"BEST RESEARCH FOR BEST HEALTH"
1. OUTLINE DESCRIPTION OF THE AHSC PROPOSAL AND THE PARTNERSHIP Integration of research, education and clinical service to improve patient outcomes Imperial College London and the NHS, as represented by Imperial College Healthcare NHS Trust, have created an AHSC model which integrates biomedical research, education and healthcare services. We are unique in the UK in the degree of integration of a university with an NHS Trust, embodied by the joint appointment of Professor Stephen Smith to the role of Principal of the Faculty of Medicine at Imperial College and Chief Executive of Imperial College Healthcare NHS Trust. This unified executive authority, while common in leading international centres, remains the sole such appointment in the UK. We were established on 1 October 2007, when Imperial College came together with Hammersmith Hospitals NHS Trust and St Mary’s NHS Trust. Our AHSC was founded in response to the paradox that while the UK is recognised as second only to the US for the quality of its biomedical research, this excellence is not reflected in its clinical outcomes; our population suffers from our failure to turn discoveries and innovations into effective new preventive interventions, diagnoses and treatments. Our goal is to improve patient care by closing the two gaps in the translational research pathway identified in the Cooksey Review of UK Health Research 1 , which are the translation of basic and clinical research into ideas and products, and the translation of new medical advances into everyday practice. The interface of basic science and medical research The engine of discovery in the AHSC is Imperial College’s multidisciplinary approach to biomedical research that enables translational medicine to interface with leading-edge biological, physical, chemical and engineering science in a world-leading science-based university. Our integrated model has the infrastructure and organisational framework to facilitate the progression of our discoveries from the university to proof-of-concept studies and subsequently clinical practice. Imperial College is structured in Faculties of Medicine, Engineering, Natural Sciences and Business, with each Faculty organised into Divisions, but has committed itself to an inter- disciplinary, cross-faculty approach to research. This multidisciplinary approach is evidenced through the examples of the successful establishment of the Institutes of Systems and Synthetic Biology, Mathematical Sciences, and Biomedical Engineering, and the cross-cutting research themes of the Faculty of Medicine outlined in the diagram. This model will be replicated through the launch of a new Institute in Global Health (Director Dr Peter Piot), and the development of two further institutes in Infectious Diseases and Endocrinology, Metabolism and Diabetes. An established mechanism for delivery of new medical advances into practice Our AHSC provides the means to translate our basic scientific ideas across the traditional university/NHS divide, into clinical and public health practice. Clinical services are organised into seven clinician-led Clinical Programme Groups (CPGs). Governance of these services is the responsibility of the CPG Directors, while research and education is the remit of the Head of Division (HoD) in the Faculty of Medicine. Research strategy is led by the university and is operationalised in the CPG through one of two models; in two CPGs the CPG Director and HoD are the same individual; and in five CPGs the Head of Division or representative holds a post as Head of Research, and provides the critical connection between research and patient care. 1 The Cooksey Review – A Review of UK Health Research Funding, December 2006 Page 2 As part of our drive to bring together NHS and College operations, we have formed a single Research Office and a Healthcare Education Office. The AHSC mission pervades all key management decisions: for example, all new consultant appointments must be agreed by the Trust and College, either of whom may exercise a veto, to ensure that all new senior medical appointments contribute to the triple mission of research, education and service. A joint capital investment programme has enabled unprecedented levels of cohesiveness in estate development, and accelerated a new £100million translational research facility at our Hammersmith campus. Our governance arrangements reflect this integrated approach. While the College and Trust remain separate legal entities, the two governing bodies, the College Council and NHS Trust Board, benefit from the shared presence of the College Rector, College Secretary and Trust Chairman. At an Executive level, in addition to the Chief Executive/Principal, the Deputy Principal sits on the Trust Directors meeting, and the Managing Director of the Trust attends the College Management Board. Multiple regular executive, capital, service, research and education meetings provide daily interaction and challenge between management, researchers and clinicians. Delivery and evaluation of results While we expect the majority of benefits to emerge over the longer-term, our AHSC has already created an environment where the translation of research is producing results. For example, the AHSC has in the past year; delivered a new blood test for the diagnosis of Tuberculosis (Prof. Ajit Lalvani) that gives results in 48 hours rather than in weeks, and that since publication in March 2008 is recommended by over 20 national guidelines; performed a world-first in minimally invasive endovascular surgery through the use of the Hansen Sensei robot to treat complex abdominal aortic aneurysm (Prof. Nick Cheshire); and seen Wyeth Pharmaceuticals acquire Thiakis Ltd, a biotechnology company focused on the treatment of medical obesity based on original research into the development of synthetic oxyntomodulin peptides by Professor Steve Bloom, commercialised with Imperial College’s technology transfer arm, Imperial Innovations plc. While we anticipate the AHSC will provide the best environment to deliver many more such examples in future, we will evaluate the long-term success of the AHSC through developing data on nationally and internationally comparable HSMR 2 patient outcomes; patient experience; population health improvement; research income; citation analysis; and impact on indicators related to translational research such as the proportion of patients in clinical trials. Value delivered We are committed to working with our NHS, academic and industry partners to deliver value beyond our immediate boundaries. We will develop a Health Innovation and Education Cluster that will bring the clinical benefits arising from our collaborations to a wider population. The cluster will build on our Biomedical Research Units with the Royal Brompton and Harefield NHS Trust, and our Collaboration for Leadership in Applied Health Research and Care with Chelsea and Westminster NHS Foundation Trust. We will work closely with the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research to develop our strategy for cancer research and services. We recognise that our vision is ambitious, but are confident that we are building on the foundations of the long history of integrated research and clinical activity in our predecessor organisations, and on the scale and strength of our position today: Imperial College is one of the world’s leading universities 3 and the Trust is one of the top three Trusts in the UK 4 , and the home of the largest NIHR Comprehensive Biomedical Research Centre. The value our AHSC will deliver is in the translation of our basic scientific discoveries through proof-of-concept into first-in-man and phase II clinical trials, and in providing the mechanisms and integrated management to deliver evidence- based best practice swiftly and effectively into healthcare delivery for the benefit of our patients and population. 2 Hospital Standardised Mortality Rates – see patient care section for detail 3 Times Higher Education Supplement, World University Rankings 2008 4 Dr Foster Good Hospital Guide, Best Performing Trusts on Mortality 2003–06 Page 3 2. EXCELLENCE IN BIOMEDICAL AND CLINICAL RESEARCH Biomedical and clinical research of international standing Research is central to the AHSC mission and all its activities. We aim to harness the outstanding research base in Medicine, Natural Sciences, Engineering and Business fostered by Imperial College, and the translational research opportunities presented by the partnership with Imperial College Healthcare NHS Trust, in order to improve patient outcomes. Imperial College is a world leading science-based university, ranked 3rd in Europe and 11th in the world for Life Sciences and Biomedicine 5 . 73% of the College’s staff, the highest percentage of all UK multi-faculty universities, had their research judged world-leading or internationally excellent in the Research Assessment Exercise 2008. The Faculty of Medicine had an annual research income in 2007/08 of £145 million, the largest competitively awarded in the UK, an increase of 18% from £123 million in 2006/07, and of 50% from £97 million in 2004/05. The College was recently awarded seven European Research Council Advanced Grants, more than any UK university, including Asthma (Prof. Johnston), Heart failure (Prof. Schneider), Gene therapy for motor neurone diseases (Prof. Mazarakis) and Computer-based systems for drug delivery (Prof. Pistikopoulos). The College undertakes biomedical research of the highest international standing. For example, Lasker Prize winner Professor Marc Feldmann led practice-changing research into inflammatory mediators in the aetiology of auto-immune diseases that led to the development of anti-TNF therapy; Professor Philippe Froguel leads a Genomic Medicine group that has identified many of the key genes associated with the risk of developing type-2 diabetes; Professor Michael Schneider’s research in cardiac muscle cell function and dysfunction is pioneering the use of stem cells for treatment of heart failure; Professor Jonathan Weber has recently been awarded a Wellcome Trust Strategic Award to create the UK HIV Vaccine Consortium, which will facilitate phase I trials of exploratory HIV vaccines in the UK; Professor Peter Openshaw has established a Centre for Respiratory Infection research under Wellcome Trust support, focussing on the pathogenesis of viral lung infection; Professor Elio Riboli is the European Coordinator of the European Prospective Investigation into Cancer and Nutrition, one of the largest long-term prospective studies in the world; and Professor Tim Aitman, Coordinator of the European Rat Tools for Functional Genomics consortium, conducts research in clinical and molecular genetics that has illustrated how genome technologies can give insights into the molecular basis of common diseases such as diabetes, heart diseases and systemic lupus. The breadth and depth of research excellence in the Faculty and Trust were demonstrated in November 2006 when the partnership was awarded the largest Comprehensive Biomedical Research Centre in England, receiving an award of £20 million a year for five years to undertake translational research across 16 research themes. Infrastructure to facilitate translational research The AHSC provides outstanding research infrastructure that is critical to meeting its goal of closing the gaps in translational medical research. We have four campuses at South Kensington, Hammersmith Hospital, St. Mary’s Hospital, and Charing Cross Hospital. The Hammersmith campus has internationally renowned imaging sciences facilities, with six PET and eight MRI for humans, including the Imperial/GSK Clinical Imaging Centre, and the GE Healthcare Imanet. The campus is home to the only Medical Research Council (MRC) Institute dedicated to translational medicine, the Clinical Sciences Centre (CSC), which has developed and implemented in vivo non-invasive imaging for rodent models, and we will shortly complete a large- mammal facility with PET and MRI imaging and interventional capabilities. The CSC also hosts genetic and genomic medicine platforms providing gene expression profiling, high-throughput genome-scale genotyping, DNA sequencing, data mining and warehousing. The Hammersmith houses an expanded vivarium for model organisms including world-leading rat genomics for 5 Times Higher Education Supplement, World University Rankings 2008 Page 4 complex traits and mouse genetics for transgenic knockout models, and GMP facilities for stem- cell intervention into stroke, heart, liver and pancreatic failure. This position will be strengthened through a new £100 million facility to incorporate cardiovascular sciences, translational medicine imaging (PET, MRI), a Wellcome Trust Clinical Research Facility and a MRC genomics centre. We have established an AHSC Clinical Trials Unit, with the appointment of a senior Clinical Trials statistician, Professor Deborah Ashby. The unit supports trial design, implementation, database development and analysis, and integrates existing clinical triallists across the AHSC. It will seek formal NIHR accreditation in 2009. The AHSC also has six Facilities for Clinical Research embedded in or adjacent to clinical speciality areas for later stage clinical investigation and clinical trials, in Cardiovascular Medicine, Neonatology, Rheumatology, Infection, Hepatology and Paediatrics. A new Facility in Respiratory Infection will be built in 2009. These facilities are investigator-led, with core nurse and administrator support pro rata to research volume. The AHSC provides infrastructure to facilitate translation from drug development through to commercialisation: the Drug Discovery Centre provides structural biology, medicinal chemistry and compound libraries to investigators; Imperial Innovations plc, a wholly owned subsidiary of Imperial College listed on London’s AIM market, supports commercialisation and licensing of the resulting therapies, devices and products. The AHSC will also build relationships with biotechnology companies, which typically have limited specialist medical input or clinical trial design capacity. It will perform ‘proof-of-principle’ trials, and is seeking companies with appropriate projects. A single research office, a single research strategy The AHSC’s approach to translational research is led through a unified AHSC Directorate of Research. The Director of Research, Professor Jonathan Weber, holds the position formally in both the Faculty of Medicine and the Trust. A single Research Office brings together previously separate functions into one organisation responsible for all research management. This office provides a single point of access for the costing, contracting, invoicing, and governance of all AHSC research, and provides investigator support for regulatory submissions, insurance and clinical trials agreements. The Directorate aims to develop an institution-wide research culture across the entire workforce. We recognise that this may take as much as a generation to fully realise, but are moving forward immediately with a programme of demonstration projects which embrace multi-disciplinary research in medicine, nursing and at least one other discipline per project. It will also lead in establishing transparent funding for research in job plans; the Trust will fund clinical research at an individual job plan level within targeted areas of activity, which will allow clinical research groups to expand their activity on the basis of successful research outputs. The Directorate will also support the scientific facilities which underpin clinical research, including high-throughput sequencing, FACS, MRI, PET and other imaging modalities. Our integrated approach enables us to harmonise senior appointments and we have a programme to appoint 30 new professors in the next three years and to target 12 new consultant level appointments per year in key areas for translational medicine over the same period. A focus on the goals of the AHSC: translational research that improves patient outcomes The partnership has a long history of discovery and its application for patient benefit, from the discovery of penicillin at St. Mary’s in 1928 to the first MR scan of a human infant brain at Hammersmith in the 1980’s. More recently, the Anglo-Scandinavian Cardiac Outcomes Trial, initiated and coordinated by Professors Peter Sever and Neil Poulter from Imperial College, studied the impact of statin therapy in hypertension on outcomes from cardiovascular events (heart attack and stroke). The results, showing a highly significant protective effect of statins, have had impact on treatment guidelines for hypertension globally, and have already saved thousands of lives. The promise of our AHSC is that we are creating the environment that will produce more such tangible examples of service change driven by research discoveries, with demonstrable impact on the delivery of care and health outcomes. Page 5 3. EXCELLENCE IN EDUCATION A centre of excellence in undergraduate and postgraduate education The AHSC will attract, train and develop a highly educated, skilled and motivated workforce, fully equipped to support the delivery of world-class research and healthcare. This will be delivered through an internationally competitive programme of undergraduate and postgraduate healthcare education that seeks to develop the staff and students who will become leading healthcare professionals of the future, within the AHSC and beyond. Our vision is to foster a supportive learning culture among all staff, and to deliver education that will reinforce the AHSC’s attractiveness to the best students, researchers and clinicians. Imperial College is a world-leading university, with a reputation for excellence in science-based education and training. Its courses aim to produce exceptional medical practitioners, clinical scientists, researchers and future leaders in the healthcare professions. Imperial College Healthcare NHS Trust also has a tradition of excellence in medical education, comprising as it now does the campuses of the world-renowned Royal Postgraduate Medical School at Hammersmith and major Teaching Hospitals at St. Mary’s and Charing Cross. Since its formation 11 years ago, the Faculty of Medicine at Imperial College has established itself as one of the pre-eminent medical schools in Europe. In 2007/08 there were 2,030 registered undergraduates with over seven applications received for every undergraduate admission for medicine, and an average A-level score on entry of 29.8 6 . There were 873 post-graduates enrolled, who benefit from a programme of teaching in generic transferable research skills from Imperial College’s Graduate School of Life Sciences and Medicine. The Faculty attracts students from around the world, with 37% of new postgraduates in 2007/08 from outside the UK. The College’s approach to medical education is to provide a science-based programme for those students who are seeking a sound knowledge of the principles and practice of biomedical science. The established MBBS/BSc six-year Medicine course includes a Bachelor of Science degree, and offers students the best of a traditional medical course in an innovative environment, where students have access to leading-edge technology. For example, the Division of Surgery, Oncology, Reproductive Biology and Anaesthetics is at the forefront of novel teaching methodologies, as pioneered by the work of Professor Lord Ara Darzi in simulators, multi-media programmes and telemedicine links, and the development of an anaesthetic simulator by Professor Mervyn Maze. The Faculty has recently launched a three-year BSc in Biomedical Sciences, and a four-year Graduate Entry scheme for Medicine for individuals with a good first degree in biological sciences. From 2009 the College will offer a three-year BSc in Pharmacology and Translational Medicine Science. The setting of this course in the AHSC will provide an unrivalled opportunity within the UK to train pharmacologists in an integrated research and clinical environment. The College and Trust have a long tradition as a leading UK centre of excellence for the training of clinical academics, stretching back to the Royal Postgraduate Medical School, a pioneer institution of postgraduate clinical teaching and research opened in 1935. In 2008, in open competition, we were awarded the largest number of Clinical Academic Trainees in England on the NIHR Integrated Academic Training Path, with 177 Academic Clinical Fellows and 59 Clinical Lecturers. We are also applying to establish a NIHR National Clinical Academic scheme for nursing, midwifery and allied health professionals that would be the first of its kind in the country. This success is partly the product of consultation with the many stakeholders in postgraduate education. We have a well-established Postgraduate Clinical Academic Training Committee that co-ordinates input from the medical school, deanery and our associated Trusts to ensure a joined- up approach. We also dedicate significant management time and resources to developing systems that support our academic trainees, including a Clinical Academic Lead for each speciality, supervisors and mentors for each trainee, and a programme of teaching in generic research skills. 6 A Level scores are based on the best three grades where A=10, B=8, C=6, D=4 and E=2, i.e. 29.8 is out of a maximum of 30. Page 6 Further evidence of our leading position was provided in 2008 following the successful bid for a highly competitive Wellcome Trust award to fund a Clinical PhD programme scheme which will support the most promising medical trainees. This scheme will fund 25 clinical research training fellows over five years, and has attracted candidates of the highest calibre. The future: an AHSC Education Strategy The development of the AHSC creates an opportunity to deepen the long-established integration between clinical service and education. To this end, we have created a new Directorate of Education to manage education provision across the College and the Trust. The Director of Education (Professor Charles Pusey) is also Head of Postgraduate Medicine at Imperial College. The Directorate will formulate the Education Strategy, ensure consistency in teaching activity and facilities across the AHSC, integrate existing resources and monitor performance. A core aim is to build on our track record of excellence in medical education to extend the benefits of education to all healthcare professionals associated with the AHSC. The Directorate of Education will be tasked with developing a culture encouraging lifelong education, learning and development opportunities for all professional groups, working closely with the Director of Nursing. It will deliver its strategy through the Heads of Education in each CPG, incorporating the needs of doctors, nurses and midwives, allied healthcare professionals, pharmacists, healthcare scientists and managers. Specific aims and initiatives of the Directorate include: Establishing a Healthcare Education Office, resourced to deliver the education strategy Developing multidisciplinary links with Imperial College, including with the Business School to develop management courses for NHS clinicians and administrators Establishing a Multi-profession Education, Learning and Development Group charged with developing appropriate courses, resources and facilities for multi-professional education across the AHSC campuses Supporting CPGs in demonstrating transparency and value for money in education budgets Ensuring every new consultant appointment has at least one programmed activity per week allocated to research or education Spreading appraisal processes that reward commitment to the delivery of education Extending support for clinical academic careers to non-medical healthcare professionals Developing the Postgraduate Health Science Academy, as described below The Postgraduate Health Science Academy Our AHSC will aim to raise standards and provide opportunities for Continuing Professional Development (CPD) over the full course of healthcare professionals’ careers, and to this end the Trust is working closely with Imperial College to develop a Postgraduate Health Science Academy. The Academy will be responsible for postgraduate and post-qualification healthcare education and for CPD for all professional groups. It will engage with a broad constituency, including not only our healthcare professionals but also those of local Trusts associated with Imperial College. The Academy will have a specific remit to coordinate, promote and provide quality assurance for all postgraduate and post-qualification short courses, ensuring that the high standards associated with the Imperial College name are upheld. It will also develop modular Masters courses, appropriate for all healthcare professionals, in collaboration with the Graduate School of Life Sciences and Medicine, with the aim of opening the route to Masters degrees, and hence Doctoral degrees, to all healthcare professionals who have the ability and application to achieve them. The Postgraduate Health Science Academy will build on our outstanding legacy to make our AHSC globally competitive in the provision of postgraduate healthcare education. Page 7 4. EXCELLENCE IN HEALTHCARE Delivery of excellent health outcomes Imperial College Healthcare NHS Trust is the largest NHS Trust in England, providing general and specialist care for patients from a nationwide base as well as serving a young, mobile and ethnically diverse local community of around three million people in West London. The Trust has consistently provided high quality care by overall UK standards, being ranked in the top three hospitals by Hospital Standardised Mortality Rates (HSMR) in England. 7 However, the AHSC aims to reach, and be compared against, the highest international standards. Our ambition is to act as an engine for change and innovation within the UK, and to develop networks that raise standards of care both in and beyond the immediate boundaries of our AHSC. The chart below of overall 2007/08 HSMR from Dr Foster Intelligence shows that mortality rates at the Trust are significantly better than expected 8 . Hospital Standardised Mortality Ratio 2007/08 The AHSC also seeks to Acute Hospital Trusts England average 95%CL 99.8%CL compare its outcomes 140 internationally. For 130 example, our vascular unit had a post carotid 120 endarterectomy stroke Relative risk of death 110 mortality rate of 1.8% 100 compared to a European 90 mean of 6.1%9, and a 80 12.5% mortality rate for 70 Imperial College Healthcare NHS Trust thoracoabdominal aortic 60 aneurysm compared to 9 10 14% at the Memorial 50 0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250 3500 Hermann Hospital at the Expected number of deaths University of Texas.10 A centre for specialist care, diffusing excellence through clinical networks There is strong evidence that specialist units performing larger numbers of cases achieve better health outcomes, particularly with more complex work. We aim to provide leading specialist care, while continuing to serve our community with a range of services as agreed with our commissioners. In time, these specialist areas will include those where the College has a world- leading research presence, such as endocrinology, diabetes and obesity, cardiovascular disease, chronic inflammation including musculoskeletal disorders, and infectious diseases. Renal Medicine offers one example of how a centre for specialist care, coupled with a well managed clinical network, can work for the health benefit of a wider community. The West London Renal and Transplant Centre at Hammersmith is the largest renal transplant unit in the UK, and since centralisation in 2005 has achieved improved patient survival on renal replacement therapy with a one-year survival rate of 88% for haemodialysis patients compared to a national rate of 80% 11 . The Centre works with eight local satellite units, which provide outpatient and dialysis services for patients who do not require acute high-tech investigation or management. Several other clinical services are at the heart of local and national networks, such as the West London Cancer network, and the UK Clinical Research Network for Diabetes run by Imperial College. We also act as a national centre for many rare conditions including pancreas transplantation, choriocarcinoma tumours, rare neuromuscular diseases, and are an internationally accredited adult stem cell transplant centre performing around 140 transplants a year. 7 Dr Foster Intelligence Hospital Guide 2008 8 Dr Foster Intelligence presentation to Imperial College Healthcare NHS Trust September 2008 9 30 day results from SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: Lancet, 2006 10 Distal aortic perfusion and cerebrospinal fluid drainage for thoracoabdominal and descending thoracic aortic repair: Ann Surg. 2003 11 UK renal registry 2007 Page 8 The AHSC is committed to breaking down boundaries between primary and secondary care; we have community-based consultant-led services in diabetes, respiratory care and chronic conditions; and have recently been selected along with community partners to deliver a £36 million innovative model of GP-led urgent care at Hammersmith and Charing Cross, which will support public health projects and research in screening, early diagnosis and public health education. As well as continuing to deliver excellent outcomes, the AHSC recognises that it must improve the patient experience and significantly increase patient satisfaction with its services. While pockets of excellence exist, such as the award-winning West London Sleep Centre 12 where over 96% of patients rated the service as good or excellent, the Trust Board has made improving the patient experience a clear priority. A Board-level committee chaired by the Trust Chairman has set in place four programmes in visibility and leadership, staff development, measurement and improvement, and communications. These programmes will see senior nurse management undertaking specific clinical commitments, and the introduction of patient experience tracker tools developed with Dr Foster in A&E and Medical wards that provide real-time patient feedback to inform future improvements. Patient Safety and Infection Prevention and Control Imperial College's Department of Biosurgery and Surgical Technology, headed by Professor Lord Darzi, is internationally recognised for its innovation in patient quality and safety. 13 It hosts one of two NIHR centres in the UK for Patient Safety and Service Quality and researches and trials new approaches and technologies to reduce human error and improve patient care. For example, St. Mary’s Hospital was a European site for the WHO international pilot study into the implementation of the surgical checklist, which reduced the rate of inpatient deaths following an operation by 40%. 14 The checklist will be rolled out across the Trust by 1 March 2009. The College and Trust also led a consortium awarded a £4.9 million grant from the UK Clinical Research Consortium in July 2008 to research healthcare acquired infections, from exploring the molecular make-up of bacteria to addressing how to bring about changes in practice. We were selected as one of six showcase Trusts to develop, trial and evaluate technologies for the prevention of healthcare acquired infections, and have reduced rates of MRSA blood stream infections by 60% since 2003/04, and achieved more than 30% year-on-year reductions in C.difficile in the six months to September 2008. Technology and innovation Healthcare delivery in the AHSC is characterised by a commitment to developing and applying the latest health technologies, drawing in particular on the discoveries emerging from Imperial College’s cross-cutting research themes, such as imaging, genetics and genomic medicine, and health technologies. For example, we are the leading centre in the UK for the use of robotic surgery, with established urology, orthopaedic and cardiovascular services, including a world-first in 2008 when a robotic arm developed to treat cardiac rhythm disorders was used on a patient with complex congenital heart disease. The presence of these technologies gives more patients access to the safest, most effective care; 60% of patients with aortic aneurysm at the Trust have endovascular repair with a stent compared to a national average of 20%. The Hamlyn Centre for Robotic Surgery, founded at Imperial College in 2008, is further pushing forward the integration of robotics and patient care. It works closely with the Institute of Biomedical Engineering, especially in robotics, remote sensing, computer-aided surgery, imaging and electronic health systems, and is developing technologies that will transform conventional key-hole surgery. It is through multidisciplinary collaborations such as these that our AHSC will channel excellence in research to provide world-class healthcare for our patients and populations. 12 Special Commendation from the British Thoracic Society 2008 13 The Department was accredited by the American College of Surgeons in April 2008 14 A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population, New England Journal of Medicine, Jan 2009 Page 9