University of Glasgow Clinical Innovation Zone

The 14 floor Queen Elizabeth University Hospital, Glasgow (adult) building is one of the largest acute hospitals in the UK and home to major specialist services such as renal medicine, transplantation and vascular surgery, with state-of-the-art Critical Care, Theatre and Diagnostic Services. Co-location advantages of clinical, academic and commercial groups working alongside each other fostering innovation and commercialisation are evident.

The atrium of the hospital houses retail shops and a coffee shop. There is a large restaurant/coffee area on the first floor of the hospital with a balcony and views out onto the landscaped area in front of the hospital.

The adult hospital is integrated with the children’s hospital with separate functions and entrances.

There is a physical link for patients and staff from the hospitals into the Maternity and Neurosciences Institute buildings. The hospitals will also be linked to the laboratory buildings via an underground tunnel and pneumatic tube.

The Queen Elizabeth Teaching and Learning Centre – Precision Medicine Scotland, developed jointly by NHS Greater Glasgow and Clyde and The University of Glasgow, is an investment of £27 million to provide a training environment for the clinical years of the undergraduate medical degree (MBChB), postgraduate training facilities for medical staff and a large variety of NHS professionals and will ensure that we can train the next generation of doctors, scientists, clinical academics and support staff.

The Campus comprises of:

• The Queen Elizabeth University Hospital (1,109 beds)
• The Royal Hospital for Children (256 beds)
• Laboratory and Facilities Management Building
• The Queen Elizabeth National Spinal Injuries Unit
• The Institute of Neurological Sciences
• Langlands Building
• WestMARC
• Maternity Hospital
• Physically Disabled Rehabilitation Unit (PDRU)

There is also an Imaging Centre of Excellence, and a new 1,200 workspace Office Block, which are co-located with the new hospitals and the Institute of Neurological Sciences.

The quality of the scientific research conducted in Scotland and the strong ecosystem supporting the development and mainstreaming of precision medicine more broadly is widely recognised internationally. The creation of the Scottish Ecosystem for precision medicine was announced by the First Minister Nicola Sturgeon in 2016 backed by additional Scottish Government funding, including funding to establish the Scottish Genomes Partnership (SGP). The strength of this ecosystem was also recognised by AstraZeneca, when SMSIC was invited to join its Global Genomics Initiative. In additional Professor Andrew Biankin, at the University of Glasgow, has led on the formation of the International Cancer Genome Consortium (ICGC) Accelerating Genomic Oncology (ARGO) project, which is analysing biospecimens from at least 100,000 cancer patients worldwide with standardised methods and high quality clinical data.

Scotland has a strong network of universities, research institutes, NHS facilities, enterprise and skills agencies and trade organisation all focussed on developing, commercialising and implementing our world class research in precision medicine, making use of existing industrial strengths in life sciences and digital technologies.

KEY MESSAGES

• Scotland’s Ecosystem for PM is highlighted as an exemplar of collaboration in Dr Dzau’s (President of The Institute of Medicine at National Academy of Sciences) global report on PM.
• Scotland has a very strong network of universities, research institutes, NHS facilities, enterprise and skills agencies and industry bodies all focused on developing, commercialising and implementing our world-class research in PM.
• NHS Scotland is a single entity, operating through a small number of large health boards. This provides many advantages for Scotland, including ease of access for industry, joined-up datasets, and a single commissioning body. NHS Scotland has been an integral partner of SMS-IC since its inception and is committed to PM.
• The main concentration of PM assets are in Glasgow and Edinburgh. Significant investment has been made in Scotland by the main health charities such as The Wellcome Trust, CRUK and British Heart Foundation.

There a number of key strengths in Scotland’s Ecosystem for PM, which differentiates its offer from other UK regions and countries:

• The quality of Scotland’s e-health records and Community Health Index (CHI) number
• Our integrated healthcare model, which involves a single healthcare provider NHS Scotland
• The continuing prevalence of chronic disease in Scotland
• Significant support for PM provided by the Scottish Government and its agencies

The quality of Scotland’s electronic health records is a major strength and differentiator. These records are among the world’s best and include a Community Health Index (CHI) unique identifier, which was introduced over 30 years ago and uniquely identifies a person on the index. Data on Scotland’s entire population is captured routinely at all points of contact with the health service including: maternity records; acute hospital admissions; psychiatric hospital admissions; drug prescriptions; and attendance at primary care etc. This means patient demographics and clinical information can be accessed and used in clinical research and trials.

Scotland has the ability to bring together real patient data, historic data and patient samples, as well as unique patient databases such as SHARE and Generation Scotland. The increasing interest from global pharma firms and their willingness to participate in collaborative research on this and other Data Commons50 highlights the potential of Scotland’s data assets in progressing PM across different disease areas. The quality of this patient data is a key differentiator for Scotland and has been identified as being an asset of international significance by several big pharma companies during this SIA process.

Scotland has a strong track record in encouraging public engagement in health initiatives designed to maximise the use of sensitive data. Whilst other parts of the UK have come up against challenges in the integration and consented use of data (e.g. delays in implementing the 100,000 Genomes Project), Scotland has progressed a number of important innovations, which demonstrate a willingness within the population to support and engage with far-reaching initiatives.

The Scottish Health Research Register (SHARE) – uses individuals’ electronic health record and surplus stored blood samples to rapidly identify cohorts for health research projects. SHARE relies on volunteers registering to have their data and tissue included in the searches and has so far recruited over 200,000 NHS registered individuals. SHARE is funded by NHS Research Scotland (NRS) and is implemented with support from all Health Boards and Scottish Universities.

Another strength is our integrated healthcare model, which effectively involves a single healthcare provider NHS Scotland. NHS Scotland is made up of 14 regional health boards and patient records and regulation is consistent across Scotland. This enables more efficient data sharing and analysis, and is supported by facilities such as the biorepositories and safe havens in Scotland that enable data access for research while maintaining data protection. The opportunity to implement PM not just in one health board area but across the country as a whole will provide a critical mass of activity. Unlike other countries, we have very limited private healthcare and this provides Scotland with the advantage of being able to access Scotland-wide data and drive PM adoption across an entire country.

The continuing prevalence of chronic disease in Scotland, and in the Glasgow city region in particular, is another important factor. These diseases include heart disease, stroke, cancer, diabetes and multiple sclerosis. The relatively large numbers of local patients provides sufficient numbers for clinical studies and trials of new treatments. In addition, Scotland has a very stable population, which also helps with longitudinal health monitoring. Table 3-2 shows how Scotland has a higher rate of new cases of cancer and also higher numbers of patients registered for coronary heart disease. The statistics also show that the NHS Greater Glasgow Health Clyde area has higher prevalence of these chronic diseases than other parts of Scotland51.

Over the last few years there has been significant support for PM provided by the Scottish Government and its agencies. There have been major Scottish Government investments in SMS-IC (through the Scottish Funding Council) and the facilities at the QEUH campus, including the new 7T MRI scanner at the ICE building (through the Glasgow City Region Deal). The Scottish Government has also provided funding for the Scottish Genome Partnership and the Scottish Ecosystem for PM, which has enabled increased activity through the SMS-IC.

There has been strong policy support from the Scottish Government through its Economic Strategy, Health and Social Care Strategy and most recently in the 2017/18 Programme for Government. In the new Digital Health and Care Strategy, the Scottish Government outlines its plans for a Scottish health and care ‘national digital platform’ to improve the provision of real-time data and information from health and care records.

“The development of the precision medicine sector is vitally important to Scotland’s future health. It will revolutionise health care, allowing specific treatments to be tailored to the individual characteristics of each patient. Scotland has outstanding strengths in this area and we will continue to build on these to assist the commercialisation of world-class research in precision medicine and genomics sequencing.”⁵²

As already mentioned, the Scottish Funding Council has been supporting PM-related R&D activity through its network of innovation centres including SMS-IC. Scottish Enterprise also provides a range of innovation, export and financial support to life sciences firms many of which are involved or interested in PM. In addition, Skills Development Scotland is providing skills support through the delivery of a Life Sciences Skills Investment Plan⁵³. ‘Personalised medicine’ (another term for PM) is highlighted as one of the key market drivers for the wider life sciences sector.