An Overview of the UK Healthcare System Professor Reza Razavi
Director of Research Kings Health Partners
Slide 2
The NHS in England health and care system since April 2013
Recent changes to NHS core structures, introduced via the Coalition
Governments Health and Social Care Act 2012, were designed to
reform who makes decisions about NHS services, how these services
are commissioned, and the way money is spent.
http://www.nhs.uk/NHSEngland/then
hs/about/Pages/nhsstructure.aspx
Slide 3
An overview of the Health and Social Care Act 2012 A move to
clinically led Commissioning An increase in patient involvement in
the NHS A renewed focus on the importance of public health A
streamlining of 'arms-length bodies Allowing healthcare market
competition in the best interest of patients The Health and Social
Care Act 2012: what the changes introduced mean: Primary Care
Trusts (PCTs) were replaced by clinical commissioning groups
(CCGs), led by groups of GP practices and other clinical
professionals. CCGs now control the majority of the NHS budget, to
buy care on behalf of their local communities. Highly specialist
services and primary care services are commissioned by NHS England.
Establishment of independent consumer champion organisation
Healthwatch, to drive patient and public involvement across health
and social care in England. Public Health England (PHE), an
executive agency of the Department of Health created, to protect
and improve the nation's health and to address health inequalities.
Additional responsibility conferred on the National Institute for
Health and Care Excellence (NICE) to develop guidance and set
quality standards The Health and Social Care Information Centre
(HSCIC) was also tasked with responsibility for collecting,
analysing and presenting national health and social care data. CCGs
can commission any service provider that meets NHS standards and
costs. These can be NHS hospitals, social enterprises, charities,
or private sector providers. Creation of a health specific economic
regulator (Monitor). Monitor aims to promote competition, regulate
prices and ensure the continuity of services for NHS foundation
trusts.
Slide 4
Understanding the new NHS
Slide 5
Commissioning NHS services CCGs were designed to put purchasing
power for NHS services in the hands of practitioners, and most
specifically, GPs. more effective, patient-led decision GPs best
placed to understand their local patient populations needs. CCGs
commission most services, including: planned hospital care
rehabilitative care urgent and emergency care most community health
services mental health and learning disability services CCGs can
commission any service provider that meets NHS standards and costs.
These can be NHS hospitals, social enterprises, charities, or
private sector providers. Highly specialist services and primary
care services are commissioned by NHS England.
Slide 6
Delivery of NHS services involves organisations predominantly
known as trusts, which can be classified as NHS foundation trusts
or NHS trusts Delivering NHS services Commissioned services
include: Primary care services are delivered by a wide variety of
providers including general practices, dentists, optometrists,
pharmacists, walk-in centres and NHS 111. Acute trusts provide
secondary care and more specialised services. Ambulance trusts
manage emergency care for life-threatening and non-life threatening
illnesses, including the NHS 999 service. Mental health trusts
provide community, inpatient and social care services for a wide
range of psychiatric and psychological illnesses. Community health
services are delivered by foundation and non-foundation community
health trusts. Services include district nurses, health visitors,
school nursing, community specialist services, hospital at home,
NHS walk-in centres and home-based rehabilitation
Slide 7
Kings Health Partners Academic Health Sciences Centre one of
five academic health science centres in the UK. brings together
world leading research, education and clinical training and
practice within an integrated environment. specifically focused on
accelerating the translation of basic discovery science into
experimental medicine and early phase clinical research, to speed
up the delivery of new treatments and diagnostics for patient
benefit. Kings Health Partners is a global collaboration between
one of the world's leading research-led universities, Kings College
London University, and three of London's most successful NHS
Foundation Trusts, including leading teaching hospitals and
comprehensive mental health services covering the London boroughs
of Southwark and Lambeth. These are Guys and St Thomas, Kings
College Hospital and South London and Maudsley NHS Foundation
Trusts.
Slide 8
The partners four highly-performing institutions Page 8
Hillingdon Harrow Ealing Brent Barnet Enfield Haringey Camden
Hounslow Richmond Wandsworth Kingston Merton Sutton Croydon Bromley
Lewisham Lambeth Southwark Greenwich Westminster Ken. & Chel.
City Tower Hamlets Newham Hackney Islington Waltham Forest
Redbridge Havering Barking Bexley Hammersmith Guys and St. Thomas
South London and the Maudsley Kings College Hospital
Slide 9
Kings Health Partners: Excellence, breadth and scale Hillingdon
Harrow Ealing Brent Barnet Enfield Haringey Camden Hounslow
Richmond Wandsworth Kingston Merton Sutton Croydon Bromley Lewisham
Lambeth Southwark Greenwich Westminster Ken. & Chel. City Tower
Hamlets Newham Hackney Islington Waltham Forest Redbridge Havering
Barking Bexley Hammersmith - Excellence in clinical service
Comprehensive portfolio of excellent quality innovative services
International recognition: in renal and liver disease, dermatology,
haematology, childrens, neurosciences, fetal medicine and mental
health Excellence in research One of top 5 biomedical research
universities in UK (2008 RAE) Five MRC Centres, three NIHR Research
Centres and BHF Centre of Excellence Institute of Psychiatry and
SLaM leading mental health research centre in Europe Excellence in
education Unique breadth of education and training to 9,500
students At the forefront of innovation and exploiting new
technology Capacity building for translational research Four
highly-performing institutions Guys and St Thomas (GSTT) Kings
College Hospital (KCH) South London and Maudsley (SLaM) Kings
College London (KCL) 25,000 staff; turnover of ~ 2.5bn p.a.
Slide 10
Page 10 The biomedical revolution
Slide 11
Precision medicine and pan-omics The biomedical revolution
Slide 12
Human genome 3.1bn bases 2003: 5 years and $3bn 2014: 24 hours
and $1k UK 100,000 Genomes Project Personalised Medicine: Use of
genetic and other information about an individual patient to guide
treatment Nature
Slide 13
Rising numbers of novel disease-causing genes identified
Slide 14
Epigenome, metabolome (much better at predicting CV risk, for
example), proteome, exposome (e.g. airborne particulates)
Integration of multiple modalities to make the best treatment
decision for each patient Personalised medicine: the future
Slide 15
The biomedical revolution Precision medicine and pan-omics
Regenerative medicine
Slide 16
Regenerative medicine: functional insulin-secreting cells
Pagliuca et al., Cell (2014) Generation of Functional Human
Pancreatic Cells In Vitro
Immune reaction Regenerative medicine: challenges Cancer
Function & stability Sources, differentiation & manufacture
Clinical Use
Slide 19
Precision medicine and pan-omics Regenerative medicine The
digital revolution The biomedical revolution
Slide 20
The past....?
Slide 21
Examples Long-term telemetry EEG before epilepsy surgery App
for schizophrenia symptoms Activity monitoring Exposure monitoring
Remote consultation and diagnosis Digital technology: remote
monitoring and intervention Future: integration of multiple
measures
Slide 22
Real-time visualisation of brain activity (MRI or EEG) Allows
patient to train themselves to modulate activity Potential in
depression, addiction, schizophrenia, movement disorders Digital
technology: neurofeedback
Slide 23
Cancer surgery: real-time analysis of tissue Digital
technology: iKnife
Slide 24
Digital technology: image-guided surgery
Slide 25
KHP Institutes
Slide 26
Animation Cancer Institute
Slide 27
Integrated Cancer Centre New Cancer Centre will include 15,000m
of clinical and laboratory space dedicated to the introduction of
novel, personalised therapies through clinical trials; 300+
researchers achieving 49m income (2012-13); Nearly 20,000 suspected
cancer patients are seen per year; 6,500 newly diagnosed cancer
patients are treated per year.
Slide 28
Cardiovascular Institute
Slide 29
KHP clinical: Many areas of high quality and innovation Primary
PCI First 24/7 service in the UK Out of hours survival n=1120
consec PPCI Transcatheter valve intervention First TAVI in UK
First-in-world procedures PCR London Valves Imaging-guided
intervention First in world XMR Vascular, cardiac, EP procedures
Heart failure Acute heart failure units 1 0 /2 0 /3 0 interface
Device therapy Vascular surgery Complex endovascular
intervention
Slide 30
KHP academic strengths Percentage of the submission meeting:
Overall rating 4*3*Total 4*/3* UoA1 Clinical Medicine: (Includes
KCL Cardiovascular Division) KCL484593 Oxford533992 Queen Marys
London 405090 Cambridge582987 Imperial483886 St. Georges293766 REF
2014 BHF funding (2011-14) Inter-disciplinarity Cardiovasc Imaging
Infrastructure Technologies Training BHF Centre of Research
Excellence
Slide 31
All the building blocks for a world-class Institute Clinical
volume and breadth Commercial Potential Academic Excellence
World-class Clinical-academic consensus and enthusiasm
Slide 32
Specialist CV centre Outreach Model of Clinical Care:
Whole-system, patient-focussed, one team Leadership of the sector
KHP cross-speciality services KHP cross-speciality services
Community services Main hospital
USPs of a KHP Cardiovascular Institute Specialist Clinical
Centre Basic + clinical research integrated with clinical care
Inherited heart muscle disease Heart failure Basic discovery
Devices, modelling Imaging-guided intervention Multimodality
imaging Cardiac / Vasc omics, biomarkers Multi-disciplinary
training Specialist training Centre of choice: Patients, staff,
students, industry
Slide 35
Commercial opportunities Academic: Interdisciplinary awards,
networks, centres Clinical: Tertiary and quaternary work
Educational: New clinical / non-clinical programmes Industry:
Start-ups, incubator, partner of choice Private patients
Philanthropy London location
Slide 36
Healthcare is changing rapidly New era of precision medicine
Health economic considerations increasingly important alongside
improving clinical outcomes The NHS is changing and much more open
to commercial partnerships There are opportunities both for
investment and and building international clinical and academic
partnerships Conclusion Page 36