This Summer 2022 updated guide aims to provide some 'tools' to help you support health and care service colleagues to further embed research activity in their organisations for patient benefit at the frontline. This is an important and critical time for research in a changing health and care system. It is both very challenging and full of opportunity. If we see a future for better research and care integration, then we need to be aware of both the Integrated Care System (ICS) landscape and its needs as well as the needs for research as an activity relevant to the wider population.
You will find information here that should support you in interacting with non research colleagues in care settings. This might be facts and figures, messaging, reports, new strategic work or examples of approaches to research engagement. It includes simple key messages that you could use, such as the one below - these are scattered through this presentation site.
Health and care research is finding out what works best for people who have health and care needs in specific areas through a ‘study’. A study aims to answer a question, in this case about best care approaches, using a carefully designed method.
How do we engage with non-research colleagues about the benefits of research? In a busy, stretched health and care service, staff are focused on immediate care needs such as elective recovery and workforce, and ‘research’ can seem like an 'extra' thing only if there is time, but not a priority. The first tip might be to start with what we have in common and talk about 'best care through research.' This immediately makes a link.
After all, research is a process, not the end product. The end product is reliable scientifically generated evidence and this is the value it offers to services and their practitioners. We need to be able to see the health and care providers as customer as well as a means by which we can get research done. Our surveys of frontline research staff show that being able to build positive relationships with non-research staff and managers is key to success in delivering studies. This toolkit seeks to provide resources to help you do this.
Its sometimes helpful to celebrate with care staff how as trained people they already use research, thus drawing attention to how important research is to best patient care:
Everyone providing care uses research. But not everyone is aware of it. The core of all good training is that it is based on evidence which can be trusted.
The 42 Integrated Care Systems (ICSs) which formally began their function as commissioning bodies on 1st July 2022 are designed to provide a joined up approach to health and care service across their geography, including clinical services, public health and social care. They present opportunities for greater reach into the general population so there is more choice about participating in research and for research to be responsive to population need across these care services.
For more on what ICSs are about here is a short video from the Kings Fund:
ICSs have an explicit remit to:
- improve outcomes in population health and healthcare
- tackle inequalities in outcomes, experience and access
- enhance productivity and value for money
- help the NHS support broader social and economic development
In order to do this they will be a vehicle for achieving greater integration across social care, public health, primary care, and Trusts as well as community base services such as care homes. From the point of view of the research world this provides both challenges and opportunities in reaching underserved communities, and a wider population than ever before.
An example of this enhanced reach is a Primary Care 'Deep End' practice in the North East of England:
To engage with such a variety of care services can be challenging and perceptions of research are not always correct and these most often often separate research from care as almost unrelated activities.
How you approach different care providers will depend on who or what they are. For example, working with a local authority is an entirely different matter than working with a Trust, and the same again for primary care. They are commissioned and resourced very differently. This context is critical when looking at embedding research activity.
It is useful to have 'tools' and facts at your fingertips which can help in conversations with non research professionals and staff or indeed could be shared with them as you see fit.
Research Ready Communities
The NIHR community Engagement Model to increase access to health and care research for underserved communities.
Be Part of Research website
'Be Part of Research' is a platform for both lay people and professionals that makes it easy to understand what research is and does and find current research studies in specific clinical areas on its database. Where patients are asking about research that may not be available in a particular Trust it can be useful. NHS staff can give patients a route into what they might be looking for, or simply and quickly check on the patients behalf for studies that may suit them.
The CQC now has a remit to assess how care organisations are supporting and using health and care research to improve population health.
New 2021 CQC Strategy specifically refers to the value of research in population care
The new CQC strategy published in June 2021 is the first to directly reference research as an integral part of achieving best patient care and follows the establishment of research indicators in the CQC Well Led Framework (Trusts) since 2018.
The new CQC strategy places the emphasis on the effectiveness of the entire patient pathway, reflecting the new Integrated Care System ethos. The Integrated Care System specific monitoring strategy is likely to come into force in April 2023.
Surveys show that care users and staff have very positive, empowering experiences of research studies.
These are useful statistics when having discussions on what is in the best interests of patients. It shows that patient choice is very important with respect to research as well as care pathways. There is a range of reason why patients might want to take part, so gatekeeping by health professionals should become choice giving.
The General Medical Council - Normalising Research: Promoting research for all doctors
The GMC published its principles for promoting research for all doctors in mid-March 2022. It is an important development by a key regulator to support all doctors to contribute to research at a range of levels. Historically this has been difficult for many doctors whose time has been restricted by employers to non research duties.
Department of Health and Social Care Publication: Saving and Improving Lives: The Future of UK Clinical Research Delivery
This vision paper was published in March 2021 by the DHSC to help move clinical research forward in the UK in the aftermath of the pandemic and the infrastructure challenges that followed it. It sets out a broad vision which includes the need to integrate research and care. It is useful to know about this work in progress.
Robert Peveler, former Clinical Director for NHS Engagement wrote a helpful blog outlining the main points, entitled 'Is this the vision for our future?' . Also you can click below to see the DHSC summary document itself.
Research can help you identify effective and cost efficient treatments, processes and systems
NHS Trust staff guide: 'Best Patient Care, Clinical Research and You'
It has been long in the making, but now the NHS Trust guide 'Best Patient Care, Clinical Research and You' has been published for roll out on the NHS R&D Forum website. Led by the CRNCC NHS Engagement team, the guide is a result of a collaboration between NHS R&D Forum, UKRD, NHS England/Improvement and NIHR CRN. The guide is designed to be localised on NHS Trust staff intranets/platforms and following a pilot involving 12 Trusts the materials for doing this are now available to all. The guide is also recognised for its potential contribution to RRG work, supporting the CQC strategy and Well Led Framework, and the NHS Long Term Plan.
- The guide has core messages for each staff group to help them understand how their role can impact on research in their Trust
- It is designed to be accessible, quick to use, easy to navigate, and relevant to staff in the Trust
- For staff to engage with it it needs to be incorporated into mainstream staff information/development/communications material, typically the Trust staff intranet. Using local pictures and visual material is encouraged.
- It aims to create a pathway to further information which is Trust based, local, as well as offering national options.
- Local information can be built onto the required core content and navigation adjusted to suit Trust platforms whilst being made as easy as possible to use.
It is useful to be aware of it at least but it may be useful to you in interactions with different non research staff as the guide addresses each of the following categories of staff:
- Clinical Staff
- Clinical Management
- Trust Chair, Executives, and Senior Managers
- Corporate Services
- Communications
- Other patient contact roles
A brief introduction to the guide, which may be useful for sending on to others can be found here
Experience shows that it is important to demonstrate how research adds value. There are perceptions that research costs more and is a burden to care whereas we know this is incorrect. There are some good research impact stories showing the value of research in care services on the NIHR website.
A growing body of evidence shows that trusts with high levels of clinical research activity have better patient outcomes (e.g. lower mortality rates).
Evidence base for the Impact of Research on the Quality of Care
It might be helpful to be familiar with some of this evidence when interacting with care staff and management at various levels. It will enable you to show another aspect of the value of research in the care provision:
In January 2020, the NIHR CRN organised a workshop to discuss what evidence we currently have about the link between research activity and outcomes and to start to identify priorities for further research in this area. Following the workshop, 3 core recommendations were made and can be found in the report linked below.
There is further work going on to look at the correlation between research activity in primary and community care organisations and their care outcomes. Early indications are that there are positive correlations in this sector too but we await final reports.
Clinical Research is Everyone's Future
'Clinical Research is Everyone's Future' is a short video designed for very busy people and provides some of the basic information about clinical research. It can be useful for frontline care staff and mangers to get a quick introduction to what clinical research is and how it works:
Research Engagement Champions
Research Engagement Champions have been established in every NIHR LCRN. Broadly their role is:
- A link between local and national initiatives in the CRN
- Part of a CRN national community of practice being built up
- A conduit for feeding back to the national CRNCC NHS Engagement team any issues, suggestions, innovations, concerns, and perspectives from the LCRN.
- Catalysing new positive ways of working with stakeholders in a joint effort to embed research in primary, secondary and community care.
If you would like to get in touch with any of the Research Engagement Champions, please contact Tania Murray in the first instance (tania.murray@nihr.ac.uk).
Key Reports and Articles
Transforming health through innovation: Integrating the NHS and academia, AMS Report: Having consulted with stakeholders across the sector, the Academy of Medical Sciences sets out a series of actions to achieve six key outcomes considered essential for enhancing the interface between the NHS and the UK’s academic biomedical and health research sector:
- Creating a healthcare system that truly values research.
- Fully integrating research teams across academia and the NHS.
- Providing dedicated research time for research-active NHS staff.
- Ensuring undergraduate curricula equip healthcare staff with the skills to engage with research.
- Incorporating flexibility into postgraduate training pathways.
Royal College of Physicians: 'Research for All' is a strong statement which follows the work with the CQC, and endorsed by a range of Royal Colleges and related organisations including the NIHR. It concludes that Trusts should:
- ensure that research activity is integral to the work of the organisation and its staff and overseen at board meetings
- use job planning to protect time for clinical research, including within the direct clinical care programmed activities
Article in the Health Services Journal (HSJ) about additional research funding for Trusts
The NIHR CRN Research Engagement Collaborative: Working together to embed research in health and care services.
The Research Engagement Collaborative a key hub resource for research delivery staff working on the frontline to deliver research in their NHS organisation. It is hosted on NIHR Learn and is designed to share what works in engaging non-research colleagues through:
- Success stories to inspire frontline staff to promote research within their department or Trust and lead key initiatives to help to create a research culture.
- A toolkit of resources to introduce clinical staff to research.
- A self assessment quiz to enable staff to evaluate their own practice, in terms of embedding research within their role and promoting a research culture.
- An interactive forum to enable staff to share success stories and key barriers/ challenges, and discuss core elements of research.
- An Expert Blog series, each edition written by a different guest speaker from different areas of the research world to improve awareness and understanding of the complexities of the research network.
- The Lunch and learn online series is a new learning tool that helps to connect frontline research delivery staff with the wider network through success stories. They showcase real innovative work being done in research that reflects the emerging ICS landscape. These online sessions comprise a presentation and a question and answer session. They can be watched of listened to live or you can see recordings of each event. To find out more, visit the Research Engagement Collaborative on NIHR Learn or contact Tania Murray.
The Collaborative is being expanded all the time, not only in content updates, but also as part of a developing active learning community, so it's worth keeping an eye on it. Think about contributing success stories as well!
You can quickly and easily register with the community using just an NHS or NIHR email address.
What next?
The NIHR CRN's NHS Engagement Team continues to work closely with colleagues inside and outside the organisation to continuously improve how research is embedded in NHS care:
Contact:
Tania Murray, Stakeholder Engagement Support Officer. email: tania.murray@nihr.ac.uk