Thirst for knowledge? Why the NHS should take clinical research seriously

In September HSJ collaborated with the National Institute for Health Research Clinical Research Network to investigate just how seriously NHS organisations take clinical research.

The premise was simple. Clinical research is not ingrained in the NHS – but it should be, says the NIHR Clinical Research Network. Successive governments have highlighted how NHS participation in research not only supports the development of the highest standards of care but also helps the country by retaining a profitable life-sciences industry.

The online questionnaire received 121 responses, including five chief executives, 68 managers (including clinical managers), more than 20 clinicians (including doctors, nurses and scientists), two non-executive directors, four R&D directors and one person who described him or herself as a litigant.

This cross section of people worked right across the NHS, with a third coming from teaching hospitals, a quarter from other secondary care settings, and others from primary care trusts, research networks, clinical commissioning groups, mental health trusts, and strategic health authorities or the Department of Health.

Key finding: 97 per cent felt research is very important or important to the NHS

“This is an extremely encouraging response,” says NIHR Clinical Research Network chief operating officer John Sitzia. “This is people saying that research is important not only to human health but to the development of the health service in England. Hopefully it reflects people seeing clinical research as core work of the NHS alongside clinical care.”

Key finding: 32 per cent said research is being undertaken in most clinical areas in their region

This finding is at odds with the facts, says Mr Sitzia.

“The fact is 97 per cent of local NHS organisations are research active and recruiting patients to NIHR Clinical Research Network studies. The handful not involved are new community trusts and ambulance trusts, partly because little research is commissioned in the pre-hospital domain.”

It is possible this low awareness reflects the fact that in many organisations only a small number of departments are involved – and may not be sharing their work more widely in their own clinical communities.

However, it was consistent with other answers given. Survey asked a series of questions to gauge the corporate importance of clinical research.

The findings overall were complementary. So, for example, 31 per cent said clinical research was embedded in planning and performance at board level; 32 per cent said it represented an important income stream; and 39 per cent said clinical research was a high priority in their organisation’s development strategy. However, 61 per cent said research was “peripheral and driven by individuals”.

“This gives us a picture of around one third seeing research as routine, embedded in the corporate culture and important as an income stream,” says Mr Sitzia. “We would like this to be higher and indicates that there is work to be done at executive and non-executive director level to raise the profile of clinical research.”

Key finding: 73 per cent said clinical research will help their organisation maximise income in the new NHS landscape

Mr Sitzia says it is encouraging to see such a large proportion recognise what is, in fact, a reality. The NIHR spends around £920m per year of which £301m is allocated to the NIHR Clinical Research Network. All organisations share a proportion of that but, roughly speaking, the more research an organisation carries out and the more patients it involves, the more of this funding it receives.

“The NIHR Clinical Research Network has been incredibly successful over the past five years in recruiting new NHS patients to research,” he says. In 2010-11, it recruited 565,000 patients—up from 330,000 in 2008-09 – and delivered 60 per cent of commercial and non-commercial trials in England.

“These sorts of figures are the envy of the world,” says Mr Sitzia. “Clinical research is now – and will continue to be – an important income stream for NHS organisations.”

Key finding: 91 per cent said research will help their organisation foster innovation

Mr Sitzia calls this an “excellent result”.

“An organisation that is research active and puts a high priority on clinical research attracts individuals who are critical thinkers about their own work and always questioning their practice,” he says.

Key finding: 33 per cent said their organisation had a strategy for developing closer commercial links with the life-sciences industry

“This shows an awareness of the need to support commercial research in the NHS,” says Mr Sitzia. “There is a key link between national wealth and growth of life sciences in the UK. It is a cornerstone of the growth agenda set out by the government.”

It is disappointing that it is only one third, he adds. “But this is a good baseline from which to grow.”

Key finding: training and understanding research roles was the most cited need for support

The questionnaire asked a series of questions about what support organisations needed to develop clinical research as a core business. Putting aside the 27 per cent who said their organisation did not envisage developing it as a core business, the most cited needs were:

• training and understanding clinical research in the NHS;
• knowledge of funding streams;
• promoting studies to patients.

Alongside this, respondents were asked to indicate their perceived barriers to research. Their free text comments talked about funding, lack of time and the bureaucracy involved.

Mr Sitzia points out that the 25 NIHR comprehensive local research networks and the NIHR Research Design Service are already able to support organisations in much of this.

Local NIHR staff can advise on funding streams, for example, although the fact that so few people seem to know this indicates a gap that needs to be addressed.  At a national level, the NIHR Clinical Research Network exists to take the pain out of the bureaucracy and is working hard to streamline processes.

“I do think there is an issue of professionalising research roles, especially for nurses,” he adds. “Doctors have a fairly well established career pathway but other clinicians struggle if they want to pursue a career in research.”

The Clinical Research Network is developing a workforce strategy to help address this. It is also looking at how to involve patients and the public in clinical research, for example by involving them in writing information sheets and consent forms for studies.

“Patients are also powerful advocates and are a great untapped resource when it comes to recruiting people to trials,” he adds. “Trusts could certainly consider how they can use their local patient groups.”

Finally he issues a word of warning to those who do not see clinical research as a core business, now or in the future. “The research agenda is closely aligned to the direction of travel of the NHS,” he says. “It is about finding ways of using resources more efficiently and effectively and using that knowledge to improve patient care. Organisations that do not feel it is a priority will find that they are being left behind as the world moves on.”