Early lessons from England's first AHSNs

Since Innovation, Health and Wealth there has been substantial interest in the first tranche of academic health science networks now being established across England. The core purpose of the networks is to enable the NHS and academia to work collaboratively with industry to spread innovation, enhance patient care and generate wealth.

Fifteen aspirant networks submitted prospectuses to the Department of Health in October 2012 and, following panel interviews, successful applicants will start to become operational from April. As the first of these prepare to launch, this article reflects on the experiences from the application process and shares emerging lessons.

‘Work will include the need to openly address concerns that the networks may overlap with, or potentially threaten, existing organisations’

Engagement

Applying to become an academic health science network (AHSN) has required joint preparation of a comprehensive business plan in under 12 weeks, with limited centralised guidance.

Given the size of each network (3-5 million population) and the number of partners involved, the pace of the application process has been testing. Sites have worked hard to engage partners wherever possible, but time pressure required quick decision making by a core group of lead organisations.

Work is now needed to fully engage all members and understand their role in the network, as well as managing the cultural tensions that arise from bringing together diverse entities, each with different agendas, priorities and historical ways of working. This will include the need to openly address concerns that the networks may overlap with, or potentially threaten, existing organisations.

Function

Before the form of each network could be decided, its function had to be defined. While the DH provided high-level guidance, each site has had latitude to determine exactly what it will “do”.

This has required local prioritisation to agree on work streams that will build on existing good practice but will also address the pressing concerns of diverse member organisations, to ensure there is “something in it” for each of them in the long term.

Commissioners, for instance, have needed assurance that the networks will tackle the health and financial burdens of long-term conditions and dementia; whereas industry has been interested by prioritisation around a single point of access to the NHS. 

‘The challenge has been to create an inclusive structure for a large number of partners while still providing good control’

Programmes have been designed to help address the system-wide challenges of the network’s members and each therefore has a unique portfolio. Work is now required by all sites to ensure these are approved and owned by the membership. 

Governance

After function follows form, and aspirant sites have had to define the governance structure that will enable delivery of their stated aims and objectives. This has meant agreeing the best legal entity; leadership, management and board structures; and membership model for each network, including voting rights.

The challenge has been to create an inclusive structure for a large number of partners, which acknowledges variations in size, complexity and legal standing and encourages active participation, while still providing good control and effective decision making. 

These proposed structures will need to be tested and refined as networks move from being loose delivery partnerships to fully functional legal entities, and as the different characteristics of wider partners become more understood.

Incentives and levers

Preliminary work has been undertaken to identify different incentives and levers that might drive conformity with network requirements. For example, some sites will withhold commissioning for quality and innovation payments to organisations that do not become members. 

However, to make this meaningful, a formal contract is now required, setting out how different AHSN bodies will work together and the levers and incentives that will be applied to ensure that directives are followed. 

For instance, if a network asserts that a new stroke pathway should be implemented across its footprint, it will need appropriate authority and devices to ensure participation and delivery across its membership.

Assets

During the application process, different partners agreed to work together. In particular, sites focused on pooling sovereignty and staff to realise the benefits of aligned, collaborative working. 

The challenge now is to agree the actual level of control and resources that members will be prepared to pool to drive system and service improvement. This may require individual sacrifices for collective gain, and some resistance may arise. 

‘While there are clear advantages to working closely with industry, some issues will continue to require negotiation’

Some sites are introducing a staged approach, whereby cash membership contributions (subscriptions) will only be required from year two onwards. This puts pressure on AHSNs to deliver in year one, and to achieve the proposed early wins that will demonstrate value to subscribers in year two. 

With an anticipated budget of £10m per annum, tight commercial and contracting arrangements will also be required to ensure that joint funding is spent effectively to generate demonstrable value for money.

Industry

Networks will forge partnerships with health technology, information, biotech and pharmaceutical industries to encourage clinical trials, enable commercialisation of innovations and promote the use of new technologies and products across the NHS. 

They will also replace multiple routes into the NHS, with a single point of access for industry. During application, the process of engaging industry partners was influenced by central guidance that professional bodies, rather than individual companies, should be engaged to minimise issues around competition, profit share and conflict of interest.

While there are clear advantages to working closely with industry, these issues will continue to require negotiation and debate on a case-by-case basis, to ensure that endorsement of commercial partner activity is seen to be equitable and truly beneficial to the wider public interest.

Preparing to begin

So far, each journey to accreditation has reflected the unique local landscape of each network footprint. These diverse journeys have had common features, and have provided an essential learning opportunity ahead of going live, laying the foundations for future organisational interaction, negotiation and joint priority setting. 

As they await their licences, sites must now sustain the momentum that was generated during appraisal, rising to the challenge of delivering immediate early impact once resource has been secured. 

‘In a sense, the first AHSNs have done the easy bit. They have navigated a challenging approval process’

One site has already achieved a successful bid to industry to access a £500,000 “dementia challenge” fund, showing that AHSNs mean business even before officially becoming live.

The joint application process has demonstrated the collective wealth of assets and experience harboured within each network, but it has also highlighted the complex and conflicted landscape that will engender challenges for collaborative working. 

In navigating their first year of business, networks will therefore need the full, non-partisan commitment of their constituent leaders to make the big and complex decisions that will enable a vision of cooperation to become reality.

Plotting a new course

As an antidote to recent system-wide upheaval, AHSNs offer an opportunity for organisations to come together, work together and plan together on behalf of the patients they serve. 

While diminishing budgets have threatened to increase organisational entrenchment, AHSNs offer a route out of segregation, potentially providing not a diminutive attempt at alignment, but a mass-scale, radical new way of working that is urgently needed. 

In a sense, the first AHSNs have now done the easy bit. They have navigated a challenging approval process with their local partners and have emerged as accredited networks. 

The test now is to plot a course through the political challenges that joint working brings, and to begin functioning both locally and nationally as new, collaborative entities.

Dr Lucy Reynolds is a senior consultant at Finnamore