Why are NHS trusts not doing more research?

Let’s talk research – recent evidence has shown us that patients cared for in UK trusts with strong research activity have better outcomes – lower mortality and less post-operative complications¹.

There’s more – the benefits apply not just for patients in the research but other patients with the condition who didn’t take part in studies.

It stands to positively impact a large number of people in society. So, with this in mind, why isn’t every hospital and healthcare professional in the UK supporting research?

Is there more trusts could be doing to allow patients and staff take advantage of research opportunities?

At the moment, research doesn’t seem a relevant priority when so much else is. To our over-pressed GPs, beleaguered consultants, exhausted trainees and short-staffed nursing teams, it can seem unrelated to their day-to-day lives.

It’s about not only creating an environment where staff have the time, knowledge and confidence to ask about research, but also about all hospital staff, from management to healthcare assistants, championing research 

Perhaps the traditional image of research and its portrayal in the media is also holding us back from embracing it more. Do you recall a recent news item on research?

It may have gone something like this: newsreader will announce a breakthrough, cut to a health correspondent interviewing a professor in a white coat, usually a view of a laboratory machine or microscope, a quick interview with a patient and then a summing-up statement from the presenter.

I fear that this reinforces that research only happens in labs by learned professors and not in our wards and so isn’t relevant to the vast majority of our health service staff.

Yet for all these staff, myself included, providing excellent patient care is what we do and why we come to work. I believe it’s important to recognise the value of research in the NHS in helping us improve care.

It’s about not only creating an environment where staff have the time, knowledge and confidence to ask about research, but also about all hospital staff, from management to healthcare assistants, championing research as something that may improve outcomes for their patients.

Recognising the value of research

Things are changing for us all. Research is now recognised in the NHS constitution² and is a key objective in NHS England’s long-term plan³.

The NIHR took this message to the Care Quality Commission who recognised its value and from 2019 now include questions about research in the “well-led” domain of their assessments of trusts⁴. The Royal College of Physicians now stresses the importance of research as part of direct clinical care for doctors⁵.

Patients express strongly positive experiences of participating in research, highlighting their empowerment and strength of their relationship with clinical teams⁶. Staff who conduct research also report positive outcomes for themselves.

What is emerging is a real consensus, from many directions, that clinical research is fundamental to improving care, and is highly relevant to our day-to-day practice.

It’s important that trusts respond to this consensus by continuing to work at incorporating research into their thinking and planning.

For those already leading or heavily involved in research, leaders should think about how they can support their organisation or colleagues in broadening the research across all specialties and ages of patients your trust cares for.

For those already leading or heavily involved in research, leaders should think about how they can support their organisation or colleagues in broadening the research across all specialties and ages of patients your trust cares for

For staff interested but unsure how to proceed, this is a good time to consider what are the key questions in your practice that you feel are important to study and check in with your research and development team as to next steps.

And for health staff who until now have been sceptical about research, it is now recognised as everyone’s business.

The NIHR’s Ok to Ask campaigns have proven that patients are keen to discuss research and hospital staff need to recognise this unmet need. These are the catalysts to NHS leaders and their R&D teams to develop organisational strategies that enable patients and their staff to take advantage of research opportunities.

The tools to help support this are already in place. The CQC Inspection Key lines of Enquiry in the Well-led domain, lists questions that enable a trust to set a framework for research.

R&D teams throughout the country were involved in the CQC project and are ready to support their organisations. The NIHR Clinical Research Network is embedded across every trust and all primary care in England – we are there to support patients and staff conduct the research that’s important to the NHS.

To the old adage that we are too busy for research, I would just ask are you busy providing the best care or could research potentially improve the outcome and your efficiency in delivering that?

References

1. Downing A, et al, (2017) High hospital research participation and improved colorectal cancer survival outcomes: a population-based study. Gut. 2017 Jan;66(1):89-96. doi: 10.1136/gutjnl-2015-311308. Epub. PMID: 27797935
2. The NHS Constitution, 2015
3. The NHS Long Term Plan, Research and innovation to drive future outcomes improvement (2019)
4. Care Quality Commission (2018) CQC Inspection framework: NHS trusts and foundation trusts: Trust Wide Well Led (W8) 
5. Royal College of Physicians (2019) Delivering research for all: expectations and aspirations for the NHS in England 
6. National Institute for Health Research (2019) Research participant experience survey