AHP research: excellent opportunities in challenging timesDr Angela GreenLead Clinical Research TherapistHull and East Yorkshire Hospitals NHS Trust & NIHR NEYNL comprehensive local research network

How important is research to the NHS?

•There will always be a need for new evidence to support or challenge practice

• Future research priorities may have to focus on improving productivity, cost effectiveness and meeting targets e.g. reducing likelihood of readmission within 30 days of discharge

DH Equity and excellence: Liberating the NHS (July 2010)

3.16 The Government is committed to the promotion and conduct of research as a core NHS role. Research is vital in providing the new knowledge needed to improve health outcomes and reduce inequalities. Research is even more important when resources are under pressure – it identifies new ways of preventing, diagnosing and treating disease.

Why research is important for your organisation

Since 2010 every NHS Trust has been required to publish an annual Quality Account which is available to the public. This includes a statement of the number of patients who were recruited to participate in research approved by a research ethics committee during that period.

Why research is important for your organisation

Using this data, the Guardian newspaper and National Institute for Health Research published a research activity league table on 2nd December 2011. N.B. This illustrated participation in NIHR portfolio studies only.

Organisation Position in table

Number of NIHR studies 2010/2011

Number of patients recruited2010/2011

Central Manchester University Hospitals

11 204 4635

The Christie NHS Foundation Trust

21 136 1301

Salford Royal NHS Foundation Trust

31 111 3167

University Hospital of South Manchester NHS Foundation Trust

42 86 21,476

North West Ambulance Service

Unplaced 0 0

How research can benefit AHP services

Knowledge is valued since, if applied, it has the potential to improve the human condition. If an organisation only undertakes established procedures, it is simply a ‘provider’ among many providers. An organisation that undertakes research and development has the capacity to potentially offer unique care, and, more importantly, is seen to have the drive to do so. Consequently, it moves into a different ‘league’. Being in this ‘league’ makes it easier to attract, recruit, retain and develop staff, and effects how the population, commissioners and other providers feel about the organisation: it becomes a source of local pride.

(HEYHT Research and Development Strategy 2009-2012).

Clinical research - Lows!You realise that there are a lack of validated outcome measures to use in your study

You discover just how much it costs to order articles through your medical library!

Mastering the IRAS (ethics) and R & D forms

Discovering that you need MHRA approval

Your equipment supplier ceases trading!

Your grant application is rejected

Your application gets lost in a bureaucratic black hole

Your supply of eligible patients disappear

Staff leave/ rotate or become to busy to participate.

Data analysis reveals no difference… or worse!

Etc……..

Clinical research – Highs!Discovering that other people value your idea

Discovering that your clinical research question will address a gap in research evidence

Securing your managers approval

Successfully obtaining funding to support your project

Receiving a favourable opinion from the research ethics committee

Recruiting your first few patients

Discovering that your data supports what you suspected, or suggests something far more exciting!

Having a paper accepted by a peer-reviewed publication

Research in nursing and the allied health professions. Report of the Task Group 3 to HEFCE and the Department of Health. Bristol: HEFCE; 2001.

underfunding relative to comparable professions

underfunding relative to the size of the professions

Funding skewed towards short-term projects There was a need to support career

development and research opportunities for health professions researchers, teacher researchers and clinician-researchers

Nurses and AHPs from 54 North West region NHS organisations and 8 HEIs were either interviewed or completed an electronic survey.

Barriers identified: Lack of time lack of funding

• To backfill posts• For education and training• To support research projects

Lack of practical support. Organisational culture focussed on achieving targets and

service delivery Lack of any clear career structure

( Pidd, H.; Tinston, C. (2009) Non medical research and development workforce scoping exercise).

Barriers to AHP research in the North West

Breaking into research study day, York 2010

Attitudinal Lack of management support Negativity from colleagues Tradition – research is not a major component of AHP job

descriptions Lack of confidence to develop ideas

Resources Time to develop idea Access to relevant IT software and hardware and desk space! Lack of appropriately skilled staff to backfill posts.

Process Work in silos – lack peer support Put off by the time taken to go through governance and ethics

Solutions: Time Impact assessment: research geared

towards key service priorities Directory of AHPs willing to be involved in

research Increased investment in joint academia/

NHS funded clinical research posts. Research Secondments with NIHR or

HEIs

Solutions:

Partial Involvement Identification of clinically relevant research questions for HEI

projects Involvement in study design & grant applications as part of a

stakeholder group/ expert panel Participation in portfolio studies

Involvement in study set up/gaining permissions Identification of suitable patients for studies

Recruitment to studiesProviding interventions under study – portfolio projectsData collection/outcome measures

Dissemination of results: Journal club or in service training sessions

Implementation of research evidence – service development

Portfolio Studies ?

Research proposals which have been successful in open, national competitions and been subject to independent peer review i.e. high quality, studies.

NIHR portfolio studies have automatic access to NHS support costs

Include multi-centre and single centre studies

Include commercial and non-commercial studies

Benefits of participating in portfolio research studies

Chance to collaborate with leading researchers in your specialist area;

Possibility of training and/or use of novel assessment tools, outcome measures or interventions;

your assistance will help ensure the success of much needed, high quality AHP research projects which provide the evidence to support or challenge what we do.

Experience of the research process CLRN support costs should be paid to your

department to support the time that you devote to the study, plus support infrastructure to help get the process underway

Accessing the UKCRN portfolio

databasehttp://public.ukcrn.org.uk/search/

Spoilt for choice?

Spoilt for choice?

Primary care study of interest to manual therapists and those trained to administer acupuncture.

Career structure: clinical researcher posts

In May 2005,

NHS employers. org incorporated five generic therapy

research job profiles on the Agenda for

Change/ KSF registerhttp://www.nhsemployers.org/

AfCmin AfCmax

Clinical Researcher 6 6

Clinical Researcher Specialist

7 7

Practice Education Facilitator

7 7

Clinical Researcher Principal

8a 8a

Clinical Researcher 8b 8d

AHP Consultant 8b 9

Doctors and DentistsNIHR Integrated Academic

Training

All ProfessionsNIHR Fellowships

Nurses, Midwives, Allied Health Professionals

Clinical Academic Training

NIHR Clinical Lectureship

NIHR Clinician Scientist Award

Masters Health Economics,Masters in Med. Statistics.

NIHR Doctoral Research Fellowship

NIHR Post-Doctoral

Fellowship

NIHR Career Development

Fellowship

NIHR Senior Research Fellowship

NIHR/CNO Masters in Clinical

Research

NIHR/CNO Clinical Doctoral Research

Fellowships

Level of AwardOther Awards

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Senior/Pre-Chair

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NIHR Research Career Pathways

SeniorPost-Doc

Early Post-Doc

Doctoral

Pre-Doctoral/Masters

Undergraduate

NIHR/CNO/HEFCE Senior Academic Clinical Lecturer

In-Practice Fellowshipsand NIHR Academic Clinical Fellowships

NIHR/CNO Clinical

Lectureships

CSO Health Care Scientist

Doctoral Fellowship

CSO Health Care ScientistPostDoctoral Fellowship

Other organisations offering fellowships to AHPs

http://www.rdinfo.org.uk/

Arthritis Research UK Diabetes UK Fight for Sight Medical Research Council Parkinsons UK Public Health agency Northern Ireland Stroke association Wellcome Trust

Funding To support research projects:

NIHR funding streams (e.g. research for patient benefit; Health services and delivery research programme etc)Professional body research funding

For education and developmentNIHR and some research and development organisations provide free research training e.g. Good clinical practice (GCP training)

For backfilling postsClinical research networks and CLRNs provide service support costs to pay for involvement in portfolio studies over and above what is considered usual care. Where there is the potential to be involved in a number of studies, the NIHR has supported research AHP posts.

Support with your own project

Organisational R & D department or consortium Regional AHP research forum Professional society NIHR networks

6 Topic Specific Networks (Cancer, Stroke, Medicines for Children, Mental Health, Dendron, Diabetes)A Primary Care Research Network

25 Comprehensive Local Research Networks National and local Specialty Groups RDinfo website (http://www.rdinfo.org.uk/) Research design service

Research design service for North West

Based at Lancaster University

rds-nw@lancaster.ac.uk.

Telephone: 01524 593209

You may contact the RDS at any stage of your proposal development, but it is preferable to contact us at an early stage to discuss your ideas.

Making research easier ?

In December 2011, the Government established a Health Research Authority whose purpose is to co-operate with others to combine and streamline the current approval system and promote consistent, proportionate standards for compliance and inspection. It will reduce the regulatory burden on research-active businesses, universities and the NHS, and improve the efficiency and robustness of decisions about research projects.

The NIHR is also developing research support services to simplify approvals and permissions, and is working towards unified knowledge management systems for the NIHR and its partners.

Key points include: wherever possible, researchers will complete procedures and input data once for

multiple uses researchers have free access to expert advice and information about regulatory

approvals, permissions and good practice systems are being strengthened to ensure more effective dissemination of outcomes

of research All organisations in England that provide care, fund research, employ researchers or

review or regulate research will be eligible to use the new systems.

In conclusion: Research is a Government priority In such financially constrained times, research is a

vehicle which will enable AHPs to demonstrate the value that we bring in enhancing hospital discharge and prevention of admission

There are a number of different sources of help and advice for novel researchers, but it is advisable to be proactive and seek help early in the process.

Interdisciplinary Collaboration and strong PPI links are the key to successful research funding bids.

If you don’t fancy being a research lead, there are many other opportunities which exist to influence future research and practice

Thank you for listening.

Humber Bridge

Hull Fair