A music therapist’s investigation into the benefits of her therapy is just one example of the new directions research is taking on the ground

Music therapist’s fanfare for research

As a music therapist working in the NHS, Catherine Carr had always wanted to study for a doctorate, but the barriers seemed insurmountable.

How could she afford the salary drop if she gave up her job? Could she juggle working and studying at the same time? What would happen to her career if she took time out?

But working with adults with mental health problems, she also had a fierce desire to do more to help her patients and those like them; what’s more, she had a good idea about how that might be possible.

“I really felt that intensive music therapy in adult inpatient settings could bring real benefits, but it was difficult to find evidence to back this up,” she explains.

“I wanted to know things like whether patients would take it up if it was offered more than once a week, what impact it would have in a hospital environment, whether it would lead to more positive outcomes for people with mental health problems, and for staff. But to find out these things, it was necessary to have a thorough understanding of the intervention.”

“What we can say about music therapy is that it gives people a chance to be heard – they don’t have to have words,” she says.

In other words, the way forward for Ms Carr was research, but she didn’t necessarily feel she was equipped to take it forward on her own. “My background was a music degree – our training didn’t really cover the basics of research,” she explains.

A colleague made her aware of the possibility of applying for NIHR funding; she was successful, and has now completed her PhD.

While this is obviously a tremendous personal achievement, the research is already having an impact on patients and health services. Early results show that inpatients who take part in music therapy several times a week experience benefits such as being able to express themselves emotionally, connect with other people, and have a better attention span. “What we can say about music therapy is that it gives people a chance to be heard – they don’t have to have words,” she says.

Improved relationships

Staff reported in particular that intensive music therapy had an immediate effect on patients’ mood, with angry patients becoming calmer, and sad or low patients becoming livelier. “[Patients] felt safe enough to say they were angry, for example,” she adds. “It also improved relationships with others on the ward.”

As a result of her findings, her trust has taken the principles of intensive therapy for adult inpatients and is looking at applying it across arts therapies. Ms Carr is also investigating whether it is beneficial for people who aren’t inpatients, which could lead to even more change.

Ms Carr is now working with East London Foundation Trust and Queen Mary University of London. Having thoroughly caught the research bug, she has now been awarded an HEE/NIHR Clinical Lecturership that will allow her to continue her joint role as a clinician and researcher.

One of her goals is developing what will effectively be a manual for other music therapists, so that they can put her research findings into practice – benefiting the NHS as a whole, staff, and, of course, patients and service users.

Healthcare scientists optimising diabetes care

Across the NHS, pathology workload is increasing at around 8 to 10 per cent each year, placing a huge burden on lab resources and trust finances.

Yet not every test is necessary, some are taken at the wrong time so are virtually useless, and there’s duplication in the system, wasting patient and staff time as well as public money.

Even in one disease area such as diabetes, getting a better handle on how, where and when tests are ordered has the potential to save the NHS millions. But how do you do it?

That’s where Owen Driskell comes in. The clinical biochemist and NIHR Clinical Research Network lead for laboratory medicine, based in the West Midlands, is working to improve test utilisation – with likely positive effects for quality and outcomes as well as the financial bottom line.

His work in diabetes has shown that huge improvements could be made to optimise testing in diabetes, with implications for all disease areas, on the basis of focused and skilled clinical research.

“The aim is to make sure that the right test is performed for the right patient at the right time to ensure the best outcome for patients while making the best use of NHS resources,” he says.

Having become one of the first recipients of a Healthcare Scientist fellowship, 50 per cent of Mr Driskell’s time has been protected for research. This has allowed him to take part in the INTERCEPT study, which aims to reduce the burden of unnecessary testing in pathology, using diabetes as a model.

“The aim is to make sure that the right test is performed for the right patient at the right time to ensure the best outcome for patients while making the best use of NHS resources,” he says.

“We know that there’s quite a lot of variety between labs, but we wanted to know why.”

He and colleagues found out that almost half of HbA1c tests in people with diabetes were taken at times that didn’t comply with guidance, some done too soon, and some too late. This is costing the NHS large sums of money, as well as potentially harming patient outcomes.

Work to improve adherence with guidelines and optimise testing, efficiency and patient outcomes is underway.

“The guidelines, at the minute, are based on expert opinion rather than research evidence. In the INTERCEPT study we have also shown what optimal testing would be and that it is associated with better diabetic control and so would lead to fewer adverse patient outcomes, for example strokes, heart attacks (which have far greater economic burden than the cost of the tests to avoid them).

“To me this highlights that laboratory results are not just numbers, they are central to effective healthcare and have an impact way beyond laboratory budgets.”

Mr Driskell has planned his career with an eye to research possibilities. “One of the reasons that I chose the job in the West Midlands was the opportunity to develop research. With the support of my boss, I was able to pursue an interest in research and then the NIHR opportunity came up. This offered the chance for me to focus on developing as a researcher, but also to do the research in this important area.”

He believes that health scientists – and patients – benefit from being engaged in clinical research, but says it is difficult for them to pursue it without support.

“We need to engage young training scientists to recognise that research is part of what the NHS does,” he says. “And we also need the NHS to be responsive and encourage staff to take up these opportunities and support them to do it.”

Spreading the message about the value of research

Anthony Gilbert really loved his job as a physiotherapist at the Royal National Orthopaedic Hospital, working with complex patients in a highly specialist setting.

But a desire to further improve the already excellent care that was offered at the trust led him to apply to do a masters degree in research at Southampton University.

Having completed the course, under the HEE/NIHR Integrated Clinical Academic (ICA) programme, he is now back at the trust with new roles, as therapies research coordinator and clinical academic physiotherapist.

Mr Gilbert feels that he has benefited personally from the masters programme – but believes his trust is the better for it too.

“I’ve been taught to be a critical reader – I can look at a journal article now and critique it. I’m also happy to challenge colleagues’ thinking – I think I’m quite unpopular now,” he laughs.

“But I actually think that research is becoming more popular in the therapies directorate. People are aware of what I’ve done, and others are interested in doing a masters, or getting involved in research.”

He also believes that doing the masters has helped his standing in the department. “People see me as more of a leader and I can support and mentor other people to do research. People can see what I’ve done, and I think they’re interested in taking something similar forward themselves.”

His research ambitions have by no means stopped with the masters degree. “I really want to do a PhD but I also want to stay in the NHS and stay in this hospital. There are challenging and complex patients here, and I love it.”

He believes, however, that people who have done the masters need to be supported to continue research when they go back to their NHS posts.

“For me, I’ve come into a newly developed post and it has a real research focus. But some of my cohort on the masters have gone back to their purely clinical posts and they don’t really feel they have the space to continue with research. It’s great that we’re training people, but I think there’s a real need to prioritise the career pathway.”

Getting support from his manager to do the masters and also to recognise the value of research has been crucial. “Without that support from my manager, I wouldn’t have been able to do it,” he says. “But I think that having a focus on research really helps the NHS. For me, it’s really exciting and there’s a real buzz in our department. It’s really making a difference.”