On Thursday, the Lords discussed Our vision for research in the NHS. It was a short debate raised by Lord Turnberg, AMRC's scientific adviser, and responded to by Earl Howe, the health minister with responsibility for research. It's a good read if you have time, but if not I've written a quick summary of some of the issues raised and Earl Howe's answers below. Particularly interesting was more information on NHS England's research strategy which is being developed at the moment and will be published for consultation in the autumn.
The Health and Social Care Act 2012 introduced, for the first time, a duty on the Secretary of State, the NHS Commissioning Board (now NHS England) and Clinical Commissioning Groups (CCGs) to “promote research on matters relevant to the health service, and the use in the health service of evidence obtained from research.”
We strongly welcome this ambition to embed research throughout the NHS, and recognise that we will all play a role in ensuring this delivers in practice.
To help play this role, we worked with partners supporting research, patients and clinicians to develop Our vision for research in the NHS.
Our vision is of an NHS where:
- Every patient is offered opportunities to be involved in research
- All NHS staff see the importance of research
- The NHS conducts high-quality research and adopts new treatments
And recognising that we will all play a role in shaping the NHS of the future, we set out practical steps that we can all take to build on the commitment to research made in the Health and Social Care Act 2012.
What issues did the peers raise?
How will NHS England promote research?
We were really pleased to hear from Earl Howe that:
NHS England welcomes the vision for research set out by the AMRC
The Minister referred to the government's mandate on NHS England, which sets it an objective to ensure the new commissioning system promotes and supports the participation OF NHS organisations and patients in research funded by both non-commercial and commercial organisations; most importantly to improve patient outcomes, but also to contribute to economic growth.
Earl Howe also announced plans for NHS England's research strategy:
[NHS ENGLAND] has recently recruited a team to lead the research agenda and develop and implement its research strategy. It is anticipated that a draft strategy will be in place by autumn this year, when extensive consultation with key stakeholders and partners, including patients, will be undertaken.
Will Clinical Commissioning Groups (CCGs) be given the support and guidance they need to promote research, and how will they be held to account to ensure they do this?
Earl Howe referred to the formal declaration of compliance which all CCGs have made, through which:
all these groups have confirmed that they understand and will comply with their statutory responsibilities regarding promoting research.
He also clarified that CCGs are committed to following the policy of ensuring the NHS meets the treatment costs for patients taking part in research funded by government and research charity partner organisations. This is good to hear restated as early guidance from NHS England had suggested that there was a lack of clarity remaining in who should cover these costs.
Explaining how CCGs will be held to account on their duty to promote research, Earl Howe referred to the government's mandate to NHS England which:
asks for demonstration of progress against the five domains and all the outcomes indicators in the NHS outcomes framework. The framework document emphasises that vital to the quality and delivery of these outcomes will be continued research and the use of research evidence in the design and delivery of services at a local level.
Can we support NHS Trusts and GPs better so they can talk about research with their patients?
Earl Howe referred to the pledge in the NHS constitution to inform patients of research studies in which they may be eligible to participate and pointed to the information developed by NIHR CRN and INVOLVE.
Will research to be included in the training programmes of all clinical trainees?
Earl Howe was very clear that Health Education England (HEE - the body responsible for the education and training of the NHS workforce) will work to build a workforce that is research-literate, with the skills and confidence to diffuse the latest ideas and innovations. They will do this by building partnerships with NIHR, Academic Health Science Networks and Academic Health Science Centres, bringing together research and education.
He was also very clear that Local Education and Training Board's (which are local committees of Health Education England and are responsible for the training and education of NHS staff, both clinical and non-clinical, within their area) objectives include building a flexible workforce that is receptive to research and innovation so research will be on their agenda.
He also referred to NIHR's programmes for research training and career development.
How will patient data be used to improve healthcare?
A couple of peers raised the value of patient data for research, the need for it to be handled safely and securely and asked about some of the initiatives underway to support that including the Clinical Research Practice Datalink (CPRD). The vision calls for "GPs to share their practice data with CPRD and respond to requests to invite their patients to take part in research studies."
Earl Howe confirmed that
CPRD is working with the NIHR primary care research network to recruit more GP practices to contribute their data to the CPRD’s data assets.
What is being done to streamline regulation and help patients take part in clinical trials?
Earl Howe referred to the NIHR Clinical Research Network figures which came out this week, showing that in the last year 630,000 participants were recruited to trials and studies hosted by the NIHR Clinical Research Network Portfolio, and more than 99% of NHS trusts were involved in the recruitment to these.
He also pointed to the NIHR's it's "ok to ask" campaign encouraging patients to ask about research opportunities and providing health professionals with resources to answer their questions and the UK Clinical Trials Gateway where everyone can find out more information about trials.
Our polling of healthcare professionals found that regulation is a big barrier - 40% of hospital doctors polled cited difficulties navigating regulatory processes as a barrier to them taking part in medical research in the last two years.
Earl Howe touched on the work the Health Research Authority is undertaking to streamline and rationalise regulation to address this - more on their latest feasibility study here.
Earl Howe didn't get time to answer all the questions, including a couple of issues we are particularly interested in - how non-NHS providers of NHS services will be encouraged to take part in research, and how we will increase the cooperation between the NHS, universities and medical schools (see more background on these issues in our brief for the debate).
But there will be lots more opportunities to raise these issues, and AMRC is planning further discussions to continue this conversation with the NHS, from CCGs to NHS England, universities, medical schools and Royal Colleges, the Department of Health and all the other partners involved.