Special report: research under the microscope

It’s probably fair to say that research has moved up the NHS agenda since its explicit inclusion in the Health and Social Care Act 2012. The legislation places a statutory duty on the secretary of state and on all levels of the NHS, including NHS England and clinical commissioning groups, to promote research. In other words, research has made the transition from nice to do to must do.

‘We’re not just talking about teaching hospitals; we’re talking about research becoming embedded in the
whole of the NHS’

But just how highly is research ranked as a priority among senior decision-makers and others in the health service? Are trusts and other health service organisations really embracing the need to engage with research, or are some paying it lip service? And what more needs to be done to ensure that the NHS becomes an environment in which research truly thrives, with concomitant benefits to patients?

An HSJ questionnaire, conducted in association with the National Institute for Health Research Clinical Research Network, investigated these issues in an attempt to get a picture of just how much progress has been made in promoting a research focus in the NHS.

We asked our readers for their views, and received 55 responses. By far, the majority were from clinicians (41.8 per cent), 9.1 per cent described themselves as an NHS acute trust board member, while 18.2 per cent were senior managers working in an acute NHS organisation.

There was one CCG clinical leader, five respondents working outside the NHS, and others including a chief executive in a social enterprise spin-out, a head of research and development, and research nurses.

There was a good geographical spread among respondents, with the biggest numbers working in the North West (21.8 per cent) and London (20 per cent).

Progress made

In general, the results show a good level of awareness of the importance of research and a desire to embed good practice in the health service.

According to Dr Jonathan Sheffield, chief executive of the NIHR Clinical Research Network, the survey showed promising levels of progress. “I think we’ve been seeing increased levels of engagement [with research] since the Health and Social Care Act came into force,” he says.

“There were always some areas which were very good, so people are starting from different stages. What’s important is that we’re not just talking about teaching hospitals; we’re talking about research becoming embedded in the whole of the NHS.”

The first question asked whether there was an executive director on the respondent’s trust board with responsibility for clinical research. Eight said there was not, 18 did not know, and the remainder said there was. Of these, 16 could give the job title of the executive in question. In most cases it was the medical director or some variation of this title, but the position was also held by nurse directors and research directors and, in one case, by the workforce and education director.

“Some of the smaller NHS trusts don’t have a research director, and that’s something we’d like to see change,” comments Dr Sheffield, although he stresses that every trust will have someone on the board with the responsibility for research.

Asked how often clinical research was discussed at board level, just under a quarter (23.6 per cent) agreed it was discussed at every meeting because it was a priority for the trust. Slightly more (25.5 per cent) said it comes up from time to time, but that clinical research was not one of the board’s priority areas, while 5.5 per cent said it was restricted to once a year when the annual report was being prepared. The remainder (45.5 per cent) did not know.

Being research active is positive for clinicians, organisations and patients, says Dr Sheffield, and he believes that message is beginning to get through. “High quality research brings new ways of delivering care to patients, and it’s as important in smaller hospitals as it is in large teaching hospitals,” he adds.

The next question probed more deeply into organisations’ attitudes towards clinical research at executive level. Just over half were very positive, with 30.9 per cent agreeing that “the executive understand the link between undertaking research and delivering high quality healthcare” and 23.6 per cent that “it’s good for the organisation, good for recruitment, good for patients and good for generating income”.

Of the others, 3.6 per cent felt it was an area of risk, with which executives felt uncomfortable, while the same number thought it was “an expense we could do without at this time of financial constraint”. Almost a quarter (23.6 per cent) thought it was viewed as a niche activity, “great when there are clinicians who are interested in pursuing research, but not something the executive requires of our clinicians”, while 14.6 per cent thought it was regarded as “a nice add-on, but not a top priority”.

Investing to innovate

According to Dr Sheffield, we are moving from a point where research was something only considered when it was time to prepare the annual report to something which is seen as core trust business all year round. He says: “I’m not saying it has to be discussed at every meeting, but you need to have a reporting mechanism, at least on a quarterly basis.”

There was a mixed response to a question about what it would take to push research up the trust board agenda. Some (16.4 per cent) said it was already high on their list, but most felt that more could be done. Just over a fifth (21.8 per cent) said a stronger lead from the executive would help, while the same number thought the solution was a better understanding at board level of the link between undertaking research and delivering high quality healthcare.

Interestingly, 9.1 per cent thought that more demand from patients to take part in trials would have an impact, while 16.4 per cent thought more clinicians demanding to undertake research would do the trick. Other suggestions from the responders were developing finance directors who subscribe to the idea of investing to innovate, and for research to be recognised in the job plans of clinicians.

Dr Sheffield believes the informed patient is an important influencer. “The more you can inform the patient to have a good understanding of the importance of research the better. But you also have to understand what patients want from research, and that means involving them at every stage.”

There was overwhelming support for the research activity of organisations to be made more visible, with 87.3 per cent saying they would like to see metrics from the Care Quality Commission or others about how research active their organisation is so they can benchmark themselves against others. Just 12.7 per cent rejected this idea, saying they did not have time to submit more data.

Dr Sheffield says that although it’s important to make research activity visible, it must be done in a way that does not mean extra work. “It should be embedded in core processes,” he says.

Again, the vast majority believed that NHS trusts should be measuring the experience of patients who take part in clinical trials (just 3.6 per cent disagreed) but only 20 per cent said this was something they were doing. The remaining 76.4 per cent thought it important, but said they were not currently doing it.

The next question related to academic health science networks. All trusts should now be part of one, and the survey asked what difference membership had made over the last year. The responses were mixed, with under a third saying it had made some or a lot of difference (27.3 per cent said some, 1.8 per cent said “a lot”). But this was not necessarily bad news because, of those who said it had not made a difference, 25.5 per cent said it was because they had already been members of a network and that research was already high on their agenda.

‘We’re trying to change the culture of the NHS around research, to benefit patients now and in the future’

Just under half (45.5 per cent) said it had not made a big impact, and that they were members but “pretty much in name only”.

These responses reflect varying stages of development, says Dr Sheffield.

Asked more specifically about the NIHR, 94.6 per cent had heard of the organisation, and there was also high awareness of its core activities in funding research, as a source of knowledge and experience of clinical research freely available to NHS organisations, and as an organisation that provides practical research support.

“I think we’re on a journey,” says Dr Sheffield. “We’re trying to change the culture of the NHS around research, to benefit patients now and in the future.”