Delivering his keynote address at the annual NHS Research and Development Forum, Peter Brindle – R&D Programme director of the Avon Primary Care Research Collaborative – made the crucial point that “it doesn’t matter how important research findings might be, unless the evidence is incorporated into practice and makes a difference to patients”. This single sentiment reinforces one of the key issues currently affecting the research community.
So why does the sector do research, and how can it really make that research count? And why is a more joined up R&D sector more important now than ever before?
The need for putting research evidence into practice
It’s no surprise to hear that the NHS is currently facing some of the greatest challenges in its history. It is estimated that there will be a £30 billion NHS funding shortfall by 2020 and, at present, approximately 20% of resources are spent on overuse, underuse or misuse of treatments. To highlight an even bleaker reality, 96% of acute trusts are in deficit, 15 million people are living with long-term conditions that require 70% of the healthcare budget, and it is highly probable that only 50% of the healthcare decisions made are being based on actual clinical evidence.
The picture painted by Brindle was very clearly that of a health service experiencing surmounting pressures, with an urgent need for things to be done differently. The reason why the implementation of joined up R&D is necessary now is precisely because resources are so low; as Brindle said, “we can’t afford to waste time and money on changes just because we hope or believe that they will make things better”.
Although there have been significant funding cuts, the National Institute for Health Research (NIHR) still spends around £1 billion each year on research. At least a billion more is provided from medical research charities and, when combined, finance from Research Councils UK, EU funding pots and the pharmaceutical and medical technology industries enables even more studies and trials to go ahead. However, the research being undertaken is not having the impact that funders want. There is a growing awareness amongst NHS staff, funders and the research sector that spending large amounts of money on research is fruitless if it’s not having an effect on patients at the receiving end.
The impact target – why is it being missed?
One of the main reasons that research is not currently having the impact it should is due to it being developed in relative isolation from the landscape that it hopes to influence. Incorporating evidence from research into actual practice relies upon the larger workforce in health and care who commission, provide and distribute healthcare innovations; however, it is these people – namely clinicians and managers – who are the furthest removed from research on the ground and therefore currently ill-equipped, through no fault of their own, to bring the evidence into practice.
If, as Brindle suggests, poor engagement of the majority of the service workforce is to blame for the limited impact research is having, then it is necessary to bridge the gap between the two. Brindle proposes that the best way to facilitate this is to place a much stronger emphasis on the co-production of research right from the start. Uniting evidence makers and evidence users at the beginning of the research pathway would provide everyone involved with a greater understanding of the needs of, and the benefits for, both sides.
As successful engagement with patients in research activity is key to effective research, INVOLVE was established in 1996 to help patients understand the nature of research as well as to help researchers understand how much more effective research could be if patients were involved from the offset. It launched its latest joint publication on public involvement in health and social care research with the Health Research Authority (HRA) on 23 May 2016 in order to raise greater awareness of public involvement when researchers are in the early stages of study design. This publication highlights the following benefits that the involvement of the public in research may lead to:
- Making research more relevant so that the research results are more likely to be useful and of benefit to patients and the public.
- Helping to define what is acceptable to research participants, particularly in controversial or sensitive research.
- Improving the process of informed consent, thus making it easier for prospective participants to understand the research and potential risks.
- Improving the experience of participating in research by checking that the practical arrangements for participants are appropriate and a respectful use of their time.
- Improving the communication of findings to research participants and the wider public by providing information on the progress of the research as well as the final results.
By bringing together the NHS workforce, patients, and researchers, a step change in research impact in the UK could very realistically be triggered.
Placing researchers on the ground
Another approach to increasing impact lies in widening the research pool. As discussed by Sarah Williams, Associate Director of Research at Solent NHS Trust, in her NHS R&D Forum plenary session Clinical Academic Careers – Building a Culture of Research Active Clinicians, it is imperative that the value and impact of non-medical clinical academic roles are publicised and promoted throughout the sector to encourage clinical academic career development, both within NHS trusts and in collaboration with Higher Education Institutions. This is because researchers immersed in clinical settings are in the best position to identify the research questions that matter the most – not only to the patients but to their profession and to health and social care overall. They are also able to confirm that the questions raised are relevant in day-to-day care, alongside being able to interpret and apply the findings in practical and useful ways. Brindle agrees with this notion, stating that academics must co-produce health research with its users in the NHS to make it work.
NHS R&D teams based in hospital trusts and in Clinical Commissioning Groups (CCGs) are ideally placed to bring the research and the service world together to drive the co-production of research forward successfully, because of their close ties to researchers and the workforce alike. To make the vision of an evidence-informed NHS a reality, service staff need to be engaged in all aspects of research. The following are some of Brindle’s suggestions for what NHS R&D teams can do to achieve this:
- promote a culture within the organisation of looking for evidence and evaluating services and interventions;
- embrace that looking for evidence will inevitably lead to finding gaps in the evidence – this will become a rich source for NHS-relevant research questions which can be fed back into local and national research;
- remind trusts that the point of research is on patient benefit and not just about maximising income; and
- highlight the risks of not using research, as research is where the evidence for improvement derives from.
Towards a joined-up R&D future
Although the problems facing the NHS are plentiful, so are the number of health researchers and innovators willing to uncover better ways of doing things.
The 2016 NHS R&D Forum was alive with ideas and interaction amongst delegates who all wanted to see a step change occur, and their own personal reasons for why they do research were displayed around the event. With so many people in the workforce sharing a passion for saving lives and improving care, it is possible to see the culture of the NHS becoming one of continuous development in finding better ways of doing things, and getting better at doing them.
But, as Brindle concluded, the NHS now needs the help of the health research community like never before. Without wasting any of the research effort, academics should work with the users of evidence and the people who commission or deliver care in the NHS, to co-produce research that the NHS really needs. And, to prevent funders from feeling removed from the environment they wish their research to improve, NHS R&D teams should strive to both keep them in touch with the NHS and help them recognise the need for greater co-production of research in the months, and years, to come.
By Emma Wootton, RESEARCHconnect