Understanding the economic and social impact of academic clinical partnerships

Stephen DaviesCambridge University Hospitals NHS Foundation Trust

NIHR Service Delivery and Organisation ProgrammeSQW Consulting (Associate)

• Why might we want to understand the economic and social impact of academic clinical partnerships?

• How might we understand this impact?

• Why might we want to understand the economic and social impact of academic clinical partnerships?

• How might we understand this impact?

Perspectives from the USA

• Social mission

• Social contract

• Economic contribution

Social Mission

‘ Why are academic health centers worth our concern and our protection? …the rationale rests on the observation that competitive markets alone are unable to produce certain types of socially valuable goods and services…..applying this rationale to the work of AHCs we identify activities – their ‘social missions’ - that are likely to be undersupplied in competitive markets’

Blumenthal, D et al ‘The Social Missions of Academic Health Centers’ NEJM 337(21) 1550-1553 (1997)

Social Contract

‘ as the millennium approached…the social contract between society and medical education had been bilaterally broken. Society was no longer providing academic health centers sufficient financial or political support. In turn, medical faculties had grown inwardly focused’

Time to Heal – American Medical Education from the Turn of the Century to the Era of Managed Care’Kenneth M Ludmerer, OUP 1999

Articulating the social contract

• Underserved patients• Rural and inner city

outreach• Uncompensated care• Care of the severely

ill• Specialist and tertiary

services

Economic impact

‘A recent AAMC report on the economic impact of medical schools and teaching hospitals indicates that many of these institutions function as engines of significant growth in their communities, affecting not only their immediate regions but also the economy of the entire nation…. total impact on American economy $326bn per annum….1 in 54 wage earners receive part of their income from an AHC’

Association of American Medical Colleges (AAMC) Press ReleaseNovember 2004

Increasing scope for unintended consequences for AHCs: England

• Choice• Payment by results • R&D funding reforms• NMET funding changes• ISTCs• Research governance• International competition – research, patients?

‘The Cambridge Biomedical Campus’

20202040

The Glasgow Southern General ‘island’

• Why might we want to understand the economic and social impact of academic clinical partnerships?

• How might we understand this impact?

employment

educationtraining and development

health carehealth promotion

social inclusion

good governance

equity and participationsocial networks

discovery

research and development

ClinicalPartner/s

innovation

procurement

Human Capital

Social Capital

Econ

omic

Knowledge

IMPACT

IMPACT

RegionalLocal

National

LocalRegional

NationalInternational

National

International

Local

MedicalSchool

Place

Local

built environment

environmental

connectivity

Projects undertaken2005-7

• Phase 1 – for AUKUH/CHMS - mainly quantitative data complied from data in public domain plus surveys. Chart book published 2006.

• Phase 2 – depth studies of specific centres, with primary data collection.– Manchester – Norwich– [Glasgow]

Quantifying economic impact

6. Estimated combined direct, indirect and induced impacton sectors at a local, regional and national level

1. Employment : occupational groups workforcecharacteristics & geography of employment

3. Expenditure on salaries

and wagesby geography

4. Non-pay expenditure

on goods and services by geography

Apply appropriate local, regional and national multipliers for indirect impact within model

Direct impactof ACPpartners

Indirect and induced impact of multiplier effects of ACP partners

Other indirect impacts of ACP partners

2. All income generated by the Trust and School of Medicine

5. Capitalexpenditureon buildings

and equipment by geography(and estimated employment)

7. Estimated student expenditure in the local economy

8. Estimated visitor impact ofnon-local visitors to the region

Economic Impact of an Academic Clinical Partnership

Minus exclusions (e.g. spend on partners)

B. Expenditure ImpactA. Employment Impact

Establishing other impacts

• Human capital– Mainly secondary data to quantify main health care

and education outputs, some survey data.• Knowledge

– Secondary data to quantify knowledge outputs plus qualitative data on research impact.

• Social capital– Qualitative data from interviews

• Place-making– Qualitative data from interviews and published

sources

Profile across membership

External Funding by Trust 2004/5

£0

£10

£20

£30

£40

£50

£60

AH E AM AF C AB U J O G N AN AD X AQ Z L AK AA S AL H AI Q AP AC AE AO W D Y B T V I

Mill

ions

External Funding External Income

Top 10 Trusts receive 63% of research funding

Comparative profiles of centres

London centre –single trust

‘Golden triangle’ partnership

New medical school partnership

Social capital

• Regarded as a key determinant of sustainable economic and social development.

• No single definition – but usually regarded as encompassing:– Social networks– Shared values and trust– Behavioural norms

• Some evidence that also a strong determinant of population health.

Place

• Growing importance of ‘place-making’ in UK public policy – e.g. Lyons Report into future of local government.

• ‘liveability’ – the extent to which localities have the qualities that make them desirable, healthy and safe places to live.

• AHC ‘place’ impact especially important in context of redevelopment – includes built environment, energy, travel, waste, contribution to local governance.

Conclusions

• Why?– National agenda – sector interest– Local agenda – centre interest

• How?– Multi-dimensional model using mixed

methods– Yields evidence that can be used at both

national and local level.

Limitations/reservations

• Variable rigour of methodology

• Demonstration of added value of partnership

• Reductionist?

‘Understanding the economic and social effects of academic clinical partnerships’

S M Davies and A Bennett

Academic Medicine, June 2008, 535-9

stephen.davies@addenbrookes.nhs.uk