highest adaptable for changing needs and social spaces will proportion of the oldest old. promote inclusion and participation. UCLPartners will work with Care City, the community, and with local 2. Social regeneration: Barking and Dagenham has health and social care leaders to design integrated both the highest rates of unemployment (10%) and services for the locality. the lowest levels of life expectancy in London (77 for men, 82 for women). Care City recognises the known The programme of work at Care City - across four domains interrelationships between society, employment and of community, innovation, research and education - health, so the programme aims to bring investment continues to evolve at pace. UCLPartners is delighted to be and opportunity to regenerate a deprived population. a member of the Executive Group of Care City and support its ongoing programme, and the system wide partnership Over the last year, UCLPartners has worked with Care City that the leaders across Barking and Dagenham, Havering to support a strategic review of the programme, grounding and Redbridge have fostered. the organisation’s ambitions in whole-system partnership for the benefit of the community. With a revised vision and remit, Care City has been awarded two important designations, with leadership, academic and system-wide “Care City was always very exciting network support from UCLPartners. but highly ambitious and therefore

In January 2016, Care City was announced as one of a risky proposal for the founding seven NHS Innovation Test Bed sites, and the only one partners. On this basis the weight in London. Over the next two years, the £1.8m grant from NHS England will enable implementation and of UCLPartners and their continued evaluation of nine innovations that will improve care presence and support for the project delivered to people with long-term conditions, improve the experience of people with dementia, and improve has been really important and is resilience of carers. Three of the innovators are part of adding great value and credibility the NHS Innovation Accelerator Programme. This test bed funding will enable innovators, social entrepreneurs to Care City and its many innovative and small and medium sized enterprises to rapidly test initiatives and plans for the future.” and implement innovations in real-life settings, and iterate and adjust their solutions based on evaluation John Brouder, Chief Executive, to maximise impact. An embedded research team from North East London NHS NHS Foundation Trust UCL will create novel methodologies for pragmatic evaluation that will support adaptation of innovations and implementation approaches as appropriate, and create the necessary evidence to support future spread.

UCLPartners Annual Report 2015/16 • Population health and system transformation 28 IN FOCUS Moving towards TRUST a paperless NHS NHS

The challenge: HEALTH

BARTS The complexity of healthcare delivery in the NHS means that there is a need to facilitate appropriate access to patients’ © information at each stage of their journey through the healthcare system, no matter where or when they receive care. In order to join-up data across organisations and create a paperless NHS, it has been essential to first understand the baseline level of digital maturity of providers and local health economies across the country.

The benefits:

Having joined-up, paperless information across the health and care system has clear benefits. It has the power to support people to live healthier lives, while improving their experience and empowering them to take a more active role in their health and wellbeing. It can enhance patient outcomes as healthcare professionals have the right information at their fingertips every time and care services across local health economies can be delivered more efficiently. Just as importantly, it can unlock insights for population health at scale and support the development of new treatments through having an overview of a whole community.

Facing the challenge Impacts and outcomes:

Through sharing learning from a scan of the digital Between November 2015 and February 2016, the digital environment across the local partnership, UCLPartners was maturity index survey received an unprecedented commissioned by NHS England to develop and support its completion rate of 99% across all acute, community, national Digital Maturity Programme to understand where we mental health and ambulance services in England. are as a national system; highlighting key strengths and gaps in providers’ ability to operate paper-free at the point of care. This helps NHS England, and UCLPartners for the local area, understand the readiness of organisations to become paper UCLPartners worked in partnership with other AHSNs to free. It shines a light on those further along on their journey conduct a literature review, support the creation of the to adopting digital working practices from whom we can survey, evaluate tools for the assessment, deliver the learn important lessons, and allows us to see where extra online tool, and create an analytics platform for the results. support is needed. Through self-assessment, providers were Working with Bilue, a small-medium sized enterprise, also able to indicate capacity and capability gaps in local UCLPartners supported NHS England in presenting the economies to transform services and operate paper free. results in a meaningful way both to providers and CCGs leading up to the publication of results on MyNHS.

UCLPartners Annual Report 2015/16 • Population health and system transformation 29 Population health and transforming systems

UCLPartners aims to improve health outcomes for patients and the population through supporting the system to implement and evaluate integrated pathways and new models of care.

Our system transformation team focus on three key areas Progress highlights of 2015/16 to bring a system-wide approach to innovation into practice and improvement to help the health and care system to Supporting the implementation of Academic Medical deliver the best possible care for patients: Centres to create leading centres of discovery science and clinical practice 1. Supporting the development of integrated pathways, with a greater focus on primary care, prevention, earlier Improving specialist cancer and cardiac care diagnosis and parity of mental health Following commissioner approval for the reconfiguration 2. Enabling organisations to develop outcome-driven of specialist cancer and cardiovascular services in north solutions to the most pressing healthcare challenges, central and east London in 2014, UCLPartners has been through supporting the implementation of existing supporting health and academic partners to establish evidence and generation of new evidence the new integrated systems of care for these debilitating conditions that cause almost two-thirds of premature 3. Supporting local partnerships, including those designated mortality in our region. as national or local vanguards, to implement and evaluate new models of care and support wider adoption.

UCLPartners Annual Report 2015/16 • Population health and system transformation 30 Improved survival for patients with heart disease, equivalent340 to lives saved per year ondon L niversity of niversity U ary ary M ueen Q

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Cardiovascular care Cancer care

• The Barts Heart Centre – the new hub for specialist • During the year, UCLPartners’ London Cancer team cardiovascular care in north central and east London supported the transition of specialist cancer services – officially opened in May 2015. Since facilitating the to the Academic Medical Centre at University reconfiguration of cardiac services, UCLPartners has College Hospital, supported by The Royal London, St continued to support the development of the centre Bartholomew’s, The Royal Free Hospital and Queen’s with director-level representation on the Barts Heart Hospital in Romford. Improved outcomes are already Centre board. being delivered, for example: ~ In renal cancer, surgical complication and mortality • The centre is the UK’s largest heart centre, and the rates at the Royal Free London are better than the biggest centre of excellence for adults with congenital national average. Rates for kidney sparing surgery heart disease. Six months after the centre opened, are 20% higher at the Royal Free than nationally. its standardised hospital mortality index (SHMI) was ~ A management pathway for small mass renal 0.535, which is equivalent to avoiding approximately cancer has resulted in 55% of patients avoiding the 340 deaths per year. Other improvements include need for surgical intervention, with increased quicker inter-hospital transfers (target now exceeded patient safety and better overall experience. by one day), halving of hospital cancellations, and full compliance against referral to treatment targets ~ n prostate cancer, robotic surgery at University across all specialties. Seven day services are in place College London Hospital has resulted in fewer for emergency electrophysiology and across a range of complications for patients, including incontinence sub-specialties, and at University College Hospital (for and impotency. general cardiology). • London Cancer has also focused on improving early diagnosis rates, patient experience and support for • UCLPartners has engaged 14 Clinical Commissioning people living with and beyond cancer across north central Groups in the development and implementation of and east London and west Essex. Highlights include: new models of care for people with heart failure and ~ 91% of patients (total of 75) have been offered a atrial fibrillation (the latter now adopted pan-London). first appointment within five working days of GP The programme has supported a 12% increase in referral through a new rapid access diagnostic anticoagulation rates since 2012/13 leading to an centre for suspected gastro-intestinal cancers estimated 100 strokes prevented across the region every ~ Data for one-year survival shows continued year. Barts Heart Centre has now appointed a Clinical improvement within the region, but there is Lead for prevention who will work with UCLPartners to continued variation across the system transform cardiovascular outcomes for the population. ~ All eight partners of London Cancer are now delivering holistic needs assessments for patients across five tumour sites

UCLPartners Annual Report 2015/16 • Population health and system transformation 31 © Queen Mary University of London

~ At Barking, Havering and Redbridge University Supporting the development and Hospitals NHS Trust and UCLH there has been a 61% implementation of new models of care for increase in the number of treatment summaries children and young people ~ There has been a 15% increase in the number of patients attending health and wellbeing events post During the year, UCLPartners has supported the treatment. implementation of i-THRIVE, a major service transformation • Further funding has been secured from Macmillan and for child and adolescent mental health services (CAMHS) Cancer Research UK to continue programmes on early diagnosis and patient experience. • i-THRIVE is now being implemented across 11 accelerator sites, in partnership with the Tavistock and • UCLPartners supported University College London Portman NHS Foundation Trust, Anna Freud Centre and Hospitals NHS Foundation Trust (UCLH) in its bid to the Dartmouth Center in the US be designated as one of three delivery arms of the national Cancer Vanguard. The Chief Medical Officer of • Half of CAMHS transformation plans in England and London Cancer has been appointed to the UCLH cancer Wales now reference intention to adopt i-THRIVE collaborative to support the national vanguard. principles

Proposed academic health campus at St Pancras • The i-THRIVE team has secured over £1m in grant UCLPartners is supporting partners to work together on funding to support further development and delivery the early stages of planning an academic health campus at of the model. St Pancras, focused on eyes and vision and mental health. If the proposal moves ahead, this could be an exciting opportunity for a joint campus supporting the aspirations of mental health and eyes and vision with shared education facilities, shared research on early detection of dementia through changes in spatial awareness, and other tests of cognitive impairment. 50% of CAMHS transformation plans in the country intend to adopt the i-THRIVE principles

UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 32 Supporting the development of system-wide • Completed an evaluation into the children’s hospital planning @ home model in Whittington Health to support optimal management of children at home. The Throughout 2015/16, UCLPartners has provided bespoke evaluation assessed initial evidence of the ability of support for partners in developing place-based systems hospital @ home to reduce child hospital attendances. of care that will deliver improved population health and Initial findings suggest that patients had a very good greater sustainability. experience of care under the programme and it resulted in a reduction in health care resource use that equated • The London Devolution Pilots were announced in to a total average saving of £928 per patient. As a December 2015, with four out of five located with the result it is likely the service is cost neutral. The greatest UCLPartners region. UCLPartners is working with the cost saving was for patients aged 3 to 5, with a total London Health and Care Devolution Programme to adjusted cost saving per patient of £1,763 compared to share the learning between and beyond the pilots and non-hospital @ home patients. The full report will be is developing a platform to support shared learning and available in summer 2016. wider dissemination in 2016/17 • Developed and tested the perinatal mental health • UCLPartners has provided director-level support to the scorecard – which aims to improve outcomes for development of the Barking and Dagenham, Havering 0-5 children and their families - with four partner and Redbridge programme, in line with the Care City organisations. The scorecard used in one site showed Test Bed site and the Healthy New Towns designation for a significant increase in screening for both antenatal which we have provided on-site director support. (Find and postnatal depression, and was shown to be cost- out more on page 28) effective in the modelled cost-effectiveness analysis. UCLPartners recommends refining, upscaling and • UCLPartners’ Managing Director served as interim evaluating the scorecard; evaluating its effectiveness chair of the Mid and South Essex Success Regime to as a QI tool; carrying out further work on the value of support the partners in the production of a detailed the scorecard; and providing capacity to spread the implementation plan. With continued support from methodology to other areas of healthcare. UCLPartners, the group has created a consensus-agreed plan to resolve issues in the region. • Worked in partnership with a SME to develop a child health informatics platform to improve understanding of local population needs and piloted this in Newham. Gaining new insights to improve commissioning decisions and delivery of new models

UCLPartners has worked with multiple partners this year to help them understand more about the needs of their populations and how to commission the most effective services. During 2015/16, UCLPartners has:

• Conducted a systematic review with the CLAHRC North Thames into interventions and initiatives that deliver cost savings without compromising quality. The aim of the report is to help inform commissioning decisions in support of local transformation plans (to be published in May 2016)

• Completed a ‘root cause analysis’ study of 110 patients on behalf of Camden Clinical Commissioning Group to understand the failures in prevention that led to patients suffering a major cardiovascular event

• Evaluated new acute neurology models across three hyper-acute neurology units in London to inform the work of the Strategic Clinical Network in extended the approach to care to other hospitals in London

UCLPartners Annual Report 2015/16 • UCLPartners Academic Health Science Network 33 IN FOCUS Newham Partnership Programme

The challenge: Highlights from ongoing programmes include:

The London borough of Newham has one of the most diverse • Building an understanding of pre-diabetes to provide and most deprived populations in the country. The borough joined-up information about risks, and piloting a has above average prevalence of diabetes, child and adult patient pathway. obesity, and a high population turnover. The need for health UCLPartners conducted the first mapping exercise of improvement is urgent. pre-diabetes risk in Newham. Through this process, we now know: ~ 38,980 people in Newham are at high risk of Addressing the challenge developing diabetes ~ 8,781 people in Newham are coded with pre- Newham Clinical Commissioning Group and UCLPartners have diabetes on the diabetes risk register been working together since 2013 to find new solutions to a ~ 35% of women in Newham progress from range of health issues affecting the population of Newham. gestational diabetes to type 2 diabetes in five years. The Newham Partnership Programme aims to improve health Following the findings of this work stream, Newham outcomes through harnessing education and research for was announced as a first wave pilot for the National the population of Newham, and is supported by a range Diabetes Prevention Programme in November 2015. of partners, including: the London Borough of Newham, voluntary sector organisations, East London NHS Foundation • Exploring the scope and feasibility of a peer- Trust, Barts Health NHS Trust, local schools, University of East supported diabetes self-management programme London, Queen Mary University of London and UCL. for young people. Since joining the programme, youth members of the The programme harnesses collaboration between health, support network have had no A&E admissions. Findings academic, education and improvement experts on the issues from the groups are currently being used to redesign the that matter most to improving the health of local people. local Young Adult Service, so it better meets the needs of Newham’s young people with diabetes.

Impacts and outputs:

Stakeholders in the borough identified eight challenges to address to have the most positive impact on the health of the borough. During the year, the following two programmes have been completed: t • Building emotional resilience in oungy people - rus More than Mentors T

UCLPartners developed and tested the feasibility tion of implementing a best practice, peer mentoring ounda F programme. Following proof of principle in the

successful pilot study, the project has secured £550,000 NHS

from a Department of Health volunteering fund to scale als up the scheme in east London over the next three years. ospit H

• First4Health Federation sity Working with the Clinical Effectiveness Group at niver Queen Mary University of London to apply Quality U

Improvement measures to enable improvement ock

across a range of metrics for participating practices. hurr By establishing a performance dashboard for T improvement, the First4Health Federation achieved: ~ Increased uptake of childhood immunisations

~ Improved the chronic disease control of patients asildon and B with coronary heart disease across the practices SCOTT

~ Increased recruitment to established research trials by building links with the Primary Care ADAM Research Network. ©

UCLPartners Annual Report 2015/16 • Newham Partnership Programme 34 • Mitigating the impact of a transient population on primary care services. UCLPartners analysed the mobility of the population in Newham to help partners accurately predict the demand for services. For the first time in Newham, we now know: ~ There is 20-40% annual turnover in Newham GP patient lists ~ A key issue is late patient registration with practices, resulting in late presentation of disease in primary care or A&E ~ There are different behaviours in different communities which will need to be addressed as part of the co-design of interventions in the next phase of the project.

• Enhancing the diagnosis and prevention of cardiovascular disease through integrated use of e-health records. Evaluating and redesigning the health check into a personalised system that empowers patients to modify their risk. Clinical pathway EMIS and Cerna templates for diagnosis and management of cardiovascular disease are currently being rolled out in pilot practices. The health check work has been presented at a national level at the NHS Annual Health Check conference 2016.

• Improving quality in primary care through training, testing new approaches and implementing systematic Quality Improvement (QI) approaches. A small scale Quality Improvement collaborative was launched with nine practices to apply improvement science in their practice settings to improve the care provided to patients. Key improvements were found in medicine reconciliation and results handling. The success and learning from this work will feed into the proposed NHS Newham CCG QI Academy. This work stream has recruited seven QI fellows and has supported the further education of three GPs enrolled in MSc programmes. All of these are Primary Care staff working in Newham.

• Co-creating a prediction and prevention programme to enable evidence-based practice for low birth- weight babies UCLPartners conducted research into the prevalence of low birth weight babies in Newham. For the first time in Newham, we now know: ~ 10.4% of babies born in Newham in 2013 weighed under 2500g compared to 7.4% in England ~ 62% of low birth-weight babies in Newham are born early ~ 18 of Newham’s 20 wards have rates of low birth- weight babies higher than the England average

The next step is to co-design a prevention programme and pilot in a number of practices in Newham.

UCLPartners Annual Report 2015/16 • Newham Partnership Programme 35 Collaboration for Leadership in Applied Health Research and Care North Thames NIHR CLAHRC North Thames

The NIHR CLAHRC North Thames conducts ground-breaking research that will have a direct impact on the health of patients with long-term conditions, and on the health of the public. The CLAHRC brings together world-leading universities, the NHS, UCLPartners, local authorities, patients, the public, industry and charities in a 55-strong partnership.

Progress highlights from 2015/16 Evaluating co-location of GPs and welfare advice

Increasing uptake of bowel cancer screening The challenge: NHS Clinical Commissioning Groups (CCGs) face extensive challenges in setting funding priorities. The challenge: Bowel cancer is the second commonest cause Demand on GPs from patients for support related to of cancer death in the UK. Early diagnosis improves survival benefits claims and social problems associated with low and the NHS Bowel Cancer Screening Programme (BCSP) income and debt has been estimated to account for a invites everyone aged 60 and 74 in England to take part in considerable proportion of consultations. CCGs are seeking screening every two years. Only around half of those offered robust evidence on whether co-locating welfare advisers in screening take up the offer. Poor uptake of bowel cancer GP practices result in improved wellbeing of patients and screening leads to late cancer diagnosis and can result in reduce costly demands for health services. preventable death. Meeting the challenge: Since December 2015, a CLAHRC Meeting the challenge: The ASCEND study (funded by a NIHR “embedded researcher” has been working closely with the Programme Grant for Applied Research, and led by CLAHRC London Borough of Haringey Council to evaluate whether researchers) comprised four major population-level cluster this co-location improves patients’ mental health, and randomised controlled trials conducted in the English Bowel subsequently reduces how often patients visit their GP. Phase Cancer Screening Programme. 1 of this controlled evaluation is being conducted across two London boroughs and will complete in July 2016, using a The research team developed and examined the effectiveness “before and after” model to gauge the impact on patients’ of low cost, simple interventions in increasing overall uptake mental health and subsequent support-seeking behaviour, of bowel cancer screening and in reducing inequalities in with comparator data from practices not hosting welfare uptake. They found that amending the screening invitation advice services. by adding a simple endorsement by the recipient’s general practice increased uptake overall. In parallel, the CLAHRC is also interviewing welfare advisers, practice staff and commissioners to elicit the impact of co- Outcomes and impact: Based on current national screening location on their work and health outcomes. Final results will figures, including a simple endorsement from a patient’s GP be published in early 2018. would result in almost 40,000 extra people screened each year. This is likely to amount to an additional 165 people with polyps classed as high or intermediate risk and 61 people with “The research input is brilliant. It’s a colorectal cancer being detected each year. The results were helping to develop robust evidence published in the Lancet in December 2015. on the effectiveness of advice hubs Given the impact at zero cost, the UK National Screening in health settings to secure future Committee approved implementation of GP endorsement, and the BCSP London Hub agreed to implement GP funding and maybe scale up this endorsement immediately. NHS England London is currently initiative across the borough.” updating GP practice names to allow for initiation of GP endorsement by April 2016. Tamara Djuretic, Assistant Director of Public Health, Haringey Council

UCLPartners Annual Report 2015/16 • NIHR CLAHR North Thames 36 Building research capacity – the CLAHRC North Challenges, solutions and future directions in the Thames Academy evaluation of service innovations in health care and public health In the last year, the CLAHRC’s training arm - the Academy - has expanded all three of its programmes to build research The challenge: In the UK and internationally, new models of capacity. care to increase quality and efficiency are constantly emerging and evolving. There is a pressing need to develop methods to • Short courses meaningfully evaluate these complex innovations in changing The Academy delivered six short courses to 160 front- environments. line NHS and public health staff in 2015/16. The one- day training provides staff with the tools and methods Meeting the challenge: The CLAHRC convened and led a they need to apply research based approaches to highly successful international meeting on the methodological assessment of services and decision making. Courses challenges in London in June 2015. This symposium aimed include Introductions to evaluation and economic to share new and emerging approaches to the robust evaluation and Getting research into practice. Due to evaluation of complex interventions. The meeting involved popular demand, the CLAHRC has developed an online an unprecedented partnership between NIHR, the Medical version of its Introduction to evaluation course so that Research Council, The Health Foundation, Universities UK more staff across the region are able to take part in this and Academy Health (the largest health service research valuable training. organisation in the USA).

• PhD doctoral programme Outputs and impact: To share learning from the conference The PhD doctoral programme has recruited nine students with the wider health and care community, the key speakers this year to join the Year 1 intake of eight. Students combined their presentations with the outputs from in-depth undertake applied health research which is of direct discussions at the meeting to produce eight essays. The essays relevance to the NHS, patients and the public. The will be published as an e-book in May 2016 and cited on Pub CLAHRC programme supplements host institutions’ Med. The entire process from idea inception to publication of graduate schemes, creating a community of students the e-book took 15 months. training in applied health research with a strong emphasis on developing practical skills to flourish in both health and social care settings and academia.

• Fellowship programme The CLAHRC Academy secured a further £500,000 award from Health Education England, to extend the Fellowship programme to develop research leaders of the future. The scheme, aimed at nurses, midwives and allied health professionals, enables Fellows to work on secondment to the CLAHRC four days per week for one year, to work towards an application for external funding to continue their research studies. Existing Fellows include a pharmacist, a physiotherapist, a matron, nurse and health visitor.

UCLPartners Annual Report 2015/16 • NIHR CLAHR North Thames 37 Highlighting and addressing sub-optimal asthma The CLAHRC is working with young people to develop a suite control in schools of resources to encourage open discussion of the condition and improve understanding among peers. This includes The challenge: Asthma affects approximately 1.1 million a school-based self-management intervention consisting children in the UK. Improved asthma control and increased of educational board and computer game that improves self-management can reduce hospitalisations and mortality knowledge of triggers and inhalers, as well as encouraging substantially. discussion of asthma between pupils. Following completion of the questionnaire data, the research team conducted focus Meeting the challenge: A CLAHRC North Thames project to groups in four schools with 58 participants who previously assess asthma control and medication adherence amongst completed the questionnaire. These focus groups included secondary school students with asthma in London, has test playing of the board game, as well as feeding back some highlighted the challenges faced by pupils in managing their of the results of the questionnaire to participants. Discussions condition. regarding possible explanations for non-adherence with asthma medications, and ideas for future interventions The research team visited secondary schools across London were also included. The outcomes of the questionnaire data between November 2014 and October 2015 to collect data will be used in conjunction with the focus group data and using an online assessment tool. The online questionnaire, a systematic review of a school-based self-management which incorporated the Asthma Control Test™ (ACT), was interventions to inform the development of a school-based completed by 766 participants from 24 schools. Questions self-management intervention to be piloted in London. covered symptoms and medication usage over a four- week period as well as school absences due to asthma and healthcare usage over a four week-period. Results showed 45.7% of participants had sub-optimal asthma control, and 56.4% of participants forgot to take their preventer inhaler at least some of the time.

UCLPartners Annual Report 2015/16 • NIHR CLAHR North Thames 38 Education Lead Provider

In 2015/16 UCLPartners continued to be commissioned by Health Education England to deliver postgraduate medical and dental education in 45 specialties across north central and east London, parts of Essex and Hertfordshire, with some programmes extending across the whole of London. Responsible for over niversity

3,000 trainees, UCLPartners is the largest lead U provider in England and has the opportunity to

make a difference to patient care by adding value iddlesex M

to the standard national training curricula. ©

Progress highlights: • Adding value for trainees UCLPartners aims to equip all trainees for a wide range • Adding value for educators of future roles within the NHS by providing training in UCLPartners believes that it is essential to have generic skills such as leadership, quality improvement and highly trained educators and supervisors for trainees. patient safety methodology. We promote cross-specialty UCLPartners has provided a number development collaboration, for example, paediatric and psychiatry programmes for education and clinical supervisors to trainees working together to better understand the support them in achieving accreditation in those roles. mental and physical health interactions in children. A total of 905 supervisors have been trained since 2012, with 170 receiving accreditation in 2015/16. • Adding value for patients Recognising the importance of support staff, we Engaging patients in education and training, and have established a training programme for medical informing education and training with patient expertise education managers which has so far involved 13 trusts is key to better patient care. The UCLPartners annual from the region. education conference in October 2015 focused on patient-centred care with excellent feedback from the “This programme has helped me to recognise the interaction between patients, trainees and trainers. different ways I can help my trainees in identifying, Our current education programme embeds patient planning and achieving their training objectives. involvement in all we do. It has especially helped build confidence in supporting trainees who may be in difficulties.” “As a carer to young children with complex healthcare needs, I am continuously impressed by the openness Dr Mohan Bhatt, Director of Medical Education, North and genuine desire on UCLPartners’ part to listen to East London NHS Foundation Trust and involve patients in their education programme.” • Adding value for partners Sibylle Erdmann, Patient Representative There has historically been a variation in the availability of resources and opportunity for training across the Looking to the future region. To address this, UCLPartners has developed faculty groups in simulation training that provide In late 2015 Health Education England commissioned for the movement of equipment and training staff a review of the Lead Provider system operating within across sites to support training wherever trainees are London. Following a detailed inspection of the UCLPartners placed. In addition, UCLPartners established a multi- provision of education and training, we await the report with professional leadership development programme for recommendations due for publication in May 2016. junior doctors, nurses and allied health professionals We are also aware of the financial savings required of the to develop core skills to support a future senior NHS health education sector during 2016/17. The onus is very leadership role. A total of 35 staff took part in the much on UCLPartners and our educators to deliver value 10-month programme during 2015/16. for money. We intend to do this through an ambitious programme of activities which underpin the UCLPartners strategy for education designed to support our trainees to provide the care that our patients really need.

UCLPartners Annual Report 2015/16 • Education Lead Provider 39 Governance

UCLPartners Board The role of the Board is to act as the custodian of UCLPartners’ values – to be patient-led, population-focused, developed in partnership and delivered at pace. Its members champion partnership working and create collaboration beyond the partnership with organisations that share UCLPartners’ strategic goals. The Board oversees the development and delivery of UCLPartners’ strategy and is accountable for ensuring that company risks, legal responsibilities and resources are managed effectively. Membership of the board includes the Chair, Managing Director, Academic Director and Chief Financial Officer of UCLPartners, with senior representatives across the partnership as well as individuals experienced in primary and community care commissioning, mental health, wealth creation and local government.

Name Organisation Appointed Nominations Audit and risk Remuneration committee committee committee

Chair • • Professor the Lord Ajay Kakkar UCLPartners March 2014 (Chair) Managing Director Professor Sir David Fish UCLPartners Oct 2009 • Company Secretary Diana Rawstron Goodman Derrick LLP Oct 2014 John Bacon Barts health NHS Trust Sep 2015 •

Philip Wright Barts Health NHS Trust April 2015 – • • August 2015

Cliff Prior Big Society Capital March 2013 •

Professor Steve Field Care Quality Commission March 2013

Liz Chidgey Essex Cares Sept 2013

Baroness Tessa Blackstone Great Ormond Street Hospital for July 2010 • Children NHS Foundation Trust

Professor Martin McKee London School of Hygiene & Feb 2015 Tropical Medicine •

Professor Baron Peter Piot London School of Hygiene & Jan 2014 – • Tropical Medicine Feb 2015

Andrew Nebel Moorfields Eye Hospital NHS April 2015 • Foundation Trust

Professor Simon Gaskell Queen Mary University London Oct 2011

Professor Richard Trembath Queen Mary University London Oct 2011 – Aug 2015

Dr Dennis Gillings Quintiles Sept 2013

Dominic Dodd Royal Free London NHS July 2009 • • • Foundation Trust (Chair)

Professor Michael Arthur UCL Sept 2013 •

Professor Sir John Tooke UCLPartners, UCL Jan 2010 – Jul 2015

Professor David Lomas UCLPartners, UCL Oct 2015

Helen Jameson UCLPartners Oct 2015

Richard Murley University College London July 2010 • • • Hospitals NHS Foundation Trust (Chair)

All information and filings of the UCLPartners Board are available on the Companies House website. UCLPartners Annual Report 2015/16 • Governance 40 Sub-committees

The UCLPartners Executive Group (for AHSN reporting) • Audit and risk committee: Considers issues relating and the AHSC Board both report in to the UCLPartners to UCLPartners’ internal control framework having Board and have a close relationship. While the CLAHRC, regard to the company’s size and the simplicity CRN and Genomic Medicine Centre have responsibility of its governance and financial arrangements. It to report directly in to the National Institute for Health reports to the UCLPartners Board on the adequacy Research and NHS England, they also report informally to and effectiveness of UCLPartners’ arrangements the UCLPartners Executive Group to align with the wider for: risk management, control and governance and UCLPartners strategy. the company’s finances, including the integrity of UCLPartners’ financial reporting arrangements and the Committee roles: financial responsibilities incumbent on the company’s directors. • Remuneration committee: Ensures the remuneration practice of the company, encourages enhanced performance and, in a fair and responsible manner, rewards individuals for their personal contribution to the success of the company.

• Nominations ommittee:c Ensures UCLPartners has a board with the right competencies, skills, experience and diversity to assist the organisation to develop and deliver on ambitious strategies for the future. It is responsible for the selection of company Board members, the Chair and the Managing Director of UCLPartners.

UCLPartners’ governance structure

Remuneration Committee

Nominations UCLPartners Board committee

Risk & Audit Committee

UCLPartners AHSC Board Executive Group

Discovery Innovation Population health science into practice and place-based care

UCLPartners Annual Report 2015/16 • Governance 41 Directors’ Report

Strategic risks

A comprehensive risk management process exists within • Organisational fragmentation across UCLPartners UCLPartners, covering all the assets and activities of the designations. With a number of different roles organisation and its strategic, project, operational and and responsibilities, there is a corporate risk that financial risks. UCLPartners will not manage its designated roles effectively. Failing to ensure alignment of these The Board and its sub-committees take account of risk as roles could lead to diminished outcomes for the part of their deliberations. Project, operational and financial partnership and risk the organisation’s reputation. risk is monitored by operational directors. Any issues arising The AHSN stakeholder survey conducted in summer are highlighted at Audit and Risk Committee meetings, or 2015 highlighted some confusion over the role of escalated for action sooner if necessary. UCLPartners. To mitigate this risk, the company has established central reporting and governance to In regards to conflicts of interest, UCLPartners asks all keep programmes and designations aligned with the members of the Board to declare conflicts, and action is overarching aims of the partnership. It is also taking taken as appropriate on a case-by-case basis. steps to improve clarity of the designations through improved communication with stakeholders. Principal risks and uncertainties • Future structural changes to the health system. The • Failure to engage CCGs, primary care providers and change in NHS structure - with the establishment of NHS social care. As an organisation that was initially created Improvement and Sustainability and Transformation to support acute providers, the company has most Plan (STP) footprints, along with the outcomes of the engagement with these partners. The organisation Carter Review - has the potential to change UCLPartners’ cannot support the system to deliver transformation position in the health and social care landscape. In spite and STPs without strong relationships with primary of this, UCLPartners is already delivering support to care and local authorities. Through this year’s work on partners in system-level change to reduce gaps in health STPs, devolution pilots and the Essex Success Regime, and wellbeing, care and quality, and financial efficiency UCLPartners is harnessing closer relationships with in line with the Five Year Forward View. The company a wider range of stakeholders and will continue to works at a national level to ensure it is aligned to future expand engagement and involvement in UCLPartners strategies. programmes.

• Increasing financial pressures causing reduced The Board is satisfied that a rigorous process has been collaboration across the partnership.Financial followed to identify these risks and that suitable mitigation is pressures can cause organisations to concentrate on being undertaken, or is planned. The Board recognises that, individual institutional priorities, and to neglect the due to external influences, the organisation can only provide needs of the wider partnership. This leads to slower reasonable assurance and not guarantee that major risks will progress on partnership projects and reduced impact be adequately managed by the partnership. in providing benefits to patients and the population. UCLPartners continues to develop relationships between partners, responding to their priorities and supporting the health economy to collectively deliver the Five Year Forward Plan, as an overarching goal. The binding of the partnership will follow the delivery of agreed objectives that also support provider sustainability and competitive global academic excellence.

UCLPartners Annual Report 2015/16 • Governance 42 People The environment

UCLPartners provides employment to 116 people UCLPartners continues to make efforts to minimise its (equivalent to 80 people working full time); 73 are direct impact on the environment. Staff are encouraged to use employees, 40 are working on a secondment basis from public transport when travelling between partners and partner organisations, and 3 agency staff help with short- to reduce paper usage by only printing what is necessary. term projects. The company has a recycling scheme in place for mixed recyclables and food waste and the office uses energy The majority of our secondees are clinical and academic efficient lighting, which is motion activated. leaders from partner organisations, who help to drive the work of UCLPartners in a way that benefits patients and staff on the front line. We encourage our secondees to share the knowledge they have gained at UCLPartners and to embed it within their own organisations. UCLPartners continues to second our team members to providers in the partnership to provide bespoke support as needed.

Staff are encouraged to look after their health and to maintain a healthy work-life balance. The organisation has launched a number of health and wellbeing activities during the year, including: free yoga sessions, a virtual step challenge from John O’Groats to Land’s End and charity walks. The number of work days lost to sickness leave totalled 207.5 for 2015/16, which is equivalent to 0.8% of the whole staff or 1.8 days per employee. This number has increased since 2014/15, but is consistently below the average for the NHS, which is 6.7 days per employee.

As part of the company employment package, UCLPartners offers a generous pension scheme to all staff who join the organisation. UCLPartners contributes 10% of an employee’s salary into the scheme, and staff are welcome to contribute as little or as much as they wish.

UCLPartners relies on the knowledge and skills of its staff to help the partnership improve health and increase wealth for the region. Ensuring that staff are engaged and enthusiastic about the aims of the organisation is integral to the partnership’s success. Communication with staff takes place at all levels, with the aim of ensuring that their views are taken into account when decisions are made that may affect their interests. Channels for engagement include, but are not limited to:

• Monthly whole staff update led by the senior team • Weekly staff newsletter • Staff intranet • Regular team meetings led by operational directors.

UCLPartners Annual Report 2015/16 • Governance 43 Financial report

UCLPartners is a company limited by guarantee, by partner • AHSN grant (£3.1m) from NHS England which, despite NHS and university organisations. The majority of revenue an 21% reduction (from £3.9m in 2014/15), has received is from the public sector and other not-for-profit enabled UCLPartners to deliver against a range of organisations. In keeping with this, annual surpluses are not objectives. Progress has been made towards spreading distributed but are reinvested in furtherance of our principle innovation, improving capability and delivering system aims and objectives. A reserve is maintained to safeguard transformation. For example, improving mental health the financial sustainability of the company. and outcomes for children and young people, and expanding the Quintiles Prime Site into Essex to improve access to clinical trials for an additional 1 million people. Business development We have also continued to deliver our patient safety programme for which a proportion of grant funding is UCLPartners has once again achieved year-on-year revenue ring-fenced, establishing two significant work streams growth (see figure 3) through continued development and for acute kidney injury (AKI) and sepsis in which 9 and diversification activities. In 2015/16 this has been achieved 13 trusts have participated respectively. through focusing on key priorities that align with national priorities: • Lead Provider contract (£1.7m) commissioned by Health Education England to ensure the quality of postgraduate • Improving health outcomes for patients and the medical and dental education. During 2015/16 key population through supporting the system to deliverables have included: 170 education and clinical implement and evaluate integrated pathways and new supervisors took part in the UCLPartners development models of care programme; and 35 staff joined the leadership development programme. • Supporting organisations and individuals to develop capability and infrastructure to improve quality, patient • NHS Newham CCG sponsorship (£1.4m) to address safety and experience and reduce costs eight identified health challenges in the borough. Two programmes were completed in 2015/16, “Building • Embedding innovation to drive change at scale and pace emotional resilience in young people - More than Mentors” and “First4Health Federation” which has • Ensuring UCLPartners is a sustainable organisation to increased the uptake of childhood immunisations in the maximise the benefits to partners, patients and the borough. Key milestones in the six ongoing programmes population. have also been delivered including first ever collation of data on low birth-weight babies and pre-diabetes risk. Our partners and other bodies have funded us to enable delivery of these priorities. The three largest contracts • In addition to the above, during 2015/16 we have delivered in 2015/16 were: delivered work on a further 19 contracts valued at over £100,000 each. Figure 3. Revenue and associated expenditure growth over five years.

Revenue growth Expenditure Turnover

2015/16

2014/15

2013/14

2012/13

2011/12

2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000 14,000,000 16,000,000

UCLPartners Annual Report 2015/16 • Financial report 44 These business developments have led UCLPartners’ turnover to increase by 5.0% to £15.4m (2014/15: £14.7m) with associated expenditure increasing by 4.4% to £15.2m (2014/15: £14.5m), see table 1. This has enabled the delivery of a surplus of £219k.

As our portfolio has continued to expand our average whole time equivalent staff numbers have decreased by 9% (from 87.8 to 80.0) and the average staff headcount has decreased by 18% (from 142 to 116). This demonstrates an efficient use of our workforce.

Table 1. Company growth

2011/12 2012/13 2013/14 2014/15 2015/16

Turnover £’000s 2,768 4,764 9,539 14,698 15,439

Expenditure £’000s (2,768) (4,765) (9,407) (14,496) (15,221)

Surplus (Deficit) £’000s 0 (2) 132 144 219 for re-investment This is inclusive of corporation and deferred tax charges

Our capital asset base has decreased by 54% to £260k (2014/15: £566k) following the disposal of the leased 4th floor premises at 170 Tottenham Court Road.

Net assets have increased by 75% demonstrating our increased sustainability. The current ratio has increased from 0.99 to 1.04 reflecting increased working capital availability to support ongoing delivery of our activities (see table 2).

Table 2. Financial ratios

2011/12 2012/13 2013/14 2014/15 2015/16

Current ratio1 0.92 0.96 0.97 0.99 1.04

Cash ratio2 0.60 0.32 0.57 0.63 0.49

1 This ratio measures the company’s ability to pay short-term obligations, which is the company’s current assets divided by its current liabilities. 2 This ratio is a measure of a company’s liquidity, which is the company’s cash divided by its current liabilities

UCLPartners Annual Report 2015/16 • Financial report 45 Revenue Our existing and future planned revenues come from various Revenues are derived from a combination of grant sources, with 46% of our revenue coming from NHS England funding, partnership contributions and contracts to deliver in 2015/16, 19% from Clinical Commissioning Groups and commissioned programmes of work. Programmes and NHS trusts (excluding partner contributions) and a further projects can range in length from one month to five years 18% from Health Education England. The remaining 17% of which helps to ensure a sustainable business model. This is revenues come from a variety of sources including charities also shown in our year end cash balance of £5.6m which is and industry. primarily allocated to on-going projects that span 2015/16 and 2016/17. See figure 4 for our revenue split.

Figure 4. 2015/16 Revenue analysis NHS England 46% Health Education England 18% Clinical Commissioning Groups 14% Partner Contributions 8% Charities 6% NHS Trusts 5% 2015/16 Other 3% Revenue analysis

Expenditure Approximately 42% of our expenditure is pay related. Of 16.4% of total expenditure is attributable to corporate costs. this, 67% is for employed staff and 30% for staff seconded As the company continues to develop, we remain focused on to us from our partners, to provide specialist and clinical ensuring all corporate costs are minimised. See figure 5 for leadership to programmes. The remaining 3% is for agency our expenditure split. staff who are recruited to enable us to start projects quickly, whilst we recruit accordingly. The majority of our non-pay costs are directly related to delivering our programmes.

Figure 5. 2015/16 Expenditure analysis Pay costs 42% Projects 27% Education 7% Property 7% 2015/16 Research 6% Expenditure IT & Telecommunications 5% analysis Governance & other support costs 4% Consultants 2%

UCLPartners Annual Report 2015/16 • Financial report 46 T TRUS

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Financial governance Statement as to disclosure to auditors As revenue and expenditure has continued to increase UCLPartners directors approve that as far as they are we have continued to focus efforts on maturing our aware, there is no relevant audit information of which the financial governance and systems. In 2015/16, this has company’s auditor is unaware. The directors have taken included conducting a reviewing of our controls and all the steps that ought to have been taken as directors processes using the Charity Commission’s self-assessment in order to make themselves aware of any relevant audit checklist, “Internal financial controls for charities”; information, and to establish that the company’s auditor although UCLPartners is not a registered charity we aspire is aware of that information. to embrace the general principles of good governance the Commission has set out in relation to financial management and safeguarding of financial assets.

Going concern After making due enquiries and undertaking normal business planning and budgeting procedures, the directors consider that UCLPartners has adequate resources to continue in operational existence for the foreseeable future. Accordingly, they have continued to adopt the going concern basis in preparing the Financial Statements.

UCLPartners Annual Report 2015/16 • Financial report 47 Appendix 1 Partnership organisations

City

Trusts Clinical Commissioning Groups 1 Barking, Havering and Redbridge University Hospitals NHS Trust 1 Barking and Dagenham 2 Barnet, Enfield and Haringey Mental Health NHS Trust 2 Barnet 3 Barts Health NHS Trust 3 Basildon and Brentwood 4 Basildon and Thurrock University Hospitals NHS Foundation Trust 4 Camden 5 Camden and Islington NHS Foundation Trust 5 Castle Point and Rochford 6 East London NHS Foundation Trust 6 City and Hackney 7 Great Ormond Street Hospital for Children NHS Foundation Trust 7 Enfield 8 Hertfordshire Community NHS Trust 8 Haringey 9 Homerton University Hospital NHS Foundation Trust 9 Havering 10 Luton and Dunstable University Hospital NHS Foundation Trust 10 Hertfordshire Valleys 11 Mid Essex Hospital Services NHS Trust 11 Islington 12 Moorfields Eye Hospital NHS Foundation Trust 12 Luton 13 North East London NHS Foundation Trust 13 Mid Essex 14 North Middlesex Hospital NHS Trust 14 Newham 15 The Princess Alexandra Hospital NHS Trust 15 Redbridge 16 Royal Free London NHS Foundation Trust 16 Southend 17 Royal National Orthopaedic Hospital NHS Trust 17 Thurrock 18 South Essex Partnership University NHS Foundation Trust (SEPT) 18 Tower Hamlets 19 Southend University Hospital NHS Foundation Trust 19 Waltham Forest 20 The Tavistock and Portman NHS Foundation Trust 20 West Essex 21 University College London Hospitals NHS Foundation Trust 22 West Hertfordshire Hospitals NHS Trust Higher Education Institutions 23 Whittington NHS Trust 1 Anglia Ruskin University 2 City University London Affiliated organisations 3 London Metropolitan University 1 Anglia Ruskin Health Partnership 4 London School of Hygiene and Tropical Medicine 2 NIHR Clinical Research Network North Thames 5 London South Bank University 3 NIHR Collaboration for Leadership in Applied Health Research and 6 Middlesex University London Care (CLAHRC) North Thames 7 Queen Mary University of London 4 Health Education East of England 8 UCL 5 Health Education North Central and East London 9 University of East London 10 University of Essex

UCLPartners Annual Report 2015/16 • Appendix 1 48 Appendix 2 Financial statements - available on the UCLPartners website

UCLPartners Annual Report 2015/16 • Appendix 2 49 Bringing together leaders in cutting-edge research and innovation to create measurable benefits for patients and populations

Get in touch www.uclpartners.com [email protected] @UCLPartners 020 7679 6633