Developing new combined clinical and research roles will be part of wider organisational and culture change that the NHS must go through in order to push more of its best people into doing research. Jennifer Trueland reports

There’s a growing body of evidence that being a research-active NHS organisation is good for patient care.

Clinical research means patients get access to newer treatments, faster; it can generate income, and help to build trust reputation and attract and retain the best staff.

But although there are significant pockets and clusters of great practice, research is still far from embedded across the NHS.

That’s a shame, says Tracey Batten, chief executive of Imperial College Healthcare Trust, who believes that some trusts could be missing a trick.

“Imperial was the first academic health science network in the UK; it’s really in the DNA of the organisation.

“All our staff know that what we aim for is excellent clinical services, research and education. It’s inherent to the delivery of everything we do.

“My view is that it ensures that our patients are getting access to the latest technology and innovations; it means we have clinicians with enquiring minds, delivering excellent and safe care. Yes, it takes investment in the workforce, but it’s a workforce that’s looking at how we can improve patient care every day.”

Culture of innovation

Of course, the money that research can bring in terms of research grants and other sources of income isn’t to be taken lightly.

Tim Jones, director of delivery at University Hospitals Birmingham, who has board level responsibility for research and development, reckons that research and development is worth some £30m to the trust.

“We’re a large, tertiary teaching hospital and we’re very interested in research,” he says. “For us, it’s pragmatic as well as altruistic. To attract the best clinicians you need a culture of research and innovation. Being known for research means we get higher calibre candidates for jobs. But it’s also reputational in a broader sense. If we’re associated with interesting research, then it can lead to positive publicity, which is great for us locally and nationally.”

He believes that more and more research is being carried out in a multidisciplinary way. He welcomes moves to encourage all health professionals to develop their knowledge, skills and confidence around research. Again, it’s a mix of pragmatism and altruism.

“It’s not only about research in itself; there are transferable skills, like learning how to build a business case.”

Brightest and best

He does believe that wider cultural change around research is needed across the NHS. “We’re buddied up with a district general hospital to help people to see the benefits,” he says. “In too many places, research is still seen as pulling people away from clinical care. But when you have clinicians involved in research it can make an immediate transformational difference that really brings great value.”

It is not only clinicians who need to be engaged in efforts to embed research, he adds. “Managers need to be willing to release staff, and sometimes the problem is that it’s your brightest and best who want to do research, so you don’t want to release them. But if you’re going to keep your brightest and best, you’ve got to support them to do what they have to do.”

Just as research has historically been more common among medics than other clinicians, so too has it often been seen as the preserve of the acute teaching hospital. Sarah Williams for one would like to challenge that view.

”We might not have large biomedical research centres, but we can excel in community and mental healthcare research and particularly AHP-led research”

Ms Williams is associate director of research and clinical effectiveness at Solent Trust, which is one of the largest providers of community services in the NHS and a research pioneer. She believes it’s vital that research takes place in all health and care settings. “Traditionally the big acute teaching hospitals have been very active in research – they’ve got the medical resources and they have the infrastructure. We’ve challenged that down here.

”We might not have large biomedical research centres, but we can excel in community and mental healthcare research and particularly AHP-led research. We need more evidence around community and out-of-hospital care, as that is the direction of travel, particularly for long term conditions.”

With a wide portfolio that stretches from podiatry to dementia and rehabilitation to sexual health, the trust is encouraging all clinicians to get involved in research. Ms Williams believes it brings benefits to the trust. “It’s not just about income and getting people access to big trials. It’s also about using research to improve the care we’re delivering. In some studies it’s a long game – we don’t see immediate benefit. But in others, you can really see it having an impact.”

She cites research that has involved engaging with care homes to improve care for people with dementia. “We’re trying to do more with social care, and be more integrated,” she says. “The real value of research is when it’s not isolated.”

Near neighbour University Hospitals Southampton Foundation Trust has a reputation as a research-active trust, and has also been a pioneer in developing interesting career opportunities for nurses and allied health professionals who want to combine research with clinical work.

Combined posts

Judy Gillow, who was until September the director of nursing and organisational development at the trust, has been instrumental in setting up two combined posts at professor level, one (for a clinical nurse chair) has already started and another post is in the pipeline. Both are joint appointments between the NHS and university.

“We’ve been working with Southampton University to develop a clinical academic research pathway,” she explains.

“The impact so far has been phenomenal; it’s been a real success and I hope there will be many more.”

There are several reasons why the trust focuses on clinical academic careers, she says. “We should be developing leading edge care, and this is a way to attract good practitioners, to broaden practice, to encourage people to ask critical questions and develop their analytical skills. The patients benefit, the trust benefits, and the individuals are happy at work.”

This rings true for Wendy Tindale, consultant clinical scientist and scientific director at Sheffield Teaching Hospitals who (among other roles) holds a chair at the University of Sheffield and is clinical director of Devices for Dignity, an NIHR Healthcare Technology Co-operative.

She and her colleague Sue Pownall, head of speech therapy at the trust, say that encouraging and training AHPs to take up clinical research has valuable knock-on effects for health services as well as the clinicians concerned.

“It builds staff confidence, they feel more able to ask questions and challenge – and that benefits patient care,” says Ms Pownall.

Professor Tindale believes that the time is right to develop clinical academic careers across the spectrum of health professionals. “It’s important to look at the big picture and the whole of the patient’s journey, and see who is in the right place to ask the right questions. But it’s also about disseminating the results of research, and I think it’s important to involve patients and the public in spreading that message.”

Creating new clinical academic posts is not necessarily easy, but it is worth it, says Sir Ron Kerr, former chief executive and now executive vice chairman of Guy’s and St Thomas’ Foundation Trust, which employs a number of staff on the Integrated Clinical Academic programme.

”While it may seem challenging to create half time clinical roles, it is not impossible, and the fears that staff would leave the trust once they completed their research, or move full time into academia, have proved unfounded”

“While it can be a challenge to create these roles, particularly among nursing, midwifery and allied health professionals, the benefits are clear. By allowing staff to combine academic research and clinical activities, we have attracted new talent to the trust and also been able to provide exciting and valuable development opportunities for existing staff.

“These staff undoubtedly bring additional skills and knowledge into the organisation and are then able to apply this to their clinical practice. The type of research that is being undertaken will enable us to improve clinical quality, safety or even patient outcomes.”

Current ICA roles at Guy’s and St Thomas’ are wide ranging and include a dietitian looking at the prevention of type 2 diabetes among patients with HIV; a nurse looking at how to improve communication about the BRCA 1 and 2 mutations to patients with breast and ovarian cancer and their potentially at risk relatives; a midwife looking at women’s experiences of risk assessment for pre-term birth; and a dietitian looking at the impact of malnutrition among elderly people accessing health and social care services in the community.

“While it may seem challenging to create half time clinical roles, it is not impossible, and the fears that staff would leave the trust once they completed their research, or move full time into academia, have proved unfounded,” adds Sir Ron.

Commercial gains – including potential profit from spin-off companies – are obviously an attraction for any trust but, back in Birmingham, Mr Jones believes there’s a bigger game afoot.

“Our vision is to develop the best in care. To do that, there must be a focus on quality, patient experience, research and innovation, and a fit for purpose workforce. Research is at the very heart of our values.”