Clinical research should be a ‘real positive’ that helps the career progression of all clinicians, not just medics, says HEE’s Nicki Latham
Nicki Latham would love to see a day when clinical research is so embedded in the NHS that it becomes an unquestioned part of it. She would like it to be seen as just something that’s done, because that is what the NHS does.
But the chief operating officer at Health Education England knows that there is still a way to go – and believes that a research-ready workforce is key to making it happen.
That is the reasoning behind the relatively recent drive to promote clinical academic careers across a wide variety of health professions, not just doctors.
For Ms Latham’s organisation, there are policy imperatives that must be met. For example, under the terms of the Health and Social Care Act, HEE has a statutory responsibility to promote research.
The organisation has also been mandated to develop a more flexible workforce that embraces research and innovation and can adapt to the changing demands of public health, healthcare and care services.
“We need our healthcare professionals to be evidence-based in their practice, so the question is how should we go about making that happen.”
But, according to Ms Latham, it goes deeper than these organisational responsibilities: it is about ensuring that research is at the heart of workforce development.
“From our perspective, it’s clear that research-active trusts provide better care for patients and it’s equally clear that you shouldn’t separate theory and practice,” she says. “We need our healthcare professionals to be evidence-based in their practice, so the question is how should we go about making that happen.”
One of the big issues, of course, is that clinical research has for many years largely been the domain of medics, particularly in terms of combined clinical and academic posts.
So how is HEE working to change that culture, and meet its other objective of supporting clinical academic careers and increasing numbers of staff across all clinical and public health professions with a proper understanding of research and its role in improving health outcomes?
Forging a link
Developing a clinical academic career framework and pathway has been a good start. “At HEE we contribute to the policy and provide the framework,” says Ms Latham. “Our teams started to work in a multiprofessional way to build that.
“What we really want to do is ensure that all health professionals have the opportunity to develop skills and confidence in research – and to ensure that we have the next leaders for the current and future workforce, and to provide the next leaders for research.”
Although the focus of the new framework – the HEE/NIHR Integrated Clinical Academic programme – is non-medical health professionals, the medical model is an inspiration, says Ms Latham.
“From our perspective, we’ve seen from medicine how clinical academics have had a real impact, contributing new medical knowledge and ways of delivering care. It’s our responsibility to provide the opportunity for other clinicians to forge that link between research and practice and make a real difference to patient care.”
She sees it as a crucial part of workforce planning, particularly as the public sector continues to grapple with well rehearsed challenges such as an ageing population, new and expensive technologies and a move to greater health and social care integration. “We need a workforce that is flexible and responsive to what the system needs,” she says simply.
The HEE/NIHR Integrated Clinical Academic programme is a vital vehicle for delivering this, she says. But it is not a silver bullet, and won’t in itself lead to the step change that is needed for clinical research to become embedded across the health and care system. “Having role models is key,” she says. “In medicine it’s accepted that doing clinical research is a real positive in terms of career progression. But when it comes to non-medics, there’s still quite a lot of work to do.”
Part of that is very definitely cultural. “In a way, it’s a change management programme,” she says. “We have to get to the point where research is something that’s seen as what we do in everyday practice. That’s about engagement and educating and empowering staff and managers.”
With its national role, HEE is “pivotal” both in creating the framework and in encouraging organisations to take it forward, she says.
“We live in difficult and challenging times, and so it’s important that research is an important constant, rather than a ‘nice to have’,” she adds.
It is early days for the Integrated Clinical Academic programme, but feedback so far has been overwhelmingly positive, says Ms Latham. “The internships are becoming really quite popular,” she says, adding that she has personally been impressed by the research that is already coming through as a result of the programme; she stresses that the grants are highly contested.
In a sense, however, HEE and NIHR are planting the seeds that will take time to reach their full potential. “We’re creating a pipeline of clinical researchers, and they are spreading what they have learned throughout their organisations and beyond.
“Of course it’s very important that research findings are put into practice when people are back in their trusts, and we need to look at evaluation to see the long term impact.”
Clinicians, she adds, are ideally placed while working on the ward (or any other healthcare setting) to recognise where there is a research need. “It needs to go from ward to research and back to the ward again,” she says.
“But doing research helps people to develop clinically as well as academically. They know the problems and the issues that their patients and service users are experiencing, and they know the questions to ask to make it better for them. That’s the important thing, and our job is to help create the policy conditions to make that happen.”
Case study: Using catheters better to fight infection
Even the most dedicated infection prevention nurse would be the first to admit that catheters are not perhaps the most glamorous part of healthcare. But catheter-associated urinary tract infections (CAUTI) can have a big impact on individuals and, indeed, on NHS resources.
That’s why Jacqui Prieto’s research and clinical work is focused on reducing rates of infection – and on reducing inappropriate use of catheters.
Currently associate professor and HEE/NIHR senior clinical lecturer at the University of Southampton and a nurse specialist in infection prevention at University Hospital Southampton Foundation Trust, she leads a combined programme of research and quality improvement to understand how catheters are used in hospitals.
Key research questions include what influences their use, what drives unnecessary use and, importantly, what can be done to reduce use in order to prevent CAUTI as much as possible, potentially saving staff time, bed days and, of course, patient distress.
“We’re looking at optimising catheter care, including prompt removal, and questioning whether they are always necessary,” she says. “Of course some patients will need catheters, but there is scope to avoid their use in a lot of cases.”
The ongoing programme of research has shown very impressive outcomes so far, including a reduction in catheterisation rate, a decrease in inappropriate catheterisation from 9 per cent in 2011 to 5 per cent in 2015, and standardised documentation for recording catheter insertion and care, and defined indications for catheterisation.
Mixing career and research
In addition, an initiative to use portable bladder scanners to assess patients for urinary retention in a non-invasive way (and avoiding, where possible, the use of indwelling catheters) has saved the trust an estimated £19,548 per month by avoiding CAUTI.
Another important part of her role is encouraging culture change, and persuading nurses that, not only can they consider alternatives to catheterisation, they should stand their ground with other health professionals, knowing that their practice is backed by the best evidence.
A joint clinical and academic appointment at professor level is unusual in nursing, so Ms Prieto is something of a pioneer. But she is determined to encourage others to follow in that path.
She believes that there is still a way to go until such appointments become the norm, but has appreciated the opportunities that working in a research-active trust have offered. “The nursing executive team has been highly supportive of this programme, which is very important,” she says.
“Typically people have had to make a choice between a clinical or academic career,” she says. “But I’ve always valued my clinical work, and for me, being able to combine the two is a dream job.”
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Having role models is key to the future of research