Jasbir Sunner on academic health science centres

For the last two years an academic health science centre (AHSC) has been high on the agenda for St Mary's trust, Hammersmith Hospitals trust and Imperial College.

AHSCs exist in many other countries (including my homeland of Canada) and their purpose is three-fold: to create new knowledge to improve healthcare delivery, to use this knowledge to optimise outcomes and disseminate it to students and staff.

Initially spurred by a letter of alliance signed by the two chief executives in January 2005, the trusts.and Imperial College have since developed a compelling vision that requires greater integration between trusts and university.

Unsurprisingly, the people most buffeted by any lack of congruence between the hospital and the university are clinical and academic leaders, and they have strongly supported and embraced this vision. We would not have come this far without their clear support over the last two years.

Our vision and strategy for an AHSC, strongly supported by clinicians, bodes well for the future of hospital services in north west London. Local issues such as ensuring service volumes to maintain quality services, the cost of technology, and the demise of Paddington Health Campus, combined with the effect of national policy changes including the introduction of biomedical research centres and payment by results, made a coming together of the two trusts almost inevitable. Competing tertiary centres three miles apart were not the solution.

The value proposition for our proposal, however, is in the creation of an AHSC rather than a merged NHS trust. From my own experience of AHSCs, they have a learning culture that generally emanates from the university and helps embed a culture of continuous improvement in the organisation. There is also the brand impact of the alignment, which tends to attract the best academics and researchers as well as top talent in all other areas, including management.

Our progress so far has been on how to achieve the alignment of governance structures across three organisations. But this alone will not guarantee success. If it is to succeed the AHSC has to deliver the following critical success factors over the next two years:

• Integrate the separate cultures of the two existing NHS organisations and a university faculty into a whole greater than the sum of the parts.
• Overcome traditional rivalries that have arisen from the historical competition between the trusts and across the sites.
• Develop a managerial, clinical and academic team from the constituent parts that demonstrates openness and fairness, yet still selects the best people for the jobs and addresses any missing skill sets.
• Develop a single strategic plan that clearly articulates priorities to succeed in a global environment for research and maintain core secondary care services required by the local communities.
• Ensure management structures and physical linkages enhance opportunities for academics and front-line clinical staff to regularly share ideas.
• Develop strategies to ensure that there is adequate investment in the trusts' buildings.

This is an exciting time, and there is great potential for creating a new kind of NHS organisation. One of the key lessons from the demise of the Paddington Health Campus was that the creation of a single accountability structure has to be the first priority in order to ensure alignment of purpose during complex change..

Hopefully by autumn of this year, depending upon consultation and approval from the health secretary, that new structure will be in place and the accountability for delivering the vision will rest with it.

Jasbir Sunner is executive director of corporate development and strategy at St Mary's trust.