Oxford Academic Health Science Network

Transcription

1 Oxford Academic Health Science Network Sustainable Best Care... and Wealth Creation

2 Contents EXECUTIVE SUMMARY... 1 A: Introduction... 3 B: Features of the Oxford Academic Health Science Network... 4 C: The Partnership... 5 D: Challenges... 5 E: Vision for the Network F: Strategic Goals G: Achieving the Network s Vision and Goals H: The Programmes Best Care Programme Continuous Learning Programme Research and Development Programme Wealth Creation and Healthcare Innovation Programme I: The Themes Population Healthcare Patient and Public Engagement and Experience Integration and Sustainability Informatics and Technologies Genomic Medicine Knowledge Management J: Innovation within the Network K: Governance arrangements Network Partnership Council The Management Board The Executive Team Programme Governance Funding arrangements L: Draft Business Plan for 2013 to Measurement M: Conclusion N: Appendices Appendix A: Oxford Academic Health Science Network Partners Appendix B: Maps Appendix C: Network response to requirements in relation to supporting research Appendix D: Network, Programme and Theme Deliverables Appendix E: Glossary Appendix F: Equality Impact Assessment... 80

3 Executive Summary The Thames Valley and the adjoining areas are home to a wealth of world-leading organisations involved in healthcare research, clinical care delivery, education and the life science industry. The creation of the Oxford Academic Health Science Network (the Network) is an outstanding opportunity for all partners working in these sectors to come together with commissioning bodies, patients and the public to form a community, to participate in providing evidence based best care for our patients and population, to innovate and in so doing, to deliver new opportunities to create wealth. The Network, based on a coherent geography and strong organisational ties, covers a population of 3.3 million, in an area with a potential for further population growth. Within it, we have gathered a comprehensive and new inclusive community of acute and mental health trusts, community and primary care providers, social care providers, commissioners, universities and research bodies in partnership with our population. Our geography is home to one of the most powerful life science clusters in the country with a strong track record of innovation in this field, and the Network has initiated a process of further focused collaboration with the local life science industry. The creation of our Network offers an opportunity to take a new approach to dealing with the challenges for healthcare today. The most fundamental of these is to continue to provide improvements in the quality of healthcare, within the limitations of the current financial constraints. This must be accompanied with an equity of provision of this care, but significant variations of healthcare provision, delivery and outcomes do exist within our geography. As the numbers of elderly grow, we also face increasingly complex problems of illness including cancer, mental health and multiple comorbidity in long-term conditions. To deal with these challenges the Network has to support transformational change in the way we deliver care. There is no other way to achieve our Vision to deliver best care through a sustainable population-centred system that ensures equity of access for our patients using continuous learning and the research-focused Network, which leads to new opportunities to create wealth by healthcare innovation. We will engage our patients and our population to make our population the centre of our healthcare system. It will not be adequate, however, to deliver such change only in pockets of healthcare excellence. We propose an ambitious plan to create a Programme of integrated Clinical Networks, which will cover healthcare comprehensively in our geography. These Clinical Networks will be cross-cut by a series of Themes, which reflect the over-arching strengths and interests of this Network. Our Themes will focus on Population Healthcare, Patient and Public Engagement and Experience, Integration and Sustainability, Informatics and Technologies, Genomic Medicine and Knowledge Management. Much of our Network activity will occur at the intersection of the Clinical Networks with the cross-cutting Themes. Here, we will use innovative tools to deliver best care and adopt innovation across our geography, and here we have chosen to focus on designing population healthcare programme budgets; redesign integrated care pathways that reduce waste and improve quality; and design informatics and technologies capacity to reduce face-to-face contacts and increase independence, to securely and reliably exchange information between databases and to develop open standards and platforms for collaborative work at scale for big data. We have also chosen, as local priorities, to focus on the projected increased demand for cancer care in the elderly, on diabetes as a long-term condition and on mental health and in particular, dementia and access to psychological therapies. To succeed we shall engage and mobilise the participation of many outstanding institutions and bodies, who are partners in our Network. These include, in addition to our eight universities: Better Value Healthcare, Centre for Acceleration of Medical Innovation, Centre for Evidence Based Medicine, Centre for Information Design Research, Centre for Sustainable Healthcare, Cumberland Initiative, George Centre for Healthcare Innovation, Health Experience Institute, Institute for Clinical Nursing Innovation, Henley Business School, Institute of Biomedical Engineering, ISIS, James Lind Alliance, Knowledge Transfer Centre, NHS Innovations South East, NHS Right Care, Picker Institute and UK Cochrane Centre and UK CRC Clinical Trials Units. We will create a learning Network with innovation and integration at its heart, with a leadership that directs and supports the necessary cultural change to enable all partners to collaborate meaningfully. Oxford Academic Health Science Network Page 01

4 As a continuous learning Network we shall support the work of the local Thames Valley Local Education and Training Board, working closely with it to ensure alignment of priorities and initiatives. We will promote a defining culture of the Network, which is that every encounter is an opportunity to learn, and reinforce the value of collaboration, sharing, support and transparency. We will promote teamwork and multi-professional training, hard wire innovation into education and help our members to cope with the unprecedented levels of information available today. The significant NIHR infrastructure (Oxford Biomedical Research Centre and Unit, the Thames Valley Comprehensive Local Research Network and the Clinical Research Facility) and UK CRC Clinical Trials Units that exist within the Network will be provided with an enabling platform the Network s Research and Development Programme to support research, to increase recruitment to trials, to facilitate adoption of innovation, to create coherent research platforms for partners and to deliver cost-efficiencies. We will create an environment where every clinical encounter can contribute to research. The Network is the home for the only UK base for HealthTIEs, a European Union initiative to generate and develop life science clusters, underlining the position of the life science industry in our geography. Our life science cluster, however, does not yet compare with the best bioscience clusters in the US but has the potential to achieve much more. The Centre for Accelerating Medical Innovation will lead the Network s Wealth Creation and Healthcare Innovation Programme to deliver better connections, synergies and collaborations between academia, the NHS and business for patient benefit, which in turn will create wealth. It will draw together this large constituency of partners to create a vibrant life science business ecosystem, and address and fulfil a number of functions, previously overlooked. Finally, in line with the Network philosophy this Programme will develop appropriate metrics for assessing Network wealth creation performance. Some of the Network s innovation activity, including its adoption of the High Impact Innovations, is described in this document while a more complete log is currently being developed and we will monitor performance and support the delivery of innovation activity by Network partners. The initial governance structure of the Network has been agreed through a preliminary partnership agreement, with Oxford University Hospitals NHS Trust acting as interim host and providing the interim Accountable Officer. The proposed formal structure of governance will support the network and allow local accountability to be respected whilst encouraging cross-organisational creativity. The Network recognises that effective leadership will be of considerable importance in establishing and embedding the appropriate culture and values-led behaviours during its early development. We consider that the development of an effective Academic Health Science Network provides the partners with an exceptional opportunity to produce tangible benefit to the health of our patients and population and drive innovation and economic benefit through collaboration with our life science industry partners. We have gathered together a powerful range of talent committed to success in this exciting venture. It will align with the Research and Development Programme for example, by making the Oxford Biobank and BioRepository facilities more accessible for partnership work with the life science industry. It will extend the established tradition of funded collaborative biomedical research within the Network, such as the unique Master Research Agreement with AstraZeneca, the NIHR Translational Research Partnerships and the Structural Genomics Consortium. While continuing to facilitate such agreements by making large population cohorts more accessible, the Network will also promote agreements with Small and Medium Enterprises such as Oxford Cancer Biomarkers. Page 02 Oxford Academic Health Science Network

5 A: Introduction 1. The Thames Valley and adjoining areas are home to a wealth of worldleading organisations involved in healthcare research, clinical care delivery, education and the life science industry. The development of the Oxford Academic Health Science Network (the Network) provides the opportunity for all partners to develop processes which will allow us to learn from the very best current practice, to innovate, to disseminate approved new products and practices and deliver evidence based best care for patients. 2. The Network brings together a broad community of interest comprising health and social care providers, commissioners, universities and other academic groups, the third sector, life sciences industry and business organisations, and the public and patients within an area covering a population of 3.3 million in the Oxfordshire, Berkshire and Buckinghamshire (known as the Thames Valley) and Bedfordshire. 3. The purpose of the Network is to make a tangible improvement to outcomes for patients and to the health of the local population; to support research and innovation; and to deliver new opportunities to support wealth creation through the UK life science industry. 4. In so doing, the Network will meet the challenges set out in Innovation Health and Wealth, (IHW) published in December 2011, and develop goals and objectives that meet the requirements of the National Outcomes Framework for 2012/2013 (NOF) and beyond. 5. The Network will focus on delivering improvements in healthcare and outcomes for patients, by improving access to and spread of, research projects in accord with the objectives of the National Institute for Health Research (NIHR), by supporting the translation of current research and the direction of future research, and by drawing on the skills, knowledge and expertise of all partners to increase the speed of dissemination, adoption, and development of innovation. 6. This application document sets out the features of the Network and the Partnership, the challenges faced, and the way in which it will ensure the delivery of its Vision and Strategic Goals through appropriate and effective partnerships and governance arrangements. It also describes the Network partners record in innovation and the proposed deliverables through a draft business plan. 7. Further refinement of the Strategic Goals, key deliverables, supporting arrangements and the business plan will continue over the coming months. Key to their determination and delivery will be the culture and Vision of the Network, the governance arrangements, the development of clinical and research networks and the Programmes and supporting Themes. Oxford Academic Health Science Network Page 03

6 B: Features of the Oxford Academic Health Science Network 8. The Network is based on a coherent geographical area characterised by the multiple mid- to large-sized towns, some small cities and their surrounding rural hinterlands between the valleys of the Severn and the Thames, the South Midlands and Salisbury Plain. Within this geographical area, we have created a Network of outstanding clinical skills and commitment, intellectual talents and creativity to serve a substantial population with a distribution and characteristics that are representative of large parts of England. It represents a group of local health economies and providers, who face common and distinctive challenges and opportunities as outlined below: l the need to support comprehensive and sustainable healthcare provision, focusing on providing the right care in the right place, locally and increasingly in the community l demographic pressures in relatively affluent populations where high health and social care demand is compounded by an ageing population, intermingled with pockets of significant deprivation l the lack of large, metropolitan, high-density population centres and a corresponding need to create service solutions without the benefits that large population centres offer for the configuration and viability of services. 9. Particular strengths within the Network include extremely strong academic institutions with excellent links into healthcare provision. All the health and social care professions are provided for in both undergraduate and postgraduate education ranging from medicine, adult nursing, mental health nursing, child nursing, midwifery, social work, therapies, operating department practitioners, dietetics and pharmacy. 10. The universities cover a wide range of research areas and institutes including the George Centre for Healthcare Innovation, the Centre for Accelerating Medical Innovations, the Health Experiences Institute (University of Oxford), the Centre for Rehabilitation and the Institute for Research into Child Development (Oxford Brookes University), the Institute for Clinical Nursing Innovation, the Allied Health Enterprise Development Centre and the Institute of Mental Health (Buckinghamshire New University), and the Centre for Information Design Research, the Clinical Health Sciences Institute, the Charlie Waller Institute and the Winnicott Research Unit (University of Reading). In addition, the Open University is a world leader in e-learning and in developing technology to increase access to education and knowledge. 11. The Network includes a number of outstanding biomedical and biotechnology networks, industries and small businesses, creating one of the largest life science industry clusters in Western Europe. The NHS SE Innovation Hub also supports the NHS across the Network. 12. Business, commercial and not for profit organisations are also brought together in a number of ways including the County and Thames Valley Local Enterprise Partnerships, the Thames Valley CBI, Chambers of Commerce, Science Vale UK and the South East Health Technology Alliance. 13. Oxford is the only UK base for HealthTIEs, a Region of Knowledge initiative backed by the European Union with 22 associated universities and over 100 companies. The cluster aims to translate life science innovations to improved outcomes for healthcare by combining cuttingedge translational research, with strong primary care and well-defined hospital catchment areas. 14. These features make the geography an attractive and vibrant location for a distinctive Network ready to address a number of significant health and social care challenges relevant locally and nationally. Page 04 Oxford Academic Health Science Network

7 C: The Partnership 15. The Network is composed of health and social care providers, commissioners, universities, life sciences industry and business and commercial organisations, and the constituent population. Its NHS affiliates provide links into Gloucestershire, South Warwickshire, Northamptonshire and Wiltshire reflecting existing and long standing clinical networks. The target population served will be 3.3 million, which is predicted to grow significantly in some areas including Milton Keynes. 16. Membership currently includes all NHS trusts and commissioners, all NIHR bodies, all universities, a range of NHS related bodies including Solutions for Public Health, the Patient Safety Federation, UK Cochrane Centre, the National Spinal Injuries Centre and NHS Innovations SE, a number of local authorities, the Oxford Academic Health Consortium 1, and, as affiliated members, a number of 3rd sector bodies, e.g. the Genetics Alliance UK, the Picker Institute and the Centre for Sustainable Healthcare, and an increasing number of networks and alliances associated with business and commercial organisations, including local enterprise partnerships, Science Vale UK, the South East Health Technology Alliance, the Association of British Pharmaceutical Industry and the Association of British Healthcare Industries. 17. In addition, a number of NHS Trusts are also affiliated members although their primary membership will be with other AHSNs: these include the following, South Warwickshire CCG, South Warwickshire NHS FT, Gloucestershire Hospitals NHS FT, Great Western Hospital NHS FT, Northampton General Hospital NHS Trust, Northamptonshire Healthcare NHS FT. Full details of the Network partners and affiliated members is included in Appendix A. D: Challenges 18. The Network faces a number of challenges. Some of these are generic to the NHS. Others have been identified as specifically local, and areas in which partners wish to make a difference. 19. The Health and Social Care Act (2012) frames the new duties on the Secretary of State for Health, the NHS Commissioning Board and Clinical Commissioning Groups (CCGs) to act with a view to securing continuous improvement in the quality of services provided to patients. 20. We will assimilate the goals of the NOF, which is structured around five domains that set out the high level national outcomes that the NHS should aim to improve. 21. These domains are embodied in the collective challenge laid out in IHW: We have the potential to create the best health system in the world, enhancing the quality of life for people with long-term conditions, preventing people from dying prematurely, helping people recover from ill health and ensuring patients have a positive experience of care. Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Preventing people from dying prematurely Enhancing quality of life for people with. long-term conditions Helping people to recover from episodes of. ill health or following injury Ensuring that people have a positive experience. of care Treating and caring for people in a safe environment and protecting them from avoidable harm 22. Despite huge advances in healthcare in this country, an increasingly ageing population and the constant emergence of new clinical therapies and technologies means that healthcare is becoming increasingly complex, and that even more is demanded and should be made available. Healthcare funding, however, is not unlimited. Contemporary national and global economic conditions require that improvements to healthcare are delivered within our current real terms funding. This is the fundamental healthcare paradox that faces the Network. 1 Oxford Brookes University, the Oxford Health NHS Foundation Trust, the Oxford University Hospitals NHS Trust, the Oxfordshire Learning Disabilities NHS Trust, the Oxfordshire Clinical Commissioning Group, the Oxfordshire and Buckinghamshire PCT Cluster, Oxfordshire County Council, and the University of Oxford have now established a new partnership the Oxford Academic Health Consortium (OAHC). Oxford Academic Health Science Network Page 05

8 23. Healthcare must therefore be even more cost-effective. The NHS QIPP initiative to deliver significant savings is relevant to all partners involved in healthcare. More of the same will not do. This means a transformational change to the way we deliver healthcare to our population. Innovation has to become a core business of the Network. Creating a system for delivery of innovation 24. Despite accelerating scientific discovery, current life and health science research does not sufficiently address the pressing needs of healthcare delivery. Change can be achieved more quickly if research is promoted and supported, and also aligned to the needs of patients and the population. The guidance describes how Academic Health Science Networks (AHSN) should collaborate with the local research management systems including the NIHR infrastructure to achieve this. 25. In Investing in UK Health and Life Sciences (2011) the Prime Minister lays out a further challenge for the UK to become an outstanding location for medical innovation. He calls for collaboration between healthcare providers, the universities and life sciences industry to open up the NHS to new innovations and new clinical trials. This is a challenge to contribute to the national creation of wealth. The Network has a critical mass in all these components to rise to this challenge. 26. The membership of the Network reflects the complexity of healthcare today. No one individual or sector can deliver the required scope and scale of transformational change alone and the development of a common vision and a shared purpose will require cultural change and leadership. Success of the Network will depend on the collective activity of complex networks comprised of decentralised and loosely associated individuals and organisations. 27. The Network will need a structure for governance, but the most important element of the new Network will be its culture. This is the greatest challenge for the Network. The aim will be to create an environment where people continually expand their capacity to create results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspirations are set free and where people are continually learning how to learn together (Senger 1990). 28. To be successful, therefore, the Network will need to ensure that its hierarchical formal structure for governance works in tandem with its non-hierarchical, self-organising structures such as networks, to maximise both organisational efficiency and local flexibility. This will require support by effective governance and broad leadership and will take time and effort. This will be a challenge for the Network. 29. Organisations, including those in the NHS, have traditionally worked within the confines of their own boundaries. The Network will recognise and embrace the diversity and complementarity of its partners and draw on the experience and expertise of all to find adaptive and participative solutions to the challenges faced by our geography. 30. This is why the Network will prioritise support for a culture that promotes a shared purpose to deliver a common vision. The Network will build on changes that have already begun prior to the designation process to produce this cultural change during the period of the licence. 31. The NHS Atlas of Variation (2011) demonstrates the significant variations in the distribution of disease, provision of healthcare services and patient and population outcomes across our proposed Network. Such unwarranted variation cannot be tolerated in successful healthcare systems. Three examples relevant to the Network's priorities are shown on the following page. Page 06 Oxford Academic Health Science Network

9 Maps extracted from the NHS Atlas of Variation in Healthcare [RightCare] November 2011 Map 4: Mean length of stay for elective breast surgery by PCT. 2009/ Lowest rate Highest rate 1 Oxfordshire 2 Buckinghamshire 3 West Berkshire 4 East Berkshire 5 Milton Keynes 6 Bedfordshire Map 7: Percentage of people in the National Diabetes Audit (NDA) with Type 2 diabetes receiving all nine key care processes by PCT. 1 January 2009 to 31 March 2010 Map 28: Percentage of STEMI patients receiving primary angioplasty by PCT Oxford Academic Health Science Network Page 07

10 32. The successful implementation of the High Impact Innovations is a challenge laid down in the AHSN guidance. This challenge includes the promotion and support of innovation across healthcare. IHW describes the barriers to the diffusion of innovation and the need to promote the interaction of the three approaches. It describes the importance of the value proposition with regards to innovation. Further information is provided in the Innovation Section (J), which includes examples of work achieved and in progress across the Network. Barriers to the diffusion of innovation Lack of effective and systematic innovation architecture Poor access to evidence, data and metrics 1 Insufficient recognition and celebration of innovation and innovators DIFFUSION Leadership culture to support innovation is inconsistent or lacking 33. Much of the information needed to inform innovation, improve service delivery, and support next-generation research is not readily available. It is scattered across different systems, recorded using different standards, and managed by different organisations. The identification and aggregation of the data needed to answer a particular question, or to support a specific study, may be expensive and time-consuming. 2 4 Commissioners lack the tools of capability to drive innovation Financial levers do not reward innovators and can act as a disincentive to adoption and diffusion Long-term conditions 36. The Department of Health believes that at least three million people with long-term conditions and/or social care needs could benefit from the use of telehealth and telecare services, which will address Domain 2 of NOF. Longer-term monitoring, for example, of patients with COPD or CHF will only be sustainable as a strategy to manage patients at home if it is properly integrated with the patient s lifestyle and the clinical pathways for these conditions. For the goals of the 3 million lives initiative to be met, it is important not to try and fit service delivery around telehealth, but rather to integrate the technology and its use, both by patients and healthcare professionals, within existing clinical pathways. 37. Long-term conditions have a very high rate of coexisting mental illness that complicates management, worsens outcomes and increases cost, requiring effective methods of delivering integrated physical and mental healthcare. Cancer 38. Early work from the Thames Valley Cancer Network predicts a growth of nearly 6,000 extra new cancer cases in the next 20 years as demonstrated in the graph below. Even more striking is the projection that 65% of this increased workload will be in the over 75 year old group, forecasting a significant demand on the healthcare budget. 34. Secure services for data access, generic tools for data integration, and appropriate frameworks for data governance are required. The successful development and deployment of these services, tools, and frameworks will require effective collaboration between the health service, industry, and academia: sharing experience, joining forces, and building upon existing achievements. 35. The challenges described highlight some specific areas for action across the Network but this is not an exclusive list. All Clinical Networks, Programmes and Themes will continue their specific work programmes in line with either agreed existing objectives or objectives to be defined in the coming months. Page 08 Oxford Academic Health Science Network

11 39. The cost of cancer care is higher in the elderly. This is poorly understood, but is possibly related to comorbidity, increased toxicity, longer hospital stay and increased costs of social support. The evidence base for cancer care in the elderly, furthermore, is also more tenuous as it is extrapolated from trials on a younger, fitter population. Benefits in this group may not translate at the same level to more elderly patients, where toxicity profiles may be different and co-morbidity is more prevalent. 40. If the predicted growth of cancer in the elderly is to be tackled, there is a real need to understand how best to address it in this population. This includes how to assess patient experience, how to establish shared decision making, how best to assess fitness and how best to treat and to aid recovery, perhaps in a care model integrated with services for the elderly. Diabetes 41. The International Diabetes Federation has described diabetes as the global epidemic of the 21st century. Today there are 2.9 million people with diabetes in the UK and it is estimated that this will rise to 5 million by The prevalence of diabetes is four times greater than the prevalence of all cancers and it is associated with around 24,000 excess deaths each year in this country. Current spending on diabetes in the UK is 10 billion, which accounts for 10% of the NHS budget; 80% of this is spent on managing the preventable complications of diabetes. There is a wide variation in service delivery for diabetes in the UK; diabetes is a significant challenge to the Network. 42. The Oxford Biomedical Research Centre (OxBRC) includes diabetes as a main theme. The over-arching objective of the diabetes theme is to identify new therapeutic opportunities for both type 1 (T1D) and type 2 (T2D) diabetes, and to translate them into clinical practice focusing primarily on correcting pancreatic islet cell dysfunction. The OxBRC requires a means of translating its discoveries in diabetes into mainstream clinical practice, which can be performed by the Diabetic Clinical Network. Mental Health Dementia 43. The Network will respond to the Prime Minister s Challenge on dementia using the Network to disseminate the defining work planned by the OAHC on dementia. This includes the projects and key commitments outlined in the Challenge, which also references to the National Dementia Strategy and the NHS s National Outcomes Framework. Depression, anxiety and related disorders 44. Anxiety disorders and depression affect 1 in 6 people with around 1 in 10 sufficiently disabled to benefit from treatment. It is particularly poorly addressed nationally in children and adolescents and may be an important component in those with medically unexplained symptoms and long-term conditions. The National Institute of Health and Clinical Excellence (NICE) indicates that until recently access to effective psychological therapies was limited, despite patients showing a 2:1 preference for them in comparison to medication. The introduction of the Government s Improving Access to Psychological Therapies (IAPT) programme, while successful nationally, has vast regional (including in the Network s geography) variability in outcomes (NHS Information Centre website). Integration of physical and mental healthcare 45. Physical illness is frequently complicated by mental illness. For example, there is a high rate of depression in patients with diabetes, heart disease, stroke and cancer. This psychiatric co-morbidity adversely affects the patient s quality of life, worsens the medical outcome and substantially increases medical costs. In the current NHS, however, such co-morbidity often goes unrecognised and untreated. The Network has academic and clinical expertise in working out how to ensure that such comorbid conditions are effectively managed by integration of physical and mental care. Early intervention for serious mental illness 46. Three quarters of cases of bipolar disorder and schizophrenia starts before the age of 24, with peak onset in adolescence and early adulthood. Yet mental health services are currently structured with separate provision for children and for adults, with a poor transition between services that has been extensively reported. The Network already contains expertise that is leading the way in biomedical and applied mental health research in this age group, and has evidence of improved health outcomes and cost effectiveness of early intervention. Oxford Academic Health Science Network Page 09

12 Population Healthcare 47. Healthcare delivery is under the constant headlights of costs. Clinicians, however, are not inspired by the rallying call for cost reduction. In fact they are battle fatigued. A redesign of care that is sensitive to clinicians values, receptive to patients needs and responsive to market demands offers a real and more acceptable solution. 48. The goal of improving value for the population is attractive to all. All will see the benefit of delivering this as efficiently as possible, and thereby mitigating the need for more blunt cost-cutting actions. 49. Such a redesign requires evidence of what matters to patients and the public, and what it costs to achieve it. It requires a framework within which relevant data are collected accurately, analysed appropriately and distributed transparently. It requires an evidence base for decision making by the community, including patients, providers and commissioners, on how funding for healthcare will be allocated. 50. Such societal decisions can be more reasonably made when restricted to segments that contain similar populations, which can be the traditional disease groups such as diabetes and cancer or groups that reflect the complexity of healthcare today such as the frail elderly and patients under 65 with multiple co-morbidity. The definition of how best the healthcare budget for segments of the population should be assigned is population healthcare. 51. Redesigning care, however, is hard particularly in a riskaverse environment. It will require vision, culture change and leadership. Patient and Public Engagement and Experience 52. Patient-centred care requires active engagement with patients, and the public understanding and use of their experience of care. These are all of fundamental importance to the operation of high quality healthcare systems. 53. Patient experience has been identified as a key determinant of the quality of care, alongside safety and clinical effectiveness. This is recognised in Domain 4 of the NOF. There is also increasing evidence that patientcentred care, and educating patients and the public about conditions is linked to improved clinical outcomes. Moreover, by taking into account the informed goals and preferences of individuals, the costs of unnecessary investigations and treatments may be reduced. 54. The public, patients and carers need access to accurate information about health, illness and healthcare, so that they can be actively involved in decisions about care received and research they participate in. 55. Engagement with the public and patients is also an essential component for creating effective, integrated systems for long-term condition management. In particular, patient understanding and input are essential for shared decision making and improvements in self-management and to inform the design and use of e-technologies, as envisaged in Domain 2 (NOF). Genomic medicine 56. Every so often, a scientific advance offers new opportunities for making real advances in medical care we believe that the sequencing of the human genome and the knowledge and technological advances that accompanied this landmark achievement represents such an advance. House of Lords Science and Technology Committee s report into Genomic Medicine (2009) 57. Genomic medicine has the potential to transform healthcare in this country by undertaking diagnosis and treatment on the basis of the patient s genome. Revolutionary scientific advances have brought genomics from the bench to the bedside and offer the opportunity for its adoption into mainstream clinical practice. The UK is at the forefront in this field and the Government has directed substantial investment in its programme to make the UK a leading place for life sciences investment. 58. To do this we must create a service delivery environment that supports and encourages the adoption of genomics, that includes pathways to facilitate the bridging of the translational gap, an infrastructure for equitable and affordable access, and advanced bioinformatics capacity, rigorous evaluation, education and training and public awareness: in other words all the functions of Network. This is the challenge laid down by genomics. Page 10 Oxford Academic Health Science Network

13 E: Vision for the Network The Network will deliver best care through a sustainable population-centred system that ensures equity of access for our patients using continuous learning and the research-focused Network, which leads to new opportunities to create wealth by healthcare innovation. twork 59. The Vision expresses our view of the Network as an exciting opportunity to build on and develop partnerships that will produce transformational change. It is an opportunity for all to realise and fulfil the potential of collaboration and partnership, by uniting to address local challenges and priorities, and build an innovative, integrated approach to healthcare and health economic development for the future. 60. Our Vision embodies the aspiration among all partners to provide best care for patients and the population. Clinicians have always been motivated by the desire to provide the best care for their patients. The delivery of this desire, however, has traditionally been designed and discharged from the provider s perspective, rather than that of the patient or the wider population. 61. We will deliver our Vision by ensuring that the patient is at the centre of all Network activities. This does not simply mean making the patient the central focus of the Network s partners. It means a new way of designing and providing healthcare by working as partners with patients and the public. 63. This in itself creates wealth by reducing waste and releasing resources to be utilised to deliver other priorities important to the population. The bringing together of a broad mix of partners also provides a fertile ground to nurture new partnership opportunities between care providers, academia, the population and the life sciences industry. A leading life sciences cluster already exists within the Network s geography. Its development and growth will be a Network priority. 64. The Network has a broader long-term Vision to work in partnership to develop innovative models of commissioning as well as service delivery. It will explore issues such as joint accountability, joint management of financial risk and alignment of incentives, and facilitate the trialling of new approaches to models of outcome and capitation based commissioning. 62. It means working in partnership with patients to achieve outcomes that meet their needs and expectations, within an affordability envelope. Providing high value care that is cost-effective from the population s perspective is the real challenge to us. Oxford Academic Health Science Network Page 11

14 F: Strategic Goals 65. The Network identified a number of Strategic Goals as part of the development of the Expression of Interest. As work has progressed, these have been refined as shown below: Goal 1: To deliver best care in a population-centred healthcare system: To identify and address unwarranted variation by disseminating evidence-based best practice, making the patient and the population at the centre of care. Goal 2: To develop an effective continuous learning network: To create a genuine partnership that develops a culture of learning, sharing and common purpose, which breaks down organisational boundaries to deliver transformational change. work Goal 3: To complete the translational research process and accelerate the diffusion of innovation into mainstream practice: To align and integrate clinical service and the translational research infrastructures to bring rapid benefits to patients and deliver NIHR priorities. Goal 4: To tackle local priorities: which include long-term conditions, mental health conditions and the development of new approaches in medicine, such as genomic medicine. Goal 5: To facilitate sustainable economic development and wealth creation in alignment with best care: To grow local life sciences clusters by promoting innovation, adoption and dissemination, entrepreneurship and by strengthening relationships with industry and business. G: Achieving the Network s Vision and Goals 66. The Network will achieve its Vision of sustainable population-centred best care through integration and networking, innovation and continuous learning. The culture and the leadership of the Network will embrace these core tools to help it achieve its Vision promoting patient experience as a key driver, honest, open and respectful relationships among all professionals; clinical data as a public good; and the assimilation of innovative research into practice. 67. The members of the Network will embrace these principles and help it achieve its Vision. Some of these tools are in the new NHS Change Model. The Network will draw on all its main components (leadership for change, spread of innovation, improvement methodology, rigorous delivery, transparent measurement, system drivers and engagement to mobilise) and from other sources to ensure that it has a systematic and sustainable approach for improving the quality of care. Achieving Sustainable. Population-centred Best Care Organisational Culture Population-centred Best Care Continuous Learning Leadership Leadership Innovation Organisational Culture Integration Page 12 Oxford Academic Health Science Network

15 68. The Network is proposing an organisational structure which will facilitate the delivery of its Vision. This organisational structure will remain flexible to adapt to an evolving Network through the licence period. The efficacy and success of this organisational model will be analysed through measurement by the Network s planned organisational development group. The Network will open a dialogue of sharing and learning with other AHSNs to identify the best organisational model. 69. The Goals of the Network will be delivered through its Programmes supported by the cross-cutting Themes as described below. The selection of the Programmes reflects the aim of providing a comprehensive health programme for the population and to address the Network challenges described above. 70. Four Programmes will provide the governance infrastructure through which the Network will discharge its functions: l Best Care l Continuous Learning l Research and Development l Wealth Creation and Healthcare Innovation 71. These four Programmes will work through their leads as part of the Network Executive to monitor and deliver the Network objectives and key deliverables. 72. The Best Care Programme will be the major platform for the activities of the Network. It will be composed of Clinical Networks with membership across the Network geography. It is the Network s aspiration that this Programme will evolve to comprehensively cover healthcare in our society. The plans for the first year cover the clinical areas shown below: 73. The Network has identified six cross-cutting Themes, which emphasise its over-arching strengths and its objectives to transform healthcare for the benefit of our patients and population. Population Healthcare Patient and Public Engagement and Experience Integration and Sustainability Informatics and Technologies Genomic Medicine Knowledge Management 74. The Clinical Networks will be intersected by the six cross-cutting Themes to form a matrix. This will be the main forum for Network activities. Adult Critical Care Cancer Cardiovascular Diabetes Mental Health Pharmacy Primary Care Renal Trauma Stroke Adult Critical Care Cancer Cardiovascular Diabetes Mental Health Pharmacy Primary Care Renal Trauma Stroke Population Healthcare Patient and Public Engagement and Experience Integration and Sustainability Informatics and Technologies Genomic Medicine Knowledge Management Oxford Academic Health Science Network Page 13

16 75. The three remaining Programmes Research and Development, Continuous Learning and Wealth Creation and Healthcare Innovation (shown below) will be responsible for discharging certain central Network objectives and supportive functions, which are described below in their respective sections. Research and Development Continuous Learning Wealth Creation and Healthcare Innovation 76. These Programmes will provide a fundamental enabling backdrop for the main innovative endeavours of the Network, which will be delivered primarily through the interaction of the Clinical Networks and the Themes at the level of the intersecting matrix. This composite relationship is represented below. Research and Development Adult Critical Care Cancer Cardiovascular Diabetes Mental Health Pharmacy Primary Care Renal Trauma Stroke Population Healthcare Patient and Public Engagement and Experience Integration and Sustainability Informatics and Technologies Genomic Medicine Knowledge Management Continuous Learning Wealth Creation and Healthcare Innovation Page 14 Oxford Academic Health Science Network

17 H: The Programmes Best Care Programme 77. The Best Care Programme will start with ten Clinical Networks which have been chosen to reflect l national priorities, l the need for balance; and l the ability to build on clinical networks already in place. 78. These Networks (shown on page 13) are currently at varying stages of maturity and development. The Thames Valley Cancer Network is well established with a strong process of peer review, clear objectives and a number of work streams on service improvement. Project management and clinical leadership have been essential to its success and much can be learned from its approach and structure. The Thames Valley Cardiovascular Network is also well established and from it has evolved the autonomous Stroke and Vascular Networks. The Trauma Network is developing following the designation of Major Trauma Centres and Units. Clinical Network development 79. The Network intends to introduce up to ten Clinical Networks in Year Two and up to ten in Year Three with a minimum of 20 by the end of Year Three. It is recognised that this is a significant undertaking and the Network will not allow this ambition to compromise the quality and function of these existing Clinical Networks and of the Programme. 80. It is the aspiration of the Network in Year Two to introduce additional Clinical Networks that are less conventional in their make-up, reflecting the complex nature of illness and healthcare delivery. These could include maternity, emergency medicine, frail elderly, longterm conditions with multiple co-morbidity, infection, rehabilitation and neurotrauma and neurorehabilitation. Discussions will take place during the first year to test the approach that might be used to tackle these important but complex areas. 82. The formal evaluation of the Network s early organisational development, particularly in relation to the Clinical Networks, and hence its effectiveness and maturity is crucial. These how are we doing? and where are the hot and cold spots in the Network? questions will be under constant review by the Executive Team and Management Board, both along the governance framework outlined below and in open forum. 83. The focus of these Clinical Networks to date has been the delivery of healthcare in the hospital environment. They will discharge an equal function of vertical integration of all providers and commissioners, underlining their pre-eminent position as the vehicle for Network activities. 84. Patient and public engagement and membership will be a crucial part of these Clinical Networks. Their intersection with the Patient and Public Engagement and Experience Theme will help define the outcomes which are important to patients and their families. It is this interaction that will ultimately help define the value criteria for the services discharged by a Clinical Network and help solve the value proposition. 85. Quality, safety and sustainability of clinical services are central to these Clinical Networks and one of their defining functions will be to oversee the uniform delivery of best care across the geography. They will ensure the alignment of the clinical services to national and local priorities. 86. Patient safety is paramount. The Clinical Networks will be able to draw on the resources across the Network which include the Patient Safety Federation (PSF) hosted by the Royal Berkshire NHS Foundation Trust and the Patient Safety Network led by the Nuffield Department of Surgical Sciences at the University of Oxford. A number of organisations within the Network have a very strong track record in patient safety. 81. This Programme and its Clinical Networks will be crucial for facilitating transformational change across the Network. It will embed the culture of collaboration, transparency, sharing and support and bring all parts of the Network together. Oxford Academic Health Science Network Page 15

18 Royal Berkshire NHS FT won the Health Service Journal Patient Safety Award for work on Getting it right for every patient every time timely antibiotics for patients with neutropenic sepsis. work established NIHR clinical research networks. Their goals and aims will be aligned and, where possible, integrated with those of clinical research networks, for example as with the critical care and dementia clinical research networks. In 2011, the Trust won a Nursing Times and Health Service Journal Patient Safety Award for Patient Safety in Critical / Intensive Care for the introduction of the pioneering 'Call 4 Concern' help line. This is an early warning hot line set-up so that relatives can by-pass normal channels if they spot a dip in the condition of a critically ill patient. The Simulation Centre at the Hospital provides staff with the opportunity to undertake training in a fully interactive environment, featuring both low and high fidelity human patient simulators with realistic anatomical and clinical functionality. Training has an emphasis on human factors and encouraging a multi-professional approach to learning and development. The Human Factors Faculty development is one of the projects that the PSF is now developing. A similar simulation and training centre is based within the Kadoorie Centre at the Oxford University Hospitals NHS Trust. 87. The collection, analysis and the transparent exchange of good quality data will be a core function of each Clinical Network. This will allow the identification of variation in the access to and the delivery of care and outcomes and value in a continuous learning environment. The Clinical Networks will address and reduce unwarranted variation in a supportive and constructive manner and facilitate the uniform raising of care quality and value across the Network. 88. The Clinical Networks will also facilitate partners understanding and adherence to national guidelines, such as those from NICE, and other NHS priorities. They will facilitate the comprehensive uptake within the Network of the defined High Impact Innovations and push technologies. It is here that the Network will promote the act of copying from each other and from other successful AHSNs. 89. These Clinical Networks will be the major foundries for all three stages of innovation described in IHW. At the intersection matrix with the cross-cutting Themes, they will invent. They will identify localities for adoption. They will be the major arteries for accelerated diffusion of successful innovation. 91. The intersection of the Clinical Networks with the cross-cutting Themes will facilitate Network partners' engagement with each other and to draw on experience and expertise that can support and develop their activities. A number of collaborations are already in place as shown below. The National Spinal Injuries Centre (NISC) based at Stoke Mandeville Hospital, is working in partnership with the Buckinghamshire Healthcare Trust (BHT) and the Stoke Mandeville Spinal Foundation to take forward the spinal research agenda. It is also working with the OUH on a multi-centre research study and with two regional expert partners in telehealth medicine; the Centre of Excellence for Telehealth and Assisted Living (CETAL) part of the Bucks New University, and the South East Health Technologies Alliance (SEHTA). CETAL at Buckinghamshire New University is developing a telemedicine application to support Telespeech and Language Therapy. Rapid technology advances, most notably the emergence of the internet and high bandwidth connections to it, have created significant opportunities for telemedicine use. The evaluation of telemedicine application is a vital element as there is a need to improve the efficiency and equity of health service delivery, in response to the increasing specialisation. Shortages of professionals and centralisation of health facilities have contributed to the rapid implementation of telemedicine. The main objectives are to support the adoption of Speech and Language Therapy (SLT) assistive technologies into Buckinghamshire (seen to be effective elsewhere in the West region); build on the initial successful work in BHT SLT Department, in using assistive technologies to support patients with aphasia following a stroke, by increasing utilisation of StepByStep 4.5 speech and language computer aided software to full potential capacity; undertake a formal evaluation study into the implementation of the SLT aphasia project, to assess the success of this intervention and to draw out the wider learning in relation to the adoption of assistive technologies locally. work work 90. The Clinical Networks will also make sure that they link closely with and do not duplicate the work of the Page 16 Oxford Academic Health Science Network

19 The University of Reading s Centre for Information Design Research brings together research and practical expertise in writing, graphic design, interaction design and psychology. We collaborate with domain experts, such as doctors and public health specialists, educationists, lawyers, and meteorologists. Multidisciplinary working of this kind is the basis for extracting generalisations from individual projects that contribute to a growing understanding of the theory of information design. Undergraduate and postgraduate students of the Department of Typography & Graphic Communication are involved in many of our projects. Recent health-related projects include: collaboration with psychiatrists, geriatricians and pain specialist nurses at Berkshire Healthcare NHS FT (BHFT) and Royal Berkshire NHS FT (RBFT) to develop a pain scale/questionnaire for use by carers of people with dementia to improve communication with hospital staff on hospital admission and reduce use of antipsychotics; work with BHFT and RBFT on tools to support assessment of capacity to make an informed decision in older patients; work with Berkshire West Primary Care Trust on the development of information about their Text-to-Nurse pilot for school children (designated an example of best practice by DH); and collaboration with a consultancy designing drug delivery devices to improve (public) user understanding of the devices (and hence their effectiveness). work 92. Given below is further information on two priority areas: Diabetes and Mental Health. Information is also provided on the Pharmacy Network which has a strong focus on the delivery of cost savings through medicines use and procurement. The Best Care Programme Steering Committee will be responsible for developing the overall programme for the Clinical Networks and for the establishment of future priorities and plans. Diabetes 93. This Clinical Network will be built on a nationally and internationally recognised translational research portfolio within the Network and on the infrastructure provided by the successful NIHR Thames Valley Diabetes Local Research Network (TVDLRN) which covers a population of 4.5 million covering 20 secondary care centres and 140 primary care sites. 94. In 2003 the 12 million Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM) opened with the following mission statement: OCDEM is a pioneering centre which combined clinical care, research, and education in diabetes, endocrinology and metabolic disease. By promoting world-class research it aims to enhance understanding of these diseases and to accelerate the search for new treatments and cures. The Centre remains at the forefront of cutting-edge research and leads on a number of global diabetes mega trials. 95. The DLRN was established in the counties of Oxfordshire, Berkshire, Buckinghamshire, Warwickshire, Coventry and Milton Keynes. The Network has recently reached agreement with the West Midlands South CLRN to support activity in Worcester and Herefordshire and has associated sites across Hampshire and the Isle of Wight. Mental Health 96. The Network provides the opportunity for all mental health trusts to combine to create a new Clinical Network in the geography. There is already significant activity in clinical research networks and these will form its infrastructure. Dementia 97. The Network will develop an integrated care pathway for Dementia that will bring together NHS providers, universities, commissioners, and local authorities and voluntary organisations, to create a network that combines optimised service delivery and patient outcomes with a comprehensive platform for clinical research. 98. The dementia theme will build on work already initiated in the dementia exemplar of the OAHC, which has mapped 104 clinical, educational and research projects, including projects that already extend across the Network (see overleaf). 99. The range of research projects includes discovery science, translational research (Vascular Dementia theme and Cognitive Health programme in the OxBRC, NIHR Programme Grants for Applied Research and research infrastructure (NIHR DeNDRoN and NIHR Oxford Clinical Research Facility). Oxford Academic Health Science Network Page 17

20 Map to show the 104 projects within the OAHC Oxford Academic Health Consortium 100. The Consortium s work will also include the projects and key commitments outlined in the Prime Minister s Challenge, which also references to the National Dementia Strategy and the NHS s National Outcomes Framework. Project 1: Dementia-Friendly Communities.Project 2: Primary Care Management of Cognitive Impairment and Dementia Project 3: Creating Sustainable Workforce Project 4: Enhanced Care Home Outcomes 101. This element of the Best Care Programme will work closely with other elements and with the cross-cutting Themes, including Patient and Public Engagement and Experience and Population Healthcare. As part of the national QIPP programme, workshops are run defining the objectives, criteria and standards of Population Based Systems of Care. A Dementia workshop supported by QIPP is being planned for the New Year to help take this work forward. Depression, anxiety and related disorders 102 This Clinical Network will contain the already successful IAPT network run through Buckinghamshire, incorporating university based researchers (including Oxford, Reading, Open University and Buckinghamshire New University), who are at the cutting edge of psychological treatment research. The Clinical Network will include both adult, and child and adolescent IAPT services and will extend its focus to medically unexplained symptoms and to patients with chronic physical health problems whose management is complicated by the presence of anxiety or depression It is in a very good position to be successful as: l it will have access to high quality outcome data on almost all patients treated in the services l many of the leading treatments being used by IAPT for panic disorder, social anxiety disorder, PTSD, OCD, insomnia and recurrent depression were developed and continue to be refined by researchers in our universities l our researchers have conducted the main Department of Health analyses of local variation in outcome and its correlates Page 18 Oxford Academic Health Science Network

21 l we are a therapist training hub for both the adult and child IAPT programmes l the national clinical advisor for the IAPT programme is part of our Network The latter means that the Network will be able to harmonise its work with the work of any national mental health networks that may emerge through the new activities of the NHS Commissioning Board Clinicians and researchers in the Network have played a central role in the national development of the IAPT programme. Their research has produced the outcome monitoring system that has provided the unprecedentedly complete data that can now be used to drive quality improvements and innovation This Network has created some of the Cognitive Behaviour Therapies (CBT) treatments that are currently used in IAPT and have already disseminated innovative new treatments (low intensity CBT focused insomnia interventions) within local services. It has on-going Wellcome and NIHR funded research programmes that are developing highly cost effective internet based versions of CBT for both adults and children. The Charlie Waller Institute at Reading University is playing a central role in the training of IAPT related therapists for both the adult, and child and adolescent programmes. Early intervention for serious mental illness 107. The services in the Network geography are already leading the way in biomedical and applied mental health research in adolescents and early adulthood, and have evidence of improved health outcomes and cost effectiveness of early intervention. There have been strategic appointments to strengthen this service The innovative True Colours text and based service facilitates self-management and the routine reporting of patient reported outcome measures. True Colours won the national NHS Live award for innovation in the 2008 Health and Social Care Awards and is already being developed and evaluated in an NIHR Programme Grant for Applied Research and implemented in Oxford Health NHS FT (Oxfordshire and Buckinghamshire) and surrounding services including Berkshire Healthcare NHS FT Oxford Health NHS FT is already the second largest research recruiting mental health Trust in the UK. The Clinical Network will increase the numbers of patients participating in research coordinating recruitment across the Network in collaboration with the Thames Valley CLRN, the Oxford Cognitive Health and Neuroscience Clinical Trial Unit and the NIHR Oxford Clinical Research Facility We will continue to involve NHS clinicians in research by building on existing local NIHR fellowship schemes and the use of honorary University contracts. The research fellowships will be used to enable NHS clinicians to spend a proportion of their time in the academic department undertaking service improvement projects, with academic supervision. This will be extended to NHS managers, and those working across sectors and providers involving local business schools including University of Oxford s Saïd Business School and the University of Reading s Henley Business School. Integration of mental and physical healthcare 112. A key challenge for the NHS advocated in many recent reports is to achieve better integration of care, including between mental and physical aspects of patient care (for example: No health without mental health implementation framework, DH 2012; Longterm Conditions and Mental Health, Kings Fund, 2012; Healthy Mind, Healthy Body, NHS Confederation, 2009). This is because increasing evidence indicates that better integration of mental and physical care offers considerable opportunities to improve the quality of care, whilst also being potentially cost saving The successful integration of care also poses challenges. We will build on our leading academic expertise and clinical initiatives to overcome those challenges by developing cutting edge innovation and research, training, and service development As part of the Network, we will build on existing links and collaborations to create a network of commissioners, providers and academics which will facilitate, coordinate and guide service development, research and training The Clinical Network will extend and develop new partnerships with academia and the life science industry. Oxford Academic Health Science Network Page 19

22 115. The University of Oxford's Department of Psychiatry has internationally recognised expertise in developing and evaluating models of integrated care. In particular it has expertise in the treatment of medically unexplained symptoms and of depression in patients with longterm medical conditions. There is also expertise in developing integrated treatments for patients with cancer, focusing on those at the end of life. Current relevant clinical research collaborations aim to develop and evaluate integrated care in patients referred to palliative medicine, those with complicated diabetes in primary care and patients suffering from cognitive impairment after stroke There is also substantial on-going joint service redesign and development work between academics, commissioners and NHS Trusts within the Network on the following topics: integrating mental health and community services (Oxford Health NHS FT), integrating psychological medicine into acute medicine and geriatrics (Oxford University Hospitals), and providing psychological medicine training and support to primary care (Berkshire Healthcare NHS FT). This is providing a rapidly growing number of clinicians with expertise and reflects the importance and value of engaging community health providers in implementing best practice and innovation as close to the patient s home as possible and ensuring that these services as fully involved with the established research and clinical networks. Pharmacy 117. The Pharmacy Network currently lies within the NHS South Central geography and includes representatives from Acute, Community, Mental Health and Ambulance Trusts and commissioning PCT/CCGs. The current Network thus covers two potential AHSNs and this has significant advantages in terms of critical mass This Network has been very successful at delivering the South Central Medicines Use and Procurement QIPP work stream that has achieved 46.5 million in efficiencies across the region in the previous 2 years and has a target to deliver a further 19 million in 2012/13. The work covers a number of areas including community pharmacy, no needless medication and procurement and supply chain The Network will focus on the distribution of medicine and the preparation and supply of aseptically prepared medicines in the future. Continuous Learning Programme 120. The Programme and the Network will support the work of the Thames Valley Local Education and Training Board (TVLETB) and the associated LETBs in the East of England, East Midlands and the Severn areas. The precise nature of this relationship will be explored further as both organisations are established and evolve, but its principle will be to ensure alignment and the avoidance of duplication of delivery of education and training functions Proposals are under discussion, but any final conclusion will include formal LETB representation on the Network s Management Board The TVLETB s organisational structure describes a Partnership Council. It is proposed that this Partnership Council should have the same membership as the Oxford Academic Health Science Network Partnership Council, together with any other organisation relevant to education and training and workforce planning. This will provide cross-representation and ensure alignment of the strategic goals of both organisations The TVLETB is accountable for the workforce planning and commissioning of education and training. The Network will contribute and participate in characterising TVLETB s strategy. TVLETB may commission some education and training functions from the Network, in addition to those it commissions from individual Network partners There is also a particular opportunity for the Network to work with the LETB to identify potential new roles and types of employees required, and their training requirements, as the nature of the health and social care services evolve The Continuous Learning Programme reflects the defining culture of the Network. It will be instrumental in ensuring that the Network learns from all its activities; that it is a learning network. It will see every Network interaction as an opportunity to learn. It will facilitate a supportive environment to foster a culture of learning. In this way all staff will be able to contribute to a healthcare delivery where critical analysis and enquiry, the routine use of evidence based best practice, and agreed clinical protocols produce best care. Page 20 Oxford Academic Health Science Network

23 126. It will ensure that the patient and the public are the target and at the centre of Network activities. It will promote and embed a culture of collaboration, sharing, support, transparency and leadership development across the geography. The Programme will draw on best practice across the Network, particularly in terms of staff engagement It will support teamwork and multi-professional training, reflecting the requirement within the NOF that the health and social care workforce are at the front line in improving outcomes for the individuals they treat and care for The Continuous Learning Programme will prioritise access to education and training and continued learning opportunities for Network staff to ensure that they have the knowledge and skills to maintain high quality care and to innovate The Programme will align with the LETBs to hard wire innovation into education. The promotion of research and innovation in the life sciences will require their integration with clinical practice to produce academically minded clinicians of tomorrow. The principles of the OUCAG School designed for medical graduates will be extended to other workforce education and training, to help engender an ethos of evidence based practice and research oriented clinicians The Continuous Learning Programme will also support the Themes such as Knowledge Management and Informatics and Technologies to support an infrastructure for continuous learning. It will facilitate the Network transition to digital records and the use of assistive technologies to create increasing opportunities to access virtual learning environments to develop knowledge and skills in staff for the delivery of everimproving quality and value in healthcare. It will recruit the established expertise of the Open University in this area This ethos of Continuous Learning will also be carried into the education and training of staff in new and innovative ways of practicing medicine such as genomic and stratified medicine, and new ways of managing complex disease such as the care of long-term conditions. Research and Development Programme (R&D) R&D Infrastructure 132. The Network is home to a wide variety of Research and Development organisations and facilities of proven quality and capacity. The Network will provide the opportunity to improve their focus and coordination further to raise their overall productivity. The R&D Programme will develop an infrastructure bringing together all the elements of the NIHR R&D support structure, to identify efficiencies and develop conduits for sharing research findings with other AHSNs It will bring together key stakeholders engaged in clinical research ranging from early translational studies to post implementation observational studies, along with those responsible for delivering the research within Trusts, across primary care and in the wider community; NHS Trusts, academic organisations and industry in partnership with the Network s NIHR clinical research networks and other associated NIHR infrastructure (see Appendix C for specific details on how the Network will deliver its role in supporting research) The Network includes NIHR funded bodies the OxBRC and Oxford Biomedical Research Unit (BRU), the Thames Valley Local Comprehensive Research Network (TVCLRN), the NIHR topic specific research networks, the UK CRC-registered Clinical Trials Units (CTU) and the NIHR Clinical Research Facility at Oxford University Hospitals There are six UKCRCregistered Clinical Trial Units in Oxford, which cover the majority of disease areas with a strong tradition of large, definitive trials and proven capacity to translate basic scientific advances into benefits for patients. l Clinical Trial Service Unit leads the way in the design, implementation and analysis of large-scale randomised trials, particularly in cardiovascular, renal diseases and cancer. l Diabetes Trials Unit s translational studies and multinational randomised trials have been instrumental in changing the management of glycaemia and blood pressure in diabetes worldwide. l The National Perinatal Epidemiology Unit is the only specialist CTU in the perinatal field in the UK and provides support and expertise to a number of other trialists and units across the UK. Oxford Academic Health Science Network Page 21

24 l The Oxford Cognitive Health and Neuroscience Clinical Trials Unit is a development of the currently registered Oxford CTU for Mental Illness to include Neurology and Experimental Psychology and is closely linked with the NIHR-funded Oxford Cognitive Health Clinical Research Facility. l Primary Care and Vaccines Collaborative CTU brings together two registered CTUs whose commonality is working in the community largely in collaboration with GP practices. The collaboration between the Oxford Vaccine Centre and the Primary Care CTU brings considerable operational capacity including management, QA, IT, and statistics. l The Oxford Clinical Trials Research Unit builds on the existing registered Oncology Clinical Trials Office (OCTO) in collaboration with the pioneering Centre for Statistics in Medicine (CSM) and the provisionally registered Respiratory Trials Unit. The existing and developing clinical trials activity in rheumatology and orthopaedics, gastro-intestinal medicine and surgery will be brought together into a multidisciplinary trials unit with the CSM at its heart The CTUs are coordinated via the Oxford Clinical Trials consortium which promotes and shares good practice, maintaining a tradition of education, training and methodological research in clinical trials. There is a central University Clinical Trials and Research Governance team overseeing all trial activity, joint meetings which promote staff development and shared excellence, and increasing standardisation of information systems and quality assurance The NIHR Oxford CRF is managed jointly by the Oxford University Hospitals and Oxford Health and provides a range of tailored services specifically to the needs of high intensity research in people with cognitive and emotional disorders such as anxiety, depression, schizophrenia, bipolar disorder and autism The R&D Programme will ensure that the R&D process draws together all elements of the NIHR infrastructure to support and enhance research delivery across the networks, ensuring CTU support is available where required for trials, and NIHR Research Design Service support is available to all researchers Trusts within the Network have a strong record in research with all involved in hosting research projects. Since its establishment the NIHR TVCLRN has overseen a doubling of patients involved in research. The Table below shows recruitment to NIHR Portfolio studies in and the planned increases in number of both studies and patients recruited will be monitored. No. of No. of Recruiting Patients Name OF Organisation Studies Recruited Bedford Hospital NHS Trust Bedfordshire PCT Berkshire East PCT Berkshire Healthcare NHS FT Berkshire West PCT Buckinghamshire Healthcare NHS Trust Buckinghamshire PCT Heatherwood and Wexham Park Hospitals Milton Keynes Hospital NHS FT Milton Keynes PCT Oxford Health NHS FT Oxford University Hospitals NHS Trust Oxfordshire PCT Royal Berkshire NHS FT TOTAL: also South Central Ambulance Service NHS FT Oxford Learning Disability NHS Trust 1 14 Southern Health NHS FT Examples of research projects and approaches involving partners within the Network are shown below. The INTERGROWTH-21st Project The UKCRN portfolio study funded by the Gates Foundation has recruited more than 9,000 mothers and newborns to the study at the OUH. It is now being rolled out to the RBFT and Stoke Mandeville. The research focuses on understanding the factors responsible for growth and development across the first 1,000 days of life (conception to the age of 2). work Page 22 Oxford Academic Health Science Network

25 The Gastroenterology Inflammatory Bowel Network. The gastroenterology specialty group is a strong, semi-formal network for inflammatory bowel disease (IBD) and a world leader in basic science, translational medicine and clinical practice. It is multidisciplinary with involvement of specialist nurses, dieticians and pharmacists. The Network brings together integrated basic science and clinical service; and translational science (T 2, 3 and 4 studies) working closely with the TVCLRN, the UKCRN registered OCTRU that incorporates a Gastro Clinical Trials' Facility and biobanking supported by the NIHR OxBRC. The Group has also developed internationally recognised specialist education, strong connections with industry, worked with local commissioning groups to develop shared strategies for managing patients on expensive biological drugs, set standards for service delivery, shared care protocols with GPs, with innovative options for follow up and continuing care, and shared database models integrating with national audits of biological drugs and clinical care for IBD. The Royal Berkshire NHS Foundation Trust has a highly successful Research and Development team working with the TVCLRN and a research portfolio in a number of specialities with over a 100 research projects running across the Trust. The NIHR portfolio is continually increasing and over the last three years, recruitment to NIHR studies has exceeded target numbers. The Trust has invested in a generic research team of practitioners and research assistants to work flexibly across departments to provide support for researchers, and specifically with clinicians participating in NIHR studies. work work The Cardiovascular Specialty group of the Thames Valley Comprehensive Local Research Network facilitates patient involvement in clinical research from both secondary and primary Care NHS Trusts across Oxfordshire, Berkshire and Buckinghamshire. Over 18 months this research infrastructure has doubled the number of patients involved in cardiovascular clinical trials across the region. As a result, Thames Valley is now one of the largest recruiters to NIHR portfolio cardiovascular studies in the UK. This increase reflects both a greater number of commercial studies and a growth in investigator-initiated studies, developed from research programmes within OUH and the University of Oxford, being successfully delivered through the network infrastructure. This growth in research delivery has been acknowledged through the designation of Oxford for responsibilities for all NIHR Cardiovascular Prevention studies across the UK. R&D Organisational Objectives work 140. These will be implemented through a continuing programme of work aligning and integrating clinical service and translational research infrastructures with the aim of: l Promoting research through increasing clinical trial recruitment, bio-banking and access to clinical outcome data l Facilitating innovations in clinical service provision l Creating a coherent clinical research platform for external partners including the life sciences industry, and l Delivering cost-efficiencies. Promoting research through increasing clinical trial recruitment, biobanking and access to clinical outcome data 141. The Programme s aim, reflecting those of the Continuous Learning Programme, is to create an environment in which it will be possible for every clinical encounter to contribute to research. The elements that will allow this Vision to be realised: innovative study designs, integration of clinical and research networks, new patterns of service delivery, a focus on patient participation and engagement, and innovative data collection and data integration are presented throughout this document. Oxford Academic Health Science Network Page 23

26 142. The R&D Programme will work to align networks and clinical services to deliver better recruitment. It will monitor alignment and greater integration with the translational infrastructure, including Clinical Networks in the Best Care Programme, to support continued expansion of participation in research across the Thames Valley and beyond, ensuring coordination with care across hospital and community settings. It will ensure that research is aligned to wider NHS priorities, and facilitate the accelerated dissemination of products of research that evaluation has demonstrated to improve care, in the early stages of translation (T1 and T2) It will support the delivery of a clinical services and IT environment that can draw knowledge from every clinical encounter. We will draw on research that is being carried out within the Network and provide opportunities for full patient participation. We will develop a Network-integrated set of procedures to obtain proactive consent for review of medical records to establish eligibility for trials, and permission to be contacted about possible participation The Network will introduce and monitor the uptake of the following initiatives that will support the vision of each encounter contributing to research: l replacing some items of routine data collection with clinically and research relevant items l introducing brief PROM data collection in clinical settings where possible using electronic data capture l reiterating brief invitations to patients to register interest in research and consent for use of routine data in research l supporting establishment of phenotypically characterised cohorts of patients with specific diseases that can take advantage of routine data collection l integrating with health economic data collection for use in establishing costs The R&D programme will actively monitor processes to ensure that member Trusts are meeting the broader aims of the NIHR infrastructure programmes, working alongside the NIHR clinical research networks. The Programme will review research performance and support efforts to further engage Trust Boards in awareness of key NIHR research performance metrics. Facilitating innovations in clinical service provision 146. This greater integration and alignment of the Clinical Networks with the research bodies and the NIHRfunded networks will be facilitated by interaction at the level of the matrix with the cross-cutting Themes. The Themes will act as a further conduit for the accelerated dissemination across the Network and beyond to other AHSNs of innovations with demonstrated potential to improve care The R&D Programme will build on existing models within the Network, where the introduction of new technology or novel research findings have been a driver of introduction of new treatments (e.g. acute stroke management), leading to further acceleration of research efforts, service redesign and formulation of new service delivery models Working with CCGs it will deliver new clinical services pathways that improve clinical care, deliver the CQUIN agenda and support the Network s research agenda. We will work closely with the CCGs to ensure early adoption of innovative approaches to care through the CQUIN process. For example, innovative IT approaches will be used to address issues of increased demand for care, collection of research data, developing new clinical pathways and integrating service delivery The Programme will also address key issues and facilitate the delivery of Network strategy such as the translation of advances in stratified and population medicine across the Network and the adoption of the findings of applied health science research. We will work with the research and clinical networks to support key projects numerous current examples of which are cited elsewhere in this document. Creating a coherent clinical research platform for external partners including the life sciences industry 150. The R&D Programme will facilitate the development of new partnerships between the leading academic institutions and clinical services for discovery science and the generation of new knowledge. For example, in Oxford, new findings from cutting-edge neuroscience are being harnessed in partnership with industry for the benefit of patients in large scale research projects including the Wellcome Strategic Award for Sleep and Circadian Rhythm Institute million and the 25 million EU StemBANCC Stem Cell initiative. Page 24 Oxford Academic Health Science Network

27 151. The Programme will adopt a proactive approach to industry and the coordination of life sciences performance across the Network. Issues of ensuring industry participation are addressed elsewhere in this document, but the R&D Programme will ensure that information about contacts with industry is collected, that metrics for participation in life science funded studies are collected, monitored and acted on to ensure problems are rapidly addressed through established mechanisms such as rapid escalation through the chain of accountability. The Network will further develop a business plan, working with the NIHR research networks, designed to establish the needs of industry and actively seek out partnerships, building on the strong relationships already in place The R&D Programme will also work to develop workforce skills and flexibility to deliver research. Elements of this are already in place; for example joint programmes for research nurse training between NIHR OxBRC and CLRN, and Good Clinical Practice training for specialist registrars in paediatrics to support recruitment to studies across the region. The Cancer Network runs an Advanced Communications Skills Course for health professionals from a wide range of disciplines across the Thames Valley that exemplifies the synergies that can be delivered with joint working between the NIHR networks and clinical services. The Network will identify further initiatives, disseminate good practice and facilitate further joint working The R&D Programme will also identify and act upon opportunities to reduce avoidable waste in research, for example by auditing the participation of organisations within the Network in national publiclyfunded trials, the extent to which existing evidence has been consulted in designing new research, and the proportion of studies submitted for publication A systematic programme to share data and the knowledge embedded in intellectual property from early phase research across the Network will prevent the repetition of those activities that have already been demonstrated to have poor returns or even harm to health In addition, the members of the Network, and especially the NHS Trusts and the CCGs, recognise the importance of managing the excess treatment costs associated with research. The Network will work within the national framework and contribute to national thinking, while seeking to be innovative in its approach. The CLRN is collecting data supplied by researchers and Trust R&D Departments and hence the Network has the opportunity to review the current situation, to identify specific issues and to try and develop approaches to help the position. Delivering cost-efficiencies 153. Clinical and research network alignment is crucial for the development of service delivery and Research Management and Governance (RM&G) functions that address efficiencies in research. For example, where there is limited availability of skills or technology in the region, service delivery pathways should ensure access to the technology and associated opportunities to take part in research. Similarly, where studies can be carried out across the Network, RM&G will be coordinated to ensure permissions are increasingly obtained through a system of single sign off across the Network. RM&G processes will be continually monitored to reduce waste and duplication of processes. Oxford Academic Health Science Network Page 25

28 Wealth Creation and Healthcare Innovation Programme 157. The Oxford English Dictionary defines to innovate as to make changes in something established, especially by introducing new methods, ideas or products. IHW takes this further and defines innovation as any idea, service or product, new to the NHS or applied in a way that is new to the NHS, which significantly improves the quality of health and care wherever it is applied Innovations provide new ways to diagnose (or categorise) disease, to treat or support patients or new ways to structure or organise health service delivery. These need to lead to measurable improvements in the quality, cost or timeliness of care to patients. These innovations include: Innovations Clinical Decision Making and Clinical Practice Healthcare Delivery, Management and Administration Medical Diagnostics and Devices Pharmaceuticals & Vaccines Advanced Therapy Medicinal Products gene therapies, cell therapies and tissue engineered products Information Technology, including informatics and Knowledge Management New Surgical techniques or operations Health Promotion & Disease Prevention Patient Driven Wellness 159. Clinical innovations are built upon biomedical research. They occur when scientific discoveries are translated into practical usage and disseminated across a healthcare system. Most innovations require investment to complete clinical research to demonstrate benefits, safety and value for money. This investment is usually done by businesses outside the healthcare system, who develop the products and services for global markets. The encouragement, nurture and support of such businesses can lead to local wealth creation. This can be in the form of returns on money invested, but also increased local economic activity (such as the creation of jobs) and improvements to the efficiency and effectiveness of local service providers (such as the NHS) Innovations also arise from clinical practice and these can have significant impact in the NHS in terms of efficiencies, cost savings and quality outcomes. They cover a range including training packages, software or medical devices that may not have large markets. They are nevertheless important within the NHS The vision of this Programme is a profusion of clinical innovations springing from our geography being rapidly tested through trials and adopted within the NHS and creating strong, successful local businesses to support the further commercialisation of the new services and products, to the rest of the UK and the world Metrics will be used to monitor the success of the Network in stimulating local wealth creation. The wealth creation goals of the Network will be developed as detailed targets to optimise the following within life sciences: Metrics New business creation and sustainability including their quality, capitalisation and longevity The growth and profitability of established businesses Job creation and security and the ability to attract investment in start-ups and established businesses Ability to translate local research in academia and the NHS into innovations Local engagement clinical research to translate research into innovations Collaborations between academia, NHS and industry started and successfully concluded Local uptake of innovations and the spread of locally adopted innovations to elsewhere in the NHS R&D commercial spend: how much is being spent developing new products and services within the region Acquisitions: number of local businesses being bought Business / Science Park / Office utilisation: ability to attract new businesses to locate within the region Big company presence: ability to attract engagement and investment from global companies Availability of local skills and infrastructure that attract investments Intellectual Property: patenting activity, exploitation and other forms of IP Numbers of studies adopted onto NIHR Portfolio with industry collaboration Page 26 Oxford Academic Health Science Network

29 163. The region to be covered by the Network already has a strong life science business ecosystem creating local wealth. This is strong by UK standards, but does not yet match the bioscience clusters in the United States and does not fully realise the scale of opportunities presented by the significant assets across the region. This ecosystem has yet to fulfil its potential. It can and should be much larger, more vibrant and successful Network partners include all of the components necessary to create a vibrant life science business. In addition to all NHS bodies, these include: l Universities undertaking biomedical and other relevant research. l Business Schools promoting entrepreneurship and knowledge transfer. l Business Parks and Incubators helping in business creation and support. l Support networks building communities and supporting businesses. l NIHR clinical research networks supporting trial recruitment through building infrastructure and flexible use of funding. l Professional service firms helping with accounting, law and patents Important assets of the Network include the young entrepreneurs acting within or outside of the NHS. The Network has some of the brightest and most highly motivated undergraduate and postgraduate students and post-doctoral researchers in the world working on some of the most interesting, exciting and challenging clinical problems. Many of these are eager to show that their research can have impact and can be translated into commercial opportunities and hence have widespread patient benefits The Network will drive additional economic value in three main ways: l increasing the generation of new life science and medical and clinical informatics business from the research in its universities, hospitals and medical schools l playing an even larger role in clinical research and other trial and development activities, in collaboration with commercial companies, large and small l developing a new culture and a new set of incentives and processes to actively identify, trial, adopt and disseminate clinical innovations in the NHS In addition, the Network will continue to encourage and support engagement and collaboration with industry to facilitate developments, trials, validation and adoption for innovations. Linkages within and across Networks can hence support wealth creation The specific activities of the Network that will make this happen include: Specific activities Building and maintaining a list of key organisations and contacts and using our networking skills to connect people and organisations and hence create synergies and collaborations. Identifying and providing information on ideas and opportunities, as ideas for innovations with commercial aspects arise. Connecting investors to opportunities and developing, supplying or identifying expertise on routes to market. Supporting and mentoring new businesses and specific development programmes and the marketing of the region. Supporting access to UK, EU and other international contacts and funds. Developing and implementing a Research Agenda around the challenges of supporting life science business support and generation. Identifying, promoting and supporting collaborations between parts of the network. Evaluating types of innovations. Supporting the piloting and early adoption of key innovations across the NHS. Participating in national thinking around wealth creation in partnership with other AHSNs. Driving strategic alignment between the strategic plans of relevant organisations in the life science commercialisation agenda. Leading the general thinking on regional development of life sciences. Influencing public policy and decision making. Developing and maintaining metrics It is recognised that achieving success will not be easy. There have been many previous innovation initiatives in the NHS with results that have been patchy at best. Efforts to stimulate innovations and accelerate their adoption into the NHS have been met by significant challenges. Oxford Academic Health Science Network Page 27

30 l Firstly, there exists a general mistrust of technology suppliers, so just arranging pitches for novel innovations will not be an effective approach. The Network will need to act as an honest broker between NHS and industry to improve relationships and engage businesses in NHS processes. A governance process for this function that engaged both industry and researchers will be developed. l Secondly, the current misalignment between the financial drivers of the NHS and innovation; changes that lead to a reduction in the number of people entering hospital, by improvement in population health or service redesign, may also reduce the revenue of the hospital. Some innovations, whilst cost effective for the population, prove difficult to cash in, because of possible financial disincentives for the acute Trusts There is also a general aversion to financial risk within the NHS which does not favour the adoption of new technology and processes. The Network will work together with the NHS to overcome these barriers Some of the key issues which hamper the adoption of innovation and their potential solutions include: l Short-term and/or "silo" budget pressures squeezing out innovations: we will conduct a rigorous process of screening innovations for added value, in terms of outcomes and costs, and engage budget holders in the Trusts and CCGs in approving the best for Network-wide adoption. l Separate and cumbersome local controls on R&D activities: resolving this issue is a high priority for the NIHR; we will work with the NIHR and new Health Research Authority to create a simplified sign-off procedure for pan-network clinical trials. This will be developed with the R&D programme and with support of NHS Trust Boards, who will need to set up systems to accept assurances from work done by other Trusts in relation to contracts and finances. l Limited engagement between the local, vibrant bioscience cluster and the NHS: the Network will sponsor events and forums that actively reach into the cluster for collaboration and adoption opportunities. l Fragmented, sub-scale academic/industry/ NHS relationships: we will target further broad relationships with major companies that combine the research and clinical practice resources in the cluster that bear on major industry problems and opportunities Specific examples of early Network initiatives in wealth creation include: l Developing a cancer genomics network that includes testing across the Network, to better target chemotherapy for better patient outcomes. A new company, Oxford Cancer Biomarkers (OCB), illustrates the capability of the Network in this field, which is reinforced by the presence of Quintiles, an OCB investor and major global clinical testing company. l Supporting the Structural Genomics Consortium (currently supported by Wellcome and four major pharmaceutical companies) as it generates potential lead molecules for pharmaceutical development, both with the founding partners and via spin-out projects and companies. l Increasing contribution to economic and social development for the benefit of the region and the UK as a whole. Successful spinout companies from Oxford Psychiatry include Minervation (a Network partner) and incubated companies include P1vital. l Supporting the development of a Big Data Institute in Oxford that will collect and analyse clinical data from across the Network and so accelerate the process of converging on best practice treatments and pathways. l Working with the Institute of Biomedical Engineering in Oxford, in conjunction with the primary care networks, and with IT and telecoms players, to increase the adoption of in-home monitoring, which is both a high potential business opportunity and a means of addressing Domain 2 of NOF. In this context, we will work especially with Vodafone, whose global headquarters are in the Network and who have already sponsored two clinical trials of mobile health (m-health) in the region to support people with Type 1 diabetes as well as patients undergoing oral chemotherapy for breast or colorectal cancer. The Institute of Biomedical Engineering has a long-standing track record in wealth creation, with a regular flow of spin-out companies from the Institute, the latest being Intelligent Ultrasound and OxeHealth. l Accelerating the roll-out of innovations that enable major changes in the productivity of care that are Page 28 Oxford Academic Health Science Network

31 either developed in the Network, contained in High Impact lists developed centrally, highlighted by current NHS Innovation Hubs or in industry submissions (IPAC etc.). An example is the CQUIN project on electronic track-and-trigger project at the OUH which links nurse observations on hospital wards with the Electronic Patient Record (EPR). l Pioneering and rolling out training modules based on best practice with high positive financial impact. An example is the ALERT TM training module that improves diagnosis of patient deterioration that has been independently estimated conservatively to save 27m, in intensive care costs Planned activities include the following: l Increasing the already high level of clinical trial activity through the Network NIHR clinical trial networks with a single sign-off procedure. Faster trial initiation and higher levels of patient recruitment could double the current economic contribution from clinical trials. l Organising "healthcare productivity priority" events that bring together the managers and clinicians most concerned about a specific issue (e.g. the better management of the COPD patient population to reduce unplanned admissions) with those companies (for example with GSK) with products or services geared to address these priorities. We will facilitate the dialogue and help both sides develop viable partnership models and business cases. For small and medium enterprises, this may take the form of joint Small Business Research Initiative (SBRI) applications. l Structuring and supporting "adult conversations" both between acute care and primary care and different Trusts, with the CCGs when necessary, where the adoption of an innovation that reshapes patient pathways faces conflicting incentives between different players. l Developing and implementing a formal challenge process whereby companies or NHS staff pitch to a mixed group ( Wealth Creation Task force ) how their technology will address either these challenges or ones they believe represent major clinical/ economic priorities. Those that pass this hurdle should go into an Implementation step where a mix of clinicians, procurement staff and managers work out how it will be done (not whether it will be done). Milestones and metrics are then set for the programme and only those meeting their goals will proceed. l Working to develop a procurement strategy for the Network that will also address issues the anticipated NHS procurement strategy publication may highlight. l Connecting investors to opportunities by linking suitable parties and assisting in the preparation of necessary documents for entering negotiations with potential investors. l Supporting and mentoring new businesses and specific development programmes, establishing a formal incubator to engage business students and young entrepreneurs. l Developing and pursuing a Research Agenda around the challenges of supporting life science business support and generation. l Stimulating discussion and participation in national thinking around wealth creation in partnership with other AHSNs The Network acknowledges that wealth creation may extend beyond the fields of healthcare as in the military model, where technologies developed for the armed forces (such as mobile communications or satellite navigation) have fuelled industries that have benefitted society at large. It will identify the wicked problems faced by healthcare and work with service organisation and businesses to facilitate and ensure that wealth creating business spills out beyond the needs of healthcare, when appropriate. An example of this might be to see whether natural language systems needed in busy or sterile environments might find wider applications at home, on the move, and in business, and to collaborate with those who can transition the solutions The establishment of the Network will deliver better connections, synergies and collaborations between academia, the NHS and business. This has great potential, not only to benefit patients, but also to enable significant local wealth creation. Oxford Academic Health Science Network Page 29

32 I: The Themes 176. The Network has identified six Themes, which emphasise the over-arching strengths and objectives of the Network in transforming healthcare for patient and population benefit. The Clinical Networks will provide the critical mass and scale for the expertise of the cross-cutting Themes that intersect them. The continual exploration for and application of innovative ways of delivering healthcare through these Themes will be a defining characteristic of the Network The Themes are: l Population Healthcare l Patient and Public Engagement and Experience l Integration and Sustainability l Informatics and Technologies l Genomic Medicine l Knowledge Management Population Healthcare 178. This Theme will engage its experience of running National Screening Programmes, of producing National Atlases of Variation and of programme budgeting through the Right Care Programme to prevent unwarranted variation in healthcare The Theme will draw on work that is already underway within the Network geography supported by the QIPP Right Care programme based at Oxford. The primary objective of the QIPP Right Care programme is to maximise healthcare value: l the value that the patient derives from their own care and treatment l and the value the whole population derives from the investment in their healthcare To succeed, reform and redesign of care must integrate both in a single model; separately, they can become opposing imperatives. Right Care for Patients No decision about me without me l Patients will be assisted to make decision about their care addressing avoidable ignorance. l Every service needs to ensure that the patient has the time and resources to participate in decisions about their care. l Empowered patients, making informed decisions, can deliver high value care for both the individual and for the whole population served by the service. Right Care for populations the accountable, integrated, care system 181. To improve outcomes and value for their whole populations, clinicians and commissioners need to manage healthcare in integrated systems which: l Understand and address variation to remove waste, and promote the adoption of higher value interventions. l Address whole populations and not just those patients who appear in clinic. l Understand spend and outcome to deliver high value healthcare; commissioners need to manage the services they contract at programme budget levels how much is spent on diabetics and for what population outcome? l Devolve Pathway Design and Management to a provider in the programme budget pathway, with commissioners focusing on outcomes. l Ensure clinical and financial accountability for providers to deliver integrated care by working together and accepting clinical and financial responsibility for entire programme budgets. l Mobilise the patient who, when informed and empowered, will select more appropriate and sustainable care The Theme will collaborate with the Clinical Networks, which represent relevant population segments of the population, to analyse data related to outcomes important to patients. Much of this information will be derived from the work of the Patient and Public Engagement and Experience Theme as it cross-cuts the Clinical Networks, to assess multiple outcomes important to patients. With these data, together with data collected by the Clinical Networks on costs, the Population Healthcare Theme will signal a departure from the conventional organisational structure designed to optimise the use of resources, to one organised to meet the needs of the population and rigorously assess its cost to design and build integrated systems of care This work will develop the capacity for systems, network and pathway design and management and also work on a Do Once and Share approach to prevent unknowing duplication. Page 30 Oxford Academic Health Science Network

33 184. The Theme will work with the first wave Clinical Networks and engage with the others as they evolve. It will recognise that different disease programmes require different population sizes to work efficiently. The Theme will assess the optimum size for each disease programme and ensure that every system produces an annual report using the same set of objectives and criteria against common standards The Clinical Networks will also extend their roles to use their collective expertise to support the assessment of health needs of their specific population, by working with commissioners and Directors of Public Health. This will help to inform prevention, public education and public awareness and eliminate waste, by supporting strategies that reduce expensive late-stage care interventions, another component of the value proposition described in IHW This thematic approach is demonstrated in work already proceeding under supervision of the Right Care team as outlined below. Buckinghamshire Healthcare NHS Trust has been working with patients, primary care and the UK Vision Strategy and Royal National Institute of Blind People to develop a Population Based Accountable Integrated Care System for Glaucoma. Following a workshop a number of actions have been agreed to cover the refinement of referral patterns, information and the development of a summary care record for glaucoma, and the introduction of an education and patient support work stream. Leg Ulcer Services in Oxfordshire is an initiative to deliver value to patients and the population. Its aim is to standardise community leg ulcer management by implementing an agreed patient referral pathway along clinical guidelines and an educational programme for nursing staff. A workshop established some key areas for further work, including the potential financial savings from changes in service provision, the reasons behind poor healing rates, local audit outcomes and the challenges to implement desired improvements. work Patient and Public Engagement and Experience 187. This Theme will build on and create new partnerships between patients, the public, professionals, academia, industry and innovation. Engagement with the public and patients and the collection and utilisation of health experience data will underpin the work of the organisations, practitioners and researchers within the Network The public, patients and carers need to be well informed about health, illness and healthcare so that they can be actively involved in decisions about care received and research they participate in. A number of organisations within the Network have already developed strong models for patient and public involvement, and for the collection and analysis of patient experiences of healthcare. These produce a wide range of information about health, illness, healthcare and research that is easily accessible to patients and the wider population. We believe that by bringing this work together we can create world-class collaborations which can fundamentally reshape the way that care is delivered, assessed and monitored in the NHS, and which will demonstrate how research priorities can be aligned with patient needs Patient experience has been identified as a key determinant of the quality of care, alongside safety and clinical effectiveness. This is recognised in domain 4 of the NOF. There is also increasing evidence that patient-centred care and educating patients and the public about conditions is linked to improved clinical outcomes, making clear the links between the three areas of healthcare quality. Moreover, by taking into account the informed goals and preferences of individuals, the costs of unnecessary investigations and treatments may be reduced Developing effective iterative information exchange, integration of care across care pathways and use of shared decision making approaches, that acknowledge complexity, risk and uncertainty, will be important aspects of work for the Network. Oxford Academic Health Science Network Page 31

34 How this theme will be addressed 191. The Patient and Public Engagement and Experience Theme will help bring together and support organisations within the Network to continue to develop patient-centred care through interaction with the other Programmes and Themes of the Network. This will require working at a number of levels within the healthcare system addressing: individual patient care, research and industry and organisational development, including education and training. Patient and public engagement. and experience Patient-centred care Personalised care..using shared decision making and where possible/ appropriate risk stratification information Information For patients and carers Outcomes..Reporting and using experience of care information and using patient and carer defined and reported outcomes Research and innovation.define research questions with public and patients.increase engagement with patients and public in order to support participation.increase population and patient health literacy Organisational development.involve public and patients in governance of organisations, including of the Network Use experience, opinion and safety data to measure, monitor and benchmark service quality Use experience data and involve public and patients in design of services and in education and training programmes 192. The Theme will run through a number of strands of work: Individual patient care l Supporting clinical services to deliver patient-centred or personalised care: We will work with Clinical Networks, individual clinicians and patients to increase patients' and carers' understanding of, and involvement in, their care through appropriate use of information and shared decision making, including using risk data. Work to support this will include work with the Informatics and Technology Theme and work with Genomics and Diabetes on shared decision making. We will draw on existing research collaborations that are developing and adapting patient decision aids and on current work to support pain monitoring in patients with cognitive impairment. l Development and dissemination of new and existing metrics to capture patient defined and reported outcomes: There is extensive local expertise in understanding and development of patient reported experience and outcome measures (PREMs and PROMS) and on-going local research to develop patient reported outcome and experience measures in schizophrenia, mild cognitive impairment and coeliac disease. We will further develop similar work with the IAPT network. In addition, on-going research is looking at ways to combine PREMS and PROMS. Through working with partner organisations and Networks, we will identify where this work could be piloted and rolled out locally, and through working with other AHSNs, where it might be rolled out nationally. James Lind Alliance (JLA) Priority Setting Partnerships (PSPs) bring together patients/carers and clinicians to identify and prioritise research questions in treatment uncertainty. As part of a wider programme of patient and public involvement, the BRC is funding a Consultant Orthopaedic Surgeon at the OUH and Reader in Musculoskeletal Science at the Nuffield Department of Orthopaedic Surgery to conduct a JLA PSP to investigate priorities in surgical interventions, such as knee and hip replacement for people with arthritis. twork Page 32 Oxford Academic Health Science Network

35 l Improving health literacy in the general public and in patients to support their capacity for active participation in decisions about health, healthcare and research, for example through promotion of the locally developed Testing Treatments interactive website designed to improve public and professionals' understanding of research methods and involvement in research, and the award winning patient experience website Healthtalkonline. Organisational development l Ensuring appropriate patient and public involvement in the structures and processes of the Network and its partner organisations. We will be developing a public website for the Network and developing a mechanism for discussions on our Vision and work as it develops. This will include consulting on the best ways to engage patients and the public in the Network. l Developing all partner organisations' ability to understand and use health experience data, including safety and complaints, to monitor quality, design services and inform education and training programmes. The Themes will support this by recruiting two pilot sites from within the Network for the on-going research (funded by the Department of Health and led locally) into the organisational use of health experience data. We will also build on local research developing an innovative approach to involve patients in experience based service design and research designing tools for primary care capture of patient safety data. twork l Within the Network's first five years all partners should aim to have developed and put into use a strategic framework for patient and public engagement and experience that will allow comparison across organisations. Research 193. Increasing engagement with the public and patients to help define research questions, increase participation in research and the uptake of innovation, ensuring involvement in all stages of research and with NIHR Clinical Research Networks. Collaboration between The Centre for Information Design Research, University of Reading and Berkshire Healthcare FT Mental Health Liaison Team and Royal Berkshire FT Old Age Care team on information design to improve patient/carer understanding of dementia and to facilitate information exchange between patients and clinicians. Work so far has focused on exchange of information relating to pain and pain relief (aimed at reducing prescription of antipsychotics) and on tools to support clinicians in an assessment of capacity, with plans to develop information prescriptions following diagnosis of dementia (aimed at reducing critical admissions through better patient/carer understanding). twork The OxBRC, in collaboration with the Oxford Health Experiences Research Group, has completed a number of studies on the experiences of being involved in clinical trials, biobanking, TIA and screening for heart valve disease. These can be viewed by patients and professionals on the Healthtalkonline website. A new study on experiences of PPI in research using Healthtalkonline video clips on experiences of trials will be tested as part several interventions aimed at improving recruitment to trials. How we will work 194. In order to embed the aspirations of this Theme we will need to draw on patient, public and professional expertise from across the Network. Initial work will include: l A scoping exercise to identify interest and best practice across Network organisations and networks in relation to the full range of relevant activities; engagement, use of experience data, shared decision making approaches etc. l Developing a network of expertise to help generate ideas and provide advice for organisations and individuals within the Network. We can draw on unrivalled local expertise in relation to collection and measurement of health experience and understanding of shared decision making approaches. We can also draw on established international links with the USA, Hong Kong and Europe. This expert network will include links with local existing and emerging patient organisations. Oxford Academic Health Science Network Page 33

36 l Developing a network of leaders and collaborative learning networks within partner organisations to help with ideas, advice and delivery. l Running expert seminars and workshops e.g. international seminar on shared decision making planned for summer 2013 and health experiences conference for l Developing related projects within other Network Programmes and Themes such as development of patient defined and reported outcome and experience measures, development of informatics to support collection of health experience data, use of priority sharing partnerships for research. l Developing specific metrics for each piece of work in conjunction with the expert and leaders networks. l Working with LETBs to identify and build on existing work with the Network, for example at the OUH with medical students. This develops student understanding of the importance of such data and the data can also be used to feed into service improvements The breadth of expertise that currently exists within the Network, along with the expertise we will develop through working with Network partners and other AHSNs, means that the Network will be in a good position to act as a resource for patient and public engagement, involvement and experience for the rest of country. Integration and Sustainability 196. Our approach to service redesign and integration will draw on the existing and growing capacity in technological and methodological innovation in health service delivery. In particular, our activities will complement and add scale to the successful OxBRC s integrated care and bioinformatics working groups. However, small-scale and proof-of-concept studies about how care delivery could be transformed are not sufficient. Technological innovations often fail not because they lack efficacy, but because they come as a poor fit to the complex healthcare delivery systems. We will, therefore, aim to align technological innovation with service delivery innovation through this collaborative Network On-going and planned research activities from several other Network themes will help create the foundations of a system that is integrated both horizontally (i.e., sharing of comparable information across multiple organisations) as well as vertically (i.e., data integration across social, primary and acute care). Building on these, the Integration and Sustainability Theme will bring academics, service providers, commissioners and consumers together to align goals and strategies for designing services, which are centred around patient needs. Working with all key partners right from the outset fosters a participatory environment that is essential for integrating grass root innovation and executive steering impulses The Network will nurture a culture amongst its provider members to look at the delivery of care beyond the confines of their own boundaries, and to draw on the experiences of the third sector and private sector providers, as well as community and social care providers By removing the obstacles associated with organisational boundaries, service redesign through clinical integration will improve existing patient pathways and facilitate the design of new patient pathways that integrate the contributions to care of all partner providers into one seamless journey We will work with existing and emerging networks to harness the power of local experimentation and largescale standardisation, which are key features of resilient and high-performing learning organisations Integration and service redesign is already occurring in many areas within clinical services in the Network and will allow the provision of care in the community as close to home as possible, potentially releasing funds where cheaper as well as more appropriate care settings and delivery models can be employed We will implement the nationally designated High Impact Innovations within our population wherever appropriate, and explore the development and deployment of appropriate teleheath tools and technologies that can be used to enhance selfmanagement and enable remote monitoring, thus reducing routine and unplanned hospital attendances and help keep more care of chronic disease in the community. Page 34 Oxford Academic Health Science Network

37 203. Integration through alignment will unleash the powerful contribution that research and innovation, and teaching and training can make to improve clinical care. Quality improvement and sustainability of clinical services requires the integration of these integral components of healthcare systems, which by innovation can lead to change. We will mobilise our extensive research and innovative capabilities and align them to our Vision, to accelerate the discovery and deployment of new relevant treatments and technologies, and to address service redesign and formulate new service delivery models. Integrated care for management of patients with chronic heart failure Heart failure is a common and costly condition, which exemplifies many of the challenges of healthcare systems. In England, it is estimated that 7% of the population aged 75 years or more are affected by heart failure and the prevalence is expected to increase by 50% by Preclinical research and clinical trials over the past two decades have established a solid evidence-base for effective drugs and devices that when applied to individual patients with heart failure can lead to symptom relief and prevention of premature death. Biomedical research will continue to advance our knowledge about how to better diagnose and manage patients affected by heart failure. Despite these advances, however, morbidity and mortality from heart failure (particularly early-on after the initial diagnosis) remain high. In the latest Heart Failure Audit report, the UK in-hospital mortality rate was 9%, which is higher than in many other high-income countries. During the median 133 days of follow-up, about half of the patients were readmitted to hospital for heart failure or had died. The report also showed substantial variations between and within hospitals in organisation, care delivery and outcomes. Effective therapies appeared to be underused. For example, of those with reduced left ventricular systolic function (Ejection Fraction <40%) only 46% were prescribed betablockers and 12% did not receive any of the five classes of drugs recommended by NICE. Despite UK s exemplary progress in establishment of outof-hospital heart failure teams, less than half of hospitalised patients with a confirmed diagnosis of heart failure are referred to nurse-led heart failure liaison services and more worryingly, only a fraction of these patients are likely to be followed up in the community by heart failure nurses. In the NHS South Central region, the ratio of community heart failure nurses to prevalent heart failure patients is 1 to 1100 (with a more than 5 fold variation). A typical community heart failure nurse looks after only about 50 to 80 heart failure patients at any time. This means that a comprehensive coverage of all heart failure patients would require a more than 10-fold increase in the number of heart failure nurses in most communities. Follow-up by GPs or specialists is similarly patchy, variable and often fragmented, due to lack of capacity and delays in communication between the different groups of healthcare professionals and patients. For example, discharge summaries are likely to be available in less than a third of patients who are reviewed in clinic after discharge. twork The inevitable rise in the prevalence of heart failure makes our current labour-intensive and uncoordinated systems of care increasingly unsustainable. Even if resources were unlimited, further growth of our traditional models of care delivery would still fail to reduce undue variation in care, because quantity of services does not usually correlate well with quality and outcomes of care. Therefore, there is unmet need for innovative service delivery models that are better capable of increasing the capacity of our systems to handle the growing demand for heart failure care. These models must deliver care at higher quality and lower prices per unit of care. We have already established a collaborative network that is devoted to the development of an end-to-end, patient-centred, affordable and sustainable system. This aims to provide proactive heart failure management based on patients needs with the use of innovative technologies and methodologies for service design. The interdisciplinary team includes members of the Integrated Care and Bioinformatics Themes of the OxBRC, external academic leaders, practitioners and commissioners. Working with the Cardiovascular Clinical Network will help to expand the network to a wider range of stakeholders for implementation and evaluation of a unique integrated model of care delivery to a large number of patients. The system will have several components: patient-controlled electronic health-record, a risk assessment and stratification component with the use of near-patient affordable diagnostics, management support component with emphasis on self-care, and an automated audit tool. We envisage this large and ambitious integrated care programme to be developed in several steps: l Development of the IT system. l Establishment and strengthening of the network to work towards a common goal. This will include working with external partners, such as NHS Direct and industry. l Small-scale implementation and adaptation. l Large-scale implementation across the whole network and rigorous evaluation. Heart failure care is only one example of this theme. In collaboration with other partners, we will develop similar care systems for other major chronic conditions. The vision is to integrate these diseasespecific management tools into a comprehensive package of care, that enables a high-quality care for management of people with multiple and common long-term conditions. Oxford Academic Health Science Network Page 35

38 204. The Cumberland Initiative brings a wealth of skills and experience in systems simulation and modelling to address and solve problems in healthcare. Successes in systems thinking, management science and risk management in healthcare are patchy and not of the scale required to deliver transformational change. The NHS has been unsuccessful in demonstrating that local applications can deliver success at a macro-level and finds it difficult to change a healthcare culture that is risk averse and unwilling to test new ways of working. The Cumberland Initiative will support Network partners to develop innovative, risk-managed, modelled or simulated methods to create solutions. It is planning to unveil the site of the new National Institute for Service and Systems Excellence in the geography of the Network Sustainable healthcare aims to deliver the highest possible value to patients from a radically reduced resource input. While aligning closely with NHS priorities on outcomes, patient experience and cost saving, sustainable clinical practice is distinguished by its level of ambition calling for rapid, transformative change Climate change is recognised as a significant threat to health in the 21st Century, yet healthcare provision is a major contributor to climate pollution (NHS SDU, 2010). The NHS Carbon Reduction Strategy commits the NHS to reduce carbon emissions to 80% below 1990 levels by 2050, in line with the legally-binding targets set by the UK Climate Change Act (2008). These targets will only be met by radically reduced resource input, which is far more challenging than the current financial constraints Sustainability demands rapid transformative change to lean, integrated, person-centred care with greater upstream intervention. Empowerment of patients to become active agents in improving their own health and partners in their care is at the heart of a sustainable system NIHR has published guidelines for reducing the carbon impact of conducting research (NIHR, 2010). There is also avoidable waste in research arising from poor study selection, poor study design and execution, biased under-reporting and poor quality of research reports (Chalmers and Glasziou. Lancet 2009) Working together to truly address the sustainable development imperative will place the Network at the forefront of innovation nationally and internationally and it will engage a broad range of stakeholders in a positive vision for health and set a new level of ambition in service transformation This element of the Theme will look to: l support a highly visible demonstration project showcasing the radical redesign of a clinical service to deliver sustainable patient-centred care l implement sustainable clinical practice in at least ten specialties, sharing knowledge and experience via Clinical Networks, and l have transparency and reduction in avoidable waste in research Specifically, the following will be put into place to support the Network, using the model of sustainable clinical practice developed by the Centre for Sustainable Healthcare. Clinical specialty teams who wish to work sustainably will be recruited to promote prevention, practise patient-centred care, develop lean pathways and chose low carbon treatment options These could be supported by three to four Sustainable Specialist Fellows, to be seconded from specialty training and hosted by the Centre for Sustainable Healthcare in partnership with Warwick Medical School. The role of the Fellows will be to embed sustainability as an aspect of quality across the Clinical Networks. Informatics and technologies 213. Advances in information technology will have a dramatic impact upon healthcare and clinical research. Interoperability standards and governance frameworks will enable the linking of data from different sources across the complex health economy, from acute to social care, to support new, integrated services and provide a more complete picture of healthcare delivery and patient health status and experience Network partners can contribute considerable experience and expertise in interoperability standards and data sharing. In particular, the University of Oxford is a leading centre for research in information systems and semantic technologies, and a number of Trusts are working on linking and sharing data from acute, primary, and social care settings. The Theme will extend this expertise to consolidate and expand this work across the Network. Page 36 Oxford Academic Health Science Network

39 215. The role of patient-reported and patient-managed data is vital for a patient-centred and populationcentred healthcare system. Internet and mobile health technologies will enable patients to provide clinicians and researchers with information in advance of, or instead of, direct consultation; patients will, in turn, be able to access their own electronic health records The innovative True Colours text system (shown below) using innovative informatics has already been described Health and social care providers face a range of challenges in the procurement, development, and integration of information systems; they face challenges also in the selection, deployment, and evaluation of innovative technologies. These challenges must be overcome if they are to meet new standards, expectations, and targets This Theme will enable providers within the Network to share experience, insights, and solutions: avoiding duplication of effort, achieving economies of scale, and creating a wider market for ideas and innovations. The Theme will build upon existing connections: for example, Oxford Health Informatics Service (OHIS) already has strong links with other services in the Network geography Funding from NIHR is supporting the extension of this system to other settings: in particular, musculoskeletal pain and surgical follow-up. In collaboration with NHS Diabetes, the University-NHS Partnership at Oxford has delivered an on-line and smart phone application for self-management of diabetes that allows uploading of self-monitoring blood glucose data and patient access to lab test results prior to clinic appointments. The next stage of development will involve deployment in the Network. Within the Network, a number of other innovative telehealth solutions for the management of longterm conditions such as Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF) have also been developed (in West Berkshire, Milton Keynes and Oxford). There are similar projects in hypertension, mostly using smart software deployed within a common NHS IT infrastructure, funded by, amongst others, the NIHR, the Department of Health and the Wellcome Trust. They have been designed so as to ensure that the use of telehealth solutions can easily be scaled up. These ground breaking clinical trials have produced evidence of the value of these technologies. twork Oxfordshire is implementing an electronic care summary service, providing more detailed information than the national summary care record, and integrating data from a range of information systems across the Oxfordshire health economy. This theme will facilitate opportunities for other partners to contribute to, and benefit from, this implementation activity. The University-NHS Partnership at Oxford has promoted a number of informatics-based innovations: for example, the StrokeNav application highlighted in the NHS Information Strategy 2012, a web-based system to support clinicians and managers involved in stroke care, was developed in Oxford and is being piloted in Milton Keynes Within the Partnership, the Institute of Biomedical Engineering at Oxford is engaged in two Commissioning for Quality and Innovation (CQUIN) projects that will serve as useful exemplars for the Network: in electronic track-and-trigger systems for early detection of in-hospital patient deterioration, and in the use of mobile health technology to support self-management of gestational diabetes in the later stages of pregnancy. work Oxford Academic Health Science Network Page 37

40 221. The aim of the work on electronic track-and-trigger is covered above. The innovative data integration and analysis software will be made available through the Network to other Acute Trusts which have adopted Cerner Millennium. Its potential for improving patient safety in the hospital will be developed in collaboration with the Royal Berkshire NHS Foundation Trust Progress in health research is increasingly dependent upon the integration and analysis of large quantities of linked data. New sequencing, imaging, and selfmonitoring technology will generate data to be linked to health records and patient-supplied information. New, automated technologies are required for analysis and visualisation of data at this scale The OxBRC and the Institute of Biomedical Engineering at Oxford are centres of excellence in translational medicine and health informatics. Network partners will be able to participate in the analysis and visualisation of big data, and in the development of open standards and platforms for collaborative scientific research. Genomic Medicine 224. The Network is well placed to deliver a strong Genomic Medicine Theme supporting stratified medicine and population healthcare. It can draw on well-functioning integrated clinical and diagnostics networks and multiple joint clinical appointments with hospitals across the Network (Milton Keynes Hospital, Royal Berkshire Hospital and the Great Western Hospital). A combined investment strategy from research funds including the OxBRC and NHS has been developed in support of the translational, fully CPA accredited OxBRC/NHS Molecular Diagnostic Centre (MDC). This receives an annual investment over 4.5m which includes funds from the OxBRC, the Technology Strategy Board ( 2.4m) and from other external academic and industry sources to identify response predictors to cancer. It also benefits from strong clinical and academic expertise, especially from the Wellcome Trust Centre of Human Genetics (WTCHG) and from close collaborations with pharmaceutical and biotechnology companies The Theme will work to establish a Network-wide innovative specialist molecular diagnostic service for diagnosis of constitutional and acquired disease that delivers research alongside clinical care. It will also support clinical trials with CPA accredited sample testing and biomarker development and validation. It will support the OxBRC initiative in biobanking. In addition, it will aim to cover the following areas of activity through its interaction with the Network, helping it to achieve its Vision: l Valuation and transfer of genomic technology. l Dissemination of equitable use of genomic technology across the network. l Promotion of knowledge about genomic medicine. l Comprehensive evaluation of the clinical utility of genomic medicine including patient engagement and experience and health economics. l Creation of a genotype-phenotype database including data from across the entire Network A number of factors support these aims including the need to provide state-of-the-art specialist molecular testing in a cost-effective and equitable way to the entire Network population and not just to patients referred to a tertiary centre. In addition, the work of the Theme will provide support and impetus in a number of key areas including: l Improvements in clinical outcome through stratified medicine. l Attracting pharmaceutical industry and academically sponsored clinical trials and research collaborations by providing molecular testing platforms. l Assistance to biotechnology firms in product development and beta testing. l Collection of true incidence data of disease causing or modifying genetic variants and response predictors for stratified medicine. l Establishing the UK as an internationally competitive player in genomic medicine The Theme will build and expand on its existing collaborative diagnostic and Clinical Networks to provide comprehensive cover in the geography, align with the NIHR clinical research networks and provide competitive pricing for service delivery. It will work with the Clinical Networks such as Cancer to ensure comprehensive service provision. Page 38 Oxford Academic Health Science Network

41 228. The Theme will perform patient experience surveys, working with the Patient and Public Engagement and Experience Theme and patient groups such as the Genetic Alliance UK. It will study approaches to obtaining ethical consent for genetic testing and the storage of genomic data It will work with commissioners on the commissioning of standardised and fully validated genomic tests. It will also work with the Clinical Networks to produce robust cost-effectiveness data and perform health economic studies to evaluate the clinical utility of genomic medicine Genomic medicine generates large amounts of data that require visualisation and analysis. The Theme will work in collaboration with the Informatics and Technologies Theme on sequence analysis pipelines and large clinical database development The Theme will work with the Continuous Learning Programme and TVLETB to develop a training programme for a new breed of molecular physicians and pathologists and continue to support the training of specialist molecular physicians and pathologists through fellowship programmes, regular Network-wide molecular workshops and the national and international collaborations already in place, including the Cancer Research UK Stratified Medicine and Australian Cancer Medicine initiative The Theme will work closely with other Themes in support of the Programmes and the Goals of the Network A number of metrics will be used to measure on the delivery of outcomes including the yearly audit of sample referrals from Network members, the number and size of industry supported and academically support trials (and the numbers of patients recruited), the publication record, patient experience and engagement surveys, the incidence of genetic variants through its genotype-phenotype database and the correlation the output of this database with conventional diagnostics and clinical data across the Network The Theme will identify additional resource requirements as part of its work in the first year and seek resourcing through the Network s business plan. Requirements will include, resource to support the development of the specialist R&D service to provide a network-wide harmonisation of ethical approvals for research study (thereby improving the number of studies and the number of patients able to take part), the appointment of additional training and fellowship positions, and a Network-wide coordinator to oversee the collection of local samples for the biobank, and the development of an end-to-end Laboratory Information Management System (LIMS). Knowledge management 235. The Network has access to a collection of knowledge organisations including the UK Cochrane Centre, the Centre for Evidence based Medicine, the Health Experiences Institute, the Critical Appraisal Skills Programme, James Lind Library and Minervation. In addition, the Network has a wide range of expertise, knowledge and skills in this field ranging from the Knowledge Management Forum at Henley Business School, the Knowledge Transfer Centre and the Centre for Information Design Research, all part of the University of Reading and the Knowledge Transfer Partnership at Buckinghamshire New University The Open University is regarded as the UK s leading e-learning institution and will be able to share its skills and experience across the Network in support of not only this Theme but all Themes and Programmes through the Continuous Learning Programme Implementation of evidence-based technologies for direct patient care requires strategies that cross-cut and integrate across the Network. First, a knowledge pathway, that inputs to the generation of evidence for implementation of effective interventions into practice, whether from NICE guidance or through rigorous systematic research. Second, the generation of systematic reviews which evaluate and informs service redesign of effective and ineffective interventions (particularly if interventions are proven to be neither cost-effective nor underpinned by rigorous evidence of effectiveness). Third, direct input to the Clinical Networks to support and undertake rapid field studies, for new or emerging technologies, that require further verification of the net benefits or harms, or measures of cost effectiveness. Fourth, a prioritisation strategy involving public and patients, which aims to shape and inform the future research directions of the Network activities. Oxford Academic Health Science Network Page 39

42 238. In terms of generating evidence the Network has expertise in the undertaking of systematic reviews for diagnosis, prognosis and therapeutic interventions that directly informs practice and policy. In addition, this knowledge translation work will directly input to answering fundamental questions that hinder uptake in clinical practice. We will continue work on improving the replication of interventions in practice, and improving the research that underpins monitoring regimes for chronic disease. Work on replication has been shown to be fundamental to improving the ability to undertake interventions in practice. Without such descriptions and programmes, tens of millions of pounds of research effort could be wasted each year, because effective treatments cannot be implemented or will lack fidelity when applied In addition, this Theme will specifically prioritise the development of systematic review evidence targeted at point of care testing for acute care and Non Communicable Diseases The Theme is working closely with industry to undertake a field study (CASM funded by Patients benefit scheme) involving 300 patient cohorts over one year with the aim of identifying if the results from randomised trials are directly transferable to practice This Theme will work in support of the Network s goals to: l develop the knowledge management capacity for all partners, individually and collectively l promote the three types of knowledge: evidence, statistics and knowledge from experience l create a single knowledge network through common internet and metadata standards l create wealth and jobs in the region based on knowledge l develop professional skills among librarians and clinicians in management l play a leading role in global initiatives on medical knowledge Underpinning these strategies is an on-going commitment to the training and knowledge management strategy to coordinate the Clinical Networks and the supporting Themes. To further develop the co-ordinated development and delivery of interventions this Theme will collaborate with the Continuous Learning Programme to support the delivery of systematic reviews across the Network, providing training modules and an expertise service In addition, we will also continue our work on the delivery of tailored evidence summaries for commissioning and prioritisation of interventions, and undertake systematic assessment of NICE guidance to prioritise intervention for implementation, determine research priorities and service redesign. Page 40 Oxford Academic Health Science Network

43 J: Innovation within the Network 244. The NHS Chief Executive s Report Innovation Health and Wealth, published in December 2011 committed the NHS to six High Impact Innovations for delivery during 2012/2013. Each has the potential to transform both quality and value and delivery will be crucial in securing CQUIN payments for 2013/2014 onwards This important area will be a focus of the Network s Management Board and the Best Care Programme with the aim of ensuring high levels of delivery across all relevant organisations, building on the good work already in place The table below describes the High Impact Innovations and the actions already underway across the Network. Dementia services Provided in line with National Institute for Health and Clinical Excellence guidance Innovation Dementia case finding Dementia diagnostic assessment and investigation Referral for specialist diagnosis Progress Berkshire Healthcare has developed the Older Peoples Mental Health Liaison psychiatry teams at the Royal Berkshire Foundation Trust (RBFT) and at Heatherwood and Wexham Park (HWPH). The Trust has enhanced older peoples home treatment teams and increased memory clinics across Berkshire to improve capacity for early specialist assessment. Diagnosis levels in primary care settings in Berkshire have been quite low compared to other areas. Recently, there has been recruitment to increase support to the memory clinics. (This also has the effect of freeing up dementia research capacity to increase collaboration with DeNDRoN). The impact of recent recruitment on improved numbers of patients accessing specialist services and diagnosis rates is being assessed. The Oxford Academic Health Consortium has launched its exemplar project which has the following aims over the next 5 years: experiences and outcomes for patients with dementia in Oxfordshire will improve through reducing variation while retaining excellence dementia related research will increase, generating new knowledge and providing access to innovative care for patients The Oxford University Hospitals (OUH) has now developed the Liaison Psychiatry Service with the support of the University to support the acute medicine service in the management of patients with dementia and delirium. The OUH is exploring potential online form solutions with automatic prompting for relevant patients to collect necessary data sets in support of this CQUIN. Heatherwood and Wexham Park Hospitals FT is working with East Berkshire CCG to provide reminiscence sessions utilising Rempods and My life IT reminiscence systems to provide a flexible and portable service that meet both the acute sector and community needs. The Trust has launched its F.A.I.R dementia care tool which supports the screening, assessment, early identification and prompt referral for dementia specialist care. Early indications are that use of the tool is supporting the objectives of the CQUIN and identifying areas where quality improvement work programmes need to be directed. A number of applications have been made by the Network's CCGs to the Dementia Challenge Fund held by NHS South of England. child in a chair in a day Progress Many trusts are extending this to improve access to wheelchairs to all patients requiring these the work is being taken forward with the PCTs and CCGs, drawing on best practice across the country Oxford Academic Health Science Network Page 41

44 Acceleration of the use of assistive technologies in the NHS, aiming to improve at least 3 million lives over the next five years Innovation Electronic Track & Trigger m-health Progress Physiological track and trigger warning systems (T&T) are used to identify patients outside critical care areas at risk of deterioration and to alert a senior clinician. At the OUH the aim of the work on electronic track-and-trigger is to link the recording of vital sign observations using hand-held devices on the ward with the Electronic Patient Record (EPR) in Cerner Millennium to obtain an integrated, real-time view of the patient s physiology and biochemistry. The innovative data integration and analysis software will be made available through the Network to other Acute Trusts which have adopted Cerner Millennium. Its potential for improving patient safety in the hospital will be developed in collaboration with the Royal Berkshire NHS Foundation Trust. OUH is currently reviewing a number of potential IT solutions in support of this innovation. OUH m-health in Gestational Diabetes: an automated smart phone glucose record and personal website access for women with gestational diabetes with a view to reducing face-to-face interviews in the management of diabetes. This is a tool for professional monitoring, clinical input, dose adjustment and referral on to consultant clinics. The aim is to improve diabetes control and reduce hospital appointments. The project is led by the University of Oxford and the Oxford University Hospitals. The smart phone application is closely linked with the Personal Diabetes Website Project with the same secure NHS IT infrastructure and could be adopted more widely either separately or together. This maps to NOF 2012/13 Domain 4. Fluid management monitoring technology Innovation Implementation of 'oesophageal Doppler monitoring' and other related technologies (ODM) Progress ODM is a minimally invasive technology used to assess the fluid status of the patient and guide the safe administration of fluids and drugs. This technology is now brought into use across the Network s acute trusts in line with NICE guidance recommending it for patients undergoing high risk surgery and certain other surgical procedures. The Royal Berkshire has introduced Goal Directed Fluid Therapy for patients undergoing major surgery. The Oxford University Hospitals has developed a strategy to ensure appropriate training for clinicians and a Clinical Fellow has been appointed and local champions identified to support this innovation. Heatherwood and Wexham Park NHS Trust has established a Goal Directed Fluid Therapy Project Group to facilitate and support the wide spread adoption of the technology. Requirement for nhs organisations to explore opportunities to increase national and international healthcare activity Progress The Network is well placed geographically to meet this challenge building on its strong reputation for clinical services, research and engagement across all sectors. Compliance with HII as a pre-qualification for CQuin payments from 1 April 2013 Progress The Network s NHS organisations providers and commissioners is well placed to build on work already in hand to deliver the CQUIN requirements. Page 42 Oxford Academic Health Science Network

45 Reducing inappropriate face-to-face contacts Digital by default Innovation Digital support in diagnoses and patient management Progress Currently face-to-face contacts account for nearly 90% of all healthcare interactions; every 1% reduction saves up to 200m Using technology to diagnose dermatological symptoms remotely a number of methods are being explored including the transmission of images directly between primary and secondary care to avoid patients having to attend clinics unnecessarily. Discussions are being held between the OUH and HWPH on solutions applicable for dermatology patients. HWPH is currently undertaking a project to introduce Skype based clinics, working with other Trusts to improve cross site working within the Trust itself and provide easier access to clinics for patients. In addition on line health questionnaires will be introduced as part of the redesign of the Pre-assessment service. OUH is also exploring the trial of digital media to manage internal referrals on inpatients at the John Radcliffe Hospital. Royal Berkshire FT has introduced the Young People's Digital Diabetes Clinic. E-technology for pathology & other results, e.g. X-rays Increase in sending pathology results to GPs via electronic format the OUH is developing the use of digital media (ICE system) and its initial download for the dashboard has been successful 247. Some examples of innovations from within the Network are provided below demonstrating the range and scope of activities in this important: Pre-natal test jointly owned IP between UoO and the OUH: twork jointly owned IP between The University of Oxford and the Oxford University Hospitals: Safe, reliable, non-invasive prenatal tests have long been a holy grail in medicine as current methods, such as amniocentesis, carry a small risk of miscarriage. A new test developed at the University of Oxford in collaboration the NHS requires only a small blood samples to be provided by a pregnant woman. In 1997 it was discovered that foetal DNA could be isolated from a mother s blood and used for diagnostic purposes. Isis licenced the technology to US-based company Sequenom who launched a new blood test for Down s syndrome in 2011, following a clinical study that showed detection of 99% of Down s syndrome cases in pregnant mothers. Sequenom currently expect to make around 60,000 diagnoses in the first year post launch. Significant revenues are expected to flow onto the University and the Trust. In addition, the technology has the potential to be applied to a broad range of conditions including cystic fibrosis, sickle cell anaemia and thalassemia. OxeHealth a new spin out from Oxford s Institute of Biomedical Engineering resulting from innovative working between the Oxford University Hospitals and University of Oxford. This allows patients health to be monitored using a webcam and software application. The software has been validated in a clinical study with patients in the Oxford Kidney Unit. In the future, OxeHealth is refining its technology for remote monitoring of COPD. Oxford Academic Health Science Network Page 43

46 NHS Innovations South East (NISE) was commissioned by the South Central Strategic Health Authority to assess the current adoption level of bladder scanner technology across the South Central region twork to identify numbers and types in current use in acute settings. Implementation of bladder scanner technology can reduce infection and save money by reducing unnecessary catheterisation. NISE also identified barriers to use and suitability of technology from stakeholder views, including value for money, maintenance, training and procurement. Relevant outcome measures to support use were identified, such as patient benefit (e.g. reduction in catheterisation and UTIs) and economic (e.g. ROI) measures to support potential business cases for adoption. NISE also supported a completed commercial deal for the trans-lacrymal cannula, a new medical device designed for use in ophthalmology surgery originating in RBFT that allows surgeons to provide drainage into the nasal cavity. This makes the procedure for patients quicker (typically by 50%) and safer and less traumatic; it reduces post-operative complications and can be undertaken as day surgery increasing productivity. Over the past six years, NISE has worked on more than 800 healthcare innovation projects. In 2011 NISE registered 149 new innovations, many of which have the potential to deliver improved patient care and / or better patient outcomes, along with significant savings for the NHS. Most also have real commercial potential, both at home and overseas including for the private healthcare sector overseas. The Oxford Knee Score (OKS) is a 12-item Patient Reported Outcome specifically designed and developed to assess function and pain after total knee replacement surgery. It is short, reproducible, valid and sensitive to clinically important changes. The OKS was designed to be completed by the patient when assessing the results themselves. The PRO was designed and developed by researchers within Public Health and Primary Health Care at the University of Oxford in association with surgical colleagues at the Nuffield Orthopaedic Centre. OKS makes follow-up of large study populations much more feasible (and cheaper) than conducting clinical assessments, requiring a return visit to the hospital; elimination of inter-observer error, good response rates and in large scale studies, the OKS has been rated the best disease/site-specific PRO for assessing outcome of knee arthroplasty (Dunbar 2001) RBFT The Copeland shoulder. Developed by consultants within the Trust this is now the standard for surface replacement arthroplasty of the shoulder. The Trust attracted the interest of Microsoft for its innovative work using the X box Kinnect to offer rehabilitation to neurology patients. The Trust did a study to identify which Kinnect games were most effective and popular with patients and subsequent media coverage generated led to Microsoft featuring the Trust on its global website. It has also led to discussions about future joint projects. Intensity modulated radiotherapy was introduced following work with the University of Pittsburgh Medical Centre (UPMC). By basing a small number of experienced staff from UPMC within the Berkshire Cancer Centre skills and experience were transferred to staff to deliver a new approach to cancer care. RBFT introduced first radiotherapy treatment centre away from a main hospital site nationally. University of Reading and Modern Endoscopy Rigid endoscopes have an optical quality which cannot be matched by fibre optic systems. University staff played the leading role in developing the small, clear, powerful rigid endoscopes that are now ubiquitous in modern medicine (for example, enabling the rapid recovery from and so cheaper practice of minimally invasive surgery). The University of Reading cooperated with a Liverpool urologist and was instrumental in solving the problem of inadequate light for minimally invasive surgery. This new structure consisting of rod lenses required a much thinner supporting tube around the optics, of considerable and obvious benefit in interventions. Working with Karl Stortz, the University introduced a further innovation: an external light source together with the rod lens system delivered light to remote sites in the body. Page 44 Oxford Academic Health Science Network

47 University of West London (UWL) and RBFT As a result of the FALLS project collaboration between the department of Clinical Engineering at the RBFT and Engineering Department (University of West twork London) a total of 13 wards have been equipped with early detection systems to detect movement before vulnerable patients fall out or get out of bed. The FALLS initiative was set up as a result of an increasing number of serious injuries and fatalities resulting from falls. The project was set up under the guidance of the patient falls and bed rails policy with the aim of significantly lowering the number of falls and improving the quality of patient care. RBFT / HWPH COPD team have developed an Interactive Voice Response System. Supported by the Strategic Health Authority, the service has instigated an interactive voice response system to compliment the admission avoidance service. Patients are contacted by telephone twice weekly on Mondays and Thursdays and asked a series of questions regarding their respiratory symptoms. Depending on their responses an alert can be triggered sending a text message to a designated telephone in the COPD office. The patient is then triaged by a member of the team and appropriate action taken. Although it is relatively early in the study, the system appears to be useful in reinforcing education regarding exacerbation symptoms and instigating more timely treatment. A full independent review is planned in the coming months to evaluate the effectiveness of the system including patient and staff feedback. At the OUH s Nuffield Orthopaedic Centre, the EvalueLogix application has been developed from processes in use within the NHS to assist with the evaluation of patients considered for Biologic therapy in the treatment of Rheumatoid Arthritis, Juvenile Inflammatory Arthritis and Psoriatic Arthritis. The system provides for the recording, calculation, analysis and graphing of a number of Assessments and Evaluation Tools. Results of the assessments can be updated and calculated with full audit trail against each element. It can schedule visits and enter NICE parameters for Threshold and Visit to Visit Comparisons; the system will then evaluate and highlight these parameters and comments against the results from each visit. At the end of each patient visit a clinic letter is produced with the relevant information and clinician comments. EvalueLogix users also have access to Reva, an online database of aggregate data from all EvalueLogix users, offering sophisticated drug performance analysis and benchmarking against selected organisations. Berkshire East PCT: The Resource Services Organiser (RSO) is a bespoke software solution for Health Promotion Services. Key features of the software package include real time library and client database display, an always accessible on line catalogue and ordering system and sophisticated stock control systems including management of overdue stocks. The RSO can be used to generate a wide range of statistical and management reports and is also the only solution of its type to offer full on-screen preview of every type of resource available, including video clips, leaflets, posters, photographs and equipment. At its most effective in multi-site settings, the RSO has shown its worth at the Berkshire East PCT, where it was originally developed, with output more than doubled despite a 48% reduction in staffing and a stand still budget. In addition it has enabled a more equitable use of public health education resources (lent and consumables) across six PCTs, and widened its user base to non-nhs staff. Oxford University Hospitals: Renal care involves complex decisions about the correct use of phosphate binders, calcimimetics and Vitamin D, but what is the right combination for each specific patient? MinAlgo users simply enter most recent patient blood corrected calcium, phosphate and parathyroid hormone concentrations, plus details of the current treatment regimen. The Algorithm analyses this data and returns information on possible courses of action. Over 24,000 different input combinations are covered, with thresholds for mineral concentrations determined by KDOQI guidelines or Renal Association guidelines or the users own custom values. The benefits of very careful calcium and phosphate management are avoidance of the CKD mineral bone disorder (CKD-MBD), and more importantly, the reduction of morbidity and mortality in patients with CKD. MinAlgo deliver options for the effective management of hyperparathyroidism, a secure web based application available to renal units worldwide; the management of targets against KDOQI, UK Renal Association or locally customised guideline values and a solution for the numerous paper algorithms currently available. Oxford Academic Health Science Network Page 45

48 K: Governance arrangements 248. The Network partners will agree a statement of intent to demonstrate their commitment to the Network, its Vision, Goals, Programmes and Themes. Further work is being done to develop the formal governance arrangements and it is expected that a form of incorporation, such as a not for profit company limited by guarantee (and an eligible body for VAT purpose), will be required. Work to establish this will continue over the coming months with the aim to have agreement on the way forward in advance of the licence date The proposed governance model is shown below. Oxford Academic Health Science Network Partnership Council Members from Network subscribing partners Independent AHSN Chair meeting 3 x year Network Management Board Members representing the AHSN partners Independent Chair meeting at least 6 x year Network Forum to be held 1 x year for all members Executive Team Interim Accountable Officer Programme Director Programme coordinators AHSN support staff (tbc) AHSN support structure Chairman Accountable Officer Programme Director Finance Officer Project management support Business planning support Committee & admin support Communications/web services OUH to act as INTERIM HOST Network Partnership Council 250. It is proposed that the Network establishes a Network Partnership Council consisting of representatives from contributing partners and organisations; this will have an independent non-executive chairman appointed by the members of the Network in accordance with national requirements. Thought is being given on whether an interim appointment might be appropriate as the Network arrangements are being developed. The Chairman will be accountable to the members of the Network, but it is anticipated that the National Commissioning Board may be involved in the appointments process for this post The Network Partnership Council will meet at least three times a year; one meeting each year would act as the AGM to receive and approve the Accounts and the Plan for the coming year and receive a report on the work of the Network for the year In addition, a Network Forum meeting will be held at least once a year to which all Network members including affiliates would be invited The Network Partnership Council will adopt the standards set out in Governance Structure and Board Arrangements, Standards of Business Conduct Policy, Ways of Working, Standing Financial Instructions and Scheme of Delegation as the standard suite of papers across all public bodies and required to ensure legal establishment. These governance arrangements will also be adopted within the Network as a whole. (supporting policies in relation to declarations of interest and FOI will also be put in place). Page 46 Oxford Academic Health Science Network

49 254 The main role of the Network Partnership Council will be to agree the Network s Strategic Goals, the annual business plan and to monitor the delivery of Strategic Goals, receiving reports from the Management Board through the Accountable Officer at each meeting The Chairman will be accountable to the members of the Network and the Accountable Officer of the Network will be accountable to the partners through the Chairman The Network will be hosted for an interim period by the Oxford University Hospitals NHS Trust and the OUH Chief Executive will act as the interim Accountable Officer pending the establishment of the substantive supporting structures and completion of definitive appointments, including that of the Accountable Officer of the Network It is proposed that a Management Board, chaired by the Independent Chairman, be established that would meet at least 6 times a year to manage the work of the Network, agree the strategic direction for the Network, agreed the annual business plan and the oversee the delivery of its agreed objectives through the Network. The Management Board 258. The following membership is proposed for the Management Board: MEMBER Chairman Accountable Officer Three independent members (roles to be advertised nationally in line with NHS appointment practice) Clinical Commissioner member It will be important to ensure a geographical spread of members BUT each member would be responsible for ensuring regular and frequent contact with constituents and providing feedback Local Area Team member Acute services member Community services member Mental Health member Primary care member Local Authority/Social Services Higher Education Institute member LETB Research member Industry member 16 (minimum) Project Manager/Support Infrastructure support e.g. website, communications and IT support COMMENT To be appointed CE of Oxford University Hospitals NHS Trust (interim hosting organisation and hence interim Accountable Officer) 1. Patient Involvement/Engagement Group 2. Commercial/Business Sector 3. Voluntary and 3rd Sector/Social Enterprise To be nominated by AHSN s CCG member organisations (part of NHS South East) To be nominated by acute trust members To be nominated by community services providers To be nominated by mental health services providers To be nominated through the Clinical Commissioners To be nominated by local authorities To be nominated by HEI members Managing Director of Thames Valley LETB (to be appointed end 2012) To be nominated by NIHR bodies To be nominated by industry TOTAL Initially provided through OUH but arrangements to be developed further Oxford Academic Health Science Network Page 47

50 259. The role of the Management Board will include the review, assessment and agreement of proposals from the Programmes and the Themes. The Management Board will also maintain oversight of Network s strategic direction, delivery of the agreed business plan and the management of the finances of the Network. In addition, it will ensure that compliance with any licence requirements is maintained The proposed NED membership is intended to ensure that challenge and scrutiny can be brought from external parties, independent of the membership. These posts would be subject to open competition through an agreed appointment procedure in line with good NHS and public sector practice. The roles would be remunerated taking account of the current NHS NED levels All representatives would serve for agreed periods of time to be determined to ensure continuity Governance arrangements will be developed with affiliates to take account of AHSN will need to be assured that they are compliance with requirements under relevant licence conditions of their partners and competition law. In particular, this work will focus on relationships with life sciences industry and the associated networks and organisations. The Executive Team 263. The Executive Team, led by the interim Accountable Officer and, it is proposed, a Programme Director, will be established to ensure the smooth running of the Network, that members are communicated with and that the work of the Programmes and Themes is monitored and the delivery of objectives overseen. The Team will also make proposals to the Management Board (and subsequently the Network Council) on projects to be taken forward/funded through the Network. The membership would include as a minimum: l The interim Accountable Officer l A Programme Director l The Financial Officer l Programme leads 264. A small infrastructure team for the Network will be established to support its work and particularly to support the work of the Programmes, Themes, the Management Board and the Partnership Council. Financial and business planning support will be put in place to ensure that the Network can deliver its financial and other responsibilities and support the Accountable Officer and Programme Director in reporting both to the Management Board and the Partnership Council on the activities of the Network Project Management resources will be provided to support of the work of the Programmes and Themes and resources will also be identified to support the work of leads in these areas together with (possible) support to enable active clinician involvement in Programmes, Themes and projects across the Network All staff within the support team would be accountable to the Accountable officer or designated deputy The support team would also be responsible for developing and maintaining communications between members of the Network, for the production of a newsletter (in a number of formats), for the arrangements of and support for Network events, and for the establishment of a website Programme Governance 268. Each of the four Programmes will have a Steering Committee, which is represented on the Executive Team by its Lead. The Programme Steering Committee and its constituent parts are the location for much of the activities of the Network. There will, therefore, be a less organised structure to encourage innovation and creation, with interaction between Network individuals occurring at traditional face-to-face encounters and in the virtual environment. The regularity of respective Steering Committee meetings will be an individual Programme choice The Best Care Programme Steering Committee at the beginning will comprise of each Clinical Network Lead, together with representatives from the CCGs or relevant commissioning body, provider primary care, social care, community care, and patient and public groups. Page 48 Oxford Academic Health Science Network

51 270. The Continuous Learning Programme Steering Committee will comprise membership from all the HEIs, the Oxford Postgraduate Deanery, all the Schools of Nursing, other workforce training institutions, Saïd Business School, Henley Business School, OUCAGS together with a representative each from the acute, mental health, primary care, social care and community care providers, patients and the public The R&D Programme Steering Committee will comprise of membership from the NIHR OxBRC and BRU, TVCLRN, the NIHR topic specific research networks and the UK CRC CTUs, together with a representative each from the Clinical Networks, the HEIs, the Wealth Creation and Healthcare Innovation Programme, patients and the public The Wealth Creation and Healthcare Innovation Programme Steering Committee will be led by CAMI and draw membership from acute, mental health, primary care, social care, community care, the R&D Programme, the CCGs and affiliated members from life sciences industry and business. Funding arrangements 273. Funding arrangements are yet to be confirmed, but it is expected that funding will be available through at least two routes: l Funding from the NHS Commissioning Board l Local resources to be contributed by members through a scaled contribution 274. Central funding will include funds already earmarked for AHSNs and additional funding flowing through the SHAs and currently available to bodies such as those subject to sunset review. Negotiations on the transfer of these funds will continue as part of the Business Plan finalisation to be completed prior to licence It is to be expected that the partners should make an annual financial contribution to support the running and development of the Network and to underline the commitment of the organisations to the Network. It is suggested that the contribution should be tailored to the turnover of the individual organisations It is important that the arrangements put in place do not deter the invaluable engagement with any partners or affiliates with limited financial resources. However, it is clear that such bodies are able to provide input and resources other than financial and these will be discussed and contributions welcomed The funding arrangements will be clarified as the Business Plan of the Network is developed in the period to 1 April Approach to Sunset review bodies 278. A number of NHS bodies are now subject to a Sunset Review. These include the Thames Valley HIEC, the NHS South Regional Enablement Group, the NHS Innovation South East Hub (NISE) and the South East Coast Quality Observatory which has absorbed the functions of the South Central Quality Observatory and covers NHS South The Network would propose to absorb the functions and financial reserves of the Thames Valley HIEC which is currently hosted by Buckinghamshire New University although the staff contracts are held by the Oxfordshire Learning Disabilities NHS Trust The focus on innovation and wealth creation within the Network requires resources and capability and it is proposed that the Network work with the management of NISE to look at options for the future, noting that NISE also provides services to other potential AHSNs including Kent, Surrey and Sussex, and Wessex. In particular, capability around awareness raising, adoption support (including needs identification, technology validation and business case support), intellectual property advice and commercialisation will be explored. NISE is also part of a wider national innovation network, including the Health Innovations Alliance, and access to this will be taken into account in future plans The Regional Enablement Group has overseen a number of work streams that a relevant to the business of the Network partners. The two key work streams for the Network are Pathology Modernisation and the Medicines Use and Procurement Programme. It is proposed that discussions take place with the Wessex Network on how these programmes might be continued within or between Networks The South East Coast Quality Observatory [SECQO] works with NHS organisation and functions in the South of England to help provide the NHS with information/ data analysis and interpretation. It also supports the creation of tools to assist evidence-based decision making and develop analytical and interpretation skills across the NHS. Discussions on future working arrangements between the Network and the SECQO continue. Oxford Academic Health Science Network Page 49

52 L: Draft Business Plan for 2013 to The Network has outlined its Challenges, Vision and Strategic Goals in Sections D, E and F. In order to respond, the Network has a number of ambitions in the form of Key Deliverables for the licence period These can be categorised into Network, Programme and Theme Key Deliverables, indicating the breadth of the Network s plans and how these support delivery of the Strategic Goals. The deliverables will form the basis of the contract negotiation with the NCB if the application is successful These are evolving and maturing as Network activity gathers pace and the draft business plan includes some headline deliverables that have already been identified and agreed. More detailed plans, together with full risk assessments and mitigation plans will be prepared over the coming weeks. (Additional Programme and Theme Deliverables are included in Appendix D.) 286. The following table maps headline Deliverables against each Strategic Goal and then looks at risks, causes, impact, effect and mitigations. Strategic Goals Deliverables Cause Effect Impact Mitigations Goal 1: To deliver best care in a population-centred healthcare system:. To identify and address unwarranted variation by disseminating evidencebased best practice, making the patient and the population at the centre of care clinical networks in. year 1..Annual Report for each with metrics and plans to tackle unwarranted variations..evidence of active patient and public engagement..annual assessment of delivery of the High Impact Innovations, CQUINs and other national priorities, including compliance with NICE guidance and TAs Poor collaboration Poor information systems Lack of transparency in Clinical Networks Lack of patient and public engagement Conflicting Network Trust priorities..inability to create Clinical Networks..Inability to create a sufficient evidence-base..inability to implement best practice..absence of patient and public data..inability to implement change Collapse of Network infrastructure Continued unwarranted variation Patient and public disengagement Contribution to financial pressure..leadership supporting a culture of collaboration..collection of data from other sources..reinforcement of the central position of the patient and public Goal 2: To develop an effective continuous learning network: To create a genuine partnership that develops a culture of learning, sharing and common purpose, which breaks down organisational boundaries to deliver transformational change...development of metric to assess the success of organisational structure and leadership..obtain evidence of good team work and networking and signs of success Inability to establish appropriate governance model Ingrained behaviour and culture Inability to create tools to assess success..poorly functioning Clinical Networks..Failure to achieve change and partnership..failure to produce effective Network gains Unsustainable specialist services and lack of innovation Requirement to scale back services Network is disbanded, partners revert to old working patterns..regular highlevel liaison with strategic partners..ensure inclusion of as many partners as possible..clarity on key objectives and outputs from Themes and Programmes..Implementation of means of communication within the Network (e.g. website, newsletters) Page 50 Oxford Academic Health Science Network

53 Goal 3: To complete the translational research process and accelerate the diffusion of innovation into mainstream practice:. To align and integrate clinical service and the translational research infrastructures to bring rapid benefits to patients and deliver NIHR priorities...establishment of R&D. Programme Steering Committee to oversee management of research participation..increase the number of contacts that can contribute to research..increase in patient numbers recruited by at least 10% in year 1..Continue work with CCGs, NIHR and Trusts on excess treatment costs..deliver coherent clinical research platforms for external partners Separate and cumbersome local controls on R&D activities Fragmented, sub-scale academic/industry/nhs relationships Failure to align clinical and research networks Poor informatics Failure to provide appropriate research training Failure to address issues related to IP..Poor adoption of innovation..limited gains from smaller implementations..failure to attract partners in research External intervention Lost opportunity for translational benefits Slow adoption of innovation Loss of research funding..leadership..strong informatics platform..strong governance and public engagement..strong and clear communication of benefits Goal 4: To tackle local priorities which include long term conditions, mental health and the development of new approaches in medicine, e.g. genomic medicine...deliverables as described by individual Clinical Networks, Themes and Programmes. (see Appendix D) Inability to engage local stakeholders Lack of focus on long-term conditions and mental health Failure to obtain investment for genomics project..disaffected local participants..lack of gains in high cost/high impact fields of study/care..lack of alternative methods of study/clinical practice Unsustainable network of local participants Long-term conditions overlooked and underdeveloped services Potentially beneficial services not developed..network design and early engagement of local providers and commissioners and industries..early focus on long-term conditions and mental health with early dissemination of new approaches..network design around clinical services to identify potential new approaches Goal 5: To facilitate sustainable economic development and wealth creation in alignment with best care:. To grow local life sciences clusters by promoting innovation, adoption and dissemination, entrepreneurship and by strengthening relationships with industry and business...a database of key organisations and contacts..an agreed mechanism for supporting the identification, testing and roll out of innovations..creation of Innovation dashboard Lack of industry involvement and engagement Entrepreneurship stifled by incumbents Inability to disseminate innovation..failure to harness wealth potential..lack of new entrants into market..innovation stifled, growth unrealised Unsustainable Network infrastructure with industry and business Innovation and entrepreneurship unrealised..detailed Network design and involvement from industry..entrepreneurship and innovation promoted from knowledge transfer centres, business schools and industry..barriers to entry reduced to minimum for Network participation Oxford Academic Health Science Network Page 51

54 Measurement 287. The Network will accurately measure everything it does in conformity with its evidence-based philosophy. Measurement will provide objective evidence of the results of its interventions and the outcomes of its activities and help it to concentrate only on those interventions and changes that provide high quality care and avoid perpetuating and replicating those that do not. We will develop a method of balanced scorecards (see below) of outcome metrics and leading indicators, including sustainability indicators, to allow progress and achievements to be measured Many of the objectives and targets for the different Network Perspectives have been outlined. Data collected through the Patient and Public Experience and Engagement Theme will generate metrics to assess the Patient and Public Perspective. The Finance Perspective will include measures such as funding income, costs, cost-efficiencies, metrics from the Wealth Creation and Healthcare Innovation Programme and other measures that make up the value proposition. The Continuous Learning Perspective will include education and training metrics such as those for skills learnt, continuous professional development, new knowledge and awareness of national priorities such as NICE guidelines. The Network Partners Perspectives will include metrics developed to assess organisational development, culture change, leadership and member satisfaction. The Network will make the development of this tool a priority Collaboration with other AHSNs in the development of these metrics and indicators common to all AHSNs will help the public and taxpayers hold the recipients of their funds accountable for the outcomes of their activities, whilst ensuring value for money for the public investment in AHSNs. Furthermore, tracking these metrics and indicators over time will enable the Network s members and Executive Team to identify emerging trends so that strategies can be adjusted to meet any changes in the environment. Finally, the Network will employ these metrics and indicators to accelerate performance improvements, by benchmarking and comparing performance across the sector and by identifying areas for collaboration, learning and sharing with other AHSNs. The Balanced Scorecard Patient and Public Objectives Measures Targets Initiatives Finance Objectives Measures Targets Initiatives Goal 1: To deliver best care in a population-centred healthcare system: Goal 2: To develop an effective continuous learning network: Goal 3: To complete the translational research process and accelerate the diffusion of innovation : Goal 4: To tackle local priorities: Goal 5: To facilitate sustainable economic development and wealth creation: Network partners Objectives Measures Targets Initiatives Continuous Learning Objectives Measures Targets Initiatives Page 52 Oxford Academic Health Science Network