Why the location of Papworth Hospital is so vital

Evidence shows that to deliver effective translational clinical research you need co-location of those professionals delivering clinical care and those scientists delivering basic and applied scientific research.

Co-location is critical for establishing unmet clinical need, to evaluate the benefit of new treatments, and facilitates the interaction of clinicians and scientists across a number of disciplines to share ideas or apply techniques in novel ways.

Developing a multi-site approach to translational research will result in a highly inefficient system: requiring staff to work on two or more sites results in increased commuting time, cost and reduced levels of productivity; it prevents the retrieval of time critical samples; requires duplication of costly technologies and facilities, and prevents economies of scale.

Economists call this co-location concept “agglomeration”, and it is a major principle in urban economics used to describe the benefit that companies and individuals obtain by locating near to each other

Economists call this co-location concept “agglomeration”, and it is a major principle in urban economics used to describe the benefit that companies and individuals obtain by locating near to each other or “agglomerating”. It is the central principle in the successful growth of major cities around the world. By co-locating or agglomerating institutions, companies reduce their costs by economies of scale, it allows for greater specialisation of services and staff, and forms a community that is mutually beneficial to one another, even if individual companies are in direct competition (which is why ITV relocated part of its activity from Manchester following the BBC establishment of a major centre at Media City UK at Salford).

The New Cambridge Biomedical Campus is a prime example of agglomeration at work. This campus, combining world class biomedical research, patient care and education on a single site, has recently attracted a £300m investment by AstraZeneca to develop a major new business hub, hoping to maximise the benefit of co-locating its major research adjacent to cutting edge translational research at the Cambridge site. Other pharma companies are following this principle by aligning, and often co-locating, near other leading NHS/University campuses in order to accelerate the translation of clinical discoveries into commercial drug trials.

Other major institutions are earmarked to relocate to the Cambridge Biomedical Campus. One such institution is Papworth Hospital NHS Foundation Trust, one of the world’s leading cardiothoracic centres of excellence, with a world renowned reputation for excellence in clinical care and research: it was the site of the UK’s first heart transplant in 1979, the first beating heart transplant in 2006, and the first total artificial heart transplant in 2011. The move to the Biomedical Campus would result in the co-location of specialist heart and lung transplantation (from Papworth) and liver and kidney transplantation (from Addenbrooke’s Hospital already at the Biomedical Campus) resulting in one of the largest solid organ transplant centres in the world.

In December 2013, the Department of Health approved Papworth’s relocation and plans for a £165m state-of-the-art hospital, awarding the project to Skanska to deliver this under PFI.

Papworth could be the first institution to face the application of these new powers and has the potential to impact significantly on Papworth’s ability to deliver truly world class research

However, only two months following the decision, and to the surprise of the Trust, the plans have been put on hold. The Department of Health and HM Treasury have asked the regulator, Monitor, to reassess the affordability and clinical strategy of the original business case approval. Crucially, they have requested the Monitor team to assess a potential option to relocate part or all of Papworth’s services to Peterborough City Hospital, 40 miles away from the Biomedical Campus.

The background to the decision is interesting and has worrying portents for future reconfigurations of clinical services.

The option to relocate Papworth to Peterborough is essentially part of a rescue plan for the parent trust of Peterborough City Hospital, the Peterborough and Stamford NHS Foundation Trust. This Trust has been declared financially unsustainable by Monitor and required £44m in emergency funding from the Department of Health in 2013. In large part the losses are as a result of the under-utilised Peterborough City Hospital PFI, which costs the Trust around £40m a year to repay.

According to reports of a recent inspection, the under-utilisation of the new hospital was costing the Trust £22m a year, and by relocating part or all of Papworth’s services to this site could assist in plugging the financial hole in Peterborough’s balance sheet. This situation contrasts markedly with Papworth, which  is one of the best performing Trusts in England, consistently scoring at the very top of the most clinical and financial NHS metrics.

If the review was to conclude that it was in the best interests of Peterborough and Stamford NHS Foundation Trust for Papworth to relocate all or part of the services to Peterborough, the secretary of state now has the power to force the move. The recent approval of Clause 118 of the Care Bill gives the secretary of state sweeping powers to reconfigure hospitals that fall within the “health economy” of other failing health institutions, irrespective of the quality of clinical services delivered or the hospital’s own balance sheet.

Papworth could be the first institution to face the application of these new powers and has the potential to impact significantly on Papworth’s ability to deliver truly world class research. In addition, the impact on Addenbrooke’s Hospital of moving the cardiothoracic and transplant services to Peterborough should be carefully appraised and not underestimated.

The medical evidence shows that co-location of clinical and research facilities produce better outcomes and more efficient translational research pathways: whether it is a new drug, new treatment, or new ways of monitoring patients, the ability for clinicians and scientists to interact in an efficient way on a daily basis significantly improves the speed by which basic research discoveries get translated into clinical practice.

In addition, the economic evidence in favour of agglomerating related institutions has been well established in a variety of disciplines over a number of years. It is essential that these arguments form part of the option appraisal currently being undertaken by Monitor.

This is a test case that is not simply about the site of a new hospital or the balance sheet of another, it is about the value of co-location in delivering world class research and clinical practice into the 21^st century.

Dr Matthew Williams-Gray is an associate director at Mace and head of strategic healthcare consultancy services