Evidence suggests being active in clinical studies helps improve trusts’ performance as well as providing a potential source of income. Alison Moore finds out how trusts of all sizes can lead the way in promoting research.

Research has often been seen as the province of teaching hospitals: but increasingly trusts across the country are becoming actively involved in research and recruiting patients to clinical trials.

Last year 99 per cent of trusts in England had some patients involved in research, often in large-scale multi-centre randomised trials. Some district general hospitals were involved in dozens of projects with thousands of patients enrolled to studies. And that widespread involvement is bringing benefits to trusts, says Dr Jonathan Sheffield, chief executive of the National Institute for Health Research’s clinical research network.

One of the benefits is attracting consultants and other staff who want to be involved in clinical research but might otherwise only consider larger or teaching trusts.

Commercial clinical research also gives a trust a different income stream, profits from which can be used to improve other facilities. For some trusts that income can be in the millions. And he also suggests that the discipline of clinical research transfers into the quality of care a trust offers.

There is also a broader benefit for patients in that research will ultimately lead to the adoption of treatments which have been vigorously tested and found to be effective for them.

While the way in which individual trusts have engaged with research has been varied, there are many examples of trusts which have really grasped the opportunities available to them. Last year the Clinical Research Network sponsored the clinical research category in the HSJ Awards.

It was won by Tees, Esk and Wear Valleys Foundation Trust, which now has more than 500 patients enrolled in clinical research projects, from a very low base.

“It showed how you can energise a relatively small NHS organisation to get involved in the national research agenda and be very successful in that,” says Dr Sheffield.

Do the right thing

Other success stories include Blackpool, which now has 22 clinical research nurses and is opening a clinical research facility. 

But that picture is still mixed. A survey run by HSJ last year found that 61 per cent of healthcare professionals believed research was peripheral to their trust.

NHS health research champion Candy Morris says there is a tremendous window of opportunity for trusts to become more involved in research. “It is hard to see what the downside is,” she says. “There is emerging evidence that if you are research active and research aware your general performance and quality of care improves. Your workforce want to do the right thing.

“Some people will say in a cash-strapped NHS IT makes it harder… but the more enlightened say that being research active and aware helps support the QIPP agenda.” She also points to public interest in research and the “patient pull” aspect of this.

So what does a trust need to do to boost its clinical research? Creating the right environment for research is vital.

Dr Sheffield says board level buy-in is important. Board support can promote research within an organisation and help overcome problems with different departments.

“If the board is ambivalent in its approach to research, other supporting departments will be ambivalent as well,” he says.

Managers often need persuading that research is important. Clinical research now has to be included in a trust’s quality accounts, but he would like to see this going further and research appearing on board agendas more regularly. And boards should be thinking about how to performance manage research to get as much value out of it as they can, he says.

Trusts also need to look at how swiftly they process applications for research and patient enrolments. “We are aiming to get people to set up and approve a study in their organisation within 40 days and then recruit their first patients within 30 days,” says Dr Sheffield. The evidence is that the UK can deliver on research as quickly as other countries once a study is set up – but it takes longer to establish studies. However, there have been examples when the UK has acted very quickly – such as around pandemic flu vaccines.

The Clinical Research Network has been looking at how lean techniques can speed up clinical trials – for example, by streamlining processes and removing duplication. This applies particularly to enrolment in research and getting informed consent from patients. Patients support research, he says, with a survey suggesting 70 per cent would be happy to engage with it. But the selection of patients could be speeded up and done earlier in the process.

While proper processes still have to be gone through, it may be possible to do them in parallel rather than series – cutting the time it takes for a research proposal to go live. 

Transparency around how trusts are doing will be important he adds. Details of how many trials a trust is engaged in, and how many patients it recruits on to them, are already made public.

The clinical research network handled around 900 clinical studies in 2011-12. Just under a third of which are sponsored by life sciences companies.

“We are building an evidence base of who the most successful trusts are and who the most successful lead principal investigators are. Hopefully that will give people information around the best places to go. We are trying to target the organisations that we think have the potential for further growth,” Dr Sheffield says.

And Candy Morris says new academic health science networks will be a “tremendously powerful approach” that help the health and wealth ambition. “There is everything to play for and the window of opportunity is fantastic,” she says.

A great new way to attract consultants

Clineal research has been transformed at United Lincolnshire Hospitals Trust over the last four or five years – bringing enormous benefits to the trust and wider community.

The trust serves a population of 750,000 – an attractive number for researchers. Teaching hospitals may have clinicians with protected time for academic work but they often lack the population needed for big studies. “That was a selling point for us,” says Dr Tanweer Ahmed, director of the Lincolnshire Clinical Research Facility. 

The increased opportunities for research has helped the trust recruit consultants, says Dr Ahmed. “Attracting consultants in Lincolnshire has always been difficult,” he says. “It’s a DGH and not on a main motorway and is not a teaching hospital. We convinced the trust board that research would help it attract consultants.”

He says patients have also benefited from drugs available through clinical trials which they would not otherwise have access to. These drugs are also supplied free of charge.

“We usually run stage three clinical trials so there is little risk and these could be the best treatments available for our patients. These drugs, if successful, are useful not just to ULH but to the NHS and across the world.”

A key part in all of this has been infrastructure funding from the NIHR. Everyone knows that clinical research is important to delivering new treatments, Dr Ahmed says, but a major obstacle has been getting additional resources for it.

He says that the funding and the way research has worked within the trust has helped to convince managers that research is important and does not put an extra burden on other departments.

Research often demands involvement not just from the originating department but also from areas such as pathology, pharmacy and imaging, which may see research as putting them under pressure. But Dr Ahmed has been able to use the additional funding to ease this pressure.

The trust has also worked to make processes smoother for commercial and non-commercial research organisations that want to work with it. The Lincolnshire Clinical Research Facility – set up around five years ago – aims to facilitate studies, “unblocking” problems in progressing studies and acting as a “one stop” office, with management and support services for clinical trials.

The trust is now involved in research across many areas including cancer, diabetes, stroke and cardiology: since 2004 it has seen the number of trials it is involved in increase from 12 to 200 and its income from research has risen from £4,500 to over £1.5m.

It was highly commended for its research activities in last year’s HSJ awards. “Research has become an integral part of our clinical services and it has strong support from the trust’s medical director, who is overall head of research,” says Dr Ahmed. 

Find out more

For more information on clinical research activity in your area visit www.hsj.co.uk/hsj-local

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