The practical rewards of undertaking research

Speech therapist hopes to transform dementia care

Although he might be very near the start of a clinical academic career, James Faraday’s work already has the potential to change practice for the better.

The speech and language therapist, who works at The Newcastle upon Tyne Hospitals Foundation Trust, wants to transform the way that healthcare staff support people with dementia to eat and drink well, improving lives and wellbeing.

He credits his time as an HEE/NIHR intern for giving him the confidence and skills to make it happen.

“For a long time, I had the sense that our work as speech and language therapists needed to be more evidence-based,” he says. “I wanted to make some efforts in that direction, but felt neither equipped nor confident to do it.

“So the advent of the HEE/NIHR Internship came at just the right time for me.”

“The real revelation was the networking,” says Mr Faraday. “I was a bit wary and apprehensive about it, but it wasn’t scary at all and was actually really useful”

For Mr Faraday, the six month programme meant 35 days out of day-to-day work but it opened up a new world. As well as workshops, sessions with a life coach, and supervision from a lecturer at Newcastle University, it brought him together with peers from all disciplines.

This, for the self-admitted introvert, was a big surprise. “The real revelation was the networking,” he says. “I was a bit wary and apprehensive about it, but it wasn’t scary at all and was actually really useful. It’s not my natural way of working, but it was really just talking to people about their ideas and talking to other people about my ideas. A lot of it was by email, which was helpful, but the face to face contact was really inspiring.”

Interns could choose to join a research project that was already taking place, or develop their own ideas. Mr Faraday decided on the latter approach. “My interest is training by speech and language therapists, particularly around dementia care and eating and drinking. It could be about the swallow, or difficulties using cutlery, or recognising food or the importance of eating and drinking, or people might have reduced appetite.

“Speech and language therapists are already integral to this, in providing assessment and management of swallowing difficulties. But I felt we could provide more training to empower nurses and carers, and in an evidence-based way.”

As part of his internship, Mr Faraday has written a protocol for a systematic review, investigating and appraising evidence with the aim of improving practice.

And that’s only the start. Since completing the programme, he has successfully applied for research funding from his own trust to continue the work, and is hoping to do a PhD in the future.

“I think the internship has been hugely helpful. It’s given me the confidence and the knowledge to take this forward. I’d always want to continue with a clinical element to my work, because helping patients is the whole point of what I’m doing.

“In my view, research and clinical work shouldn’t be compartmentalised.”

He has been spreading the word about the ICA programme to colleagues at the trust, and has sparked some interest, he says. “I really want to enthuse people and encourage them to do research. I’ve felt very supported by my managers and my colleagues. I feel very lucky.”

Nurse helps to tackle chronic pain

Thanks to Gillian Chumbley, some research funding, and a trip to Australia, there are patients in the UK who are no longer suffering the pain that was making their lives a misery.

Based at Imperial College Healthcare Trust in London, the nurse consultant has been responsible for a change in practice that led to the trust introducing ketamine to control post-operative pain in some patients.

Having received a travel bursary to Australia to learn about the use of ketamine in acute pain, followed by a four year clinical lectureship from the NIHR to research its use in chronic post-surgical pain, Ms Chumbley became the first nurse in the trust to be chief investigator in a randomised control trial of a medicinal product.

Now she is determined to support other nurses, allied health professionals  and healthcare scientists to follow careers in research. “Being clinical, you see gaps in knowledge and you see questions you want to answer. But being funded to do research as well allows you the time to step back and do something about it.

“As a nurse consultant I’ve been lucky because I can spend 25 per cent of my time on research – although that tends to work out as one day a week. But the NIHR grant really gave me the time to make it happen.”

“Obviously you have to have a passion for what you do, and you have to be persistent to deal with the frustrations along the way,” she says. “You also have to accept that something’s got to give – you can’t do everything perfectly.”

Ms Chumbley’s career so far has involved breaking down a number of barriers, and there have been challenges along the way. This includes juggling her research with her continuing clinical role.

But having developed a strong nursing team with a real research ethic helped, as did supportive management and a trust environment that is respectful of and committed to research.

“Obviously you have to have a passion for what you do, and you have to be persistent to deal with the frustrations along the way,” she says. “You also have to accept that something’s got to give – you can’t do everything perfectly.”

The really positive thing is the benefit that patients are already feeling as a result of the ketamine research, she says. Although the study, which concluded in July, shows that ketamine doesn’t appear to prevent patients (after thoracotomy) developing chronic pain, it did show that they needed less in the way of opioids after surgery.

What’s more, Ms Chumbley has been asked to talk at national pain conferences, so has helped to spread practice beyond her trust’s walls.

She has also been able to develop collaborations that have led to further research and has successfully bid for other funding – such as a £100,000 grant for a back pain project – none of which would have been possible without the NIHR grant.

“It can be hard to be the one breaking through, but we’re making it easier for the people coming behind. That’s good for the NHS and good for everyone.”

Physiotherapist – and clinical research professor

As a professor in musculoskeletal health in primary care at Keele University, Nadine Foster has led or contributed to more than 100 papers in peer-reviewed publications, supervised masters and PhD students, and is president elect of the Society of Back Pain Research in the UK.

But it’s when the physiotherapist talks about the importance of improving the care of patients that her face really lights up.

“My research is all about trying to help patients with aches and pains,” she says simply. “There’s a large population of people who suffer from this – they consult their GP with back pain, or knee pain, and for a lot of patients, the outcomes aren’t good.

“Essentially, we’re trying to improve the lot of patients, and to reduce the global burden of disease.”

In 2012, she was awarded an HEE/NIHR Research Professorship for five years to support a large programme of translational research focused on improving outcomes for patients in primary care with common aches and pains.

This involves working directly with patients in primary care. “All my work is done in the NHS ‘lab’,” she laughs. “I feel very lucky to be supported by a high quality funder, and have very good research collaborations with medical colleagues. The multidisciplinary aspect is very important.”

Certainly her own work is a good example of the benefits that can accrue to the NHS from research.

She has been working with clinical commissioning groups to stratify care to identify patients who can be supported to self-manage – freeing up time and resource for those who need clinical intervention.

Professor Foster says that although she “fell into research”, as a young physiotherapist there weren’t the same opportunities for a clinical academic career as there would have been for a young doctor in a similar position.

Optimistic about the future

Nevertheless, she pressed ahead, completing a PhD, then moving up the academic ladder to her current position. That’s not to say it’s always been easy. “At times I felt disadvantaged. I didn’t want to move full-time into academic life; I wanted to work with patients. If I had been a medical doctor I wouldn’t have had to decide between one or the other; I’d have been able to combine being a clinician with being an academic.

“I think it’s really important that we are now seeing career pathways for non-medical clinical academics, and I think that’s got to be good for the health service and for patients, as well as the clinical academics themselves.”

Having been a pioneer herself, she is optimistic about the future. “There are plenty of great people coming behind us,” she says.  “We know that what we all want is improved care and better outcomes and what we want is a system that is focused on this. Clinical academics are the sort of people who are curious, who will ask questions, and that leads to cycles of continuous improvement. It’s really important that clinical services are research-active, and it needs to be the case throughout the system.”