Creating world class partnerships for health and wealth Prospectus 2013 â€“ 2018 1st October 2012
YORKSHIRE & HUMBER AHSN
Section 1: Ambition and Strategic Goals
Section 2: Approach and Existing Collaborations
Section 3: Business Plan
Section 4: Governance and Management
20 Appendix 1 Members and Partners of the AHSN
Appendix 2 Information at the Core
Appendix 3 Translating Research & Learning into Practice
Appendix 4 Collaborating on Education & Training
Appendix 5 Increasing Participation in Research
Appendix 6 Glossary
Appendix 7 Expression of Interest for a Yorkshire & Humber Academic Health Science Network
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
Since we submitted our AHSN expression of interest (Appendix 7) in July, a considerable amount of progress has been made developing this prospectus with the enthusiastic support and excitement of NHS and academic organisations, public sector partners and the business sector. This has allowed us to bring the considerable strengths of the region together for the first time to build strong partnerships that will focus on improving public health, care outcomes and patient experience, cost effectiveness and economic growth. There has been considerable involvement from organisations across the region through an integrated programme of conferences through July and August culminating in an Accelerated Solutions Event in September which generated the first draft of the prospectus. Altogether well over three hundred people have been involved in contributing to this prospectus. It is clear that the ambition of developing the AHSN has brought a focus to the health and wealth agenda that is needed as the NHS intermediate tier is replaced in 2013.
There is still much to be done and we are continuing to develop our business plans, governance and communications strategies. We are looking forward with enthusiasm to the next stage of the AHSN process and the prospect of delivering significant improvement across the region.
Sir Andrew Cash
On behalf of the Yorkshire and Humber AHSN partners 1st October 2012
Accelerated Solutions Event
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
AMBITION The Academic Health Science Network (AHSN) for Yorkshire and the Humber will create and harness a strong, purposeful partnership between patients, health services, industry, and academia to achieve a significant measureable improvement in the health and wealth of the population. The AHSN will generate significant added value for partner organisations by reducing service variability and improving patient experience. The AHSN will also enable partners to improve efficiency and effectiveness and collectively create an environment that supports inward business investment leading to economic growth. The AHSN will become a partner of choice for local, national and international businesses wishing to innovate in the health sector. The AHSN will have the following features: 1.1 It will systematically seek out innovations and best practice from across the world to improve outcomes, experience, effectiveness and efficiency. 1.2 It will build on existing successes to develop excellent working relationships with local, national and international business to expand investment and joint working opportunities across the region.
1.3 It will determine the most effective ways of implementing evidence, working with business, NHS partners, higher education institutions, other public sector organisations and the third sector. 1.4 It will drive transformation through partnership to deliver significantly improved services by developing, testing and promoting rapid adoption of these innovations in health care delivery and public health. 1.5 It will support, stimulate and harness the energy, talent and enthusiasm of NHS staff to drive improvement with a strong focus on patient needs. 1.6 It will actively support organisations to deliver business plan benefits and targets, providing graduated levels of performance management support to ensure that services which already provide care of the highest quality drive improvement throughout the region at pace. 1.7 It will seek out and act upon public, patient and industry feedback to continually strive to improve public health, services for patients and economic growth. 1.8 It will thoroughly evaluate the work it carries out to ensure full delivery of planned benefits or understand why things weren’t achieved according to plan.
STRATEGIC GOALS The AHSN has three primary goals:
R BO N LA COL ATIO C EDU
A & T IN G TR AI O N N IN G
G R TO ES E PR A R C H AC TICE
IN AT I SL NG N A I TR N AR & LE
• To improve health and reduce inequalities in population health by focusing on the chronic diseases which make the biggest impact on regional morbidity. • To transform the quality and efficiency of health services in the network through supporting the development, testing and rapid adoption of effective service innovations whether developed internally or outside the NHS.
INCR EA SIN IN G P RE S
N IO AT ORE C E E AR
TION INF IPA TIC H AT ORM R TH A RC EA MING HEALT OR H F C NS
These three goals are linked and success in each will support the others. The achievement of these goals will be supported by planned activities in four underpinning work streams (see Innovation Framework) which puts information at the core of the AHSN, establishes mechanisms to routinely translate research and learning into practice, stimulates collaboration on education and training and increases participation in research. Further details of these work programmes are provided in Appendices 2-5.
• To generate wealth in the region and the UK by stimulating innovation in partnership with medical technology, digital health, pharmaceutical and other commercial enterprises.
APPROACH There are notable recent examples of effective approaches to the adoption and spread of innovation and good practice in Yorkshire & Humber. (see case study on TAPS) The problems we are now facing are too complex to be solved by any one person, organisation or discipline. Real progress requires a strategic, systems-based effort in which we bring people together from a variety of backgrounds. The AHSN will, for the first time, bring together NHS organisations, universities, the Voluntary Community and Faith sectors (VCF) and the business community in a common pursuit, sharing ideas, and investing resources to stimulate and accelerate the development, adoption and spread of ‘evidenced base’ innovations. Our approach will ensure that the AHSN provides the leadership and drive for achieving this vision. We will do this by being systematic and using an evidence-based approach, supported by accurate and meaningful information. This will be underpinned by an enabling management and governance framework. Drawing on international examples (Best et al, 2012; Gabow et al, 2012), we are designing the AHSN to incorporate the features likely to enhance the success of largesystem transformation in health care.
Our approach will be: • Evidence-based and planned: our work will link theory and evidence to implementation strategies for innovation and change which have been shown to be valuable in the region, elsewhere in the country or internationally. We will, for example, develop our partnership with and learn from, the considerable advances that have been made within the U.S. Veterans Health Administration (VA) in systematically implementing evidence into practice. This has been achieved through a system-level programme focused on collaboration and partnerships between policy makers, managers, clinicians, and researchers (Trivedi & Grebla, 2011). The AHSN will establish a rich environment in which NHS members will explore, test and exploit the processes of innovation and service transformation using the extensive expertise of business and our universities. • Informed by good data and intelligence: we will use data derived from our improved information systems to identify variations, performance gaps and process failures as well as successes to inform our strategies. We will establish a Centre for Innovation and Best Practice Intelligence to systematically elicit and evaluate new technologies and services, providing intelligence on innovations, a best evidence service, and monitoring variation in practice and AHSN impact.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
• Involve patients and the public: a Patient, Carer and Community members group will be established to promote sustained involvement of patients, their families and the public. This will increase our awareness of patient perspectives and priorities and so help drive improvements in care processes and patientcenteredness.
TAPS The Training and Action for Patient Safety (TAPS) on-line learning module and development workshops support teams to identify their own patient safety problems and solutions and measure the impact of any intervention on practice and patient outcomes. Evaluation of the pilot in Bradford demonstrated positive engagement and improvements in knowledge, skills and attitudes of 11 multiprofessional teams. Eight of the teams demonstrated significant improvements in patient safety practices and/or outcomes and reported that the programme had served to promote better multiprofessional communication and teamwork. The “Safety in Numbers” learning network has linked teams in Trust across the region to challenge and support potentially isolated teams and individual to drive up respective performance and share successes.
• Systematic and active: partners will develop, sign up to and have responsibility for implementing A Charter for Quality, Research and Innovation to ensure patients receive the right care in the right location at the right time and achieve standards of care in the upper quartile in key areas. An Innovation Accelerator will drive and reward rapid evaluation and adoption of innovation from within and outside the NHS in services and technologies. Ideas from other AHSNs will be shared through an ‘innovation swap shop’. Small scale pilots, led by clinicians and managers, will be used as demonstrators of the value and feasibility of adopting innovation in order to promote more widespread adoption. We will ensure that frontline staff will be encouraged to engage and those who actively participate in innovation and its spread and adoption will be supported and valued in their organisations. • Based on strong inclusive leadership: effective leadership is central to the success of the AHSN. We will adopt a model which blends strong designated leadership with distributed leadership in which professionals, teams and partner organisations share responsibility for mobilising effort and delivering change. An integrated leadership development programme will be implemented which will be multi-disciplinary, encourage rigour and be assessed in terms of real impact in leading change. The AHSN will actively manage the strategies for change using change agents to stimulate and make change easier to implement. A Transformation Academy will be established to help build a collaborative culture of excellence and change, to drive leading-edge innovation, research-based practice and optimal models of service delivery, to ensure the right workforce is being prepared and to develop leadership at all levels. The AHSN will create a proper environment for sharing so that clinicians, managers, patients and industry representatives can meet to better understand needs and how new developments could help solve problems.
• Supported by good governance and management: effective governance and management will support the successful delivery of the ambitions of the AHSN at local, sub-regional and regional level. The AHSN must ensure that it enjoys the full confidence and support of its partners from the outset and that this sense of confidence becomes even stronger over time. The values we adopt and the way we work will be more important than the structures through which we work. So we will; • Build a strong inclusive partnership approach within and between NHS organisations, universities, local authorities, the business community and voluntary community and faith organisations. • Align the goals of the network and those of its member organisations. • Develop a set of valid and meaningful quantitative and qualitative measures for change which will be consistently applied across the network to identify problems and priorities, monitor progress, inform future actions, incentivise change and improved performance. • Manage the performance of the AHSN using a framework which reflects the importance of each of the strategic goals and includes clear and simple measures, which will be placed in the public domain. The framework will also be the subject of continuing evaluation, scrutiny and appropriate adaption to ensure effectiveness.
EXISTING COLLABORATIONS We will build on currently strong networks (existing collaborations) to establish an effective regional AHSN to deliver large scale improvement. The Yorkshire and Humber AHSN has a particular strength in medical technologies, including telehealth and we will drive both the development of innovative technology and its adoption, for the national benefit. In addition to developing capacity for innovation amongst all provider organisations, clinical networks and primary/community health care teams, we will ensure that Clinical Commissioning Groups (CCGs) play a full part in the AHSN. The proposed AHSN is co-terminous with the new Yorkshire and Humber Strategic clinical network which will support commissioners with their core purpose of quality improvement. The AHSN will also collaborate with the Local Authorities (in particular through the Health and Wellbeing Boards) and voluntary organisations to ensure that we can impact more fully on the public health.
Existing Collaborations We have collaborated successfully over several years in a number of programmes: the Yorkshire-wide Health Innovation and Education Cluster (HIEC), Local Education and Training Board (LETB), Yorkshire Quality and Safety Research Group, the White Rose University Consortium, 3 Local Enterprise Partnerships (LEP) and the Public Health Observatory (PHO), the national Medical Technology Innovation and Knowledge Centre, the INSIGNEO Institute for in silico medicine, through a number of National Institute for Health Research (NIHR) platforms: 3 Comprehensive Local Research Networks (CLRN), Primary Care Research Network (PCRN), 4 topic specific networks (cancer and stroke), 2 Collaborations for Leadership in Applied Health Research and Care (CLAHRC), a Biomedical Research Unit in Musculo-Skeletal Disease, the School for Public Health, 2 Clinical Research Facilities, an Experimental Cancer Medicine Centre, Research Design Service and 3 Clinical Trials Units.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
BUSINESS PLAN IMPROVING POPULATION HEALTH
Aim The AHSN will improve health outcomes and address the gap between the poorest and most affluent within communities in Yorkshire and the Humber. Through its activities members will work to prevent ill health, provide high quality health and care services and impact positively upon the underlying determinants of health, particularly jobs, wealth and opportunities. Objectives We will develop programmes which build on the strengths of the network to address specific local causes of inequalities and chronic ill-health, in three of the four domains of the Public Health Outcomes Framework (2013-2016). The AHSN will focus on areas where the current population health burden and inequalities are greatest. In Yorkshire and the Humber these are cardiovascular disease, cancer, dementia, chronic obstructive pulmonary disease, diabetes, maternal and child health, oral health, depression and selfharm. The AHSN will work with partners to identify key priorities based on greatest need and ensure the delivery of measureable improvement within three years. We will support Local Authorities in tackling the social determinants of ill health, influence unhealthy behaviours, and ensure that effective treatments are rigorously applied to all those who stand to benefit. In particular the AHSN will support members to reduce inequalities in health through targeting more disadvantaged groups with prevention, access to high quality services and job opportunities. (see Wealth Creation at 5.4) The programmes of work will be evidence-based (Bambra et al, 2010; Roberts, 2012), developed in collaboration with Clinical Commissioning Groups (CCGs), the Public Health Observatory (PHO), local Health and Wellbeing Boards (HWB) and local employers, and informed by Joint Strategic Needs Assessments (JSNAs) and a Health & Wealth Equity Audit. In some of the areas of work the AHSN will play a supporting role, in others, where health services play a more central role, it will lead. These will focus on areas in which local CLAHRCs, HIEC and university members have significant strengths and a track record of innovative collaborative working (see case studies on Addressing Inequalities).
• The two NIHR CLARHCs have strong programmes in inequalities and innovative ways of supporting self-management for chronic conditions, (including the development of assistive technologies, telecare and telehealth in collaboration with industry, NHS and academia) and programmes in addictions, stroke, maternal and child health. • The Humber Obesity, Nutrition, Education and Innovation (HONEI) collaboration, between the University of Hull, Hull and East Yorkshire Hospitals Trust, City Health Care Partnership and the Hull York Medical School, provides a focus for working with the pharmaceutical and food industries, to reduce obesity, developing innovative methods of education, prevention and treatment. • The Nutritional Epidemiology Group at the University of Leeds studies the relationship between diet and chronic disease and has, for example, developed a mobile phone app to support weight loss. • The NIHR School of Public Health Research, led by the Dean of ScHARR, University of Sheffield, has prioritised the development and evaluation of effective public health interventions in the areas of inequalities, older people and alcohol. • The National Centre for Sports and Exercise Medicine (NCSEM) has one of its three centres in Sheffield and focuses on the promotion of physical activity in both prevention and management of chronic disease. • The University of York is a collaborator in the Department of Health funded Public Health Research Consortium bringing together senior researchers to strengthen the evidence base for interventions to improve health, with an emphasis on tackling socioeconomic inequalities in health.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
Improving SHMI The Hull York Medical School NHS Partnership working with the Yorkshire Quality Observatory has analysed factors affecting mortality rates across the member Trusts as well as those affecting mortality in the wider care system including the provision of primary care. The work has been shared across partners to develop a system wide approach to reducing mortality and improving the quality of care. This links very effectively to the ongoing programme to improve the Summary Hospital-level Mortality Indicator (SHMI) across the region.
Deliverables All partners will support the implementation of NICE public health guidance in at least three topic areas increasing to ten by the end of the 5 year license. The AHSN will work with Public Health England to ensure good data on the public’s health and its determinants to prioritise interventions and monitor impact. In some of the areas of work the AHSN will play a supporting role. In others, where health services play a more central role, it will lead. The following activities will be delivered directly through the Improving Population Health programme. The Transforming Health Care and Wealth Creation programmes will also contribute.
• Create a programme of activities to improve physical health care for people with mental health problems. • Create a programme of activities to improve mental health care for people with physical health problems such as diabetes and cancer. • Implement a programme of brief interventions to reduce unhealthy drinking and/or smoking amongst health service users, building on work of the CLAHRCs. 4
Our programmes will be organised under 5 areas where there is evidence of clearest population health impact.
• The AHSN will collate and share best practice to promote “workplace wellbeing” and physical activity programmes to promote the health of the workforce.
• Create programmes of activity to promote independence, self-management and care for people with current, emerging and complex long-term conditions through the implementation of evidence-based innovation in assistive technologies, telehealth and related therapies.
• As part of their duty of corporate social responsibility all AHSN partners will sign up to implement employability and workplace wellbeing programmes.
Intervene early in the life-course to prevent the development of risky health behaviours or chronic conditions • Build on the work of the HIEC to improve infant and maternal health and nutrition such as promoting breast feeding, particularly in disadvantaged communities. • Work with schools and Local Authorities to improve access to healthy foods and provide safe places for physical activity. • Evaluate and improve school and home-based programmes to tackle obesity in children. • Support HWBs in the widespread introduction of early years interventions in particular pre-school enrichment programmes and school-based social development programmes.
Ensure that effective interventions for chronic conditions are applied rigorously and targeted on those with greatest need • Improve the early detection and rigorous treatment of cancer, diabetes, hypertension and CVD, especially among the more susceptible groups (see Transforming Health Care) and use active monitoring and audit to ensure that those most in need are effectively treated.
1. Improve the physical and socioeconomic environment of deprived areas
• We will engage with workplaces, supermarkets, employers and local authorities to improve access to healthy foods, improve the quality of housing and enhance local employment opportunities, including for those with mental and physical conditions, in both the public and private sectors.
Attending to the close interplay between physical and mental health
The use of fiscal and financial policy instruments to enable deprived populations to live healthier lives • Support Local Authority actions to reduce availability and affordability of alcohol. • Reduce smoking in the most deprived groups by focusing on price and availability, while providing stop-smoking services targeted to help the poorest quit.
TRANSFORMING HEATH CARE Aim The AHSN will accelerate the transformation of health care services adopting best practice, eliminating waste and improving quality in line with the 5 domains of the NHS Outcomes Framework. The Yorkshire and Humber area through the work of the AHSN will provide consistent, effective, cost-effective and safe care and reduce inequalities in access and treatment. This will be supported by timely and accurate information, high quality leadership and robust improvement frameworks to promote innovation and spread. Objectives • The reduction/elimination of unjustified variation in quality and safety of care, addressing ineffective/poor quality practice identified by using good routine data systems. • A stepped increase in the adoption of world class scientific endeavour (including diagnostics, imaging, experimental medicines, assistive technology, telehealth) delivered throughout the region. • Deployment of new service models and patient pathways, utilising technology where appropriate, to deliver excellent outcomes at lower cost. • Implementation throughout the AHSN of the six high-impact innovations identified in Innovation, Health and Wealth. How we will achieve this Establish a Yorkshire and Humber Transformation Academy co-ordinated by an experienced, multidisciplinary team of academics and health professionals/ managers with expertise in improvement science. It will adopt frameworks and methodologies found to be useful elsewhere (such as ‘Lean’ or the Veterans Administration (VA) ‘QUERI’ approach Stetler, et al, 2008) to redesign pathways and cut out waste. We will collaborate with and learn from international organisations and world class innovators (including Veterans Administration, Partners (Boston), Jonkoping) and identify affordable solutions from the developing world.
The AHSN will develop deeply-rooted clinical networks that promote peer-led management and require excellence as standard across all health delivery partners, acute, community and primary care. It will bring together patient representatives and patient groups, NHS and academic partners from across the region. We will build on our early experience with Yorkshire Quality and Safety Research Group to build a dense horizontal network of service improvement to promote innovative approaches to improving quality and safety in healthcare. This programme has already adapted lessons from the highly successful Matching Michigan network in the USA. We will develop a Charter for Quality, Research and Innovation which all NHS partners will sign up to and promote. This has parallels with the recent Institute of Medicine’s CEO Checklist for High-Value Health Care (Gabow et al, 2012). Managers will be held accountable for essential processes of care. An Improvement and Innovation Observatory will develop organisational dashboards for Innovation Health and Wealth indicators including quality and safety. This will identify performance gaps, failures and successes along with actionable factors contributing to these. This will be underpinned by a sophisticated IT network (see Appendix 2) that monitors performance, tracks quality and identifies variations in care. Building on our expertise with the Yorkshire and Humber Public Health Observatory we will develop new approaches to assessing quality of services including Geographical Information Systems (GIS) mapping using individual patient data. More rapid diffusion of information and innovation in the region will not only improve care but can contribute to reducing inequalities in health (Wang et al, 2012).
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
• Tap into that expertise and enthusiasm using an internal consultancy model to support evidence based diffusion and spread e.g. opinion leaders and social and professional networks, developing a positive deviance hierarchy, led by organisations that consistently demonstrate exceptionally high performance (Bradley et al, 2009). • Create protected time and protected talent for both exemplars and adopters in job plans and through buying out the time of ‘local champions’.
Altogether Better Altogether Better began in 2008 as a £6.8m BIG Lottery funded Wellbeing Programme aimed at improving the health and well being of communities across Yorkshire and Humber. Using evidence based community engagement and empowerment approaches this community health champion model has worked to unlock the full potential of people, patients and communities to improve their health and wellbeing and that of the people they live and work with. To date over 15,000 community health champions have been recruited. These have reached over 90,000 people. Altogether Better was runner up in the National Lottery Awards Best Health Project.
The Patient, Carer and Community Members Advisory Group will advise on how best to strengthen patient leadership to help the AHSN Partners understand, measure and act on patient experience. The AHSN will support partners to ensure service users become producers and participants in the process of care, skilled and confident to influence others in creating new solutions and collaborative approaches. (see case study on Altogether Better) It will develop and disseminate examples of high quality patient experience. Initially we will use data from the NHS patient survey, but over the five years we will develop our expertise in novel methods of patient reporting (tablets at the bedside, mobile phone apps, web-based) to provide rich real time feedback to all organisations. Through the Transformation Academy we will establish a Positive Practice Network across NHS, academic and industry partners to identify, import and spread learning and competition in quality improvement between Trusts. This will enable the AHSN to: • Identify organisations and individuals who deliver excellent services across all sectors e.g. implementation of NICE guidelines, hospital at night, safe prescribing, culturally sensitive midwifery services, digital health and telemedicine, care in nursing and residential homes. • Study and understand the processes, context and culture that have enabled and sustained innovation and improvement.
• Find and select the best innovations; develop a process to nurture and select those innovations of high potential benefit as well as those of proven worth. • Harness social media to develop improvement networks, following from our @safetyinumbers patient safety improvement success. • Establish a mechanism with Industry to co-sponsor and lead “priorities for innovation” initiatives across the network. • Create a formal accelerated innovation adoption process (AIAP) for the other locally determined high impact innovations from 1 April 2013. • Establish a formal horizon scanning service (led by University partners with NHS clinicians and managers) to identify 3 additional transformational innovations per year and put them into to our accelerated process. • We will measure innovation adoption by focusing on the impact on patient outcomes and experience. We will provide leadership in developing phase 2 of the Innovation Scorecard. •We will incentivise change with an innovation premium payable to those member organisations which adopt the innovation within the designated time. • We will establish a regional programme to ensure that all staff grades access high quality training in Improvement Science (see Appendix 4). • We will work to build a measure of how staff have contributed to improved health and healthcare through innovation and adoption of best practice through personal development plans across partner organisations.
Delivering the high impact innovations A key measure of the network’s early impact is our ability to support delivery of the six high impact innovations (HII). The Chief Executives in Y&H demonstrated their early commitment to accelerating the adoption and spread of these innovations by commissioning a High Impact Technology Adoption Programme to support implementation of three of the six innovations (3million lives, Digital First and Intra-operative fluid management) and by investing Regional Innovation Funding to support every Clinical Commissioning Group and NHS Provider Trust. The AHSN will build on the important work already underway. 3million lives Digital First As reflected throughout the business plan Partners have extensive experience and pedigree in delivering new service models incorporating assistive technology and digital health. This is a particular strength of the Yorkshire and Humber AHSN and one that we intend to capitalise upon to deliver the 3million lives and Digital First agendas. The partners are well represented at a national level within the 3million lives programme with 2 pathfinder sites and active participants in the Delivering Assisted Living Lifestyles at Scale (DALLAS) programme and Assisted Living Innovation Platform (MALT). The HIEC and the SY CLAHRC have created toolkits and other implementation resources that have been recognised as class leaders. In collaboration with the National Technology Adoption Centre, the SHA and the HIEC are currently delivering a programme of focused support to CCGs and Provider organisations implementing new service models utilising assistive technology for people with long term conditions. This complements the national Long Term Conditions Quality Innovation Prevention Productivity (QIPP) programme.
A range of educational training and development resources have been produced in conjunction with industry partners that are being utilised across clinical professional curriculums. The Regional Telehealth ‘HUB’ is a unique asset supporting service delivery, academic evaluation and implementation expertise. The Regional Stroke Network has fully embraced telemedicine and the Regional Burns network is currently exploring the benefits of utilising remote video-consultation technology for distance diagnosis and treatment management. E-consultation and online preassessment were pioneered within the Region. Leading university and research groups are extremely active alongside industry in pan European research collaborations in assistive living and digital health (RICHARD, HeartCycle, Independent). There is growing recognition that one way for the NHS to earn additional income is to use telemedicine to deliver clinical experience and expertise overseas. (see case study on Rare Disorders) The potential for robust business cases featuring digital health and assistive technology to transform service models in a plethora of clinical areas is recognised as the highest priority across AHSN partners. Our pedigree and experience leads us to believe that we can offer real insight not only across our own network but across the network of AHSNs as a whole. We also recognise the common nature of the challenges, particularly with respect to long terms conditions, the frail elderly and wellness across the developed world. The AHSN will enable us to engage in a more coordinated and strategic way with industry partners at scale, the devolved administrations across the U.K., European partners including the European Commission, and international collaborators to share insights and experience.
Rare Disorders Laboratories in Sheffield Children’s NHS Foundation Trust already generate considerable income by marketing specialist testing for rare disorders in the UK and overseas, Screening services are provided on a contractual basis for overseas users and genetic testing is offered in support of commercial trials in the UK and abroad. Income from NHS and non NHS customers has shown year-onyear growth of more than 20% pa for the last 10 years and last financial year achieved >£2m. Perkin Elmer working with a leading international nutraceutical manufacturer have been in discussion with The Trust to provide whole programme diagnostic and treatment solutions in the area of health screening for rare disorders into emerging markets including India. The added value offerred by the healthcare expertise available within the NHS makes this an attractive proposition for industry partners and customers. UK India Business Council and NHS Global are helping facilitate and guide the project planning and a co-ordinated public relations inititiative is planned in India in 2013.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
Intraoperative Fluid Management
Support for carers of people with dementia
Work is in train across the Region in collaboration with the National Technology Adoption Programme to ensure that optimal processes of fluid management are adopted in surgical procedures. York Hospitals NHS Foundation Trust is pioneering this work and the lessons learnt are being disseminated through organisational leads within a region wide learning network. In addition all NHS trusts in Yorkshire & Humber have taken up the opportunity of accessing a Regional Innovation Fund (RIF) bursary to support their implementation activities. The AHSN will build upon these foundations drawing on the experience of the HIEC and the CLAHRCs to promote, embed and review best practice in this area across Yorkshire & Humber.
A recent SHA audit of plans for improving support for carers of people with dementia highlights variable progress. A number of Primary Care Trusts have commissioned the Alzheimer’s Society to provide a review of information provided to carers as part of local memory clinic services. The work of North Lincolnshire CCG has been identified as an exemplar of good practice.
Child in a chair in a day The SHA is working in partnership with the Yorkshire & Humber Collaborative Commissioning Group to undertake a review of wheelchair services for children in line with the Whizz Kids Child in a Chair in a Day specification The recently published Department of Health (DH) checklist for benchmarking services enables local organisations to: • Identify gaps in practice and funding arrangements. • Recommend commissioning models that integrate the procurement and assessment functions. • Identify where improvement plans are required. • Produce an improvement plan where services are not currently meeting the Whizz Kidz specification by the end of November 2012. These can then be used as part of the criteria for meeting Commissioning for Quality and Innovation (CQuIN) payments. NHS Hull has been identified as an exemplar site having piloted work in this area and Doncaster PCT is cited as a case study in the High Impact Innovations website.
To accelerate the adoption of best practice the NHS in Yorkshire & Humber is: • Rolling out the use of the dementia pathway on Map of Medicine which includes information on support for carers. • Requiring providers to undertake an audit of 50 care plans of their dementia patients, to ensure they are meeting the requirement to assess the needs of carers and provide information on what support is available as part of the care planning process. The AHSN will build on the work already underway in accelerating the adoption and spread of innovations in this area linking to the CQuIN qualification process for 2013/14. International and Commercial Collaborations Medipex, the Yorkshire & Humber Innovation Hub is working in partnership with the NHS and industry locally, nationally and internationally to support the development of innovative new healthcare products and to generate wealth through an increase in commercial activity. Medipex currently have 22 live projects with direct industry involvement in the joint development of a new product or technology with the NHS. A further 5 NHS innovations have now progressed to become spin out companies with part NHS ownership. The AHSN recognise Medipex and Medilink as key partners to continue to support the NHS in Yorkshire & Humber increasing national and international health care activity. (see further details in the wealth creation section). We will also proactively contribute to NHS Global, exploit regional initiatives that are developing international partnerships including (i) The International Office of the North, (ii) The Worldwide University Network, (iii) The Advanced Manufacturing Research Centre and (iv) The Insignio programme.
How will we achieve this
Stimulate and facilitate innovation
The Yorkshire and Humber Academic Health Science Network (AHSN) will develop and deliver new approaches to the creation of wealth, jobs and economic growth as identified in the respective strategies for growth from the Department of Business Innovation and Skills (BIS) and Department of Health (DH). We will address comprehensively for the first time local and regional opportunities for wealth creation in a global healthcare economy.
• Embed a culture of expectation regarding innovation within the NHS that encourages intellectual property creation and recognises when it exists.
We will address opportunities across the whole value chain from research and concept development to manufacture and service delivery. In particular it will: • Stimulate and facilitate innovation • Attract companies to research in the NHS • Deliver industry required performance • Add value for industry and the NHS • Attract inward investment • Promote the rapid adoption of new costeffective innovations in the NHS
• • • • • • •
• Work in partnership with industry to develop and evaluate innovative products and services through early stage clinical trials, establishing internationally leading centres for early stage clinical evaluation. • Develop and expand exploitation of NHS intellectual property in the region through Medipex to create opportunities for private sector investment. • Stimulate and reward innovation by NHS staff and develop curricula that prepare all health professionals to be innovative and receptive to innovation (see Appendix 4). • Adopt proven approaches to innovation developed in the Medical Technologies Innovation and Knowledge Centre at the University of Leeds and the Advanced Manufacturing Research Centre at the University of Sheffield. They bring businesses together with experts to accelerate the commercial development of new products and services which have already attracted over £100m investment and international recognition for excellence in working in partnership.
Adopted from National Medical Technologies Innovation Knowledge Centre
Yorkshire Partners Innovation Wealth Creation System
medical technology digital health and assistive living telehealth medical engineering and manufacturing computer science health economics disease specific transformation in musculoskeletal, cardiovascular and cancer care
• Translate this world leading research to create new start up and spinout companies and jobs, developing licence opportunities to support investment from global healthcare companies.
• Market the NHS and its products internationally
Devices for Dignity is a pilot healthcare technology cooperative hosted in Y&H – one of only 2 in England. Over the last 5 years as an organisation embedded in the NHS, working with industry and academia it has married unmet clinical needs with industry capability, commercialisation know-how and adoption expertise to get innovative products used in mainstream practice. The UroDiary for example is hand held electronic diary on which episodes of micturition, together with volume and the occurrence of other urinary symptoms can be immediately recorded by the patient. The secure data is remotely reported to the clinician for quick analysis and diagnosis. A spin out company Elaros 24/7 ltd integrates the UroDiary as part of a complete in home continence assessment, diagnostic and triage service.
• Build on our clusters of international research excellence in:
Objectives The AHSN will generate wealth in the region and the UK by stimulating innovation and partnership with medical technology, digital health, pharmaceutical and other commercial enterprises. The engagement with the business community will enable us to develop and rapidly adopt (i) new medical devices, (ii) therapies to improve patient care, (iii) new care processes, (iv) innovative technology and information solutions across all our programmes. This will build on and extend successful models we already have in the region. (see case study on Devices for Dignity)
Devices for Dignity
Adoption and Diffusion
Evaluate Impact and Benefit
Return on Investment
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
The Medical Technologies Innovation and Knowledge Centre The Medical Technologies Innovation and Knowledge Centre is founded around Europe’s largest integrated multi-disciplinary medical engineering centre, the Institute of Medical & Biological Engineering at the University of Leeds. It is home to more than 250 researchers working across 10 departments. There is a portfolio of 123 collaborative projects with 38 companies having secured £84 million income and a number of NHS partners to support new research translation and innovation. We are directly supporting 12 Proof of Concept projects and 6 CoDevelopment projects and plan to support a total of 40 Proof of Concept and CoDevelopment projects by 2015. We have contributed to 36 new product developments and 20 are commercially available or progressing to market. Medical Technologies is unique, working with clinicians and industry to deliver innovation right across the medical technology spectrum, from implantable devices through to regenerative therapies that can be enhanced with autologous stem cells. The centre focuses on technologies that have viable and feasible routes to commercialisation and supports these through an approach that reduces late failure and cost and provides AHSN partners with a series of exceptional opportunties to co-develop and deploy innovative products.
Encourage companies to conduct research in the NHS • Adopt a single system for research approvals based on mutual assurance. • Further develop the nationally leading Clinical Research Networks (CRNs) across the region, building on our distinctive, integrated population base and information systems, to be the leading national centre of excellence for recruitment for late stage trials. • Make it easier for companies to conduct research in the NHS (see Appendix 5). • Support local business and industry in the development of integrated information systems and networks for health. • Create a culture of openness and sharing between the NHS and industry, and mechanisms which enable industry to access unmet clinical needs and expert clinical opinion on product concepts, in a way which creates a step change from current practice. (see case study Promoting Links with Business) Attract inward investment • Secure a structured partnership with the region’s health technologies industry, the AHSN will partner with Medilink (Yorkshire & Humber) Ltd which has over 100 health technology company members in the region and through its network of licensed Medilinks has access to health technology life science companies across the UK (over 500 members nationally). • Establishing an international reputation for the region as the right location for health innovation. • Medipex will utilise their expertise in intellectual property commercialisation and knowledge of the NHS across the region to deliver an innovation assessment and adoption pathway that provides a highly visible and coordinated point of entry for industry. Local innovation scouts, trained by Medipex, and based in each trust will support the innovation process.
• Medipex will work with Medilink, Local Enterprise Partnerships (LEPs) and other local partners to identify regional companies interested in collaborations and licensing of NHS intellectual property. Medipex will act as the translator working between Small and Medium size Enterprises (SMEs) and the NHS to help broker colaborations leading to the delivery of products and services the NHS needs. Using its strong links with York Health Economics Consortium it will help build a cost effectiveness case to support procurement and adoption of new innovations within the NHS. • Enable local NHS organisations and partners to actively engage and attract net global inward investment. Promote the rapid adoption of new costeffective innovations in the NHS • Increase procurement of products and services from local and national providers. • Make it easier for business (especially SMEs looking to supply new products) to deal with the NHS and reduce the complexity of the tendering process by establishing an optimal contracting model with all bodies involved in procurement for NHS organisations across the Yorkshire and Humber region. • Develop an ‘industry partnership’ that will explore joint risk & reward sharing between companies and the NHS around creation and adoption of new technology. • Initiate a Technology Alert Service to promote awareness of high impact healthcare technologies suitable for immediate adoption which are likely to improve the quality and cost of healthcare delivery in the Yorkshire and Humber region and beyond. • Establish a system to monitor scale and impact of the adoption of innovation using a clear measure. Market the NHS and its products internationally • Medilink Yorkshire will also provide an important link with United Kingdom Trade and Industry (UKTI) for Life Sciences. Our global aspirations are reflected in the pioneering work done by Sheffield Children’s hospital on rare disorder genetic screening with the Brazil, Russia, India and China (BRIC) countries and through our strategic partnerships with the Veteran’s Administration and Partners (Boston) in the USA.
Promoting Link with Business • Procurement surgeries – where companies proposing new developments can liaise with NHS procurement staff and commissioners to exchange information and ensure that developments are suitable for future NHS needs. These surgeries will be proactive where the NHS identifies future priorities, and reactive where companies have an opportunity to present new products and services. • Technology showcases – where NHS staff get exposed to new technologies that are being employed successfully globally or in other parts of the NHS. • Thematic innovation workshops – where unmet clinical needs are presented to an invited audience of academics, entrepreneurs and clinicians to stimulate solutions and potentialy create new joint intellectual property. • Small Business Research Initiative (SBRI) Style – collaborative procurement challenges are introduced around an urgent priority clinical area with industry invited to work collaboratively with AHSN partners to develop and implement one or more solutions within a defined timescale. • Dragon’s Den style “expert forums” where companies can pitch new ideas/products to expert panels in specific clinical areas from the NHS.
DELIVERABLES Short Term • Establishment of clear innovation & adoption pathways including Trust based innovation scouts • 20 companies collaborating with NHS on innovation related projects • 10 new market ready innovations • Run 1 pilot procurement event for regional SMEs • 50 companies collaborating with AHSN; 10 of these are Research and Technological Development projects involving NHS, Academia and Industry • 20 NHS innovations adopted across AHSN • Develop 3 international collaborations between AHSN and multinational corporations or overseas health economies to explore knowledge transfer/commercial consultancy Medium Term • Generate an additional £1bn leveraged income. • 20 high impact innovations saving £20m pa for NHS in Y&H • 75 commercial licence deals generating £5m £6m commercial income – gross sales equivalent to £60m per annum • 5 new spin outs with £10m investment of private sector capital with a £1 billion worldwide market • 200 new jobs in companies directly as a result of AHSN wealth creation activity • 100 SMEs assisted • 150 industry sponsored clinical trials generating £10m income
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
GOVERNANCE AND MANAGEMENT THE TRANSITION PLAN A transition team has been appointed to establish the AHSN. This comprises a transition steering group and executive team. It has been responsible for planning the conferences and writing the expression of interest and prospectus. There is now a focus on implementing a communication plan, establishing partnership groups and developing performance metrics. The programme management office is also being established commencing with the interim appointments of Programme Director, Medical Director and Academic Director. The establishment of the AHSN will take place in two phases; â€˘ During the six months from October 2012 until April 2013, the AHSN will be established in shadow form. A Memorandum of Understanding setting out the objectives of the ASHN will be signed by all the partner organisations and details of work programmes developed. â€˘ From April 2013 to October 2013, the AHSN will become a legal entity. During this six month period the substantive governance arrangements including Board structure will be established in shadow form and the Chair and Managing Director appointments made.
The AHSN governance and management will be overseen by the transition steering group and driven by the transition executive team until April 2013, by the Shadow Board until October 2013 and then by the AHSN Board. The transition steering group comprises: Sir Andrew Cash (Chief Executive Sheffield Teaching Hospitals NHS Foundation Trust), Maggie Boyle (Chief Executive Leeds Teaching Hospitals NHS Trust), Phil Morley (Hull and East Yorkshire Hospitals NHS Trust), Chris Butler (Leeds and York Partnership NHS Foundation trust), Ian Atkinson (Chief Operating Officer, Sheffield Clinical Commissioning Group). The executive transition team comprises: Andrew Riley (Project Director, Sheffield), Dr Yvette Oade, Medical Director (Hull and East Yorkshire Hospitals NHS Trust), Professor Wendy Tindale, (Clinical Director Devices for Dignity, Sheffield), Professor Stephen Smye (Leeds Teaching Hospitals NHS Trust), Professor Trevor Sheldon (University of York), Professor Tony Kendrick (Hull York Medical School), Professor David Cottrell (University of Leeds), Professor Elizabeth Goyder (University of Sheffield), Professor John Fisher (University of Leeds). The programme management office is being established under the guidance of the executive transition team by Dr Paul Rice (HIEC, Yorkshire & Humber).
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
Operating Principles and Values How the AHSN is managed, works in practice and the culture it establishes will influence its ability to transform services, build partnerships and be sustainable. We will develop the network in a way that will promote engagement, collaboration and trust and elicit the behaviours needed to make the NHS able to innovate in ways which benefit patients and the public. Establishing and nurturing these kind of relationships takes time and effort and will be an important focus in the first 12 months of the development of the AHSN. Substantive Arrangements It is intended that the AHSN will be a membership organisation that will take the legal form of a Special Purpose Vehicle (SPV). Work is being undertaken to determine the specific details of the SPV and these will be included in the next iteration of the AHSN business plan. A Board of Directors will be accountable for running the AHSN. All organisations providing NHS services, including Trusts, qualified providers and commissioners and partners will be eligible to become members and upon payment of the agreed membership fee will be entitled to full benefits of membership. There will be an opportunity for organisations to become associated partners and it is expected that boundary NHS organisations, business partners and other smaller organisations could take this option of association. Full membership details will be completed as part of the next iteration of the business plan.
The AHSN will agree and work closely to deliver national, regional priorities and areas of focus where collaboration necessarily adds value in terms of scale and insight. Additionally there will be flexibility and discretion for members to address local priorities adopting and adapting solutions that best reflect the requirements of their communities. Partners within the AHSN will be performance managed and incentivised across the whole range of the activities they conduct as part of the AHSN. The AHSN will operate according to the following principles and values; • Network membership and participation will be inclusive, highly-valued, rewarded and reinforced. • Leadership will be clear, accountable and distributed, valuing open recognition of challenges, stimulating effective collaboration in achieving solutions and celebrating the success of all network partners. • We will engage, develop and inspire AHSN leaders through effective personal development programmes that span member organisations • We will have clear objectives which are regularly scrutinised • Network programmes and priorities will be selected on the basis that network participation adds value and success could not be achieved independently of the AHSN. • Performance will be measured, managed and transparent. • The principles of equality and diversity will be supported by appropriate policies (including equality impact assessments), procedures and good practice.
In order to deliver these principles and values we will ensure that; • There is a designated AHSN lead on the Board of every NHS member organisation. • Measures of AHSN performance are integrated into the normal board performance reports of every member NHS organisation. • Assessment of AHSN participation is included within each AHSN member Chief Executive’s appraisal, based on an annual assessment. • Successful delivery of AHSN programmes will attract financial reward to the participating NHS member organisations • A robust performance management framework is used, reviewed, and adapted to ensure effectiveness. • There will be a rigorous Network audit programme to measure the impact of the AHSN. Source and application of funds At this stage in the process budget costs are being developed. This section is in summary only and will be expanded in the next iteration of the business plan. Source of Funds (per annum)
Department of Health
Additional contribution from trading (rising to £10m/year)
References Bambra C, Joyce KE, Bellis MA et al. Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence-based policy. J Public Health 2010;32:496-505. Best A, Greenhalgh T, Lewis S, et al. Large-system transformation in health care: a realist review. The Milbank Quarterly 2012; 90:421-456. Bradley EH, Curry LA, Ramanadhan S et al. Research in action: using positive deviance to improve quality of health care. Implementation Science 2009;4:25. Gabow P, Halvorson G, Kaplan G. Marshaling leadership for high-value health care: An Institute of Medicine Discussion Paper. JAMA 2012;308:239-240. Roberts H. What works in reducing inequalities in child health? (2nd edn), Bristol: Policy Press, 2012. Stetler CB, McQueen L, Demakis J, Mittman BS. An organizational framework and strategic implementation for system-level change to enhance research-based practice: QUERI Series. Implementation Science 2008;3:30. Trivedi AN, Grebla RC. Quality and equity of care in the veterans affairs health-care system and in medicare advantage plans. Medical Care 2011;49:560-8.
Application of Funds (per annum)
Business programme support
Wang A, Clouston SAP, Rubin M et al. Fundamental causes of colorectal cancer mortality: the implications of informational diffusion. The Milbank Quarterly 2012;90:592-618.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
APPENDIX 1 MEMBERS & PARTNERS OF THE AHSN The following organisations have committed to being part of the Yorkshire and Humber AHSN:
Clinical Commissioning Groups 1. 2. 3. 4. 5. 6. 7. 8. 9.
Leeds South and East Clinical Commissioning Group Leeds West Clinical Commissioning Group Leeds North Clinical Commissioning Group Bradford City Clinical Commissioning Group Bradford Districts Clinical Commissioning Group Airedale, Wharfdale, Craven Clinical Commissioning Group Calderdale Clinical Commissioning Group Greater Huddersfield Clinical Commissioning Group North Kirklees Clinical Commissioning Group
10. NHS Wakefield Clinical Commissioning Group 11. Hull Clinical Commissioning Group 12. East Riding of Yorkshire Clinical Commissioning Group 13. North East Lincolnshire Clinical Commissioning Group 14. North Lincolnshire Clinical Commissioning Group 15. Harrogate & Rural District Clinical Commissioning Group 16. Scarborough and Ryedale Clinical Commissioning Group 17. Vale of York Clinical Commissioning Group 18. Barnsley Clinical Commissioning Group 19. Bassetlaw Clinical Commissioning Group 20. Doncaster Clinical Commissioning Group 21. Rotherham Clinical Commissioning Group 22. Sheffield Clinical Commissioning Group
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
Acute NHS Trusts
1. 2. 3. 4. 5. 6.
1. 2. 3. 4. 5. 6.
South Yorkshire and Bassetlaw Cluster Calderdale Kirklees and Wakefield Cluster The Humber Cluster NHS Leeds NHS Bradford NHS North Yorkshire and York
Leeds Community Healthcare Trust Hull and East Yorkshire Hospitals NHS Trust Yorkshire Ambulance Service Trust Leeds Teaching Hospitals NHS Trust Mid Yorkshire Hospitals NHS Trust Scarborough and North East Yorkshire Health Care NHS Trust
Acute Foundation Hospitals 1. 2. 3.
Airedale NHS Foundation Trust Barnsley NHS Foundation Trust Bradford Teaching Hospital NHS Foundation Trust 4. Calderdale and Huddersfield NHS Foundation Trust 5. Doncaster and Bassetlaw Hospitals NHS Foundation Trust 6. Harrogate and District NHS Foundation Trust 7. Rotherham NHS Foundation Trust 8. Sheffield Children's NHS Foundation Trust 9. Northern Lincolnshire and Goole Hospitals NHS Foundation Trust 10. Sheffield Teaching Hospitals NHS Foundation Trust 11. York Hospitals NHS Foundation Trust
Mental Health Trusts 1. 2. 3. 4. 5. 6.
Bradford District Care Trust Humber NHS Foundation Trust Rotherham Doncaster and South Humber NHS Foundation Trust Leeds and York Partnership NHS Foundation Trust Sheffield Health and Social Care NHS Foundation Trust South West Yorkshire Partnership NHS Foundation Trust
Other Partners 1. 2. 3.
Yorkshire and Humber Medipex Yorkshire and Humber Medilink White Rose University Consortia; Leeds University, University of Sheffield and University of York. 4. Other Universities; Bradford University, Sheffield Hallam University, Leeds Metropolitan University, University of Hull, Huddersfield University 5. NIHR CLRNs in West Yorkshire, South Yorkshire and North and East Yorkshire and North Lincolnshire. 6. HIEC Yorkshire & Humber 7. Leeds, Bradford and York NIHR CLAHRC and South Yorkshire NIHR CLAHRC 8. Leeds City Region and Sheffield City Region Local Enterprise Partnerships (LEP) 9. Yorkshire Chambers of Commerce 10. Science City York
APPENDIX 2 INFORMATION AT THE CORE Aims The AHSN will ensure that robust comprehensive information is the engine which drives the majority of our activities. Objectives 1.
Refining our clinical information and management systems to ensure accurate and timely information is delivered to every point of need within the network. Building on existing strengths in health informatics and clinical analytics to improve the functional integration of health data bases across different sectors. Combining our academic and NHS expertise in computer science, health informatics and clinical information systems we will bring the latest developments in “big data” and “cloud computing” to the frontline of healthcare.
How we will do this We will: • Create robust health information to support decision making at patient and population levels to provide a platform for health technologies innovation. Research programmes will explore how available information can be processed to stratify the patients by risk, determine appropriateness of treatment, and in general to better support clinical decision making. • Develop an intelligence function at the core of the AHSN on service utilisation to enhance our understanding of the patient journey from presentation in primary care through to the management of advanced complex conditions.
• Formulate a common data approach that enables all local information systems to talk to one another, including through common data models and standards. In liaison with key national bodies we will produce an agreed set of standards and codes to capture clinical data. For example, Yorkshire Centre for Health Informatics is currently delivering the National Laboratory Medicine Catalogue which will underpin interoperable diagnostic test reporting. • Develop and promote routine clinical data capture mechanisms and explore technological opportunities for prospectively identifying patients suitable for participation in health research (see Appendix 5). For example we will develop a single query portal for academics and industry to identify cohorts for inclusion in portfolio-adopted clinical trials. The implementation of a region wide model of preconsent will streamline and increase research trial participation. In addition we will implement a model of presumed consent, in line with national initiatives, enabling de-identified clinical records to be used in ethically approved research. • Work with SMEs to identify where the accelerated use of assistive technologies could improve peoples’ lives and where digital health can provide clinical support, lean care processes and increase patient and carer self-management and participation. • Use advanced cutting edge data analytical techniques, process modelling, behaviour modelling and data modelling to improve clinical diagnostics across the region. These insights will be incorporated into clinical training and drive service improvement.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
• Adopt a patient-led approach to understanding the impact of health service delivery on patients’ satisfaction, economic impact, quality of life, well-being and long term health outcomes. We will extend the leading work by ScHARR in tracking A&E and ambulance activity to primary and secondary care systems, incorporating electronic patient reported outcome tools (ePROMS) to enhance our ability to understand and model the whole systems impact. • Develop a clinical portal that pulls all relevant clinical information together at the point of care. We have already made major advances in linking the two thirds of our population with primary care records in SystmOne to our open source clinical portal solution. All Trusts in the region are contracted to use a desktop, portal-compliant, clinical record viewer which will make the summary care record available to all clinical staff in the region. • Accelerate uptake of pathway-driven care through the production of a region wide governance framework for sharing clinical data. We will learn from international exemplars, for example Scottish Care Information and the Veterans Administration in the USA, taking the best of their practice for our region. • Train front-line clinical staff in the need to record data accurately and through Continuing Professional Development (CPD) and MSc programmes ensure that informatics staff are competent in new technologies and approaches to healthcare (see Appendix 4). • Develop a health portal for all citizens within Yorkshire and Humber. This will empower the public to jointly manage their clinical conditions with health professionals, and proactively manage their wellbeing through the routine collection of basic health indicators. This will promote independence and self management of long term conditions linking to assistive technologies and telehealth solutions.
• Continue to attract UK and international funding to conduct population modelling, personalised healthcare modelling, risk assessment and behaviour modelling for wellbeing initiatives, exploiting the advanced scientific analysis processes such as treatment planning and personalised device construction. Deliverables Short term • Stocktake of information sharing and analytical capacity across the ASHN. Medium term • A single regional data sharing agreement for all participating organisations. • A regional architecture to enhance data sharing to support clinical services. • A regional agreement in place to facilitate data sharing between organisations. • A regional portal available on all clinical desktops which includes a summary and detailed care record viewer for secure access to any patient data at the point of care. • 500 staff involved in CPD / MSc programmes in health informatics. • An analytics platform to support academic and industrial research through secondary use of clinical data. • 500 analysts in the NHS organisations using common data analytical techniques in support of commissioning. • 1m patients access their own GP records.
Integrated Information Network Performance Quality
Specific Regional Health Issues
• Historical data, not always detailed enough for regional analysis
Yorkshire and Humber Local Health Provider
Number of Users
• Risk stratification • Pattern recognition • Predictive modelling • Clinical data • Activity data
APPENDIX 3 TRANSLATING RESEARCH & LEARNING INTO PRACTICE Aims The AHSN will develop a culture of innovation, learning and change in which the workforce actively seeks out evidence, tries new ways of doing things and shares success, to improve patient care. Objectives 1.
Maximising our existing collaborations and using our expertise in applied research and implementation science to support the healthcare workforce and patients to use evidence and knowledge to drive improvement. Better understanding of the needs of patients and to identify exemplars of good practice across the service and share these lessons. Making evidence from research more accessible for managers, frontline staff and patients to drive change. Identifying gaps in the existing evidence base to generate new insights and funding opportunities with local Universities and Industry. Using social media and new technologies to share knowledge.
How we will do this We will • Establish a locally focussed, cross-cutting Yorkshire and Humber Transformation Academy, applying the best improvement science thinking, increasing the engagement of clinical leaders and building capability amongst partner organisations to transform services. • Develop agreed approaches to translation based on reviews of evidence and practice internationally, nationally and locally. • Recruit a multidisciplinary team of 20 core facilitators with clinical and non-clinical backgrounds, from the health and social care, university, charity and industry sectors. Facilitators will be trained in innovation, behaviour change, implementation science, knowledge translation and improvement methods. • Support one year secondments for managers, academics and clinicians to work in the Yorkshire and Humber Transformation Academy or across sectors. • Together with our partner Universities and the NHS Leadership Academy develop a CPD programme on Leadership for Innovation (see Appendix 4).
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
• Establish a Helpdesk with explicit evidence translation and knowledge management functions enabling network members to request evidence on a given topic. Within 4 weeks they will receive a rapid review of evidence. Where research evidence is unavailable, information on emerging solutions in the region and from “trusted” international sources and collaborations will be provided. This will draw on existing capacity and expertise from Centre for Reviews and Dissemination (CRD) and the two CLAHRCs. This also includes horizon scanning to ensure we are keeping pace with national and international developments in practice, responding to pull from the NHS and push as new science and evidence emerges. • Recruit 1,200 translational associates (clinicians, managers, patients, academics) recognised by time and title to build linked communities of practice at scale using peer-led learning to promote grassroots involvement. • Work closely with industry colleagues to identify strategic challenges and opportunities for example working with United Kingdom Medicines Information (UKMI) to identify new opportunities to improve clinical outcomes as medicines come off patent for example primary prevention using statins. • Establish joint posts between partners, working with industry to bring industry colleagues into the NHS and NHS colleagues out to industry to focus on defined areas of implementation across the system. • Create effective partnerships with Local Authorities, the Voluntary Community and Faith (VCF) sector and Industry to ensure that cutting edge techniques to define, understand and address needs are introduced. For example user centred design and evidence-based approaches to engaging and supporting individuals in communities. • Engage with CCGs and Any Qualified Providers (AQPs), Local Authorities and the VCF to adopt a common CQUINS framework that proactively incentivises innovation adoption and diffusion. • Using evidence to underpin challenging decisions, for example disinvestment. • Understand inconsistencies in care, using positive outliers as benchmarks and to understand the context of success and failure.
• Engage with the NICE Implementation Team to ensure that expertise from within the AHSN contributes to the development of national guidelines so that the AHSN can start early whole system planning to implement the guidelines effectively in advance of the 90 day period. This will include seconding AHSN experts to the NICE Implementation team and would ideally include seconding experts from the NICE Implementation Team to the AHSN. Deliverables Short term • Establish the Yorkshire and Humber Transformation Academy and confirm the detail of its links and relationships with local organisations. • Scope the development of the CQUINs framework to reward organisations and systems for managing complex “wicked” issues successfully together. • Create an engagement strategy for working with NICE on the basis of proactivity, responsiveness and reciprocal learning. • Identify in partnership with Industry the first examples of new innovations with the potential to deliver rapid improvement in clinical efficiency and effectiveness, improved patient outcomes and experience, driving their adoption through AHSN mechanisms. Medium term • Secure the capacity and expertise of the translational associates and core facilitators through appropriate HR processes – including secondment and joint appointments. • Create the rapid access knowledge management and evidence translation helpdesk function. • Create the relevant infrastructure to exploit social media and new technologies as effective knowledge exchange and transfer mechanisms.
APPENDIX 4 COLLABORATING ON EDUCATION & TRAINING Aims The application of evidence and best practice in education and training through collaboration will significantly increase the knowledge and skills of our workforce, promote a willingness and ability to adapt to new evidence and innovation, and reduce health inequalities. We have evidence based best practice in parts of the region and the AHSN will ensure these practices are universally applied and adopted. Collaboration through the network will ensure a consistent training approach and standards for implementing improvement science, incorporating behavioural change techniques and introducing healthcare technologies. Objectives 1. 2.
Addressing the education and training needs of the whole workforce. Exploring new technologies in educational media to ensure that the whole workforce has ready access to training and educational opportunities and to encourage the sharing of best practice. Introducing Inter Professional Education across the AHSN to improve patient care, services and outcomes. Addressing the post-registration education and training needs of health professionals in new roles, for example Advanced Practitioner roles. Supporting the AHSN in preparing staff with the ability to lead the AHSN at all levels of the network and contribute to the achievement of the goals of the AHSN.
How we will do this We will • Develop a major focus on inter-professional CPD, with training of teams rather than individuals to ensure rapid uptake of innovation. For example by accelerating the adoption of a common language for needs assessment to provide a more effective service to patients in the delivery of care closer to home, particularly in the rural areas across much of Yorkshire and the Humber. An outstanding example of existing inter-professional learning is the Assessment and Learning in Practice Settings Centre for Excellence in Teaching and Learning (ALPS –CETL) based in West Yorkshire. This collaboration has created inter-professional common competency maps and assessment tools across core competencies including patient safety. Similar principles will guide the development of team based approaches to flexibility in the workplace and new evidence based pathways for patient care. • Ensure that all staff receive some training in improvement science and innovation, providing a regional programme to support the transformational activities of the AHSN. As part of this staff should also be trained in understanding how to use Patient Reported Outcome Measures (PROMS) to monitor the impact of their care.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
VERT Virtual Environment Radiotherapy Training (VERT) is a virtual replica of a radiation therapy room, the first of its kind in the UK, and was developed by the University of Hull and Hull and East Yorkshire Hospitals NHS Trust. It gives users the sense of being present in an actual treatment room and offers students and practitioners the chance to hone vital skills without setting foot in the treatment room. Prior to its development, radiotherapy training was severely limited and the only option for practising skills was on real patients. VERT was the brainchild of the late Professor Roger Phillips and James Ward, at the Hull Immersive Virtual Environment (HIVE) at the University of Hull, and Professor Andy Beavis of the Princess Royal Hospital, Hull. VERT has radically changed national policy on how radiotherapy students and clinical staff will be taught and trained in England.
• Build on the investment in leadership development in Yorkshire and the Humber in conjunction with the NHS Leadership Academy. We will explore which leadership models are most appropriate for staff and invest accordingly. • Review the supervision and mentorship models in place across clinical settings and the coaching of clinical teams. • Develop key relationships with the LETB and professional bodies to develop, train and evaluate new roles to create a flexible and agile workforce which is able to move across a range of settings as the health and care needs of the population change in both urban and rural environments. • Build on the work of the `Health Regional Skills Alliance’ to secure greater awareness and employer buy in to invest in more apprenticeships and provide the infrastructure to effectively support their uptake. Partnerships with commerce and industry will provide opportunities to offer apprenticeships and secondments in new areas such as human resources, information technology and finance. • Develop and adopt educational standards for AfC bands 1-4 or equivalent. The AHSN will increase the range, number and quality of apprenticeship opportunities, for existing staff as well as new posts, across the whole health and care workforce by 100% in 5 years. Building on the excellent models of practice that exist in Sheffield, for example Sheffield College and Sheffield Hallam University have partnership agreements and progression routes in both Apprenticeship and Prepare to Care programmes. • Increase the training opportunities for other groups of staff such as porters, estates and catering workers and increase apprenticeships across the whole workforce. • Work with the VCF sector to address the training needs of volunteers and carers which is currently patchy and of variable quality.
• Explore new technologies in educational media both in terms of ensuring the whole workforce can access education and training needs in a timely way but also for the sharing of best practice. (see case study on VERT) Good foundations that already exist in the SHA e learning club and through HIEC collaborations with commercial E-Learning providers can be further developed and expanded. We will go further to embrace social media as a means of accessing learning and sharing best practice in education. Deliverables Short term • A step increase in the volume of training and development across sectors and disciplines delivered through intra-professional learning with a focus on key areas – patient safety, use of new technology, patient experience. • A step increase in the number and scope of apprenticeships used by NHS organisations to attract candidates from the widest range of backgrounds and experience. • An increased number and range of educational resources delivered through innovative means including new social media. Medium term • A range of co-created learning opportunities and formal programmes of development introduced in partnership with the VCF sector to support volunteers and carers in their caring roles.
APPENDIX 5 INCREASING PARTICIPATION IN RESEARCH Aims
• Develop high quality region-wide information systems to support research and enable recruitment (see Appendix 2).
The Yorkshire and Humber AHSN will be a powerful coalition of member organisations that delivers major change in the way research is integrated into care, and innovation is supported. It will ensure a greater number of people in Yorkshire and Humber actively participate in health service and health science related research activities. It will create an environment which increases the impact of health research on the health & wealth of the people of Yorkshire & Humber.
• Unified local sign-off of research proposals within 30 days in place across the AHSN.
Ensure each organisation increases the proportion of patients participating in high quality research studies including device studies, new technology and telehealth to at least 10%. 2. Treble the number of individuals participating in commercial research (which includes multinational pharmaceutical companies) over 5 years 3. Adopt a single system for research approvals based on mutual assurance and ensure that >90% of NIHR trials achieve the set-up and delivery targets stated in the NIHR high level objectives. 4. Increase the number of commercial studies fourfold over 5 years. How we will do this Working with the NIHR Clinical Research Networks, we will; • Implement a unified system for local sign-off of research proposals within 30 days, approval of excess treatment costs within 30 days of application and researcher mobility.
• Establish a network-wide system for supporting public and patient engagement in research. • Support services (pathology, labs, imaging and pharmacy) will develop the capacity to meet agreed Key Performance Indicators (KPIs) to support research effectively and in a timely manner.
• Unified research governance risk assessment strategy in place across AHSN. • Unified process to provide decisions on key service support in 10 working days in place across AHSN. Medium term • Work towards providing a standard decision on excess treatment costs within 30 days of application well advanced across AHSN. • A support and training programme for key staff and public to develop local and network research champions in place across AHSN. • The number of patients in the AHSN recruited to portfolio studies has been doubled. • The number of individuals participating in commercial research (which includes multinational pharmaceutical companies) has been trebled.
• Adopt a unified research governance risk assessment strategy (low, medium, high). • Create a virtual single portal for industry seeking to recruit patients to portfolio-adopted trials and commercial research.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
APPENDIX 6 GLOSSARY ABHI Association of British Healthcare Industries
HTA Health Technology Assessment
ABPI Association of the British Pharmaceutical Industry
KPI Key Performance Indicator
AHSC Academic Health Science Centre
KSF (NHS) Knowledge and Skills Framework
AHSN Academic Health Science Network
LA Local Authority
AP Assistant Practitioner AQP Any Qualified Provider
LAT Local Area Team of the NHS Commissioning Board
BIS (Department for) Business, Innovation and Skills
LEP Local Enterprise Partnership
BRU Biomedical Research Unit
LETBs Local Education and Training Boards
CCG Clinical Commissioning Group
LRNs Local Research Networks
CCRN Comprehensive Clinical Research Network
LTC Long-term Conditions
CHD Coronary Heart Disease
MCRN – Medicines for Children Research Network
CLAHRC Collaboration for Leadership in Applied Health Research and Care
MEE Medical Education England
CLRN Comprehensive Local Research Network
MHRN – Mental Health Research Network
COF Commissioning Outcomes Framework
NCRN – National Cancer Research Network
CPD Continuing Professional Development
NHSCB NHS Commissioning Board
CQC Care Quality Commission CQUIN Commissioning for Quality and Innovation
NHSI NHS Institute for Innovation and Improvement
CRF Clinical Research Facility
NHST NHS Trust
CRNCC Clinical Research Network Coordinating Centre
NICE National Institute for (Health and) Clinical Excellence
CSR Comprehensive Spending Review
NIHR National Institute for Health Research
CSS Commissioning Support Service
NIHR BRC National Institute for Health Research Biomedical Research Centre
CSU Commercial Support Unit CTU Clinical Trials Unit DGH District General Hospital DH or DoH Department of Health DRN Diabetes Research Network EIA Equality Impact Assessment FT Foundation Trust HEE Health Education England HIEC Health Innovation and Education Cluster HSRN Health Services Research Network
HWB Health and Wellbeing Board
NIHR CRF National Institute for Health Research Clinical Research Facility PbR Payment by Results PCT Primary Care Trust PHE Public Health England PCRN Primary Care Research Network QIPP Quality Innovation Productivity Prevention SHA Strategic Health Authority SRN Stroke Research Network UKMI United Kingdom Medicines Information
APPENDIX 7 EXPRESSION OF INTEREST FOR A YORKSHIRE & HUMBER ACADEMIC HEALTH SCIENCE NETWORK Vision
Create a step improvement in the health of the regionâ€™s population and transform the quality and efficiency of health care by: generating evidence, testing and delivering new service models and accelerating the translation, adoption and spread of innovation and research, creating a workforce trained for new ways of working, and partnering with industry.
The AHSN includes over 5.7 million people, 23 NHS provider trusts, 22 CCGs, 16 Health & Wellbeing Boards, 9 universities (3 medical schools). We have collaborated successfully over several years: the Yorkshire-wide HIEC, LETB, Yorkshire Quality and Safety Research Group, the White Rose University Consortium, 3 Local Enterprise Partnerships and the Public Health Observatory, as well as through a number of NIHR entities: 3 CLRNs, Primary Care Research Network, 2 CLAHRCs, 3 topic specific networks (cancer and stroke), 3 CTUs, a BRU, 2 CRFs, an Experimental Cancer Medicine Centre, and Research Design Service. We recognise the benefits of building on these collaborations to establish an effective regional AHSN that will deliver large scale improvement.
Approach The AHSN will have 6 core elements: (i) A Population Health Focus on reducing chronic diseases that make the biggest impact on regional morbidity; (ii) A Charter for Quality, Research and Innovation which all NHS partners will sign to ensure patients receive the right care in the right location at the right time and achieve standards of care in the upper quartile in key areas; (iii) a Patient, Carer and Community members group to promote strong engagement; (iv) A Centre for Innovation and Best Practice Intelligence to systematically elicit and evaluate new technologies and services, providing intelligence on innovations, a best evidence service, and monitoring variation in practice and AHSN impact; (v) a Transformation Academy to build a collaborative culture of excellence and change to drive leading-edge innovation, research-based practice and optimal models of service delivery; to ensure the right workforce is being prepared and to develop leadership at all levels; (vi) an Industry Partnership to promote partnership with medical technology, digital health, pharmaceutical and other commercial enterprises.
Strategic Goals and Key Deliverables 1. Driving population health and service improvement â€˘ A network-wide individual health and wellbeing improvement programme, informed by research in partner institutions, leading to a measurable improvement in the health and wellbeing of the network population, especially hard to reach groups, reducing the incidence, and improving the outcomes of people suffering from cancer, cardiovascular disease, COPD, diabetes, depression and self-harm.
We will share learning with other AHSNs and international partners to increase our effectiveness.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
• A platform to develop and test new ways of organising and delivering care, building on the region-wide work of the Yorkshire Quality and Safety Research Group and the successful “Right First Time” programme leading the redesign of patient flows and pathways to better integration of services and so ensure AHSN partners deliver the 6 high impact innovations in IHW and commit to be early adopters in at least six additional areas. • Prioritise areas for service development which reflect the NHS Outcomes Framework and research strengths including: Cardiovascular, Stroke and Dementia Care, Respiratory disease, Mental Health, Maternal and Child health, Musculoskeletal, telehealth, Diabetes, Dentistry Rehabilitation, Trauma, Wound Care and Patient Safety. • Promote independence, self-management and care for people with current, emerging and complex long-term conditions through the implementation of evidence-based innovation in assistive technologies, telehealth, new drugs and therapies, including a full economic assessment of new systems. 2. Promoting participation in research • Implement a unified system of sign-off, approval of excess treatment costs and researcher mobility, to accelerate research approvals and in other ways facilitate the conduct of research in the NHS. • Create a single portal for industry recruiting patients to portfolio-adopted trials and commercial research. • Establish a network-wide system for supporting public and patient engagement in research. • Increase the proportion of patients offered access to high quality research studies, so patients in the AHSN will be twice as likely to be offered access to a high quality study as any other patient in England.
3. Translating research and learning into practice • Establish a locally-focussed, cross-cutting, service Transformation Academy, applying the best improvement science thinking, increasing the engagement of clinical leaders and building capability amongst partner organisations to transform services. • Appoint 3000 translational associates (clinicians, managers and academics), recognised by time and title, to build linked communities of practice at scale using peer-led learning to promote grassroots involvement. • Provide a bespoke evidence synthesis service as a routine component of service planning in the network, based on the Centre for Reviews and Dissemination and support from the CLAHRCs. • Adopt a common CQUINS framework to incentivise implementation and increased trial recruitment. 4. Collaborating on education and training • Develop core curricula of undergraduate and postgraduate programmes to produce a health and social care workforce which is creative and embraces change and innovation to continually improve patient outcomes and experience. • In collaboration with the LETB, evaluate new types of health professional roles designed to be more effective in the new service models. • Collaborate with the Y&H LETB to develop transformational leadership at all levels of the NHS. 5. Ensuring information is at the core of the AHSN • Build on partner universities’ strengths in health informatics (e.g. the Yorkshire Centre for Health Informatics), the NHS Information Centre, the PHO and the two national theme-based observatories (Child and Maternal Health and Diabetes) to improve the functional integration of health data bases across different sectors. • Underpin service redesign with robust health information to support decision making at patient, population and commissioning levels and to provide a platform for health technologies innovation. • Provide intelligence on service utilisation and enhance our understanding of the patient journey from presentation to primary care through to the management of advanced complex conditions • Develop and promote routine clinical data capture mechanisms and explore technological opportunities for prospectively identifying patients suitable for participation in health research.
6. Wealth creation • Establish a clear innovation assessment and adoption pathway that provides a highly visible and coordinated point of entry for local, national and international industry to create an integrated research and development pipeline, leading to economic growth, job creation and a doubling of the number of industry partners. • Collaborate with Local Enterprise Partnerships, local government, Medilink and Medipex to build on our world class centres of innovation in medical technology, computer science, bioengineering and bio-pharmaceuticals to create an eco-system for encouraging innovative thinking, incubating viable ideas, trialling them locally and creating an environment of commercial development and market exploitation generating tangible benefits for patients, the NHS and investors. • Use our Industrial Partnership arm to build on existing international collaborations in USA, Europe and Asia to double inward investment from major global healthcare companies into the region and UK. Governance, Resources and Operational Management The AHSN will be run so as to ensure that its activities reflect the needs and aspirations of partners and that a common sense of excitement and purpose is developed, where success is recognised and celebrated. We propose to establish the AHSN as a special purpose vehicle, with a Board of directors (representing the AHSN constituency) led by an independent Chair and Managing Director. The central management structure will be small and focussed on delivering benefits to patients, working closely with partners adopting the principle of mutual accountability. It is proposed that there would be an annual membership fee which will support the widening of programmes over the five years licence period. The Partners will work with the Board to develop and deliver the work programme. This will be designed to address local health care needs and partner capacity so that all are able to achieve the AHSN’s goals.
Yorkshire & Humber AHSN:Prospectus 2013 - 2018
Yorkshire & Humber AHSN Email: firstname.lastname@example.org Web: www.yhahsn.org.uk