Why research and development is a key component of trust outcomes

The government’s response to the NHS Future Forum contains a number of commitments relating to research, including a new duty for the secretary of state to promote it. In this current state of reorganisation, capturing the power of research and development as a tool to bolster the quality, innovation, productivity and prevention drive and enable quality care to be delivered has never been more important.

In 2008 Heart of Birmingham Teaching Primary Care Trust embarked on an ambitious R&D programme, which achieved recognition from the National Institute for Health Research’s Clinical Research Network for promoting a research culture in the organisation. Here we look at the strengths of the programme and suggest a winning formula, which can be adopted by any provider or commissioning organisation intent on championing R&D.

Key to the success of the programme was support from the trust’s executive. The chief executive endorsed the programme, keen for it to enable the organisation to become more effective at commissioning which, in turn, would deliver better health outcomes for the population it serves.

The director of public health was given responsibility for R&D within their portfolio. This was a clear signal of the value of the programme and helped to facilitate engagement with the whole organisation.

The appointment of a dedicated R&D programme manager was a further commitment to the programme’s development. The existing R&D committee was strengthened with representatives from the whole organisation, including provider services, commissioning, public health, governance, the local clinical research network and academia.

R&D accountability and reporting was also restructured. Regular reports were presented to the integrated governance committee, which reported directly to the board. When necessary there was an opportunity to present directly to the senior management team and the board.

A new vision for R&D was needed to ensure the effective development and implementation of the strategy – a key element to delivering an R&D programme. The strategy was developed through extensive engagement with internal and external stakeholders and included half-day workshops to develop draft strategic goals that would:

• support the effective utilisation of research evidence as part of a broader knowledge management activity to benefit the trust and its population;
• establish the trust as an organisation recognised for supporting, conducting and commissioning high quality research on health and healthcare relevant to its population;
• identify and use opportunities to develop research capacity and capability among the trust’s staff, population and patients.

The final strategy was linked to the national strategy with an action plan, evaluation metrics and strategic objectives, each of which were owned by named board members.

Board-level commitment 

Funding is essential for any R&D programme and can be sourced from within the organisation and external sources. The commitment from the trust board was demonstrable through the allocation of £400,000 per year for three years to commission research projects.

Every year commissioners, providers, public health practitioners, individuals or teams were invited to submit research ideas. These ideas were then prioritised by the R&D committee. Projects were chosen based on their compatibility with the trust’s research themes and the projected benefit to the commissioning function. A robust procurement process was then used to commission external suppliers to carry out the research.

The National Institute for Health Research rewards NHS organisations that actively engage in research. The trust was awarded £130,000 through flexibility and sustainability funding. The allocation was driven by three applications for research for patient benefit, one for a programme for applied research, and the contract.

The strategy was the main catalyst for developing capacity and capability. Through the life of the programme this was expanded incrementally through R&D appointments in provider services and primary care. A lead clinical research specialist was appointed in provider services and GP champion appointments were made in primary care.

An innovative collaboration between Birmingham Clinical Research Academy and the trust resulted in the creation of a joint research grant coordinator post. This key resource provided a bridge to bring together the NHS and academia to deliver successful joint funding applications.

As with any R&D programme, support from the organisation and external bodies was crucial to delivering the outputs in the strategy. Support was provided from internal teams including the organisation’s procurement, finance, communications and engagement and contract management teams. Externally, links were developed with local universities, a comprehensive local research network, the Primary Care Research Network and the Midland Research Practices Consortium. The programme provided a vehicle for these organisations to come together to develop collaborative working in which research was at the heart of improving patient care.   

Key results

The success of the R&D programme has been demonstrated in a number of areas:

• R&D projects commissioned by the trust have informed the evidence base for commissioning and decommissioning of services;
• there has been significant success in attracting flexibility and sustainability funding;    
• the programme has now been adopted by a newly formed Birmingham provider organisation and will be integrated into the Birmingham and Solihull NHS Cluster, which is comprised of acute trusts and PCTs in the area, thereby demonstrating how it can be adopted for any provider and commissioning organisation.

R&D is not an add-on but a necessity in order to deliver QIPP. The question to be asked now is not “can we do without this function?” but rather “can we afford not to have R&D in every NHS organisation?”.

As R&D leads, it is our responsibility to keep it at the forefront of the new NHS architecture, whether in the form of foundation trusts, clinical commissioning groups, commissioning support organisations or the NHS Commissioning Board.