1. “Best Research for Best Health” Andrew Riley Managing Director

2. Outline 1.The Problem; What was happening to R&D in the UK? 2.What is the Evidence? 3.The Strategy

3. UK plc; R&D business 2007 Commercial Studies £4.2bn UK Pharmaceutical investment 73,000 People directly employed by UK Pharmaco # 1 UK Trade surplus rankings Academic Studies £1.8bn Value of Research Grants

4. Source and Use of UK Medical Research Funds

5. The Market IndicatorUK performance i Market Map High Cost, low patient numbers 1 Market Share Largest relative fall (6% - 2% in 6 years) 2 Recruitment Fallen from 38,000 to 14,000 in 4 years 3 Growth 10% contraction 4

6. Academic Research 1. Evidence that Patients do better in Research Active Organisations (Du Bois 2005) – as few as 40% of NHS Trusts are research active 2.Active management of Research Studies - No coordinated study performance management or metrics and frequent study extensions. 3.Translation of study findings into routine care - limited analysis of translational benefits

7. The UK Scorecard TargetPerformanceRating Strategic Relevance UK is a large market with slow to moderate uptake of new technologies and drugs compared to competitor countries Quality of Research On a par with competitor group Timeliness Significantly slower set up and recruitment than competitors Reliability Poor record for delivery on agreed recruitment targets Cost Highest cost in Europe by a good margin – effecting competitiveness

8. Patient Recruitment Performance

9. Study Set up

10. Cost

12. NIHR Vision & Strategic Goals Vision To Improve the health and wealth of the nation through research. Vision To Improve the health and wealth of the nation through research. Mission To create a health research system in which the NHS supports outstanding individuals, working in world- class facilities, conducting leading edge research focussed on the needs of patients and the public Mission To create a health research system in which the NHS supports outstanding individuals, working in world- class facilities, conducting leading edge research focussed on the needs of patients and the public Strategic Goals 1.Establish the NHS as an internationally recognised centre of research excellence 2.Attract develop and retain the best research professionals to conduct people based research 3.Commission research focussed on improving health and care 4.Strengthen and streamline systems for research management and governance 5.Act as sound custodian of public money Strategic Goals 1.Establish the NHS as an internationally recognised centre of research excellence 2.Attract develop and retain the best research professionals to conduct people based research 3.Commission research focussed on improving health and care 4.Strengthen and streamline systems for research management and governance 5.Act as sound custodian of public money

13. Clinical Research Networks National Institute for Health Research Infrastructure Clinical Research Facilities & Centres Clinical Research Networks Research Research Projects & Programmes Research Governance Systems Research Information Systems Systems Patients & Public Universities Investigators & Senior Investigators Associates Faculty Trainees Research Units & Schools NHS Trusts Research “Commissioning and funding research focused on improving outcomes for health and social care” Key objective is to improve the quality, relevance, and focus of research in the NHS and social care by distributing funds in a transparent way after open competition and peer review. NIHR funds a range of programmes addressing a broad range of health priorities. Funding is based on the quality and relevance of the research to personal social services and the NHS. New and recent Calls for Proposals on the NIHR Website Homepage Research “Commissioning and funding research focused on improving outcomes for health and social care” Key objective is to improve the quality, relevance, and focus of research in the NHS and social care by distributing funds in a transparent way after open competition and peer review. NIHR funds a range of programmes addressing a broad range of health priorities. Funding is based on the quality and relevance of the research to personal social services and the NHS. New and recent Calls for Proposals on the NIHR Website Homepage NIHR Faculty “To attract, develop and retain the best research professionals” 1.Enhance the professional status of Faculty Members 2.Value research leaders and collaborators 3.Support research that meets the needs of patients and the public 4.Promote academic training paths for healthcare professionals across all health and social care disciplines. Membership is automatic for any researcher supported by NIHR or PRP funding as long as: part of their salary costs are funded by the NIHR or PRP and the researcher is employed by the NHS or by a University. There are no other membership criteria. NIHR Faculty “To attract, develop and retain the best research professionals” 1.Enhance the professional status of Faculty Members 2.Value research leaders and collaborators 3.Support research that meets the needs of patients and the public 4.Promote academic training paths for healthcare professionals across all health and social care disciplines. Membership is automatic for any researcher supported by NIHR or PRP funding as long as: part of their salary costs are funded by the NIHR or PRP and the researcher is employed by the NHS or by a University. There are no other membership criteria. Systems The aim is to create a vibrant and efficient research environment in England, by streamlining the procedures underpinning research by: 1.Establishing world class research networks 2.Simplifying processes to save time. 3.Introducing information systems to harmonise and simplify approvals and permissions 4.Developing a unified knowledge management system for the NIHR and its partners. This will: Allow researchers to complete procedures and input data only once for multiple uses Provide researchers with free access to expert advice and information about regulatory approvals, permissions and good practice Promote wider availability of research outcomes in order to improve translation to health service delivery. Infrastructure 1.Ensure patients and healthcare professionals from all parts of the country are able to participate in and benefit from clinical research 2.Integrate health research and patient care 3.Improve the quality, speed and co-ordination of clinical research 4.Increase collaboration with industry partners and ensure that the NHS can meet the health research needs of industry. 5.Achieved through: Biomedical Research Centres and Units; leading innovation, translation, early adoption, patient benefit, sustaining scientific excellence and playing a leading role in improving the UK’s international competitiveness. Clinical Research Facilities for Experimental Medicine will be purpose-built, cutting-edge clinical facilities that will help place the UK at the forefront of developments in basic biomedical research and so transform patient care. Clinical Research Networks; make it possible for all patients and health professionals across England to participate in relevant clinical trials. Infrastructure 1.Ensure patients and healthcare professionals from all parts of the country are able to participate in and benefit from clinical research 2.Integrate health research and patient care 3.Improve the quality, speed and co-ordination of clinical research 4.Increase collaboration with industry partners and ensure that the NHS can meet the health research needs of industry. 5.Achieved through: Biomedical Research Centres and Units; leading innovation, translation, early adoption, patient benefit, sustaining scientific excellence and playing a leading role in improving the UK’s international competitiveness. Clinical Research Facilities for Experimental Medicine will be purpose-built, cutting-edge clinical facilities that will help place the UK at the forefront of developments in basic biomedical research and so transform patient care. Clinical Research Networks; make it possible for all patients and health professionals across England to participate in relevant clinical trials.

14. NIHR Faculty “To attract, develop and retain the best research professionals” 1.Enhance the professional status of Faculty Members 2.Value research leaders and collaborators 3.Support research that meets the needs of patients and the public 4.Promote academic training paths for healthcare professionals across all health and social care disciplines. Membership is automatic for any researcher supported by NIHR or PRP funding as long as: part of their salary costs are funded by the NIHR or PRP and the researcher is employed by the NHS or by a University. There are no other membership criteria. NIHR Faculty “To attract, develop and retain the best research professionals” 1.Enhance the professional status of Faculty Members 2.Value research leaders and collaborators 3.Support research that meets the needs of patients and the public 4.Promote academic training paths for healthcare professionals across all health and social care disciplines. Membership is automatic for any researcher supported by NIHR or PRP funding as long as: part of their salary costs are funded by the NIHR or PRP and the researcher is employed by the NHS or by a University. There are no other membership criteria.

15. Programme Management “Commissioning and funding research focused on improving outcomes for health and social care” Key objective is to improve the quality, relevance, and focus of research in the NHS and social care by distributing funds in a transparent way after open competition and peer review. NIHR funds a range of programmes addressing a broad range of health priorities. Funding is based on the quality and relevance of the research to personal social services and the NHS. New and recent Calls for Proposals on the NIHR Website Homepage Programme Management “Commissioning and funding research focused on improving outcomes for health and social care” Key objective is to improve the quality, relevance, and focus of research in the NHS and social care by distributing funds in a transparent way after open competition and peer review. NIHR funds a range of programmes addressing a broad range of health priorities. Funding is based on the quality and relevance of the research to personal social services and the NHS. New and recent Calls for Proposals on the NIHR Website Homepage

16. Systems The aim is to create a vibrant and efficient research environment in England, by streamlining the procedures underpinning research by: 1.Establishing world class research networks 2.Simplifying processes to save time. 3.Introducing information systems to harmonise and simplify approvals and permissions 4.Developing a unified knowledge management system for the NIHR and its partners. This will: Allow researchers to complete procedures and input data only once for multiple uses Provide researchers with free access to expert advice and information about regulatory approvals, permissions and good practice Promote wider availability of research outcomes in order to improve translation to health service delivery.

17. Infrastructure 1.Ensure patients and healthcare professionals from all parts of the country are able to participate in and benefit from clinical research 2.Integrate health research and patient care 3.Improve the quality, speed and co-ordination of clinical research 4.Increase collaboration with industry partners and ensure that the NHS can meet the health research needs of industry. 5.Achieved through: Biomedical Research Centres and Units; leading innovation, translation, early adoption, patient benefit, sustaining scientific excellence and playing a leading role in improving the UK’s international competitiveness. Clinical Research Facilities for Experimental Medicine will be purpose-built, cutting-edge clinical facilities that will help place the UK at the forefront of developments in basic biomedical research and so transform patient care. Clinical Research Networks; make it possible for all patients and health professionals across England to participate in relevant clinical trials. Infrastructure 1.Ensure patients and healthcare professionals from all parts of the country are able to participate in and benefit from clinical research 2.Integrate health research and patient care 3.Improve the quality, speed and co-ordination of clinical research 4.Increase collaboration with industry partners and ensure that the NHS can meet the health research needs of industry. 5.Achieved through: Biomedical Research Centres and Units; leading innovation, translation, early adoption, patient benefit, sustaining scientific excellence and playing a leading role in improving the UK’s international competitiveness. Clinical Research Facilities for Experimental Medicine will be purpose-built, cutting-edge clinical facilities that will help place the UK at the forefront of developments in basic biomedical research and so transform patient care. Clinical Research Networks; make it possible for all patients and health professionals across England to participate in relevant clinical trials.

18. Clinical Research Networks PCRN 6 TCRNs Stroke, Cancer, Diabetes, Mental Health, Medicines for Children, Dementias and neurodegenerative diseases 6 TCRNs Stroke, Cancer, Diabetes, Mental Health, Medicines for Children, Dementias and neurodegenerative diseases CCRN 25 Comprehensive Clinical Research Networks CCRN 25 Comprehensive Clinical Research Networks NIHR Clinical Research Network Coordinating Centre NIHR Clinical Research Network Coordinating Centre Budget: £42mBudget: £90m+ Budget £2m

19. CLARHCs 1.Seven pilot NIHR “Collaborations for Leadership in Applied Health Research and Care” (CLAHRCs) have been established in England. LNR is becoming a successful example. 2.Collaborative partnerships : Between a university and surrounding NHS organisations focused on improving patient outcomes through the conduct and application of applied health research. creating and embedding approaches to research and its dissemination specifically designed to take account of the way that health care delivered across sectors and a wide geographical areas. 1.Seven pilot NIHR “Collaborations for Leadership in Applied Health Research and Care” (CLAHRCs) have been established in England. LNR is becoming a successful example. 2.Collaborative partnerships : Between a university and surrounding NHS organisations focused on improving patient outcomes through the conduct and application of applied health research. creating and embedding approaches to research and its dissemination specifically designed to take account of the way that health care delivered across sectors and a wide geographical areas.

20. Service Delivery Organisation (SDO) Established to consolidate and develop the evidence base in the organisation, management and delivery of health services to: 1. increase the quality of patient care 2.Ensure better patient outcomes 3.Contribute to improving overall population health Established to consolidate and develop the evidence base in the organisation, management and delivery of health services to: 1. increase the quality of patient care 2.Ensure better patient outcomes 3.Contribute to improving overall population health NHS Institute of Innovation and Improvement

21. Network Focus QualityTimelinessReliabilityCost Feasibility Support Workforce Development Clinical Specialty Groups NIHR Portfolio CSP Risk Assessment & Performance Management Study Management & Administration Research Passport Study Planning Support RMG Advice Standard agreements for the conduct of research (mCTA) Performance Management Partnership Management Industry Costing Template Activity based funding (ABF)

22. Systems 1.Central System for gaining NHS Permission implemented 2.Central database for all NIHR approved studies implemented 3.Research Passport implemented 4.Activity Based Funding from 1 April 09 Systems 1.Central System for gaining NHS Permission implemented 2.Central database for all NIHR approved studies implemented 3.Research Passport implemented 4.Activity Based Funding from 1 April 09 Performance Data Infrastructure & Faculty 1.15 BRC/BRU 2.7 CLAHRCs 3.25 CLRNs 4.6 TCRNs 5.1 PCRN 6.Faculty Established Infrastructure & Faculty 1.15 BRC/BRU 2.7 CLAHRCs 3.25 CLRNs 4.6 TCRNs 5.1 PCRN 6.Faculty Established EU Average Non-CRN Avg

23. Issues 1.Commercial research important, worthy of support 2. UK plc 3.Use of Industry Costing Template. 4. CSP will work best backed by organisational change. 5.Research departments/researchers reluctant to change importance of service support cost 6.Voluntary target development 7.NIHR portfolio research, ABF from 01 April 09 8.Balance between Service, Education and R&D

24. Conclusions 1.UK Commercial sector has been in decline, performance needs improving UK wide – still a risk 2.Opportunities to improve investigator led study performance, outcome measurement and translation to service. 3.NIHR infrastructure offers structured, consistent and transparent systems to support NHS and Industry partners. 4.Broader base for R&D being established 5.Early evidence showing benefits being achieved 6.Balance R&D, service and education agendas.

25. For Further Information http://www.ukcrn.org.uk http://www.nihr.ac.uk Or Email; a.riley@ukcrn.org.uk