Linking the integrated care organisation to the academic health science centre

The move to personalised medicine

The ICO will keep people out of acute hospitals if there is no clinical need for them to be there. This will take unnecessary pressure off acute hospitals, freeing them to focus on clinical excellence in sub-specialities.

This clinical excellence needs to embrace the dramatic advances in the practice of science and medicine. The molecular biological and information revolution of the past 70 years is now leading to the greatest transformational change in the practice, prevention and delivery of healthcare in history. Personalised medicine is becoming a reality23.

The new biology, and genetic medicine, make it possible to identify the unique DNA profile of an individual and to tailor preventative medicines and treatments for that individual24. Work in these areas is already under way in the best UK universities, such as Imperial College25.

The relationships between the ICO and the AHSC

The ICO is the nexus that wraps services and treatments around the individual patient, including that person’s unique genetic profile. The anonymised aggregation of this information allows scientists and clinicians to discover links between the genome and disease. In turn this makes possible the determination of future outcomes and trends that allow for the implementation of population-wide preventive and treatment programmes and, sensationally, the delivery of these discoveries back to personalised therapies for the individual in the context of the ICO30.

Without the two delivery models of the ICO and the AHSC, the United Kingdom will suffer not only deteriorating health and social care outcomes relative to other advanced nations, but also an impoverishment of the country’s prominent global position in biomedical science.

The role of the AHSC

In 2014/15, the United Kingdom had four of the top 10 universities in the world26, and all of them are global leaders in the discipline of biological sciences27. To retain that position, and to deliver personalised medicine, we again need a new type of delivery vehicle: the academic health science centre (AHSC). These unite acute healthcare providers and universities, bringing clinical practice together with research experience to make scientific discovery work for the benefit of the person on the street. They advance biomedical science, especially genetic medicine.

AHSCs consolidate clinical units. For many conditions, there is already a strong clinical consensus that this improves health outcomes28. There will be fewer acute hospitals in the country, but there will be bigger centres of global clinical eminence spread across the United Kingdom, each of which will be a dynamic nucleus of innovation and performance.

This consolidation does not mean closing hospitals: there is a symbiosis between the out of hospital ICO and the AHSC that means existing hospital buildings can be repurposed rather than closed down. The ICO needs new settings – such as intermediate/skilled nursing units and polyclinics29 – that should be developed in existing facilities.