Integrating Care: Insights from Imperial AHSC

Professor Stephen Smith Pro-Rector(Health) Imperial College CEO, Imperial College Healthcare NHS Trust Trust Four perspectives:

Integrating Working Integrated Working Service, with other Care together for Research and AHSS specialist across health & Education: providers ICO pilot primary wealth in Imperial College and London and Imperial secondary

College care London AHSCs

The UK’s first AHSC Healthcare NHS Trust The Cooksey Gaps

Wealth Creation United Kingdom 6%>2% Health

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

INVENTION EVALUATION ADOPTION DIFFUSION Imperial College AHSC

Enfield

Barnet

Harrow Haringey Hammersmith Hospital Waltham Redbridge Forest Havering Brent Islington Hillingdon Camden Hackney Barking Tower Newham Ealing Westminster Hamlets Ken. City & Chel. Southwark

Hounslow Lambeth Greenwich Bexley Wandsworth Richmond Lewisham

Queen Charlotte’s & Merton Bromley St Mary’s Hospital Chelsea Hospital Kingston Croydon Sutton

Charing Cross Hospital Two leading organisations coming together as the first AHSC in the UK Imperial AHSC – a closer look • AHSC partnership formed in 2007 - created largest acute Trust in England – improved all Key Performance Indicators within 9mths • Over 1,000,000 patient contacts a year - Serving a local population of 2 million • 9,500 staff including 850 consultants, and over 200 clinical academics • Hospital Budget of c £900M Excellence in research – 73% of all college research activity judged as world- leading or internationally excellent, highest in UK – Times Higher Education Supplement 2010 World University Rankings rated the College 3rd in Europe and 9th in the world overall (in 2009 3rd/5th)... – ... and 3rd in Europe and 5th in the World for pre- clinical, clinical and health – One of the largest Medical Faculties in Europe with an annual research spend of over £162m (08/09) University Tech Transfer Companies

– Imperial Innovations the first majority university-owned technology transfer company to float in the UK

– £284M Market value, November 2010

– Profit of £5.5 million, 2009/10

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Therapeutics for cat, Developing stents and Peptides to reduce dust-mite, grass allergy grafts obesity From AHSC to AHSS • Building on strong relationship through the National Heart & Lung Institute • Royal Brompton & Harefield Foundation Trust became first Associate in 2010 Integrated Care Pilot for North West London: driving collaboration across care providers

Pilot providers includes General Practice, Imperial College Healthcare Trust, Central London Community Healthcare, Local Authorities, Mental Health Trusts and Third Sector 1

ICO Pilot What are we going to do? Three core benefits:

1) Inspire collaboration and Improvement integration of services to quality of patient care 2) Decrease emergency admissions by 30% and nursing Creation of a home admissions by 10% for richer diabetics and frail elderly professional 3) To overall reduce cost of these experience groups by 24% over 5 years Improved 4) Significantly improve patient Finances experience 2

Clinicians will develop a more pro-active approach to managing care through more frequent interaction… Group (50,000+)

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

Practice (~5,000)

District nurse Social care Specialist

GP Community matron Regular meetings Mental Health Less frequent attendance Specialist Regular additional calls

Social worker

Practice nurse Community Mental Health Acute Specialist worker 3 Preliminary modelling suggests that the pilot could significantly reduce emergency admissions across North West London

Pilot Practice GP

▪ Avoid 2,300 1 avoided admissions across the admission per whole pilot pa month assuming participation 4 avoided of 380,000 population admissions per month ▪ Savings of ~£9m from reduced admissions per annum

190 avoided admissions per month

SOURCE: HES 2007/08 - 2008/09, ICO benefits and costs modelling 4

Several enablers have been identified to support leaders and clinicians working across provider organisationsClinical enablers within the IC pilot in this new way A Aligned incentives B Joint governance

Outcomes incentives aligned Joint governing, decision-making body that monitors and acts on Providers will share a pool of funding issues

C D Organisational development and Information sharing culture

A mechanism for sharing that aggregates patient-level data - - joint training and development Better analysis - develop own team cultures Easier access London AHSCs Working together for health & wealth in London • Integrated Care Pilots • With the Marsden/ICR and SHA on cancer services for London • On research infrastructure & programmes • On wealth creation London needs to be competitive globally

Bay Area

Tel Shanghai London Aviv ?

San Diego Boston Singapore

Dubai California • San Francisco and San Diego’s universities published ~7300 life sciences papers and were awarded 87 patents in 2007 • Home to over 1900 biotech companies and ‘lighthouse companies’ such as Genentech and Amgen • Over 60,000 people are employed in biotechnology companies in California • 2010: Pfizer’s first Global Center for Therapeutic Innovation with UCSF What about London?

GMEC

NHS Reforms need to help not hinder More needs to be done to encourage collaborations with industry