Putting clinical research at the heart of the organisation

Getting involved with clinical research can be daunting for those working outside big teaching hospitals but the focus of much research is moving towards primary and community-provided services, offering opportunities for many organisations and staff to get involved.

Clare Morgan, performance and industry director at the National Institute for Health Research’s clinical research network, says the past two or three years have seen a growth in research outside the traditional settings, with growing interest from the commercial sector.

As more people develop long-term conditions and are treated closer to home, it is important to look at what makes a difference to them – and that may point to different research projects than in the past.

‘It has been shown that organisations that are participating in clinical research have better patient outcomes’

So what helps organisations without much previous experience in research get off the ground? Dr Morgan says support from the board is enormously helpful. “When you have leadership buy-in that research is important and the trust should be participating - that’s what really starts to drive behaviours. Staff feel empowered to look at opportunities,” she says.

That was certainly the experience at Sussex Partnership Foundation Trust. It was once a “sleepy trust” that was not research active, says director of research Mark Hayward. But it now has a research income expected to hit £1.25m this year and a reputation for engaging not just staff but service users and carers in research.

This shift came about partly as a result of the board committing to put research at the heart of the organisation – and being prepared to invest £250,000 to pump prime its own research.

Selling point

A key selling point with many boards can be the growing body of evidence that having research-active staff has other pay-offs for organisations. “It has been shown that organisations that are participating in clinical research have better patient outcomes,” says Dr Morgan. “People start to question their own clinical practice – that’s the culture that research generates.”

One barrier for many organisations outside the acute sector is lack of research experience. This can make it hard to get involved with commercial partners, who may want to see evidence of experience before working with it.

‘We have to show that research has clinical impact, otherwise it will go to the bottom of a very long list of things to do’

The NIHR has a portfolio of multi-site research projects. Many of these are open to new sites and provide a first step into research for individuals and organisations – especially as there is funding for the infrastructure around the project. And it can help avoid the chicken and egg situation with commercial partners of needing research experience before participating in trials.

The NIHR portfolio has proved valuable to many organisations, including Staffordshire and Shropshire Healthcare Foundation Trust. It has all the challenges of serving a massive predominately rural area, and running services as far away as Cambridge and the Isle of Wight. It is now involved in a number of the portfolio trials run by NIHR and also has some other clinical trials running. Head of research and development Eleanor Bradley identifies the move towards portfolio trials as important in opening up the opportunities for trusts like hers.

Staff involvement

One of the most significant changes has been getting more staff able to act as principal investigators – essential for involvement in clinical trials. There were some doctors in the trust with research experience but others have been mentored and developed to take on the role. The trust’s associate specialists have been particularly keen to get involved in research as they see it as an important part of their career development.

But enthusiasm is not limited to doctors. The trust was able to involve a nurse who worked in a drugs and alcohol project but wanted to get involved in research in some of the portfolio studies and he is also doing a piece of project work, and hopes to go on to do a masters degree.

“Once we have found someone with enthusiasm and potential, we have to be able to find them the opportunities,” says Professor Bradley. Staff get the opportunity to apply to spend one day a week doing a small scale evaluation, with mentoring. The feedback she is getting is that this is improving practice at the coalface. “Research can’t sit outside – it has to be integral,” says Professor Bradley. “NHS services are pressurised. We have to show that research has clinical impact, otherwise it will go to the bottom of a very long list of things to do.”

One challenge for mental health and community providers is keeping staff engaged and informed when they may be spread over a wide area, operating from different sites and sometimes working in the community and only sporadically coming back to base.

‘NHS services are pressurised. We have to show that research has clinical impact, otherwise it will go to the bottom of a very long list of things to do’

In Sussex, communication with staff has also been important: the trust is setting up a research network to ensure staff and service users are kept informed of research opportunities that might interest them, and has recently launched a research magazine. 

But there is also a focus on getting out to meet staff face-to-face. The research team also use screen savers to remind staff across the trust about research. And governance of research projects has recently been brought inhouse to ensure that the process is completed as quickly and smoothly as possible.

Engaging service users

But it is not just getting staff involved that benefits research – patients and service users are also important. Professor Bradley says the research department at South Staffordshire and Shropshire is now taking calls from users and their carers asking whether there are research projects they could be involved in. Offering all services users the chance to be engaged in research, if they choose to, is one of her ambitions.

Ruth Chandler, coordinator of service user and carer involvement at the Sussex trust, says that involving service users at the design stage helps effectiveness. The trust has set up a lived experience advisory panel to ensure this happens.

“We have a real sense of making sure that research means something to each of the stakeholders and that our culture supports research across the cycle,” says Dr Hayward.

A fragmenting and evolving picture of NHS-funded provision is also likely to impact on research. The NIHR clinical research network is committed to supporting research in all settings but is having to adjust as new organisations become involved in provision. “We know that with any qualified provider, social enterprises and so on we will have to keep an eye on how research is embedded in them,” says Dr Morgan.  

Social enterprise Nottingham Citycare – which grew out of the provider side of the primary care trust 18 months ago – is involved in several research projects.

‘We have a real sense of making sure that research means something to each of the stakeholders and that our culture supports research across the cycle’

One of the major pieces of work the social enterprise has been able to push forward is a feasibility study looking at developing a falls package aimed at carer homes.

Like many community services providers, it has a falls prevention team and has a package of care for patients who fall over – but this has mainly been aimed at people who are living independently. Care home patients will have different issues – for example, they may be less mobile and a significant proportion will have cognitive impairments such as dementia. Delivering care is also likely to need the involvement of care home staff.

A package of care designed for patients in care homes is being tested in a small number of patients (with controls) and the work will look at the feasibility of a larger study.

Improving mobility

Other pieces of work include a study into the role of outdoor mobility in patients after stroke, which started while it was still part of the PCT and which is also funded by the NIHR. A project on preventing falls in early-stage dementia patients is also planned.

“We have to do research which is pertinent to our population. We are not a laboratory-based environment and we don’t have any medics in the social enterprise,” says Pip Logan, an occupational therapist who divides her time between clinical care and research and is lead researcher for nurses and allied health professionals in the organisation. “Our key selling point is about building this research culture in the staff and building staff up.”

But does being a social enterprise help this? Ms Logan says there is a flatter management structure, which can aid quick decision making about research. It also has a written research strategy. Research ideas very much come from the bottom up and are based in the issues staff encounter in their everyday work – issues which are likely to be encountered by community staff across the country,

Future possibilities include clinical academic posts which are being set up by the NIHR to offer staff the opportunity to do research while remaining in their jobs. “The organisation has got really keen on this – it is a win-win situation for the staff and research,” she says.