̽��ֱ�� of Cambridge - Patrick Maxwell

A very healthy relationship: the ̽��ֱ�� and the NHS

cjb250 — Mon, 03 Jul 2023 15:40:21 +0000

As the NHS celebrates its 75th anniversary, we look at how the close relationship between the ̽��ֱ�� and the hospitals on its doorstep is driving major improvements in how we care for patients.

How mass testing helped limit the spread of COVID-19 at the ̽��ֱ�� of Cambridge

cjb250 — Tue, 01 Jun 2021 10:49:36 +0000

A combination of testing programmes for staff and students, infection control measures and genomic surveillance helped reduce the number of cases of COVID-19 at the ̽��ֱ�� and keep the wider community safe.

Asymptomatic screening and genome sequencing help Cambridge understand spread of SARS-CoV-2 among its students

cjb250 — Mon, 11 Jan 2021 10:32:57 +0000

Initial results suggest that the screening programme, together with the ̽��ֱ��’s public health measures and responsible student behaviour, has helped limit the spread of the virus.

Now, the team running the programme has joined up with researchers at the COVID-19 Genomics UK Consortium (COG-UK) to track how infections spread among the student population. They have shown how a small number of transmission events early on were likely responsible for most of the infections at the ̽��ֱ�� and found little evidence of substantial transmission of SARS-CoV-2 between students and the local Cambridge community in the first five weeks of term.

Around 12,000 students living in College accommodation (80% of eligible students) signed up to the asymptomatic screening programme, which uses a pooled sample approach to reduce the number of tests to fewer than 2,000 per week. In the first weeks of term, 1-2 students from each ‘household’ were tested each week; this has now increased to all participating students being tested each week. In addition, the ̽��ֱ�� offers tests to students and staff who show symptoms of potential COVID-19.

̽��ֱ�� ̽��ֱ�� is also playing a leading role in COG-UK, which is sequencing the genetic code of samples of the virus isolated from infected individuals to help better understand the spread of infection. As a virus spreads, its genetic code acquires mutations. By comparing the genetic code of samples, it is possible to plot a genetic ‘family tree’ known as phylogenetic tree and to say, coupled with epidemiological information, whether two cases are related – identical or almost-identical samples are likely to be closely related, while genomes with a larger number of genetic differences are less likely to be related.

As part of this work, COG-UK is analysing virus samples from students identified as positive through the ̽��ֱ�� of Cambridge’s testing programmes and comparing them to samples taken from people in the wider Cambridge community. COG-UK and the ̽��ֱ�� have released their interim report, covering the first five weeks of term.

̽��ֱ��analysis showed that in week two, 90% of infections were confined to three lineages (related viral genomes). This lack of diversity suggests that a small number of transmission events at the start of term led to the majority of infections in the ̽��ֱ��.

Outbreaks that have largely been restricted to single Colleges appear to have been contained, suggesting that measures to prevent spread of the virus were successful. In one of the largest clusters (which included 32 cases by week three), half of the students were asymptomatic, highlighting the importance of screening programmes in helping identify infected individuals.

̽��ֱ��largest cluster of cases (139 cases by week five, including 135 students, 1 staff member and 3 individuals from the local community) was the source of ongoing transmission within the ̽��ֱ��. It included students from a number of Colleges, courses and years of study. However, it is not clear whether these can be traced back to a single event that led to dispersion amongst colleges and courses.

Dr Dinesh Aggarwal from the Department of Medicine at the ̽��ֱ�� of Cambridge and a member of COG-UK said: “It appears that a few instances of the virus being introduced to the ̽��ֱ�� account for the majority of cases of established transmission. This suggests to us that in most cases, when a virus was introduced, students behaving responsibly and complying with infection control measures helped stop the virus in its tracks.

“We hope it will be particularly reassuring that so far we have not found evidence of substantial transmission between our students and the local community.”

Dr Ben Warne, a Clinical Research Fellow and one of the leads on the ̽��ֱ��’s asymptomatic screening programme, added: “It’s clear we need to better understand how the virus spreads between students on different courses and at different Colleges. Once established, these widely-distributed outbreaks are more challenging to control, potentially resulting in continued spread. Genomics should help us piece together this puzzle and help us target prevention strategies.”

̽��ֱ��team say their findings appear to suggest that a regular screening programme to detect asymptomatic infection and robust containment measures can be effective at limiting transmission both within the ̽��ֱ�� and to the wider community. This will be particularly important with the emergence of a new, more transmissible variant and substantially higher levels of transmission within the community.

Patrick Maxwell, Regius Professor of Physic at the ̽��ֱ�� of Cambridge, said: “Getting our screening programme up and running in time for the start of term was no small order, but we believe it has paid off. Asymptomatic screening can help identify cases of infection early, including where students are unaware of infection, and inform infection control measures. This has never been more urgent, with the emergence of the new variant.”

̽��ֱ�� ̽��ֱ�� recently announced that while it will remain open, almost all teaching and learning for undergraduate and postgraduate taught students will move online for the entirety of the Lent term. Undergraduate and postgraduate taught students have been asked to remain where they are currently staying, other than for certain exceptions.

Since the start of the academic year in October 2020, the ̽��ֱ�� of Cambridge has been offering regular SARS-CoV-2 tests to all students living in its Colleges, even if they show no symptoms.

Asymptomatic screening can help identify cases of infection early, including where students are unaware of infection, and inform infection control measures. This has never been more urgent, with the emergence of the new variant

Patrick Maxwell

Sir Cam

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Cambridge ̽��ֱ�� to provide weekly coronavirus testing for students resident in colleges

cjb250 — Wed, 09 Sep 2020 09:01:41 +0000

When term begins on 8 October, around 15,000 undergraduate and postgraduate students will be resident in accommodation belonging to one of Cambridge's 31 Colleges. To reduce the risk of transmission among the Cambridge community, the ̽��ֱ�� will be launching their own programme to test all of these students on a weekly basis.

Students will use a swab to take a sample from their nose and throat. Swabs will be pooled by household, enabling the ̽��ֱ�� to reduce the number of tests required to around 2,000 per week. For most Colleges, a household will be classified as a unit where students share communal facilities, such as toilets and showers and kitchen facilities.

Samples will be sent to the Cambridge COVID-19 Testing Facility at the Anne McLaren Building on the Cambridge Biomedical Campus. If a pooled household test is positive, the students in the household will be informed within 24 hours and offered individual tests to confirm the positive result. Students with confirmed SARS-CoV-2 infection and their household and contacts will be supported in following national guidance on self-isolation and household quarantine.

Participation in the programme will be voluntary; however, it is hoped that the great majority of students will take part. In combination with contact tracing and the ̽��ֱ��’s established testing facilities for symptomatic students and staff, the programme will help reduce the risk to other students, staff and members of the local community.

Professor Stephen J Toope, Vice-Chancellor of the ̽��ֱ�� of Cambridge, said: “We look forward to welcoming our students back to Cambridge and want to reassure them – and the wider local community – that we are doing everything we can to make sure they feel safe and supported while they are here. This screening programme is just one of a number of measures that we are putting in place to keep our ̽��ֱ�� and city safe.

“Although the programme is voluntary, we are confident that the overwhelming majority of students will want to take part as this will help ensure they are able to enjoy and make the most of the Cambridge experience in the current challenging circumstances.”

A related testing programme has been operating since early on in the pandemic as a partnership between Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust and the ̽��ֱ��, helping the Trust reduce the risk of hospital-acquired coronavirus infections. It has also enabled staff members potentially exposed to the virus to return to work safely or to isolate as appropriate.

Professor Patrick Maxwell, Regius Professor of Physic at the ̽��ֱ�� of Cambridge, added: “Offering testing to all students in college accommodation, who make up the majority of our student population, will help us reduce the risk of outbreaks by identifying individuals who will often not be aware that they are infected.”

Due to limited capacity, it is not possible to offer testing to all students. ̽��ֱ��risk of transmission and outbreaks is expected to be higher in college accommodation, where the density of students and potential for interactions are greater; hence, the programme is targeted at these students.

In addition to the asymptomatic screening programme, the ̽��ֱ�� is providing COVID-19 testing free of charge to any member of the ̽��ֱ�� displaying symptoms, along with members of their household, and any student showing possible symptoms should use these facilities. Testing is currently available at either Addenbrooke’s Hospital or at the Department of Engineering.

Additional information is available on the Stay Safe Cambridge Uni website.

̽��ֱ�� ̽��ֱ�� of Cambridge is to offer all students living in college accommodation a weekly test for infection with SARS-CoV-2, the coronavirus that causes COVID-19, even if they show no symptoms. Whilst the testing of asymptomatic students is not national guidance, the ̽��ֱ�� will be launching this programme as part of their ‘Stay Safe Cambridge Uni’ public health initiative.

This screening programme is just one of a number of measures that we are putting in place to keep our ̽��ֱ�� and city safe

Stephen J Toope

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Coronavirus

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Cambridge medical students graduate early to help NHS respond to crisis

cjb250 — Thu, 09 Apr 2020 06:57:50 +0000

This forms part of a national effort by medical schools, the GMC and the NHS following the government’s call for additional medical staff in these times of crisis due to the COVID-19 pandemic.

Patrick Maxwell, Regius Professor of Physic and Head of the School of Clinical Medicine at the ̽��ֱ�� of Cambridge, said: “I would like to offer my warm congratulations to all of our successful final year medical students. These individuals are all entering the medical profession because they want to make a difference to people’s lives. Their years of clinical training will have helped prepare them for this day, but even so, this is an extraordinary and challenging time. We owe them, and all our NHS colleagues, a huge thank you and wish them well in the future.”

Diana Wood, Clinical Dean at the School of Clinical Medicine, added: “I am immensely proud of our 2020 finalists. Clearly this was not the culmination of their medical student careers that they expected, and they all feel keenly the lack of shared celebration with the staff and their student colleagues at this time.

“Our students responded to this national crisis in an exemplary fashion, and I have been both impressed and moved by their reactions and their willingness to put their years of medical education into practice at this time. I wish them all the very best for the next few months and great success in their future careers.”

In the light of the COVID-19 outbreak and the pressure it is putting on the NHS, the School of Clinical Medicine last month took the decision, in consultation with the GMC, to cancel its final clinical examinations. ̽��ֱ��students had already completed their final written examinations and been assessed on clinical competence in previous examinations and on placements in a range of clinical environments.

On Monday, 265 final year medical students from the ̽��ֱ�� of Cambridge graduated early, allowing them to seek early registration with the General Medical Council (GMC) and enter the NHS workforce before their expected date in August.

This is an extraordinary and challenging time. We owe them, and all our NHS colleagues, a huge thank you and wish them well in the future

Patrick Maxwell

Thank you message to Cambridge ̽��ֱ�� final year medical students

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Physician, heal thyself: engineering a new National Health Service

Anonymous — Tue, 19 Mar 2019 11:00:00 +0000

Alongside the Chinese People’s Liberation Army, Indian Railways and Walmart, the NHS ranks among the world’s largest employers. In England, it treats more than 1.4 million patients every 24 hours and will this year spend £126 billion. But as communities gathered to celebrate the NHS’s 70th birthday in 2018, reports continued to emerge on the ailing health of this much-loved national institution.

Analysis by another national treasure, the BBC, revealed that nearly one in five hospital trusts were failing to hit any of their key waiting-time targets. Hospitals seemed to be lurching towards over-crowded A&Es, bed shortages and queuing ambulances unable to hand over their patients.

Two ̽��ֱ�� of Cambridge researchers have a grand vision to rethink the system to make it fit for the next 70 years – a vision that’s rooted in research with local patients and doctors.

Professor Stefan Scholtes works at Cambridge Judge Business School and Dr Alexander Komashie is at the ̽��ֱ��’s Engineering Design Centre. Both are engineers by training, both have spent the past 10 years studying different parts of the local healthcare system and both are passionate believers that, as researchers, they can help make the NHS better.

System design

̽��ֱ��NHS faces numerous challenges but the real test, says Komashie, is understanding how to design better delivery systems by working with patients. “That’s where engineering comes in,” he says. “Engineers excel in designing large systems that work well, from worldwide telecommunications networks to the Airbus A380. What motivates me is translating the engineering practice of a systems approach into healthcare.”

̽��ֱ��first step is understanding the system requirements. “It sounds obvious, but to design a system to do something you need to understand what it is you want,” Komashie explains. “In engineering, a lot of effort goes into defining what the system should do. When you understand that, you can ask how the system is set up to deliver it.”

Komashie has applied this systems engineering approach to adult mental health services within the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), and ran a series of workshops for patients and clinicians. Patients’ stories allow him to unpack each component of the delivery system and represent them in visual diagrams so that services can be improved in a systematic way. ̽��ֱ��project was funded and supported by the National Institute for Health Research (NIHR) East of England Collaboration for Leadership in Applied Health Research and Care (CLAHRC), hosted by CPFT.

“My goal is developing a new way of describing the system, and hearing people talk about their experience of care helps me understand it. If through patient and public involvement, we can get rich enough stories, it gives us a window into the system behind the story,” says Komashie, who has recently been awarded an interdisciplinary fellowship for research into health systems visualisation at ̽��ֱ��Healthcare Improvement Studies Institute (THIS Institute). “Hearing patients’ accounts of what matters most helps to ensure the system designs and delivers the support they need.”

Sarah Rae, CPFT Expert by Experience, worked closely with Komashie in bridging the gap between the academic researcher and the patient participants. “As workshop co-facilitator I gave the participants a better understanding of the research by helping them to make the connection between systems engineering and mental health,” she says. “Sharing my own lived experience of mental health also helped the participants feel more comfortable about describing their experiences authentically.”

Komashie is now taking the tools he developed in mental health and applying them to vascular surgery and spinal cord injuries at Addenbrooke’s Hospital in Cambridge and holistic neuropsychological rehabilitation at ̽��ֱ��Princess of Wales Hospital’s Oliver Zangwill Centre in Ely.

Working with GP practices

Headlines about NHS waiting times, bed shortages and ambulance queues invariably focus on capacity, which Scholtes argues is a misdiagnosis. “People say we’ve got a capacity problem but that’s wrong. We have a complexity problem. There are so many things going on simultaneously but pulling in different directions. Complexity is killing hospitals.”

At Addenbrooke’s, for example, where Scholtes spent three sabbaticals over the past 10 years, the hospital does everything from pulling wisdom teeth to multiple organ transplants. He argues that delivering this breadth of services in a system already at full stretch is impossible. Instead, hospitals need to be “decomplexified” by delivering most of their routine services in community settings.

It sounds simple, but it’s not. “ ̽��ֱ��problem is that there’s no landing space. We have 92 GP practices locally, so how can you move work currently centralised in a large hospital to 92 small businesses? It’s impossible. ̽��ֱ��only way to make headway is to scale up primary care so that it can take on more responsibility,” says Scholtes.

This is exactly what he’s doing with Granta Medical Practices, a large Cambridgeshire GP practice where he spent his most recent sabbatical evaluating the practice’s innovative operational and business model.

A critical barrier to change in primary care is the traditional GP partnership model, he says. By leaving GP partners with unlimited liability, the model creates risk aversion and hampers transformative change. In response, Granta is developing an innovative business model – an employee-owned trust akin to the John Lewis Partnership – which could enable it to deliver 70% of routine outpatient activity in the community and cut by 25% the number of emergency bed days among its patients.

Dr James Morrow, CEO of Granta Medical Practices, describes how Granta Medical Practices has gained enormously from working closely with Sholtes and his colleagues at the Cambridge Judge Business School: “Several of our senior clinicians have participated in formal educational programmes through the Judge and have brought back insights and skills from other sectors. Stefan’s sabbatical with the practice has refined and clarified our thinking around not just service delivery and user-experience but also helped with developing our longer term strategic goals as we embark on a period of rapid health system reform.”

But how can transforming Granta help the NHS as a whole? This is where the ̽��ֱ�� comes in, says Scholtes, who hopes to establish a Primary Care Innovation Academy, drawing on research expertise from across the ̽��ֱ��.

̽��ֱ��Academy would provide leadership and management training for GPs, practice managers and lead nurses, and also ensure that interventions taken to transform the local primary care system are robustly evaluated. As such, it would add to the ̽��ֱ��’s increasing capacity in creating the evidence base for improving healthcare. For instance, THIS Institute is focusing on how to improve quality and safety across the system.

A “radically different” NHS

Addenbrooke’s Hospital itself has been transformed over the past three decades with a major emphasis on recruiting clinical academics in partnership with the ̽��ֱ��, who split their time between practising medicine and carrying out research.

Professor Patrick Maxwell, Head of the School of Clinical Medicine, explains: “Clinical academics have been central to the development of tertiary referral services and a major trauma centre. This has helped to create an excellent district and regional hospital with outcomes that are among the best in the country. Currently our priorities include improving prevention and early diagnosis of diseases, so that fewer patients need hospital services.”

Meanwhile, in January 2019, the NHS released its new 10-year plan, which included aims to boost ‘out-of-hospital’ care through increased investment in primary medical and community health services.

All in all, Scholtes believes that, by the time the NHS reaches its 80th birthday, it could look radically different: hospitals could be doing 60% of what they do now by focusing on cases that can only be treated in hospital and on cutting-edge treatments and research, while more integrated, scaled-up primary care practices will be taking full responsibility for out-of-hospital care.

“If this work is successful, it has the potential to bring the local health economy back onto a sustainable path by establishing a new model of primary care that can be scaled throughout the NHS,” he concludes. “It’s ambitious – but we can do it.”

̽��ֱ��National Health Service turned 70 in 2018 – but, amid the celebrations, its health is faltering. By working closely with local hospitals and GPs, researchers at Cambridge ̽��ֱ�� are developing bold new ideas they believe will help the NHS thrive for decades to come.

If this work is successful, it has the potential to bring the local health economy back onto a sustainable path by establishing a new model of primary care that can be scaled throughout the NHS

Stefan Scholtes

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Cambridge receives £100 million for major new children’s hospital

cjb250 — Mon, 10 Dec 2018 16:14:37 +0000

Built on land adjacent to Addenbrooke’s and the Rosie Hospitals, the children’s hospital will bring together some of the world’s top scientists to explore new ways of diagnosing and treating some of the most challenging diseases of childhood. Mapping the whole human genome and understanding the genetic basis of disease and recovery is central to the hospital’s vision. It aims to make an important contribution globally to the development of children’s healthcare while providing world class care for families in the east of England.

̽��ֱ��project is a partnership involving Cambridge ̽��ֱ�� Hospitals (CUH) NHS Foundation Trust, Cambridgeshire and Peterborough NHS Foundation Trust and the ̽��ֱ�� of Cambridge. ̽��ֱ��development is a major part of the strategy to invest in world class facilities led by the Sustainability and Transformation Partnership for Cambridgeshire and Peterborough.

̽��ֱ��Vice-Chancellor of the ̽��ֱ�� of Cambridge, Professor Stephen Toope, said: “ ̽��ֱ��announcement from the Secretary of State is extremely positive. It is not only an investment in the research and clinical expertise in Cambridge but, importantly, it is an investment in the future of our children and young people. By helping us to improve how we treat those young people unfortunate enough to be affected by serious childhood diseases, the new hospital has the potential to transform the provision of healthcare for families in the East of England.”

Patrick Maxwell, Regius Professor of Physic and Head of the School of Clinical Medicine, said: “This is a welcome and very significant investment from the government. ̽��ֱ��new children’s hospital will bring together clinical and research expertise from across Cambridge, enabling us to make a major difference to the health of young people across the East of England and, through our research, throughout the UK and beyond.”

Professor David Rowitch from the Department of Paediatrics at the ̽��ֱ�� of Cambridge added: “It is time to bridge the divide between physical and mental health and move away from silo working. With strengths across the board from genomics to complex medical care, child and adolescent psychiatry, Cambridge is perfectly positioned to lead by example.”

̽��ֱ��announcement has also been welcomed by the chief executives of the two NHS trusts involved. Roland Sinker, CUH chief executive, described the announcement as “a tribute to our outstanding staff who care for very poorly children day in day out in facilities that currently are not reflecting the world class service we provide”. Tracy Dowling, chief executive of Cambridgeshire and Peterborough NHS Foundation Trust, which provides mental health services for young people and adults as well as physical health services for older people and those with long-term conditions, said the new hospital would provide “the most incredible opportunity” to bring together physical and mental health services under one roof.

Adapted from a news story from CUH.

̽��ֱ��Secretary of State for Health and Social Care, Matt Hancock, has announced up to £100 million of public capital for an innovative children’s hospital for the east of England. This will be a new facility that is purpose-built to meet the needs of the region’s youngest patients, integrating mental and physical health and combining the highest quality services with world class science and research.

It is not only an investment in the research and clinical expertise in Cambridge but, importantly, it is an investment in the future of our children and young people

Professor Stephen Toope

Margaret Weir

Children playing

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Unique science for health policy think-tank joins ̽��ֱ�� of Cambridge

Anonymous — Thu, 29 Mar 2018 07:00:00 +0000

̽��ֱ��PHG Foundation, which has received major funding from the Hatton Trust for over ten years of its twenty-year history, will be hosted by the ̽��ֱ��’s School of Clinical Medicine. ̽��ֱ��Foundation already enjoys close links with other parts of the ̽��ֱ��, including the Centre for Law, Medicine and Society at the Faculty of Law, the Department of History and Philosophy of Science, Cambridge ̽��ֱ�� Health Partners and Hughes Hall.

̽��ֱ��think-tank will also be working with the Clinical School, the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) and the Cambridge Institute for Public Policy (CIPP) to create cross-cutting policy impact in the application of science to benefit health and society.

Commenting on the new association, the Vice-Chancellor Professor Stephen Toope said:

‘This initiative brings together the unique research strengths of both the PHG Foundation, which has led such exemplary thinking around how science can best work for health, and the ̽��ֱ��’s world-leading School of Clinical Medicine. It marks a new stage in a long association between our two organisations, and one which has great potential in working across disciplinary boundaries. I am enormously grateful to the Hatton Trust for making this possible, and look forward to the ̽��ֱ�� and the Foundation jointly addressing some of the major health challenges facing society today.’

̽��ֱ��Regius Professor of Physic and Head of the School of Clinical Medicine, Professor Sir Patrick Maxwell, said:

“As the world of medicine changes more rapidly than perhaps ever before, and the ethical and societal questions that we face become ever more complex, interdisciplinary collaboration will increasingly be the key to success. I am delighted that we will be working so closely with the PHG Foundation, an organisation which shares our unswerving commitment to excellence in healthcare and to ensuring that biomedical innovation can truly deliver better health for all.’

̽��ֱ��Founder and Chair of Trustees of the PHG Foundation, Dr Ron Zimmern, said: “It has long been my vision that excellence in medicine should combine with that in law, ethics, philosophy and the humanities to consider both practical policy needs and wider societal implications posed by scientific innovations for health. I am delighted to see the work of the PHG Foundation over the last twenty years recognised by the ̽��ֱ�� of Cambridge, and I am sure that the unique combination of a policy think-tank and Clinical School will be highly successful.”

PHG Foundation Director Dr Mark Kroese said: “We support policy development that accelerates the appropriate use of the very best new science in healthcare, offering better patient experiences and outcomes. ̽��ֱ��Clinical School is a world-leading source of medical excellence, research and leadership, and we are very much looking forward to working more closely with colleagues there as we continue to provide multidisciplinary perspectives on the policy issues around cutting-edge medical interventions and technologies.”

A leading multidisciplinary think tank, the PHG Foundation, will become part of the ̽��ֱ�� of Cambridge from 1 April this year, with a focus on making science work for health. This has been made possible by a philanthropic gift from the Hong Kong-based Hatton Trust, which has recognised the ̽��ֱ��’s global eminence in science, medicine and the humanities alongside the pioneering policy development work of the Foundation.

As the world of medicine changes more rapidly than perhaps ever before, and the ethical and societal questions that we face become ever more complex, interdisciplinary collaboration will increasingly be the key to success.

Patrick Maxwell

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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