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Increasing transparency and tackle potential bias in medical AI technologies: BHP researchers publish new recommendations

Written by Louise Stanley on . Posted in Health inequalities.

Patients will be better able to benefit from innovations in medical artificial intelligence (AI) if a new set of internationally agreed recommendations – published in The Lancet Digital Health and NEJM AI – are followed.

Led by the University of Birmingham and University Hospitals Birmingham NH Foundation Trust, ‘STANDING Together (STANdards for data Diversity, INclusivity and Generalisability)’ is an international initiative and its recommendations are based on a research study involving more than 350 experts from 58 countries, aiming to help improve the way datasets are used to build Artificial intelligence (AI) health technologies and reduce the risk of potential AI bias. 

Innovative medical AI technologies may improve diagnosis and treatment for patients, however some studies have shown that medical AI can be biased, meaning that it works well for some people and not for others. This means some individuals and communities may be ‘left behind’ or may even be harmed when these technologies are used.

The STANDING Together recommendations aim to ensure that medical AI can be safe and effective for everyone. They cover many factors which can contribute to AI bias, including:

  • Encouraging medical AI to be developed using appropriate healthcare datasets that properly represent everyone in society, including minoritised and underserved groups;
  • Helping anyone who publishes healthcare datasets to identify any biases or limitations in the data;
  • Enabling those developing medical AI technologies to assess whether a dataset is suitable for their purposes;
  • Defining how AI technologies should be tested to identify if they are biased, and so work less well in certain people. 

Dr Xiao Liu, Associate Professor of AI and Digital Health Technologies at the University of Birmingham and Chief Investigator of the study said: “Data is like a mirror, providing a reflection of reality. And when distorted, data can magnify societal biases. But trying to fix the data to fix the problem is like wiping the mirror to remove a stain on your shirt. To create lasting change in health equity, we must focus on fixing the source, not just the reflection.”

The STANDING Together recommendations aim to ensure that the datasets used to train and test medical AI systems represent the full diversity of the people that the technology will be used for. This is because AI systems often work less well for people who aren’t properly represented in datasets.

People who are in minority groups are particularly likely to be under-represented in datasets, so may be disproportionately affected by AI bias. Guidance is also given on how to identify those who may be harmed when medical AI systems are used, allowing this risk to be reduced.

Professor Kiran Patel, Chief Medical Officer at University Hospitals Birmingham NHS Foundation Trust (UHB), said: “In the UK, and especially in cities like Birmingham, where communities from diverse backgrounds form a significant part of the population, ensuring diversity in datasets is essential for improving health outcomes for all patients.”

“As technology advances, these recommendations are crucial in preventing the health inequalities we know exist in our communities from persisting or worsening, ensuring vulnerable populations have access to the treatments they need.”

The research has been conducted with collaborators from over 30 institutions worldwide, including universities, regulators (UK, US, Canada and Australia), patient groups and charities, and small and large health technology companies.

The work has been funded by The Health Foundation and the NHS AI Lab and supported by the National Institute for Health and Care Research (NIHR), the research partner of the NHS, public health and social care.

In addition to the recommendations themselves, a commentary published in Nature Medicine written by the STANDING Together patient representatives highlights the importance of public participation in shaping medical AI research.    

Sir Jeremy Farrar, Chief Scientist of the World Health Organisation, said:  “Ensuring we have diverse, accessible and representative datasets to support the responsible development and testing of AI is a global priority. The STANDING Together recommendations are a major step forward in ensuring equity for AI in health”

Dominic Cushnan, Deputy Director for AI at NHS England, said: “It is crucial that we have transparent and representative datasets to support the responsible and fair development and use of AI. The STANDING Together recommendations are highly timely as we leverage the exciting potential of AI tools and NHS AI Lab fully supports the adoption of their practice to mitigate AI bias’’

The recommendations were published on Wednesday 18 December 2024, and are available open access via The Lancet Digital Health.

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Central and North West Midlands Awarded Prestigious NIHR Commercial Research Delivery Centre

Written by Louise Stanley on . Posted in Birmingham Health Partners, Clinical trials, Health inequalities.

Birmingham Health Partners (BHP) has successfully led a bid to establish one of the UK’s new National Institute for Health and Care Research (NIHR) Commercial Research Delivery Centres (CRDCs) to expand access to innovative clinical trials and deliver life-changing treatments to some of the UK’s most underserved communities.

This transformative £7m investment will establish the Central and North West Midlands (C&NWM) Commercial Research Delivery Centre, hosted by BHP founding member Birmingham Women’s and Children’s NHS Foundation Trust (BWC), working closely with regional partners Midlands Partnership University NHS Foundation Trust – host of Staffordshire and Shropshire, Telford and Wrekin Health Research Partnership (SSHERPA) – and the Black Country Provider Collaborative.

The new CRDC will make it easier for individuals across the C&NWM region to take part in research trials for cutting-edge healthcare treatments, partnering with drug companies to deliver treatment trials in a safe and responsible way. The new centre will also work closely with local businesses, patient groups and charities to help it reach a broad range of communities, including those that haven’t taken part in research before.

The C&NWM region, home to 4.2 million people, includes many of the UK’s most economically deprived communities who face significant health inequalities and higher rates of serious illness. The CRDC will focus on addressing these inequities by increasing access to clinical trials for patients who have the greatest need – dovetailing with BHP’s strategic focus on addressing health inequalities and giving greater opportunities for residents to participate in research.

Professor Lorraine Harper, Managing Director of Birmingham Health Partners and Director of the C&NWM CRDC, said: “This is an incredibly exciting opportunity to transform the health outcomes of our communities through world-class clinical research.

“By bringing together the expertise, resources, and passion of over 25 clinical and academic partners from across our region, we will create a thriving research ecosystem that not only delivers cutting-edge treatments but also makes clinical trials more accessible to all, including those in underserved populations. The NIHR’s investment will enable us to innovate and collaborate to improve healthcare in the Central and North West Midlands.”

Jeremy Kirk, R&D Director at BWC and Deputy Director of the CRDC said: “The primary objectives of the CRDC are to increase the number of trials in the region, boost participation from diverse communities, and speeding up the clinical trial process through streamlined workflows and innovative trial designs. BHP is already leading work to optimise academic trials and reduce bureaucracy, and so extending this programme into commercial trials is a natural next step.”

Professor Neil Hanley, Executive Director of Birmingham Health Partners and Pro-Vice-Chancellor and Head of the College of Medicine and Health at the University of Birmingham, said: “The success of the Central and North West Midlands CRDC bid is testimony to the deepening relationship between BHP’s partners. All of our academic and clinical member organisations were involved in developing our bid, which will bring tangible benefits to the wider partnership and help drive better health outcomes and economic growth to the region. It is yet more proof of the central importance of the health and life sciences sector to the region and country.”

Innovative approaches such as community-based trial locations, mobile research units, and digital technologies will ensure the CRDC reaches individuals who have never previously participated in research. Public involvement will be central to every stage of the Centre’s work, ensuring that its methods are inclusive, supportive, and effective in addressing local healthcare challenges.

Professor Lucy Chappell, Chief Executive Officer of the NIHR and Chief Scientific Adviser at the Department of Health and Social Care, said: “Clinical trials help improve lives. Boosting the NHS’s capacity to deliver commercial clinical research through these new Commercial Research Delivery Centres will support recruitment across all communities and bring innovative treatments to patients.

“The effects of these centres will be felt right across the four nations, bringing investment into the UK’s life sciences sector.”

£72 million investment

A total of 20 CRDCs are being established across the UK. In addition to the CRDCs in England, there will be four in Scotland, and a one nation approach in Wales and Northern Ireland. As part of the 10 Year Health Plan, the centres will shift clinical trials beyond large hospital trusts and into community settings, meaning those in underserved regions will now be able to participate in research, boosting access to new treatments in the trial stage.

This £72 million investment over seven years, beginning in April 2025, is awarded from the £400 million Voluntary Scheme for Branded Medicine Pricing, Access, and Growth (VPAG) Investment Programme and partly from NIHR in England.

The VPAG programme is a unique partnership between the UK Government and the pharmaceutical industry to boost the global competitiveness of the UK life science sector and stimulate economic growth. It will invest up to £300 million to bolster commercial clinical trial activity and help advance the delivery of new medicines and vaccines to patients.

The full list of C&NWM partners is:

  • HOST: Birmingham Women’s and Children’s NHS Foundation Trust
  • Aston University
  • Birmingham and Solihull Mental Health NHS Foundation Trust
  • Birmingham Community Healthcare NHS Foundation Trust
  • Black Country Healthcare NHS Foundation Trust
  • Dudley Integrated Health and Care NHS Trust
  • East Staffordshire PCN
  • Keele University
  • Midlands Partnership NHS Foundation Trust
  • Modality Partnership Limited
  • NHS Birmingham and Solihull Integrated Care Board
  • NHS Black Country Integrated Care Board
  • NHS Shropshire, Telford and Wrekin Integrated Care Board
  • NHS Staffordshire and Stoke-on-Trent Integrated Care Board
  • North Staffordshire Combined Healthcare NHS Trust
  • Sandwell and West Birmingham NHS Trust
  • Shrewsbury and Telford Hospital NHS Trust
  • Shropshire Community Health NHS Trust
  • Solihull Healthcare Partnership
  • The Dudley Group NHS Foundation Trust
  • The Royal Orthopaedic Hospital NHS Foundation Trust
  • The Royal Wolverhampton NHS Trust
  • University Hospitals Birmingham NHS Foundation Trust
  • University of Birmingham
  • Walsall Healthcare NHS Trust

(BHP member organisations in bold type).

BHP’s health inequality lead set to head up NIHR Challenge Maternal Disparities Consortium

Written by Louise Stanley on . Posted in Birmingham Health Partners, Health inequalities, Maternal health.

Professor Joht Singh Chandan – BHP’s heath inequalities lead and Clinical Professor of Public Health at the University of Birmingham – has been announced as co-lead of a new consortium which will research inequalities faced by expectant and new mothers.

The new NIHR Challenge Maternity Disparities Consortium is led by nine UK universities, all aiming to tackle inequalities in maternity care while building capacity for further research to help improve services over time. The consortium will help support professionals who plan and deliver services for women and babies across both health and social care.

Professor Chandan said: “I am honoured to take on the role of co-lead for the NIHR Maternity Disparities Consortium. Tackling inequalities in maternity care is a critical priority, and this consortium brings together a wealth of expertise to drive meaningful change.

“Our goal is to address disparities before, during, and after pregnancy by focusing on research that leads to real improvements in care for families and their babies across the UK. I am particularly looking forward to learning from and working alongside the communities most affected by these inequalities, ensuring that their insights shape our work and lead to lasting, impactful solutions.”

Professor Chandan will be joined by co-lead Dr Victoria Hodgetts Morton from the University of Birmingham, Dr Beck Taylor from Warwick University, Professor Will Parry-Smith from Keele University and Dr Marion Gibbon from Birmingham City Council.

Professor William Parry-Smith, Professor of Obstetrics and Gynaecology at Keele University, said: “I’m pleased to be leading Keele’s contribution to this nationally important work. Research and capacity building undertaken by the consortium will tackle the problem of maternity disparities. We have the opportunity in the West Midlands to understand and to then make a real difference crucially to improving maternity outcomes.”

Dr Beck Taylor, Clinical Associate Professor in Public Health, University of Warwick said: “This new consortium is an unparalleled opportunity to tackle the persistent maternity inequalities affecting life chances across the UK. These unacceptable differences are felt particularly by communities in our own region, the West Midlands. This consortium the first of its kind, and we cannot wait to get started on this programme. As part of the consortium we’ll bring together the communities, professionals and researchers to drive the change that women, babies and society urgently needs.”

Professor Marian Knight, Scientific Director for NIHR Infrastructure, said: “We are delighted by the level of engagement shown by researchers with this important research priority. I am confident we have an exceptional consortium to tackle the challenge of maternity inequalities; working in partnership with existing NIHR funded infrastructure and programmes. We look forward to working with the consortium and their collaborators across the UK to develop the final plans for their ground-breaking new research projects over the next few months.”

Health Minister Baroness Gillian Merron said: “Every woman should receive safe, personalised and compassionate maternity care, regardless of background. We are determined to tackle the stark and unacceptable inequalities in maternity services and are working with NHS England to urgently improve care. Government-funded research like this is crucial to driving positive change.

“This is part of our mission to build an NHS fit for the future by harnessing the full potential of our research and life sciences sector.”

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BHP welcomes Birmingham Community Healthcare to strategic research alliance

Written by Louise Stanley on . Posted in Birmingham Health Partners, Health inequalities.

Birmingham Community Healthcare NHS Foundation Trust (BCHC) has become the sixth NHS member of Birmingham Health Partners – and its ninth overall – adding crucial community care to the city’s strategic health research alliance for the first time.

BCHC provides more than 100 core NHS community services for the 1.1m people in Birmingham, as well as specialist rehabilitation and dental services for the wider West Midlands population of 6.5m. Its vision is to provide the best care possible to support the people who use its services, many of whom are among the most vulnerable in our society, to live well in healthy communities.

The Trust is active in research, with live projects including the EPIC Neck Study – evaluating a new approach to exercise for people with persistent neck pain – and Move More, which is testing the feasibility of an app to help people with long-term disabilities to increase their activity levels. Both of these studies are being delivered collaboratively with BHP founding member the University of Birmingham, with whom BCHC also works closely at Birmingham Dental Hospital.

Professor Lorraine Harper, Managing Director of BHP, commented: “BCHC provides vital services to adults and children across the city and beyond. Being responsible for the healthy management of long-term conditions and chronic illnesses, and a strategic focus on promoting equity and reducing health inequalities, their values align perfectly with BHP’s strategic objectives. We are excited to extend our collaborations with BCHC across our membership for the benefit of the patients and communities we serve.”

Dr Robbie Dedi, Chief Medical Officer at BCHC commented: “We are on a challenging journey to improve the health of our communities whilst ensuring equitable access and outcomes. Joining with BHP provides a really exciting opportunity to expand the research and evidence base across this field and translate this into practice. We look forward to BHP supporting research capability of our teams so they can make a lasting impact on patient care within their fields.”

E-MOTIVE wins prestigious Trial of the Year Award

Written by Louise Stanley on . Posted in Clinical trials, Health inequalities, Maternal health.

The landmark E-MOTIVE study, led by University of Birmingham researchers and coordinated by the Birmingham Clinical Trials Unit, as been awarded ‘David Sackett Trial of the Year Award’ by the Society of Clinical Trials, recognising the importance of the findings and the potential impact as the simple, low-cost approach is rolled out around the world, dramatically improving maternal health across the globe. The trial tested a package of low-cost interventions that resulted in a 60% reduction in heavy bleeding following childbirth.

Each year the award goes to a randomized, controlled trial published in the previous calendar year that is considered to improve the lot of humankind and provide the basis for substantial, beneficial change in healthcare, amongst other criteria.

“This has been the largest set of nominations for the Trial of the Year Award in all my time on the committee. We received numerous nominations for worthy trials, from around the world and across a large number of clinical disciplines – including obstetrics, emergency medicine, infectious disease, and cancer. We had a challenging time as a committee to choose a winner” said Andrew Cook, Chair of the SCT David Sackett Trial of the Year Committee.

Postpartum haemorrhage (PPH), or severe bleeding after birth, is the leading cause of maternal deaths worldwide. It affects an estimated 14 million women each year and results in around 70 000 deaths – mostly in low and middle-income countries – equivalent to 1 death every 6 minutes. The E-MOTIVE study found that objectively measuring blood loss using a simple, low-cost collection device called a ‘drape’ and bundling together WHO-recommended treatments – rather than offering them sequentially – reduced severe bleeding by 60%, and women were less likely to lose their life.

Dr Adam Devall collected the award, on behalf of the E-MOTIVE team, from the Society of Clinical Trials 45th Annual Meeting, in Boston, USA, and said: “I’m honoured to accept the Trial of the Year Award on behalf of the E-MOTIVE project. E-MOTIVE was a huge international team effort, and this award speaks to the dedication of teams at each of our 80+ sites. More high-quality clinical trial evidence is desperately needed for pregnancy and maternal health so we’re delighted to receive this recognition of our work and the impact it will have on deaths from PPH.”

Professor Arri Coomarasamy, who led the E-MOTIVE trial and is the Co-Director of the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham said: “This new approach to treating postpartum haemorrhage could radically improve women’s chances of surviving childbirth globally, helping them get the treatment they need when they need it”.

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Birmingham Health Partners announces theme leads to drive strategy

Written by Louise Stanley on . Posted in Birmingham Health Partners, Clinical trials, Health inequalities.

The second city’s clinical-academic alliance, Birmingham Health Partners, has appointed three strategic theme leads to support the implementation of its new five-year mission: to work together, transforming Birmingham’s healthcare through high impact innovation.

Taking the new role of Health Inequalities Lead, Dr Joht Singh Chandan is a Clinical Associate Professor in Public Health at the University of Birmingham where his research focuses on identifying and addressing health inequalities – with a particular interest in abuse and violence prevention inspired by many years of working as a voluntary police officer.

As the UK’s third-poorest city, with a diverse ethnic profile and socioeconomic demographics, Birmingham experiences significant health disparities. Joht will develop a detailed action plan for improving population health in the city, underpinned by his experience of issues that impact widely on health and wellbeing; factors that prevent early detection; and barriers to accessing healthcare.

Joht said: “We shouldn’t see reducing health inequality as just the responsibility of public health bodies. The determinants of inequality are so interlinked that not only can we not tackle issues in isolation, we can’t tackle them as one institution. Working across the partnership and linking health data platforms, we’ll be able to work in a much more representative and inclusive way to improve physical and mental health outcomes for our local communities.”

Tasked with optimising data integration across the partnership, Professor Simon Ball has been appointed Academic Lead for Data. A Consultant Nephrologist, Simon has had various roles in developing electronic health care records and using data to improve patient care and support research. His other roles currently include Associate Director for the Midlands Health Data Research UK and Senior Responsible Officer for the West Midlands Secure Data Environment (WMSDE).

Simon said: “NHS Trusts in Birmingham were among the first to adopt electronic health records systems, meaning we have access to a wealth of data – including blood tests, scans and biopsies – spanning several decades. This can provide valuable insight into an array of diseases, health conditions and care pathways – but only if it is integrated. Working together, BHP and the WMSDE can ensure our data is analysed, learnt from and used to optimise healthcare across our region.”

Leading the ‘Reducing Bureaucracy in Clinical Trials’ programme is Amy Smith, an experienced Senior Programme Lead with considerable experience in clinical trials across multiple BHP NHS Trusts and NIHR infrastructure. The programme responds to the challenges identified by Professor Adam Tickell and Lord O’Shaughnessy, ensuring patients in Birmingham get access to clinical trials more quickly. 

Amy said: “I am very proud to be leading this exciting project which showcases BHP as a leader in clinical trials.  Through trust, transparency, and collaboration we will harness the extensive knowledge and expertise within BHP, delivering improved setup times. Ultimately our aim is to make trials accessible to a diverse range of patients, quicker – increasing our attractiveness to funders and industry partners.”