Louise Shepherd - How to embed research in NHS trusts to improve patient care
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Presentation by Louise Shepherd, Alder Hey Children's NHS Foundation Trust: How to embed research in NHS Trusts to improve patient care event at How to embed research in NHS Trusts to improve patient care event at The Foresight Centre, Liverpool on 28 November 2019
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Louise Shepherd - How to embed research in NHS trusts to improve patient care
- 1. Inspired by ChildrenInspired by Children Embedding Research in NHS Trusts: The Alder Hey Experience Louise Shepherd Chief Executive Alder Hey Children’s NHS Foundation Trust
- 2. Inspired by ChildrenInspired by Children Background • Specialist Children’s Trust • Serves a population of 8 million people • Provides secondary, tertiary and quaternary services, including community • Largest recruiter to NIHR CRN Children studies (>45,000 since 2009)
- 3. Inspired by ChildrenInspired by Children Patient recruitment to clinical trials: Alder Hey 2019-2020 BUT…….
- 4. Limited time for research in paediatrician’s jobs plans Source: RCPCH Participation in Child Health Research Survey 2015 Novel, multi-sector approaches needed to address imbalance
- 5. Inspired by ChildrenInspired by Children • Trust Boards required to balance the needs of multiple external drivers (including RCP) • Many competing demands on consultant SPA time (research, education, QI, etc) • Creative solutions involving multiple partners needed (Charities, commercial sector, etc) • Sharing knowledge, experience and best practice Protecting research time in a time poor environment
- 6. Inspired by ChildrenInspired by Children Research Leadership and Culture
- 7. Inspired by Children CQC NHS trust-wide well-led inspection framework The 2019 update of the well led framework includes research questions (Section W8) https://www.cqc.org.uk/sites/default/files/20190412_Trust_ wide_well_led_inspection_framework_v6.pdf used by NHS trusts to plan to meet the requirements
- 8. Inspired by Children A whole system for ‘well-led’ research in NHS trusts Equity Facilitation Strategic Leaders Patients Divisional Managers and Staff
- 9. Inspired by ChildrenInspired by Children • Strategic use of NIHR Research Capability Funding (RCF) • Rheumatology: – 7 Research PAs across four consultants – Research income generated enables research PAs to be self funding – RCF recycled – virtuous circle Supporting Research Intensive Departments
- 10. Inspired by ChildrenInspired by Children • Income directly supports junior medical salaries releasing PI time to deliver research tasks • Income distribution model being piloted to enable reinvestment into wider clinical services Commercial Research
- 11. Inspired by ChildrenInspired by Children • Secured £340k to support protected time for healthcare professionals • Pump-priming investment from national DMD and CF charities for commercial research capacity – Enabled research infrastructure posts to become self-sufficient – Includes medical time • Alder Hey ‘approach’ to Patient Recruitment Centre Working with Charities
- 12. Inspired by ChildrenInspired by Children • Not always possible to include research time in consultant job plans • ‘Indirect’ mechanisms to reduce research burden and increase capacity for PI time in existing job plan – Providing administrative support (for DCC or research activities) – Research nurse allocation – Data administration support (e.g. case report completion, data quality checks) • Personalising the supportive resource to the needs of the consultant/clinical team Supporting Infrastructure
- 13. Inspired by ChildrenInspired by Children • Trust Boards have to prioritise and balance competing demands on the medical workforce • No single approach to increasing medical research capacity • Case studies are informative, but not always scalable • Joint working between NHS and other sectors needed • Sharing best practice and NHS wide collaboration with RCP essential, e.g. through UKRD Summary
Editor's Notes
- 1311 or 81.6% did not have PAs for research in their job plan and 875 or 54.5% do no research work 8.1% have less than 1 PA for research in their job plan, although 25% of respondents spend this amount of time on research Average PAs in job plan for research per respondent was 0.37 and the average PAs actually worked for research per respondent was 0.66.
- In early October 2018 the CQC published the 2018 Well Led Framework (Trusts) and this included the new clinical research prompts: https://www.cqc.org.uk/sites/default/files/20180921_9001100_trust-wide_well-led_inspection_framework_v5.pdf The new research prompts are: Are divisional staff aware of research undertaken in and through the Trust, how it contributes to improvement and the service level needed across departments to support it? How do senior leaders support internal investigators initiating and managing clinical studies? Does the Vision and Strategy incorporate plans for supporting clinical research activity as a key contributor to best patient care? Does the Trust have clear internal reporting systems for its research range, volume, activity, safety and performance? How are patients and carers given the opportunity to participate in or become actively involved in clinical research studies in the trust?
- The work on research is focussed on CQC’s Well Led category. For research this concerns how a Trust as a whole incorporates clinical research into its healthcare governance and delivery and makes it available to patients as an option. The 3 Levels: Research equity – how does the organisation support the research programme across the breadth of its services? Research facilitation – how does the organisation proactively support the delivery of research from board level to the clinical setting(s)? Research awareness – how does the organisation make research opportunity known to patients, the public and healthcare professionals?