Conducting Research in the UK National Health Service Dr Stephen Brett Reader In Critical Care

 The National Health Service  £127.5bn in  Funded from general taxation  Additional 10% private  Free at point of delivery  Treatment based entirely on need- with caveats  Major budgets now held by primary care  Purchaser provider split

Research Types Epidemiological Basic science Observational Clinical trials Outcomes Health services research Qualitative/social science Funding Unfunded Charities Local National- Wellcome, Dunhill, ICF, Cancer Research UK BHF Government Medical Research Council National Institute for Health Research

Intensive care Sickest patients in hospitals Emergencies*** and major elective surgery Specialist medical, nursing and AHP staff Equipment for support of failing organs Cardiovascular, respiratory, renal……… In theory for people who can benefit Mortality 20-25% ITU Discharge Significant long term consequences for patient and family Health and non-health related

Context 1. Primary duty to patient care 2. Academic healthcare is better healthcare 3. Innovation to improve outcomes and efficiencies 4. Drive for patient safety 5. Focus on health economics 6. Encourage macroeconomic growth 7. Strict rules about patient confidentiality and datahandling 8. Robust framework for both clinical and researchgovernance

Imperial College Healthcare NHS Trust

Why conduct research in medicine? 1.New knowledge to improve health of individuals and populations 2.Innovation 3.Health- and macro- economic benefit 4.Excitement of new knowledge 5.Career advancement 6.Academic healthcare is better healthcare  Increase environment data richness  More specialisation and knowledge  More resources  Hawthorne effect  All-around Increased motivation

Research questions  Learn about  Disease natural history  What does the disease do?  How does it do it?  Who has it?  How do we diagnose it and monitor it?  What does it cost us- human and financial?  Treatment  What to give?  How to give it?  How to monitor its effect?  System  How to deliver care?

Publication type  Original primary  Basic science  Clinical  Observational  Interventional  Epidemiological  Qualitative  Systematic review  Meta analysis  Guidelines  Commentary  Editorial  Case reports  Educational things  etc