Driving progress in health care through NHS researchNational Institute for Health Research

IntroductionWilliam van’t Hoff, Clinical Director for NHS Engagement, NIHR Clinical Research Network

• Provide a flavour of the many different ways in which the NIHR is driving progress in healthcare

• Share our experiences of the NIHR, but also provide a wider national view

• This will be followed by a Q&A panel session

Come talk to us about how the NIHR can help your NHS improve through research – stand 119

The benefits and impact of clinical academics and NIHR traineesGilly Howard-Jones, Lymphoma Clinical Nurse Specialist,University of Southampton NHS Foundation Trust and NIHR Clinical Doctoral Research Fellow

Overview

• My background

• My research

• Clinical development during the fellowship

• Outcomes so far

• Looking to the future

My background

• RGN Diploma 1993• Cancer nursing • BSc. Nursing 1996• MSc. Medical Anthropology 2000• NIHR MRes 2012, NIHR Internship 2013• NIHR Clinical Academic Fellowship 2014

My Research : The influence of social networks on self-management support in cancer survivors: A mixed methods StudyQuantitative postal survey

Qualitative interviewsInvited to

participate from survey

Interpretation based on Quantitative (qualitative )

results

Undertaking clinical development• Planning the application with clinical staff

- Member of NICE Guidance Development Group for NHL - Patient Triggered Follow Up - Advanced Nurse Practitioner role development

• Engagement with Lymphoma Association - Supporting development of survivorship services

Outcomes so far…..

• Patient experience

• Team

• Hospital Trust

• University

• National influence

Looking to the future

•Completing my PhD !

•Creating a new clinical academic post

•Clinical Lectureship application- TIME and

RESOURCES

Thank you

Email: ghhj1e11@soton.ac.uk

Twitter : @GillyhjJones

How DRAFFT improved care, made cost savings and achieved consistency across the NHSMike Reed, Consultant Trauma and Orthopaedic Surgeon,Northumbria Healthcare NHS Foundation Trust

About Me

Trauma and orthopaedic surgeonFull time clinicianI just do regular trauma on callI’ve run some clinical trialsNo involvement in this study (although I did do some surgery)“So why are you here?”

Background

In the Western World, 6% of women will have sustained a fracture of the distal radius by the age of 80 and 9% by the age of 90

Most common interventions in the UK

• Wires• Volar fixed-angle plates

Most common interventions in the UK....

VS

Funding• National Institute for Health Research

Health Technology Assessment

• Why?

• Clinical and cost-effectiveness

DRAFFT Centres

Outcome MeasuresPrimary • Patient Reported Wrist Evaluation (PRWE)Secondary• Disability of the Arm, Shoulder and Hand (DASH)• Radiographic changes• Complications• Health Economics (EQ-5D, resource use)

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Numbers

• Screened: 12,000 patients with a distal radius fracture• Eligible: 639 patients• Recruited: 461patients (more than anticipated)• Follow-up: over 90% at each time-point

Patient-rated wrist evaluation

Lower score = better outcome

The result

This large, multi-centre, pragmatic clinical trial shows that there is no difference in patient-reported wrist evaluation in the twelve months following Wire fixation versus locking-plate fixation.

Confidence intervals exclude a clinically relevant effect (95% CI; -4.5 to 1.7)

The result: sub-groups

No difference in under 50 years versus over 50 years

No difference in those with intra-articular extension versus extra-articular

Result: further surgery• 5 patients in the wire group and 2 in the plate group

required revision surgery for loss of reduction

• 9 patients in the plate group required removal of symptomatic metalwork (4 for screw penetration of the joint) and 1 patient with a buried K-wire required removal in theatre

The result: Health EconomicsEconomic evaluation completely driven by the choice of implantWires were cheaper: £54 vs £854No difference in Quality of Life in the 12 months after surgery

Therefore, wires are cost saving

So what happened next?

• Did anyone take any notice?• Did anyone get upset?

• And, did anyone change their practice?

National/international presentations:

• Trauma Trials Meeting• OTS• BSSH• BOA• EFORT• OTA• NZOA

Local presentations/meetings

• Many site visits• Local presentations by the Principal Investigators• Teaching courses

Papers

• British Medical Journal• NIHR-HTA Monograph• Bone and Joint Journal• Patient newsletters

Modern stuff…

• Podcasts• Journal Blogs• ‘Tweeting’…

So did anyone get upset about DRAFFT?

Yes

…mostly the hand surgeons…!

Reaction…

• “…in my hands…”

• “I’m not a statistician, but I have concerns about the statistics”

So people heard the results, but did they take any notice?

English HospitalEpisode Statistics:surgery for fractureof the distal radius

Cool!

• But surely not everyone changed their practice…

• Surely not the hand surgeons…

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So everyone is changing?

NORTHUMBRIA

Conclusions• Use more wires. Save lots of money.

• UK Orthopaedic Trauma Surgeons can deliver multi-centre clinical trials

• They really do change clinical practice!

How the money stacks up…

DRAFFT cost the taxpayer about £1.5 million

The 25% shift in practice has already saved £1.6 millionWill continue to save year on year.

NIHR Musculoskeletal Trauma TrialsPROFHER

RESULTS NEXT WEEK

Patient experience of participating in researchVee Mapunde, Associate Consumer LeadNational Cancer Research Institute

The NCRI Consumer Forum – BackgroundFormed in April 2015, funded by NCRI (with NIHR support), follows CLG (funded by NIHR Clinical Research Cancer Specialty Group)

Objective:To create a professional, focussed and committed constituency of consumer research partners, who can help NCRI achieve its aims

Nine specific points, including: To provide a pool of well-trained consumers to input into NCRI and partner research activities, committees and groups, as equal and valued partners

How I got involvedDiabetes• Why him? And why now?• Could I have stopped this?

Prostate Cancer• Why is it that some people can “live” with this condition?• Why is it more aggressive in some ethnic groups?• How does this affect patient outcomes?• What impact can I make?

How patient involvement benefits the NHS• Patient experiences can drive service improvements and promote research• Patients get involved in finding solutions when researchers bring ideas or problems to

them • Taking part in research is associated with better experience of care – 88% of all

cancer patients are satisfied/v satisfied with care; increases to 93% for participants• Increase our understanding of challenges associated with hard-to-reach groups,

geographical inequalities of access to research opportunities, gaps in clinical trial portfolios, matching patient priorities

• We can change practice faster – working with the NIHR, NICE and MRC CTU

Q&A panel session

Remember, we’re on stand 119 if you would like to find out more

Thank you all for attending and taking part