Abstract

BackgroundAs in many countries around the world, there are high expectations on academic health science centres and networks in England to provide high-quality care, innovative research, and world-class education, while also supporting wealth creation and economic growth. Meeting these expectations increasingly depends on partnership working between university medical schools and teaching hospitals, as well as other healthcare providers. However, academic-clinical relationships in England are still characterised by the “unlinked partners” model, whereby universities and their partner teaching hospitals are neither fiscally nor structurally linked, creating bifurcating accountabilities to various government and public agencies.DiscussionThis article focuses on accountability relationships in universities and teaching hospitals, as well as other healthcare providers that form core constituent parts of academic health science centres and networks. The authors analyse accountability for the tripartite mission of patient care, research, and education, using a four-fold typology of accountability relationships, which distinguishes between hierarchical (bureaucratic) accountability, legal accountability, professional accountability, and political accountability. Examples from North West London suggest that a number of mechanisms can be used to improve accountability for the tripartite mission through alignment, but that the simple creation of academic health science centres and networks is probably not sufficient.SummaryAt the heart of the challenge for academic health science centres and networks is the separation of accountabilities for patient care, research, and education in different government departments. Given that a fundamental top-down system redesign is now extremely unlikely, local academic and clinical leaders face the challenge of aligning their institutions as a matter of priority in order to improve accountability for the tripartite mission from the bottom up. It remains to be seen which alignment mechanisms are most effective, and whether they are strong enough to counter the separation of accountabilities for the tripartite mission at the national level, the on-going structural fragmentation of the health system in England, and the unprecedented financial challenges that it faces. Future research should focus on determining the comparative effectiveness of different alignment mechanisms, developing standardised metrics and key performance indicators, evaluating and assessing academic health science centres and networks, and empirically addressing leadership issues.

Highlights

  • As in many countries around the world, there are high expectations on academic health science centres and networks in England to provide high-quality care, innovative research, and world-class education, while supporting wealth creation and economic growth

  • Given that a fundamental top-down system redesign is extremely unlikely, local academic and clinical leaders face the challenge of aligning their institutions as a matter of priority in order to improve accountability for the tripartite mission from the bottom up

  • Future research should focus on determining the comparative effectiveness of different alignment mechanisms, developing standardised metrics and key performance indicators, evaluating and assessing academic health science centres and networks, and empirically addressing leadership issues

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Summary

Discussion

Accountability for patient care Under the current model of academic-clinical relationships, all hierarchical, legal, and political accountability for patient care is concentrated in the NHS, and universities are free from any formal accountability for the provision of patient care. Summary At the heart of the challenge for AHSCs and AHSNs in England to provide high-quality care, innovative research, and world-class education, while supporting wealth creation and economic growth, is the separation of accountabilities for the tripartite mission of patient care, research, and education in different government departments It prevents universities and healthcare providers from cross-subsidising academic and clinical missions and from creating fully integrated AHSCs and AHSNs. Given that a fundamental top-down system redesign to allow the structural integration of universities and healthcare providers is extremely unlikely, local academic and clinical leaders face the challenge of aligning their institutions as a matter of priority in order to improve accountability for the tripartite mission from the bottom up. All authors read and approved the final version of the manuscript

Background
Darzi A
46. UK Research Integrity Futures Working Group
48. House of Commons Health Committee
52. Pelletier SG
55. Darzi A
58. Imperial College Health Partners
65. Daugherty RM Jr
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