In conversation with Araminta Ledger

In the latest Connect: Health Tech member spotlight, host Paula Rogers-Brown sits down with Dr Araminta Ledger, Deputy Executive Director at Cambridge University Health Partners (CUHP).

Read this interview to discover:

  • Minty’s career journey from lab research to developing large-scale strategic projects.
  • More about CUHP as an organisation and the projects it gets involved in.
  • A perspective on integrated care systems and their role in the future of interdisciplinary collaborations.

How did you start your career journey? I started as an academic researcher. I did a PhD in organometallic chemistry, which is very lab-based and when I reached the end of that, I was a bit frustrated with how removed from any sort of real world impact my PhD was, even though I really enjoyed it. As part of my PhD, I did a lot of NMR spectroscopy which is the same technique essentially as MRI, so then I moved to the Institute of Cancer Research in London and did a postdoc there. I was also working with a small med tech start-up company who were trying to develop a new MRI scanner for breast cancer imaging so that was really interesting, and I did that for a few years, after which I got a fellowship from NIHR to keep going with the MRI research, focused on breast cancer risk. When I got to the end of my fellowship, I took a bit of a step back to assess what I enjoyed and what I didn’t. I liked the birds-eye view aspect, taking a strategic look at things and communicating complex information, and wasn’t sure that an academic career pathway was the one for me. I moved to the clinical school at Cambridge University where I worked with Prof. Patrick Maxwell doing research management and putting together large strategic research bids.

After a couple of years, I moved to CUHP where my first role was focused on campus development and now, I'm the Deputy Executive Director focused on strategy and operations. I'm also a governor for the Cambridge Academy of Science and Technology, which is based on the campus. So, I’ve had quite a varied career path.

Can you open up the world of CUHP for our readers, and tell us what type of organisation it is and what it does? CUHP is an Academic Health Science Centre (AHSC). There are eight designated centres in England, and we go through a competitive process to be awarded AHSC status, linked to three different government departments: NHS England, NHS improvement and NIHR. AHSCs are a centre of excellence for research, clinical care and medical education and our members are the University of Cambridge and three NHS Trusts that are local to us. Recently Anglia Ruskin University has also joined the partnership, which is fantastic and gives us greater breadth and reach across the region.

CUHP’s current focus is on the life sciences cluster and how we make sure that it remains globally competitive for talent and investment, ensuring excellent health outcomes for our local population. We get involved in certain projects that are of value to more than one partner. We work with stakeholders like the combined authority, thinking about place and physical infrastructure, talent and skills, and also around the data infrastructure that's going to underpin our partnerships - how can we make sure that third parties can safely and responsibly access our health and care systems? We also look at how can we pull innovation into our NHS trusts, so it is very broad ranging, which from my point of view is very interesting because I get to see what's happening across the ecosystem and try and bring people together to collaborate.

What types of activities would CUHP get involved in? Take data infrastructure, for us that is a mixture of strategy work and then specific projects.

We've just commissioned McKinsey to undertake a piece of strategy work across the CUHP partnership to look at how we are going to better integrate and utilise health and care data, including particular use cases that we might want to get started on such as a particular pathway for clinical care. For example, if we pooled our data, we could improve that specific pathway for users, patients and the public. So that's the kind of big piece of strategy work which we've just kicked off, but there are other specific projects where we work very closely with other partners across the ecosystem. One that you might have heard of is the Health Data Research UK Innovation Hub for Inflammatory Bowel Disease, called Gut Reaction.

Gut Reaction is led by our Director of Research, Professor John Bradley, supported by Mark Avery, Director of Health Informatics, as the operational lead. Over the last three years this academic, NHS, charity, and industry partnership has worked alongside the IBD patient community to combine NIHR BioResource phenotypic and genomic data, with health and care data from 13 NHS Trusts, the UK IBD Registry, and national datasets from NHS Digital in a secure cloud-based architecture, where it can be analysed by academic and industry researchers.

Mark is also supporting another key informatics infrastructure project led by Prof Serena Nik-Zainal called CYNAPSE which is focused on implementing a platform to facilitate the storage, retrieval, processing, sharing, and analysis of genomic data across research groups in the NIHR Cambridge Biomedical Research Centre (BRC). A further DARE UK project builds on this platform seeking to demonstrate a proof of concept for federated analysis of genomic data between the NIHR Cambridge BRC and Genomics England (GEL). Federation essentially involves leaving the very large genomic data in its current location and analysing it remotely to pull results only into a secure research environment.

Why is it still important, given the advances of technology enabling remote working, to have an environment like the biomedical campus? One of our partners said something which I thought was thought provoking. He said, “science is still a contact sport.” When you're working in labs there isn't any other way to do the work than being physically in a lab and interacting with other scientists. Being able to get out and talk to people and meet people is important.

However, having said that, I think being able to meet people remotely really has its benefits – being more accessible and diverse in our approaches suits a lot of different groups which is brilliant, but there's definitely still a place for physical networking of the type that you get on the biomedical campus where you can bump into people, those water cooler moments that people talk about. So, while I think we will continue to see a hybrid approach between some remote working and some in person, many stakeholders tell us there's no substitute for physical networking and it is still that kind of serendipitous interaction that is important.

Do you see the work of CUHP as being able to facilitate opportunities, serendipity or purposeful collaborations? That’s an interesting question as there's always a lot of work behind serendipitous interactions – a lot goes into creating the opportunity to bring people together. Cambridge has a huge number of events, networking and challenge competitions, different organizations bringing people together, helping people meet across different sectors and disciplines. CUHP I would say creates structured serendipity depending on the project or activity we're working on.

How challenging was it for CUHP and CBC partners due to pandemic restrictions? For the core CUHP team, we redeployed during the pandemic because we're all part of the NHS. All employees moved into different roles, and I did a lot of work around the research response to the pandemic. It was so impressive to see different parts of the University coming up with novel research to support the NHS Trusts during that time.

It was also great to see the strength of existing partnerships really being harnessed. For example, the testing centre that was set up on the biomedical campus was a collaboration between AstraZeneca, GSK, Cambridge University Hospitals and the University of Cambridge. Because of this strong existing relationship, they could pick up the phone very quickly to galvanise activity and everyone pitched in to get things set up. The centre was up and running in a matter of weeks in the Anne McLaren Building before it became part of the national Lighthouse lab facilities during the first year of the pandemic.

Article: Cambridge COVID-19 Testing Centre passes 2 million tests milestone.

Have there been any key lessons learned? Yes, definitely on the research side of things. The pandemic removed a lot of barriers in relation to research, things like streamlined ethics approval for COVID related trials and access to health and care data. Organisations like NIHR and the Clinical Research Coalition are trying to retain this learning from the pandemic around streamlined regulation and that would be good because now we know we can do it safely and responsibly.

In addition, the pandemic demonstrated the power of having one single goal that everybody was aligned on and the ability to do things much more quickly and effectively around a single endpoint. There is certainly a driver to keep the learning for that around research.

From your perspective what does the future of interdisciplinary collaborations look like? The Integrated Care System offers the opportunity for industry partners to work with a much broader system and to bring their innovation through to larger geographical areas – instead of running a pilot in one NHS Trust then having to go to another NHS Trust and run a different pilot to build up the evidence base for a product or an innovation. More system-wide working is certainly something I would like to see more of in the future.

As part of our strategic remit, the work that we've been doing with our NHS partners has been to look at the possibility of forming dedicated landing zones within our NHS Trusts around innovation. This would be to create a team of people whose job it is to talk to industry partners or SMEs who've got products that they want to test. And then behind the scenes within the Trust the different processes are sorted out, such as information governance for instance. Currently, feedback from innovators tells us it’s not easy to find the right person to engage with. So, what we're working on with our NHS partners is setting up landing zones, which would effectively be project management teams to work with innovators and make it easier for technology to get adopted.

What areas of health technologies are you interested in right now? During the pandemic we started to see a lot more remote technology and working being used and more accepted within the NHS. If utilised in the right way and in the right circumstances, approaches like remote consultations could be a benefit for some patients and certainly help with the enormous backlog within the NHS.

Using new AI algorithms or machine learning to help triage the patients on the waiting list, so that those who really need to be seen first could be a very helpful way of deploying technology. Professor Fiona Gilbert is undertaking work where she's using new AI algorithms to analyse mammograms rather than relying solely on radiographers, who are in very short supply, to get through this backlog. So maybe having one radiographer and an AI algorithm rather than just two radiographers could keep things moving. We've got this amazing technology that works well, we can now start to actually use it within clinical pathways. I would like to see a lot more of that where we're using technology and the expertise in those areas, like radiology, which in Cambridge is amazing. Dr Rajesh Jena is another example - working to reduce the time for radiotherapy planning and there's lots of ways that we could be starting to use technology much more efficiently.

What's the most important lesson you have learnt in your career to date? I would say being open to opportunities, we work in such an amazing ecosystem and when opportunities open up and it sounds interesting, I think just engage with it and get involved!

Read the full version of this article on the Connect: Health Tech website here:

Dr Araminta Ledger