Imperial leads merger on hunt for joined-up research

If the visionaries have their way, north west London will become home to Britain's first academic health science centre.

The centre aims to bring together the best research, teaching and clinical excellence to create and test knowledge before disseminating it through the medical profession. In short, it hopes to change the way the health service works.

This AHSC would be the first of its kind in the UK, but something that the US and Europe have long used. The UK is highly placed in biomedical research tables but does not match that in outcomes; its founders hope the AHSC will redress that.

Consultation for the first stage of the process, to merge Hammersmith Hospitals trust with St Mary's trust, got under way on 1 May. Uniquely, the faculty of medicine at Imperial College London will be overseeing the merger of the two trusts.

If everything goes to plan, the government will approve the application for an AHSC in August after a 12-week consultation. Hammersmith and St Mary's will be merged on 1 October, and if the secretary of state approves Imperial College will 'integrate' with the new organisation.

Following a year of sound finances and adherence to other requirements currently being worked through with Monitor, Imperial College will apply for the AHSC to become a foundation trust. This will be the first such application from a non-NHS body.

In search of the holy grail

The senior responsible owner of the ambitious plans, and Imperial College faculty of medicine principal Professor Stephen Smith, admits he is in search of a 'holy grail' in linking research so closely with frontline healthcare.

Professor Smith has worked in the NHS for 40 years and was a professor at Cambridge for 15 years before moving to Imperial. He says: 'I have a reasonable record of academic health science leadership. What we are creating here is something different. It is not just a straight merger of two trusts, it is a differently structured organisation and a whole host of people can do the post, but if it's about academic health science then I think my personal previous experience qualifies me.'

He adds: 'We want to try to ensure from the very beginning that the research, teaching and clinical excellence agendas are slightly more closely aligned than in the current NHS structures.

.'We want to create a unique structure. We are mindful that this is a global competition and the UK will probably have a very small number of these which are able to compete with the rest of the world, but it is also very important that this is seen as producing very real benefits for the community and local patients.'

Professor Smith hopes that the AHSC will go some way to correcting the UK's deficit between research and outcomes.

Embedding creativity

'Britain is always very good at coming up with things and somebody else benefits,' Professor Smith says. 'We want to be able to use this innovative embedding of creativity to undertake healthcare in a slightly different way; to break down barriers between primary and secondary care so the patient is at the centre. Facilities should be brought around the patient rather than the patient having to access different parts of the system.'

He also acknowledges the important role that primary care will play: 'We want to stop this idea of an isolated hospital and we are very anxious from the outset to make sure our colleagues in primary care commissioning are involved at the centre of this discussion.'

It is a notion reflected by the fact that the chief executives of Westminster and Hammersmith and Fulham primary care trusts both sit on the AHSC steering group.

Westminster PCT chair Joe Hegarty says it is up to the PCT to ensure its commissioning remains strong and local patients get good care. 'It will be a positive for the area, in terms of healthcare and economic spin-offs. There may be some rationalisation but that will be subject to future consultation and it will be to improve outcomes. It is our job to ensure patients with more ordinary illnesses are not sidelined by being involved. We have been involved in the discussion at all levels and many of our words found their way into the consultation.'

Commissioning requirements for services from St Mary's trust from all London PCTs are currently handled by Westminster, and Mr Hegarty says the precise commissioning arrangements following the. merger will be discussed with Hammersmith and Fulham and other PCTs.

He adds that the PCT will need reassurance on the financial positions of the merged acute trusts.

There are some concerns that patients with less academically intriguing illnesses may be pushed aside. NHS Confederation policy director Nigel Edwards explains: 'There is an anxiety about the difference between what does well in research and what the local PCTs' needs are. Things on the research agenda are not high up on the list of things suffered by local populations. Research is going to be a very big objective for the AHSC and it will. be interesting to see how responsive it is.'

However, Professor Smith disagrees: 'It is true to say that the nature of research 20 or 30 years ago focused on rare disorders, but that has changed. One of our main areas of interest is diabetes, particularly because of the higher rates in the local population. We are world leaders in some of the diseases which affect large numbers of people.'

Postcode priorities

Imperial College is home to a small unit involved in producing life expectancy statistics by postcode. He says: 'Having a fundamental knowledge of that sort of data will come from systems where outcomes are measured, which is poorly developed in the NHS.

'We will champion that, we will have a deep commitment to that and that is how we will drive value into the healthcare system.'

St Mary's trust chair Baroness Hanham explains that the trust and the university are already working very closely together. 'What we are setting out to achieve is to bring all the research from Imperial into patient care. We have always traditionally had consultants here to do research under the Imperial umbrella, as has Hammersmith; we do a lot of things in common.'

Opportunity knocks

'There is a great opportunity now to bring all three organisations together, the research that is done will benefit patients enormously and it also in development and attracting research money,' says Baroness Hanham.

'We already gained a biomedical research centre programme between Hammersmith, ourselves and Imperial so we are working together because of that anyway.'

If the merger goes ahead, the centre will be one of the UK's 11 biomedical research centres and will get£19.5m each year for the next five years.

Professor David Taube is clinical director for the already merged renal services of Hammersmith and St Mary's, and medical director for Hammersmith. Since the April 2004 merger the department has achieved better outcomes than the two standalone departments, he says.

He believes that merger will stand as best practice for the many specialist units that will, if all goes well, merge in October.

He claims that combining the renal department has meant round-the-clock consultant cover, enabling those on the nightshift to receive training. He adds that it will facilitate networks as consultants will be more able to carry out. clinics in other hospitals which is. in line with bringing patient care closer to home.

Professor Taube says clinicians have mixed views on the merger. 'The medical profession is very cautious and very conservative, they don't like change. There are some middle-aged clinicians who don't really want to be spending the next five years with everything changing. Some will welcome it as a fantastic opportunity, probably younger consultants, as they will benefit from research and treating people in new and innovative ways.'

When and if the AHSC gains foundation status, the proposal. is that the board will be headed up by a joint principal and chief executive.

Professor Smith explains: 'In US AHSCs the chief executive is also the dean. For all sorts of historical reasons we have not gone down that road. We have a small amount of medical leadership in managerial ranks. It's an issue the NHS is mindful of.'

He hopes the AHSC will compete with its international equivalents, and will need to be headed up by somebody who understands the competition, but he does not rule out an NHS manager.

'One of the features I have noticed is that these institutions in the US have a very close working relationship between managers and clinicians, and I would set that out as one of the great markers for success.'

Capital moves

Guy's and St Thomas' foundation and Barts and the London trusts are also looking at ways of developing into AHSCs.

And NHS London chief executive Ruth Carnall says there is a possibility of more AHSCs in the capital. 'I am absolutely determined it will get off the ground; that's not to say there aren't some challenges but it is really important for London.

'It will bring properly integrated, world-class research and service delivery and with that a dramatic improvement in quality, and not. just in north west London. It will help us to substantially attract investment and talent from abroad into the UK.

'It will also improve our world competitiveness, otherwise we will slip down the league tables, which is not what we want for a capital city.'

She adds: 'This makes the day job worth doing and it will be a really good thing for London.'