By Mike Cowley
How can big new advances get into its bloodstream speedily? The letters AHSN are key.
When Aneurin Bevan opened the Park Hospital in Manchester on July 5, 1948, it was the first time that doctors, nurses, pharmacists, opticians, dentists and indeed hospitals had been brought together under an umbrella organisation to provide services that were free for everyone at the point of care. That umbrella was, of course, the National Health Service.
Today, the NHS remains the jewel in the crown in terms of healthcare, the service that other countries understandably have always looked on – and still do – with admiration. Faced, however, with slow economic growth combined with increased demand from an ageing population, the NHS is under ever-increasing pressure to change in order to meet the demands imposed on it by the society it serves.
In a world awash with technology, the Royal College of Surgeons states that it can take between ten and 15 years for a new procedure to be fully adopted in UK hospitals – and this when the NHS constitution states that it should be at the cutting-edge of technology.
Understandably, much of this is due to governance and the need to ensure that anything new being introduced is tried and tested to ensure patient safety. Once again, the sheer size of the NHS and the pressure it is under plays a part in holding it back from fully embracing the innovations needed to transform its working practices.
When you consider that much medical correspondence still goes by second class post – or by something called a fax, if anyone can remember those – then it is easy to appreciate the problems faced by the NHS.
If that was not enough of an issue, there is also the difficulty – in a society dominated by the IT of Everything – faced by clinicians struggling to gain easy access to the holistic records of patients (and that includes people who attend Accident and Emergency departments, a time when knowing as much about a patient as possible can be the difference between life and death). The fact that the NHS remains so well loved suggests that its staff are little short of miracle workers.
There are companies spending huge amounts on research into innovative products with the potential to improve the care of patients, but until recently it has too often been difficult for companies to engage with the NHS.
Some companies have become so frustrated with this that they have taken either themselves or their products abroad. This in turn is detrimental not only to the NHS but also to UK plc, as the health market is potentially a big money earner and job creator.
Now for the good news. The Government has become increasingly aware that unless the NHS can find a new way of working through cost-saving innovations, it is going to provide even more of a financial headache than is the case today. So two years ago, an initiative through NHS England saw the establishment of 15 Academic Health Science Networks (AHSNs), with the brief to ensure that innovations broke into the NHS loop in the shortest possible timescale.
Working with the Northern Health Science Alliance – which has been put in place to stimulate and look after health research – the AHSNs are there to see that the NHS adopts innovations. Effectively, the AHSNs are bridge-builders to see that NHS staff are equipped with the best tools for the job while retaining patient safety as the priority. This is particularly true for staff working out in the community, as one of the objectives for AHSNs is to reduce the workload on hospitals by treatment at home.
In the North, there are four AHSNs: for the North West Coast (which has changed its name to the Innovation Agency), for Greater Manchester, for Yorkshire and Humber and for the North East and North Cumbria. Fortunately, each of these is headed by someone with an extensive NHS background, and with an intimate knowledge of the market being served and both its strengths and its shortcomings. The North is fertile ground for the AHSNs, as there is no sector where the North/South divide is more clearly seen than in health. In many health outcomes, Northerners fall short of their cousins in the South. This has nothing to do with the actual quality of care – the North has some of the leading and most respected hospital trusts within the country – but is due to social determinants such as jobs and money, or rather the lack of such things.
To understand the extent of the divide, you need to know that someone living in Bradford, Yorkshire can expect to live 19 years less before experiencing a major debilitating illness than someone living in Guildford, Surrey – and that applies to the current crop of babies as well as to adults.
The Northern AHSNs are fortunate, however, in that they have a significant platform on which to build with regard to innovation. The region is rich with regard to health research, being home to some of the leading research trusts and university medical schools. The North also has more than 1,000 companies operating in the innovative life sciences field.
This will be reinforced even further by a project called Health North, announced by the Chancellor last year. Health North, which will be managed by the NHSA, will provide funding and resources to link all the major centres in the North, in a similar way to the plan for the Northern powerhouse. The first part of Health North is a programme called Connected Health Cities which will be launched later this year by George Freeman, the life sciences minister.
While each AHSN is there to look after its own patch, with local knowledge and contacts being seen as critical to the operation, the four work together closely, sharing some projects and all relevant information.
Stroke treatment has become a common area of interest, as the North is one of the worst parts of the UK for this fatal or debilitating condition. Focusing on atrial fibrillation (irregular pulse) detection, an early warning sign for one in five strokes, a high-profile trial was held where 500 patients were tested resulting in the detection of 34 abnormal pulses.
Each of these people had agreed that a letter could be sent to their GP setting out their problem, which allowed them to start treatment that would avoid a future stroke. The AHSNs are now providing some GPs and other health staff with handheld detection devices as part of their toolkit in the ongoing fight to prevent stroke. (See page 9.)
Alcohol abuse is another sector where all the Northern AHSNs are actively involved, again because it is so prevalent across the region. The work involves mapping the data to find hotspots with a surfeit of pubs and off-licences and very little community support for addiction – and then attempting to change the conditions accordingly.
Sponsoring a culture of innovation in the North remains key to the work of the four AHSNs (see pages 4-5). In Liverpool, the Innovation Agency has been instrumental in supporting the new Alder Hey Children’s Hospital. This is now a world leader in paediatric care advances, thanks in part to consultant paediatric surgeon Iain Hennessey. The driving force behind the project, Mr Hennessey is not only clinical director for innovation but also an “innovation scout”, one of a network of such AHSN people whose job title is self-explanatory.
“Having worked in the hospital environment, what is happening at Alder Hey is nothing short of amazing,” says Dr Liz Mear, chief executive of the Innovation Agency. “It has to be the only hospital in the world where you have 3D printing and robots delivering linen to wards.”
The issue of digital health is also very much on the agenda in the North, with Greater Manchester AHSN building a world-beating platform for sharing patient data with a project known as DataWell (see pages 8-9). The key here is getting over the hurdle of patient confidentiality, which Greater Manchester intends to do by producing an app with which patients can agree to share all or part of their medical records with relevant clinicians.
“We currently have the ridiculous situation where people turn up at A&E and are asked what medication they are on, and they reply ‘two of the blue, one of the pink’,” says Mike Burrows, managing director of Greater Manchester AHSN. “Once we have made shared data a reality, this will be a major breakthrough and will provide a really exciting data-rich environment for software and application developers.”
All these initiatives are, in turn, being funnelled into coming up with new ways of working (see page 11), including a programme of “test beds” which is designed to use the latest technology to support frail and elderly patients with long-term conditions.
The North is home to three of England’s 13 Genomic Medicine Centres, supported by the AHSNs and designed to feed data on patients with cancer and rare conditions – and data on family members – into the national 100,000 Genomes Project. (See pages 10-11.)
One of the Genomic Medicine Centres covers the Yorkshire and Humber region. “Genomics or gene profiling, will deliver major benefits for people’s health in the future,” says Andrew Riley, head of the Yorkshire and Humber AHSN, “signposting and identifying those variations in people’s genes which will make them more susceptible in years to come. It will lead to ways of modifying genes to get rid of those defects.”
And finally comes an area which all four AHSNs recognise as being of critical importance: the support of business (see pages 6-7). This ticks two of the main boxes for AHSNs, in that it not only encourages health but also wealth.
The AHSN for North East and North Cumbria has already achieved a significant breakthrough here, in that it is has developed the Innovation Pathway which is now being adopted by all 15 AHSNs across the UK.
“The Innovation Pathway is the front door for companies to access the NHS and the means by which the NHS is supported to develop and commercialise its own ideas,” says Seamus O’Neill, the North East and North Cumbria chief executive, “and as an AHSN, we are the honest broker to help them both”.
Now there is a statement that Nye Bevan would have appreciated had he still been around today.