The current provisions around relationships between universities and the health system in Ireland are unlikely to be sustainable into the future and Ireland is likely to be compelled to move towards establishment of Academic Medical Centres or Academic Health Science Centres, Mr. John O’Brien told a recent HMI Forum organised by the Dublin Mid Leinster Regional Committee.
The current provisions around relationships between universities and the health system in Ireland are unlikely to be sustainable into the future. In this respect, Ireland is likely to be compelled to move towards establishment of Academic Medical Centres or Academic Health Science Centres, Mr. John O’Brien told a recent HMI Forum organised by the Dublin Mid Leinster Regional Committee.
Maintenance of contemporary health service, academic and organisational standards, our international reputation and peer status will demand an ultimate shift in this direction. Ireland is poised to potentially significantly advance AMCs/AHSCs. They are consistent with the new government intent for the health system, and fit strongly with HSE integration, ISA, and Clinical Care Programmes. There would also seem to be good support for such developments across the system.
Where AMCs/AHSCs have been successful in Europe, they have been underpinned by strong Government/ Health Ministry policy and legislative support and this requires urgent attention in Ireland
However, some essential facilitative support is necessary if the AMC/AHSC objective is to be achieved. Two fundamental pre-requisites in this regard are as follows:
Development of enabling policy and legislation. Where AMCs/AHSCs have been successful in Europe, they have been underpinned by strong Government/ Health Ministry policy and legislative support. This requires urgent attention in Ireland.
Initiatives in the area are on a strong timelined project footing. Where work has commenced in Ireland on AMCs, it has been slow to progress.
O’Brien said there were four groupings in the country already at varying stages of AMC evolution. The most advanced were UCD/the Mater and St. Vincent’s University Hospitals and TCD/St. James’s Hospital and AMNCH.
He defined an AMC/AHSC as a partnership of one or more universities and healthcare providers focused on achieving excellence in and integrating the joint mission areas of service, research and education
The UCD initiative is centred around an incorporated company, co-owned by UCD, the Mater, St. Vincent’s – the Dublin Academic Medical Centre. All participants remain corporately independent with provision for some delegation of authority by each to DAMC in specified small areas. They are currently moving to corporately unify the health system.
The TCD initiative provides for joint governance by an unincorporated committee in the first instance. This is enabled through a formal agreement between TCD, St. James’s and AMNCH, which again makes some small provision for joint authority delegation in specified areas. They are at present driving significant expansion of the health system through incorporation of further hospitals and creation of a comprehensive ISA within the framework of the AMC.
He defined an AMC/AHSC as a partnership of one or more universities and healthcare providers focused on achieving excellence in and integrating the joint mission areas of service, research and education. Latterly, there had been an added emphasis on enterprise and innovation.
These partnerships can be established at differing levels of intensity, each of which is likely to support achievement of the impact and value of AMCs to varying degrees:
- An informal partnership with loose, unstructured, inter-mission recognition – minimal/no impact
- A memorandum of understanding with formal inter-mission commitment – patchy impact
- A collaborative agreement which provides for joint corporate oversight, delegated authority, full joint mission commitment – high impact.
- Full integration comprising a singly incorporated entity with full joint mission ownership – high impact.
The rationale and benefits of these types of partnerships include:
- Interdependence considerations. Health education and research cannot function without service linkages. Conversely, the health service is dependant on health academia for education/training of professionals, new knowledge, standards and quality. AMCs consolidate interdependence.
- Economic development/knowledge economy considerations – The knowledge economy in Health is centred around AMCs. A higher level AMC/AHSC is more likely to deliver on knowledge economy objectives.
- Scale issues – Stand alone health service entities of contemporary Irish size are not sustainable. They require horizontal and vertical integration. Health academia requires increasing scale for research/education purposes and to achieve economic development potential of research. AMCs facilitate this.
- Translational issues – Discovery to care timelines are shown to be radically shortened in AMC/AHSC environments. The larger and broader the scope of a centre or system the more successful it was likely to be in rapidly delivering discovery to patients.
- AMCs/AHSCs are likely to allow for improved development of new models of health professional education and training and to create an environment which attracts and retains the highest level service and research health and health sciences professionals and executives.
International models of AMCs and AHCs
AMCs and AHSCs are well established internationally, John O’Brien told the Forum.
He said the longest established are in the USA, where some examples are Johns Hopkins in Baltimore, Partners/Harvard in Boston, Duke in Raleigh/Durham, the University of Pennsylvania in Philadelphia and New York/Presbytherian/Columbia in New York. While models in the US differ they all display some critical underlying characteristics for success including
- A single overarching corporate governance with full devolved authority
- A single corporate executive head for the AMC
- Strong underpinning health system and academic heads
- Centralisation of corporate services and functions
- Full participant commitment
- Strong personal relationships at leadership level
In England, a formal government initiative in 2009 set to establish and support AHSCs, with selection based on competition. Successful bidders were Cambridge University Health Partners, Imperial College, Kings Health Partners, Manchester AHSC and UCL Partners.
The Netherlands has established eight AMCs around academic hospitals and universities on foot of a formal and legislatively based government initiative.
Scotland has developed an interesting hybrid by creating University/NHS partnerships around four health boards and four universities at Edinburgh, Glasgow, Aberdeen and Dundee. The initiative was governed by a strategic oversight board, chaired by the Chief Medical Officer, reporting to the Head of the NHS in Scotland. Its primary focus was to target public investment in research.
John O’Brien is a former CEO of St. James’s Hospital, Dublin. He was also National Director of the National Hospitals Office and Adviser to the then CEO Brendan Drumm at the HSE