AHP research: excellent opportunities in challenging times Dr Angela Green Lead Clinical Research Therapist Hull 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 2 nd December N.B. This illustrated participation in NIHR portfolio studies only. Organisation Position in table Number of NIHR studies 2010/2011 Number of patients recruited 2010/2011 Central Manchester University Hospitals The Christie NHS Foundation Trust Salford Royal NHS Foundation Trust University Hospital of South Manchester NHS Foundation Trust ,476 North West Ambulance Service Unplaced00

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 ).

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; 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 studies Providing interventions under study – portfolio projects Data 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 database

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 register AfCminAfCmax Clinical Researcher 66 Clinical Researcher Specialist 77 Practice Education Facilitator 77 Clinical Researcher Principal 8a Clinical Researcher 8b8d AHP Consultant8b9

Doctors and Dentists NIHR Integrated Academic Training All Professions NIHR 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 Award Other Awards Senior/ Pre-Chair NIHR Research Career Pathways Senior Post-Doc Early Post-Doc Doctoral Pre-Doctoral/ Masters Undergraduate NIHR/CNO/HEFCE Senior Academic Clinical Lecturer In-Practice Fellowships and NIHR Academic Clinical Fellowships NIHR/CNO Clinical Lectureships CSO Health Care Scientist Doctoral Fellowship CSO Health Care Scientist PostDoctoral Fellowship

Other organisations offering fellowships to AHPs 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 development NIHR and some research and development organisations provide free research training e.g. Good clinical practice (GCP training) For backfilling posts Clinical 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 ( Research design service

Research design service for North West Based at Lancaster University Telephone: 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