uk research articles

Smartphones, social media, and teenage mental health

A public health response must facilitate technology’s potential positives while firmly safeguarding our young people’s mental health.

Does platelet rich plasma (PRP) treatment really work?

PRP is regularly endorsed by celebrities for a variety of conditions from impotence to dentistry. Sangeetha Nadarajah looks at the evidence

Reusable devices to apply cold sensation in the assessment of regional anaesthesia

This article outlines the environmental benefits of using reusable cold sensation devices

TDR at 50: advancing a longstanding commitment to inclusion

Fifty years after the formation of the Special Programme for Research and Training in Tropical Diseases, how has the organisation advanced inclusive internationalism in health research?

Labour’s pledge to clear NHS waiting list within five years will be tough to achieve, say leaders

Junior doctors in england announce five day walkout ahead of general election, us state classifies mifepristone and misoprostol as dangerous controlled substances, sex diversity in surgical teams is linked to better postoperative outcomes for patients, research finds, forget about replacing doctors with ai—just get our computers to work, covid-19: south african disclosures reveal secretive world of nations’ vaccine contracts, tislelizumab plus chemotherapy versus placebo plus chemotherapy as first line treatment for advanced gastric or gastro-oesophageal junction adenocarcinoma, latest articles.

Sudan: Aid workers describe “bloodbath” in Darfur as hospitals are repeatedly attacked

Gps could threaten mass resignation over nhs contract, us doctor convicted of murder is freed from prison after pardon secured by doctor who took over his practice, improving infection prevention could avoid 750 000 deaths a year, say experts, man arrested after gp is stabbed at practice in sidcup, gp leaders reject “venomous” language that “condemns” physician associates, sixty seconds on . . . prepping, gps share stories of patient violence amid calls for tougher sanctions against perpetrators, covid inquiry: what have we learnt about northern ireland’s response.

Clinical and healthcare use outcomes after cessation of long term opioid treatment due to prescriber workforce exit

Effect of the hpv vaccination programme on incidence of cervical cancer by socioeconomic deprivation in england, long acting progestogens vs combined oral contraceptive pill for preventing recurrence of endometriosis related pain, guidance on terminology, application, and reporting of citation searching: the tarcis statement, ultra-processed food consumption and all cause and cause specific mortality, comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus, reverse total shoulder replacement versus anatomical total shoulder replacement for osteoarthritis.

New WHO guidance can support transparent and informed engagement with the private sector

Homelessness is a health emergency: criminalising homeless people will only make it worse, “start private, end private”—a principle that could help protect the nhs from subsidising private care, sas and locally employed doctors deserve more support and respect, how to deliver equitable access to the best possible care, a potential new treatment for alzheimer’s disease … and other research, david oliver: nhs england’s proposals to aid junior doctor retention are basic good practice presented as radical ideas, forgiving medical student loan debt could help protect the future of a diverse nhs workforce.

Summary of WHO infection prevention and control guideline for covid-19

Cardiovascular toxicity of immune therapies for cancer, work and vocational rehabilitation for people living with long covid, surgery is better than nasal sprays for people with severely blocked airways caused by septal deviation, april top picks: hope springs eternal, deprescribing in older adults with polypharmacy, toxic household exposures in children, ask the consultant: old age psychiatry, irritable bowel syndrome: low dose antidepressant improves symptoms, pelvic organ prolapse: self-management of pessaries can be a good option, israel is using starvation as a weapon of war in gaza.

We are witnessing the onset of a man made and entirely preventable famine in Gaza, say Sameer Sah and Khaled Dawas

The global health community must call for an immediate ceasefire and unrestricted humanitarian aid in Gaza

Silence from the global health community makes it complicit, argue Fatima Hassan and colleagues

Gaza: Israel begins Rafah attack despite WHO warning of “bloodbath”

Gaza: paediatricians call on uk government to stop selling arms to israel, gaza-israel conflict: world medical association backs bma’s call for sustainable ceasefire, gaza: hundreds of bodies are recovered from mass graves at two major hospitals, bmj medicine, incidence and treatment of group a streptococcal infections during covid-19 pandemic and 2022 outbreak.

This study by Christine Cunningham and colleagues supports the findings of routine surveillance reports, indicating a reduction in group A streptococcal infections during covid-19 restrictions, followed by a peak in December 2022

Regular use of fish oil supplements and course of cardiovascular diseases

Regular use of fish oil supplements might be a risk factor for atrial fibrillation and stroke among the general population but could be beneficial for progression of cardiovascular disease from atrial fibrillation to major adverse cardiovascular events, and from atrial fibrillation to death, finds Ge Chen and colleagues

Development of a national centile-based maternal early warning score

Neonatal hypoglycaemia, to adjust or not to adjust: it is not the tests performed that count, but how they are reported and interpreted, identification of patients undergoing chronic kidney replacement therapy in primary and secondary care data, current issue.

Infected blood scandal: “Chilling” cover up hid truth for decades, public inquiry finds

Pregnancy associated osteoporosis: nhs is “failing women”, epidural analgesia during labour and severe maternal morbidity, ovarian cancer: identifying and managing familial and genetic risk—summary of new nice guidance, epidural analgesia during labour and severe maternal morbidity: population based study, ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses, effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials, association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study, tislelizumab plus chemotherapy versus placebo plus chemotherapy as first line treatment for advanced gastric or gastro-oesophageal junction adenocarcinoma: rationale-305 randomised, double blind, phase 3 trial, latest responses, developing ai applications that are more friendly to doctors - maybe it's not don't want to but don't know what to do, re: to increase public satisfaction in the nhs, we need a new conversation about how to improve it, esketamine in women with prenatal depression symptoms: a warning on the benefit-harm ratio, the transfer of benefits between pharmaceutical and medical device companies and doctors may not be eliminated, re: health literacy matters- improving our hq, what are your thoughts.

Covid-19: Researcher blows the whistle on data integrity issues in Pfizer’s vaccine trial

Covid-19 vaccines and treatments: we must have raw data, now

Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis

Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study

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Impacts of COVID-19 on clinical research in the UK: A multi-method qualitative case study

David Wyatt

1 School of Population Health and Environmental Sciences, King’s College London, United Kingdom

2 National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, United Kingdom

Rachel Faulkner-Gurstein

Hannah cowan, charles d. a. wolfe, associated data.

Data from this study take the form of interview transcripts, Hospital Trust and national documents, and observations of closed meetings. These data cannot be shared publicly, but extracts from interviews are presented within the body of the paper that make up the "minimal dataset."

Clinical research has been central to the global response to COVID-19, and the United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out globally for the scale and speed of its COVID-19 research response. This paper explores the impacts of COVID-19 on clinical research in an NHS Trust and how the embedded research system was adapted and repurposed to support the COVID-19 response.

Methods and findings

Using a multi-method qualitative case study of a research-intensive NHS Trust in London UK, we collected data through a questionnaire (n = 170) and semi-structured interviews (n = 24) with research staff working in four areas: research governance; research leadership; research delivery; and patient and public involvement. We also observed key NHS Trust research prioritisation meetings (40 hours) and PPI activity (4.5 hours) and analysed documents produced by the Trust and national organisation relating to COVID-19 research. Data were analysed for a descriptive account of the Trust’s COVID-19 research response and research staff’s experiences. Data were then analysed thematically. Our analysis identifies three core themes: centralisation; pace of work; and new (temporary) work practices. By centralising research prioritisation at both national and Trust levels, halting non-COVID-19 research and redeploying research staff, an increased pace in the setup and delivery of COVID-19-related research was possible. National and Trust-level responses also led to widescale changes in working practices by adapting protocols and developing local processes to maintain and deliver research. These were effective practical solutions borne out of necessity and point to how the research system was able to adapt to the requirements of the pandemic.

The Trust and national COVID-19 response entailed a rapid large-scale reorganisation of research staff, research infrastructures and research priorities. The Trust’s local processes that enabled them to enact national policy prioritising COVID-19 research worked well, especially in managing finite resources, and also demonstrate the importance and adaptability of the research workforce. Such findings are useful as we consider how to adapt our healthcare delivery and research practices both at the national and global level for the future. However, as the pandemic continues, research leaders and policymakers must also take into account the short and long term impact of COVID-19 prioritisation on non-COVID-19 health research and the toll of the emergency response on research staff.

Introduction

Clinical research is a core part of the global response to COVID-19. The United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out by commentators globally for the scale and speed of its COVID-19 research response, particularly in terms of trial recruitment [ 1 – 3 ]. Reporting from within the UK context, Darzi et al. suggest that participating in clinical trials should be part of the clinical pathway for all COVID-19 patients [ 4 ]. To date, 95 nationally prioritised COVID-19 research projects, labelled Urgent Public Health studies, have commenced [ 5 ]. These and a large number of other COVID-19 studies have rapidly been set up and rolled out across UK hospitals. Supporting and facilitating such research has been made possible by the widespread reorganisation of the NHS’ existing embedded research infrastructure. This reorganisation was initiated by the UK’s Department Health and Social Care (DHSC), which on 16 th March 2020 stated that all National Institute for Health Research (NIHR) funded staff should “prioritise nationally-sponsored COVID-19 research activity” [ 6 ]. They later clarified, stating “the NIHR Clinical Research Network is pausing the site set up of any new or ongoing studies at NHS and social care sites that are not nationally prioritised COVID-19 studies [ 6 ].” Such decisions were said to “enable our research workforce to focus on delivering the nationally prioritised COVID-19 studies or enable redeployment to frontline care where necessary [ 6 ].” To date, reports have focused on the outputs of this research, such as the outcomes of vaccine studies or results of treatment trials, and on frontline clinical staffing, healthcare provision and resource strains faced by hospitals and health care systems at national and global levels [ 7 – 12 ]. As yet, there has been no analysis of the organisation of the research response and the broader impact of the reorganisation of hospitals and research facilities that has allowed clinical research and emergency care work to take place during the pandemic.

In this paper we provide a detailed exploration of how the embedded research infrastructure in one NHS Trust in South London. Throughout this paper, we e use the pseudonym South London Acute Trust (SLAT) to avoid direct identification. This Trust was repurposed to support the completion of COVID-19 research and delivery of frontline care. SLAT is one of the UK’s most research-active Trusts, annually recruiting over 19,000 patients to more than 550 studies. Between February and December 2020, SLAT opened over 80 COVID-19 studies, with more than 18 of these classed as Urgent Public Health studies, recruiting over 7,000 participants. Within this context, we ask: what have been the impacts of COVID-19 on SLAT’s clinical research system, and how has the embedded research system been adapted and repurposed to support the COVID-19 response?

Prior to the pandemic, the process of setting up and managing a clinical research study within a UK NHS Trust involved multiple steps and several actors. Decisions on whether or not to open specific studies rested primarily with the relevant clinical directorate who would vet the study for its appropriateness, scientific merit and feasibility. Other processes were centralised by the Trust’s Research and Development (R&D) governance office, like the sponsorship review (that is, deciding whether the Trust will take responsibility for the study and study compliance) or assisting researchers to gain approvals from national regulatory bodies like the Medicines and Healthcare products Regulatory Agency (MHRA) and the Health Research Authority (HRA). With approvals in place, R&D would then assess whether sufficient resources were available to support the study (the capacity and capability review). Completing this process was often both onerous and time consuming. As a result of the COVID-19 pandemic, substantial parts of this process were reconfigured, as we detail below.

This is a case study of how the embedded research infrastructure at one NHS Trust was repurposed to support the delivery of frontline care and COVID-19 research. The case study method allowed us to track how the research system was adapting in real time, and enabled an in-depth look at the processes and mechanisms that have underpinned operational changes [ 13 ]. As an instrumental case study, one that focuses on socially, historically and politically situated issues, we use a single site to examine issues that are also faced by other hospital Trusts [ 14 ]. We employed an online questionnaire of research-involved staff, document analysis of emails and official national and Trust documents, observations of planning meetings and semi-structured interviews. Data were collected from individuals working in four levels of the research infrastructure: (1) central research oversight and governance (including R&D leads and research governance staff); (2) principal investigators (PIs); (3) the research delivery workforce (including research nurses, clinical research practitioners, data analysts and research managers); and (4) Patient and Public Involvement (PPI) managers and PPI representatives. Triangulating these four data sources and four levels allowed us to consider the representativeness of our data across the case. Redeployment figures and wider workforce information were provided through a request to SLAT’s research management office.

Sampling and data collection

Data were collected by DW, RFG and HC over a period of six months, from May to October 2020. In the first stage of research, an online questionnaire was disseminated to all research-involved staff at SLAT (approx. 700) on 18 th May 2020 via pre-existing mailing lists. The questionnaire closed on 10 th June 2020 with 170 responses, yielding a response rate of approximately 24%. Whilst 24% would be an inadequate response rate for statistical analysis [ 15 ], it was not intended as a validated survey, but rather a method to gain a broad understanding of staff’s experiences of the COVID-19 research response, with most questions open-ended. We received completed questionnaires from nearly a quarter of research staff during the pandemic. The questionnaire also enabled us to identify and recruit a maximum variation sample of staff involved in the research response across the four groups to interview. Interviews allowed us to explore in more depth some of the recurring themes first identified in the questionnaire.

Interview participants were also recruited using purposive and snowball sampling with an aim to maximise the representation of a variety of experiences across the case [ 16 ]. Key staff within SLAT were identified based on searching the Trust’s website, reviewing staff lists and by speaking to senior personnel for guidance. Interviews were conducted digitally on Microsoft Teams and were recorded and transcribed verbatim. Interviews focused on participants’ work prior to the pandemic, how this work has changed as a result of COVID-19, and the short and long term impacts of COVID-19 on health research more broadly.

Additionally, we obtained permission to observe the regular research prioritisation meetings convened by the Trust’s Director of R&D. These meetings took place over Microsoft Teams once or twice a week and were attended by an average of 10 senior clinical, research and research delivery leaders per session. We attended the meetings as non-participant observers, taking notes and recording proceedings. Recordings were transcribed verbatim. We also analysed all documents that were produced or circulated in connection to the prioritisation meetings. These included email discussions about specific projects, national directives, Trust protocols as well as the applications submitted by investigators to the prioritisation committee.

Lastly, we attended the handful of PPI meetings that were held by the few active PPI groups during this period. We participated in discussions about specific research projects and heard participants’ experiences of PPI during the pandemic. PPI is a core part of the pre-COVID-19 research and research design process [ 17 ]. It was therefore important that changes to PPI were considered within our study. We were also able to present our research and get feedback from groups about our aims. PPI meetings were not recorded, but detailed notes were taken during each session.

Conducting qualitative research during the COVID-19 pandemic has required us to adapt data collection methods to accommodate restrictions on face-to-face meetings and access to the hospital. Studies note that while video conferencing has many benefits, issues such as the familiarity of participants with online platforms and access to technology and high-speed internet can be barriers to the successful use of these technologies in interviewing [ 18 , 19 ]. We experienced only a handful of technical problems in our interviews. In all but two instances, interviews were conducted with cameras on so that we could observe non-verbal communication [ 20 ].

Our data were managed and analysed through NVivo 12 using a two stage process [ 21 ]. In the first stage, we analysed the data for a descriptive and narrative account, paying attention to the contours of the emerging response to COVID-19, including national and Trust decision-making and action [ 22 ]. In the second stage we used thematic analysis to develop an analytic account based on emerging themes [ 21 , 23 ]. Data were coded for key themes independently by DW, RFG and HC iteratively throughout the data collection process. Codes and core themes were then discussed and verified across the researchers. As part of our analysis process, we also presented initial findings to research staff at SLAT and at another NHS Trust. These methods of challenging our analysis both internally and externally were crucial for ensuring we reflected on our own influences on the data and the data’s utility beyond our specific case [ 24 ].

Ethics approval for the study was granted by North East—Newcastle & North Tyneside 2 REC (reference: 20/NE/0138).

We completed 24 interviews, lasting from 24 to 105 minutes (mean average of 52 minutes), observed approximately 40 hours of research prioritisation meetings and 4.5 hours of PPI meetings, and received 170 responses to the questionnaire. In the results that follow our interview participants are divided into four groups. We identify participants using a letter to denote group and number for interview within this group:—G-n (Governance/R&D staff), R-n (Research leaders/PIs), D-n (Research delivery staff), P-n (PPI managers). 3 participants sit in more than one of these groups due to their multiple roles within the Trust. These participants were interviewed using questions from interview guides for all relevant groups. Questionnaire participants are identified as Q-n, followed by a brief description of their role. See Tables ​ Tables1 1 and ​ and2 2 for a breakdown of participants.

Centralisation: Prioritising COVID-19 research and redeploying research staff

Centralisation within the research apparatus occurred across two levels.

National decision-making

At the outset of the pandemic, DHSC took steps to assert central control over national research priorities in order to coordinate the national response to COVID-19. This included the shut down or partial shutdown of the normal functioning of the research system. A document circulated throughout the NHS on the 13 th March 2020, which included information from 25 separate Trusts, announced that elements of the UK’s national R&D infrastructure, including the UK Clinical Research Facilities (CRF) and NIHR Clinical Research Network (NIHR CRN) Coordinating Centre were “joining up working to ensure consistency of approach” and that “currently UK NIHR/RC and EU research funding bodies are in the process of selecting research that will be prioritised for approval and delivery across the NHS during the pandemic.” On 16 th March 2020 a directive from the DHSC and the Chief Medical Officer (CMO) ordered the suspension of all non-COVID-19-related research and the reorientation of research capacity towards the effort to develop COVID-19 treatments and vaccines [ 6 ]. Only those studies funded by the NIHR and where “discontinuing them will have significant detrimental effects on the ongoing care of individual participants involved in those studies” were allowed to continue [ 6 ]—in short, those studies where research was the standard of care, for example, with experimental cancer treatments. Decisions on which studies met this threshold were decided at the Trust level. Table 3 documents the scale of the pause in the normal research pipeline at SLAT. Participant G-2 saw this DHSC and CMO directive as an effective way to focus research resources:

I think the really helpful bit was the sort of diktat from Chris Whitty and Louise Wood at DH [Department of Health and Social Care] to say, “Stop everything that’s not COVID.” […] So, to actually have something centrally that said, “No, you’re not actually allowed to do that because we’ve got to focus on the COVID stuff,” was very helpful because people just stopped asking–which was great. And we were freed up to change processes as we needed to.

Following this directive, a new system of badging certain studies as of Urgent Public Health (UPH) was established, run by DHSC and the CMO. All clinical studies including COVID-19 treatment and vaccine trials that hoped to recruit patients within NHS sites were required to apply for UPH status. An Urgent Public Health Group was convened, chaired by Nick Lemoine, the medical director of the NIHR CRN. The group was responsible for deciding which protocols to label UPH, based on evaluations of scientific merit, feasibility and greatest potential patient benefit [ 25 , 26 ]. Of the 1600 research protocols received by the CMO from March 2020 to February 2021, only 83 were considered national priorities [ 5 , 27 ]. Once a study had received UPH badging, hospital sites like SLAT were required to open them, if resources were available.

This centrally-organised prioritisation of COVID-19-related research removed the authority of individual Trusts and directorates to shape their own research portfolios. This was an unprecedented move by the DHSC, but allowed resources to be concentrated on studies deemed to have the greatest potential impact.

Trust-level decision-making

In order to enact the DHSC mandate to prioritise COVID-19 research, SLAT created a Trust-level prioritisation process. Twice-weekly prioritisation meetings commenced early April 2020 and were attended by research governance managers, research delivery managers and senior clinicians as well as representatives from the local Clinical Research Network and partner hospitals within the network. The aim of the prioritisation meetings was to protect resources and ensure capacity to undertake UPH-badged research. However, it also ensured effective, timely communication with PIs, helped identify local PIs for new COVID-19 studies led elsewhere, and managed the pause and restart of all non-COVID research. A proforma was introduced to facilitate and standardise prioritisation decision-making. Investigators were asked to provide information summarising their projects, resource requirements and whether they had received UPH badging. Proformas were reviewed during these meetings. By the end of February 2021, this group had reviewed 170 research projects using these proformas across 68 meetings, approving over 80 studies for local setup.

During the first wave of the pandemic, prioritisation group meetings focused mainly on how to open UPH-badged studies, as all other new research had been halted. One important exception was COVID-19 studies that require little or no NHS resource and took place within a single NHS site. These studies were also discussed in these prioritisation group meetings, often with a focus placed on clinical and academic merit. Most of the studies that fitted these criteria and were approved by the prioritisation group involved university researchers analysing patient data collected and pooled in the COVID patient ‘data lake’. This enabled the Trust to maintain research activity in areas not explicitly identified as urgent public health. The research reported in this article was approved through this process.

The joined up approach between national and local decision-making however did cause confusion and frustration. The process of determining whether or not a study would be badged UPH and thus allowed to proceed was initially opaque to Trust researchers and R&D, and the national UPH review process often took weeks from application submission to outcome. Furthermore, the decision to grant a study UPH was and remains out of the hands of the sites that are tasked with delivering this research, even when internally questions were raised about the appropriateness, feasibility or scientific merit of the study. Some researchers designing studies to address key issues in relation to COVID-19 struggled to negotiate the system:

In terms of national COVID studies, we tried to get a number of studies up and going, focusing on older patients. And ran into quite a lot of obstacles and barriers. [..P]eople weren’t certain whether this was research or whether it was quality improvement, audit-type, survey-type work. And that was pretty frustrating, not being able to get clear answers on that from the senior team within R&D. And access to data was very difficult. So, despite lots of conversations about why we really needed to be focusing on older patients, the majority of people with COVID, the biggest impact being in care homes, it was quite frustrating getting hold of people who could actually sign off on studies that we would have like to have done (R-7).

At the Trust level, the prioritisation of research was also important because of the reduction in available research delivery staff. As Table 4 documents, the clinical research delivery workforce, which totalled 165 on 14 th April 2020, was reduced by 79% or 131 staff members during the peak of the first wave due to redeployment to frontline care. A further 52 non-clinical research staff were redeployed to support other Trust activity. With such a reduction of staff, the ability to maintain even those studies which had not been halted was not certain and indeed many studies required changes and protocol deviations as a result. A key point of discussion in all prioritisation meetings was the resourcing requirements of proposed studies and how these requirements might be managed alongside existing commitments. In tandem with these discussions, work was done by the research delivery manager to create a central register of research delivery staff within the Trust. The push to centralise oversite of research delivery staff was initially driven by the requirement to rapidly redeploy staff including nurses and clinical trials practitioners to support the Trust’s emergency response but it was also crucial to the prioritisation group’s understanding of the availability of research resources. Prior to the pandemic, there was no central list of all research delivery staff at the Trust, as D-2 discusses:

A benefit was actually establishing who all the staff are. The systems we have in R&D which relate to where staff sit within the Trust system depends on where they’re funded from. And because research teams have lots of mixed types of funding, some of the staff are visible to me through the systems and some aren’t. So, the only way for me to know who all the staff were, was to manually myself, physically ask. There was no system anywhere that listed who the research staff are.

In addition to being redeployed to the clinical frontline, research staff were also pulled from across the Trust’s many directorates to form a new dedicated COVID-19 research delivery team. This team became responsible for the rapid set up and roll out of COVID studies of national and international importance, like the Oxford AstraZeneca vaccine trial, among others. Centralising oversight and management of the previously dispersed research delivery workforce enabled SLAT’s research system to react quickly and flexibly to the rapidly evolving clinical demands and research requirements of the pandemic.

While research activity was centrally coordinated within SLAT, R&D were initially left out of Trust emergency planning. An organogram produced by the Trust to represent its emergency response plan did not include R&D or any element of the research system, and a briefing document prepared by SLAT R&D for the Trust’s Gold Tactical Command Unit dated 14 th April 2020 noted this absence, and that there was also no “obvious place in the structure for R&D to naturally sit.” Participant G-3 reflected on what was perceived initially as a failure to consider the role of research:

I think […] the Trust essentially, corporately, hadn’t involved the R&D department in what they were thinking. […] We didn’t have a tactical subgroup where everybody else, every other area in the Trust had a tactical subgroup. […] There was nothing in place. You know, we’ve all voiced this, certainly in meetings at the senior management level–is that, and the words used were, “R&D has been forgotten.” We were forgotten. So, what the Trust had set up and which is, I think, probably a policy or a set of actions that they have for crisis management […] was very militarily organised. […] And we didn’t slot in, nor were we invited on to any of those tactical groups. And didn’t have representation on gold or silver command either. So we were left out of that whole process. […] We had to make real efforts to reach out and offer up. We felt that obligation and we did that.

By late April 2020, R&D were fully integrated into the Trust’s Gold Tactical Command Unit. By this time, however, the prioritisation process had been implemented and oversight of research delivery staff had been centralised, facilitating redeployment to frontline care and COVID-19 research. While the research system contributed staff and other resources to the Trust’s emergency response, it did so at its own initiation.

Pace of work: Shifting gears for the COVID-19 response

One of the most striking aspects of the research infrastructure’s response to the pandemic was the sheer pace of activity and change. The sociological literature on pace suggests that demands for faster productivity are common, and indeed this demand can be seen in the health services literature which often criticises clinical research for not moving fast enough [ 28 – 31 ]. However, the sociological literature also notes the importance of considering where things slow down or even halt [ 28 , 32 ]. In this section we document how pace appeared in participants’ accounts, acknowledging both areas where there were rapid increases in the speed of research work as well as how research work slowed down in other areas.

Increasing pace: Redeployment, research set up and research completion

Particularly within the first wave, it was the “reserve army” (D-3) of the research delivery workforce who were required to act at speed. As per Table 4 , staff were quickly released from research duties and redeployed to the frontlines to help deliver care. In addition, all NIHR funded staff with clinical training who were not completing COVID-19 research were asked to prioritise frontline care if their employer asked [ 6 ]. Within two weeks, more research delivery staff were redeployed to COVID-19 research teams. Staff were called up one day and told to “come in on the next day” (D-8), and managers were told “they’re going tomorrow. This is their last day with you” (D-4).

As pace of redeployment accelerated, so too did the speed of research. The pace with which researchers demanded studies be delivered and set up was “ten times quicker than normal […] as if someone’s taken a time warp machine to it” (R-2). Those already working in the research infrastructure were aware that research was vital to the pandemic response and, as one participant (D-1) explained:

we needed to start the research while we’re right in the middle of the surge in numbers. And so […] you have studies that come, they need to be set up tomorrow, recruit the first patient by the end of the week.

Such shifts in normal timeframes for work were facilitated in part through centralisation, as noted above. “The real step change,” research manager G-4 suggested, “was having a Prioritisation Group and having [the] team agree a fast-track way of doing things.” Alongside streamlined approval and set-up processes, wider research infrastructures and research practices were adapting at great speed:

I was amazed that, for example, by the end of March, there were–I counted them– 13 granting agencies that, some way or another, had calls on urgent COVID-19 research (R-4).

As a result of these rapid research projects, new knowledge was being produced at an unprecedented rate, as one participant succinctly put it, “science doesn’t usually change that quickly” (D-9). This speed was met with enthusiasm by PIs and research delivery staff alike, but also caused some nervousness. Some were concerned, for example, that PPI had “dropped off the radar” (G-3), whilst others were wary of publication prior to peer review:

the […] thing which is a challenge is that we’re pre-printing research, we’re putting pre-prints out when we’re submitting to journals, because–and we’re rushing to get the pre-prints out. […] And I guess that’s good. But it is also a bit of a–a stresser because […] maybe we haven’t quite got the message right yet (R-1).

Others warned that the pace of research during the first wave of the pandemic came at a human cost. Some researchers had vastly increased workloads, “going at max […] for 5 months” (R-1), where in some cases “there’s not been a single day when [they’ve] not been working in the laboratory including all Sundays and Saturdays, Easter and so on” (R-4). Whilst some enjoyed this fast-paced moment, for those closer to the frontline it has caused anxiety. As one participant (G-5) explained, “we’ve been fire-fighting”, and at least one member of staff, another explained, “can’t come near the hospital. She has panic attacks” (D-3). Whilst it has already been documented that critical care staff’s mental health has suffered in the pandemic, these participants suggest there may also be concern for the staff involved in the research response [ 33 ].

Seeing what is possible within the exceptional circumstances of a global pandemic led some researchers and PPI managers to question the normal slower pace of regulatory approvals and assert, “if you can do it during COVID-19, you can do it any other time” (R-6). The often slow processes such as ethical approvals, data sharing guidelines, funding applications, and study set-up was a common comparator to what has been possible during the COVID-19 pandemic. Yet, as G-1 explained: “The reason [research processes have] been quicker is just because there’s been less studies.” This is evident in SLAT’s own R&D data. Table 5 documents the difference in study numbers and timeframes from initial sponsorship review to final capacity and capability approval (allowing the site set up and recruitment to commence) across 3 financial years. While some approval processes were adapted, generally research governance requirements, both internal to the Trust and at the regulators the MHRA and the Health Research Authority, remained the same. The quick approval processes were possible because no new non-COVID-19 studies were reviewed, COVID-19 studies were processed as quickly as possible and almost all non-COVID-19 related research was halted.

Slowing or halting non-COVID-19 research

For some investigators, the halting of non-COVID-19 research led to a slower pace where researchers could play catch up. “People have just been writing up their papers” (R-3), and this period of time “gave […] the opportunity, freed up time” (R-6) to apply for grants. Whilst many tried to set up studies so they were ready to go when restrictions were lifted, they also found that “regulatory bodies have been slower” (R-6) due to their focus on COVID-19. It was apparent that these researchers had more time to engage in PPI whilst putting these grants together–one PPI manager working in cancer (P-3) suggested “PPI activity has probably increased” during the pandemic. Whilst many researchers were understanding of the need to halt research, others found it devastating for patients and the reputation of UK research. These researchers (R-3 and R-6) pointed to other international contexts where they saw standard research continuing. Researcher R-6 was surprised “with the UK being such a […] clinical trials powerhouse”, that decision-makers didn’t “do everything it could to retain that reputation even through the COVID-19 crisis.”

On 21 st May 2020 the DHSC and NIHR circulated a framework for restarting new and paused non-COVID-19 research. Stratifying research studies into three levels of priority, this framework made no distinction between commercial and non-commercial research. Using this framework, the Trust implemented its operational Restart Plan the week commencing 1 st June 2020. Recommendations on which research studies were important or urgent to restart within each directorate was managed a directorate level, with the Prioritisation Group acting as the Trust-level decision making body for the restart plan. The Prioritisation Group continued to meet weekly to approve restart plans for research projects. By mid-summer restart was well underway but the pace of resuming all these studies could not match the pace that research stopped, and researchers were concerned that they “haven’t really been able to pick up our trial recruitment in between [waves], because recovery has been so slow” (R-5). The time of “let’s get back to normal quickly because COVID’s over”, participant R-2 explained soon turned to “actually, let’s not rush back into things because we don’t know what’s coming.” At this point the centralisation of research infrastructures hindered speed rather than aided it–one research governance manager (G-4) suggested that “we need to respect the decision-making of the research managers and matron and the R&D leads now”, but instead studies were “number 507 in the queue”, and having to “wait another week for this prioritisation meeting” whilst “people are really scared about their finances […] frightened about not finishing […] patients are waiting.”

Adopting new and virtual working practices

The response to COVID-19 pandemic has resulted in broad shifts in working patterns across the labour market, and will likely lead to longer term transformations to work practices stemming from these temporary changes [ 34 – 36 ]. In health, research highlights the accelerated adoption of digital and virtual working practices as a result of COVID-19, such as the use of telemedicine in secondary care [ 37 – 39 ]. The implementation of new working practices, taking advantage of digital technologies for communication and the adaptation of existing processes so that they can be completed (at least in part) during the pandemic are also crucial elements of the research response to COVID-19, particularly for facilitating the continuation of research.

Reducing patient visits

Clinical research is a highly regulated domain, with strict oversight on practices and procedures, and reporting requirements overseen by multiple regulators. While research setup and governance processes became more centralised, the successful conduct of research during the pandemic required a degree of flexibility and creative adaptation. The move to more remote or virtual ways of completing, supporting, regulating, and facilitating research relied on the speedy adoption of new technologies and ways of working.

On 12 th March 2020, the MHRA issued guidance to sites and investigators “regarding protocol compliance during exceptional circumstances” [ 40 ]. The guidance stated that the MHRA recognised “the difficult current situation” and advised on how to manage trials during the pandemic [ 40 ]. The MHRA also noted in this guidance and on the MHRA Inspectorate website that a redistribution of human resources during the pandemic:

may mean certain oversight duties, such as monitoring and quality assurance activities might need to be reassessed and alternative proportionate mechanisms of oversight introduced (such as phone calls, video calls) to ensure ongoing subject safety and well-being. We would advise a brief risk assessment and documentation of the impact of this [ 40 ].

While this guidance came before the formal research shutdown, it remained important, especially for the small amount of research which was allowed to continue because it was the best or only treatment option left available for patients. However, research practices and trial protocols needed to be adapted, particularly as there were restrictions on who could physically visit hospital sites, as G-5 highlights:

If a protocol says that a participant will have a visit at week 1, week 2, week 3 and week 4 and those are protocol visits–it’s unacceptable not to do those visits. They are protocol deviations. However, during the real surge of the pandemic, those visits couldn’t be done. They couldn’t come in and have an MRI scan, and ECG and bloods taken. What they did have was someone contacting them by telephone or by Skype or other formats, media format–to say, “How are you doing? Are you okay? Is there anything you need to report? Keep in touch” (G-5).

Through delaying or adapting follow-up appointment requirements so they could be completed over the telephone or through videoconferencing, many studies were able to maintain some level of continuity. For these research participating patients, other parts of the research process needed sensitive negotiation, as one PI explains in relation to changes in the format of patient consultations:

Some [participants] were actually a bit reluctant and felt a bit fobbed off to be called at home [when] they were due a face-to-face consultation. We had to be a bit careful about that, particularly if we were discontinuing treatment or discharging people from our care. That almost always went badly if we tried to do it remotely. And if we were having a really definitive conversation like that, it was worth–we found, in the end, patients coming up. Other patients were reluctant to come and readily accepted our advice that rather than coming for a CT scan, we just do a chest x-ray when we next saw them. So, there is a difference of approach, which is personal–not particular to their circumstance (R-5).

Balancing the need for face-to-face consultations and the protection offered by telephone or video consultations required thoughtful, individualised decision-making. For other studies however, digital consultation was simply not possible, which lead to investment in supporting people to attend the hospital:

A few studies have been done remotely, but the one that I have taken on, patients really have to come in. So, we had to do a lot of logistic development there, like bringing them in by car, paying for whatever is necessary just to make sure that they continue coming in (D-6).

Working from home

Another crucial step in facilitating research and frontline care was asking large numbers of staff to complete their work from home. For some participants, working from home lead to greater productivity, but for many others it meant the blurring of home and work lives. Numerous factors impacted on participants’ experiences, from juggling work alongside home schooling and caring responsibilities, to feelings of isolation, through to more practical issues, such as having a space to work at home, having sufficient internet bandwidth and having stable access to Trust systems (see Box 1 ).

Box 1. Indicative questionnaire responses to: What, if any, challenges have you had to face working from home?.

While research staff were transitioning to working from home, research spaces were transformed to facilitate frontline care. By April, two of the four Clinical Research Facilities (CRFs) in the Trust were repurposed to deliver frontline care and training space for frontline staff. The remaining two CRFs were refocused on supporting COVID-19 research. The vacant R&D department’s office spaces were also used by Trust staff to facilitate socially-distanced meetings and computer work for those who needed to be onsite. Careful repurposing of offices and clinical space provided the Trust with additional, flexible physical space to assist in the emergency response to the pandemic.

Digitalising research processes

Research work still occurred within the normal parameters of how health research is conducted in the NHS. These practices were, however, done differently to adapt to COVID-19 social distancing measures.

Firstly, researchers initially had to find a workaround for consent to research in COVID-19 wards. Because of infection control protocols no materials, including paper consent forms, could be removed from COVID positive wards. As there were no protocols in place to gain consent digitally, staff developed a local workaround, as D-1 explains:

we managed to get some […] work phones so that we could take a picture of the consent [form]. So, the consent [form] was held up to the window [in the COVID ward], the team outside could take a picture of the consent form and send it directly through on the Pando app, because [Pando] could have patient details. So, it could then be turned into a PDF and printed and put in the patient file.

Another example of a slow but necessary digital solution was with site monitoring. Site monitoring allows commercial companies and other trial sponsors to visit research sites to assess the quality of the data and ensure study protocols are being followed. Despite MHRA instruction that this “should not add extra burden to trial sites” [ 40 ] and that monitors could not be justified as an extra body in the building, these activities are crucial not just for validating data but for hospitals to be able to bill sponsors for the completed research. Workarounds were further limited because of data protection regulations that prevent the digital transfer of patient data or remote access to Trust systems by external individuals. Where site monitors would usually work alone on site, it became a long and arduous process:

a member of the research team within the Trust sits at a screen and shared that screen through Microsoft Teams with the external person. So, no data is held, no recordings are being done, no data is transferred. But it’s very, very labour-intensive. (G-5)

Whilst workarounds were quickly found for some research practices, others took longer. Despite the fact that Patient and Public Involvement in research (PPI) is a core element of contemporary UK health research [ 17 ], there was initially “zero PPI” (G-1). Rather PPI group managers focused on care work: “putting them in touch with local services that could do things like pick up prescriptions for them, get shopping, get the food boxes delivered” (P-1). It was only with time that not only did researchers planning non-COVID research begin to engage more than usual with their PPI groups, but that funders and regulators demanded that PPI should still be prioritised even in emergency research [ 41 , 42 ].

While researchers voiced concerns about the equity of shifting online and assumptions about who will and will not engage with online PPI, this did not appear to be a problem in practice:

There’s often a sort of an ageism about who can–it’s like kind of what you were just saying about older people can’t do PPI. Well, bollocks. I mean actually they’ve been as responsive to this pandemic as anybody else. The rates of use of, you know, technology, has like skyrocketed in the over 65s, because of their need to talk to their grandchildren etc. So, you know, they are adaptive (R-1).

R-1’s experience was echoed by PPI representatives. Reflecting on the move online, these representatives noted some disadvantages, such as the absence of many social aspects of attending PPI meetings, and video fatigue. But participants were generally positive about the potential of virtual PPI for involving those who cannot always travel long distances due to their illnesses, those who work full-time but could attend an hour session online in their lunch break, and representatives in different countries.

In short, the process of realigning and digitalising research practices was not simply one that sped up research and productivity, but it involved a set of necessary, labour-intensive workarounds. It did, however, also bring about possibilities for long term positive effects, such as diversifying involvement in PPI groups.

COVID-19 has brought to the fore the critical importance of the UK’s clinical research infrastructure which has over the past 15 years become increasingly embedded within the NHS. It has enabled NHS hospitals to deliver research of global importance at an unprecedented pace while simultaneously providing critical care for record numbers of acutely ill patients. We provide an analysis of how this was possible through an in-depth case study of the transformations and reconfigurations of the research system at one research-intensive Trust. Our data show that a large-scale reorganisation of research staff, research infrastructures and research priorities took place during the first few weeks and months of the pandemic. We have documented many of the changes in organisational structure, national policy and everyday working practices that facilitated the Trust’s response to COVID-19. These rapid changes have brought about new ways of working, and new perspectives on the role of research which may have far reaching consequences for the future of the clinical research system in the UK.

The pandemic occasioned a large-scale mobilisation of research staff as a “reserve army.” Research staff were crucial in supporting the care-function of NHS hospitals during the first wave of the pandemic. At the same time, the embedded research system helped to streamline, facilitate and deliver rapid COVID-19 research.

Our study documented some of the challenges that the research system has faced in seeking to operate in a COVID-safe manner. At the same time, our participants described instances of improvisation in order to adapt protocols to the COVID-19 environment. Research staff developed effective practical solutions borne out of necessity, rather than the result of prior planning. This points to the resourcefulness of research staff, but also highlights the ways in which the research system was initially largely absent from existing emergency planning within the health system.

Our research was conducted while the Trust we were studying enacted national COVID-19 policy, responded to local care needs and supported clinical research during a global pandemic. This allowed us to observe these events unfolding while gathering data in a COVID-safe manner. But the pandemic created limitations as well, especially impacting the range of methods we were able to use. While working digitally did give us a first-hand experience of how a large proportion of the decision-making infrastructure had to move online, it limited our access to frontline care and everyday research activity.

There are also limitations of looking at a research active Trust like SLAT. While research is increasingly becoming a routine component of all NHS settings, SLATs size and existing research portfolio meant there was a large amount of resource available to redeploy towards COVID-19 care and research delivery. This picture may not be representative of all NHS Trusts, particularly those that are smaller, where less research takes place. Such resource, particularly in the form of biomedical research infrastructures embedded within NHS Trusts, have provided what Roope et al. label ‘option value’ in research, additional capacity to support public good, which in normal times may appear an inefficient use of resource [ 43 ]. Roope et al. highlight that, in comparison to funded, individual research studies, funding research infrastructures allows greater flexibility and speed of response when emergencies arise, such as the COVID-19 pandemic. While the research workforce, funds and infrastructures were used to support other research prior to COVID-19 (as opposed to being excess capacity), the ability of such resource to be reallocated to COVID-19 at such pace underpinned much of the UK’s success in its research response and much of the work described in this paper. It is important to acknowledge, however, that research capacity is distributed unevenly throughout the NHS, and resources such as Clinical Research Facilities and Biomedical Research Centres tend to be situated in major teaching hospitals and trauma centres rather than geographically more localised hospitals. More research is needed to understand how this unequal distribution of resources affected outcomes of care and research during the pandemic.

In documenting how the pace of research work changed dramatically during the pandemic, both in terms of increasing the speed of certain activities and decreasing the speed of others, our paper also contributes to broader discussions of pace in clinical research. In particular, the key question—how do we most effectively streamline the research pipeline, from bench to bedside? Hanney et al. highlight the potential to overlap parts of the translational research pathway to speed up the process, and some of the barriers to this, such as ethical approvals and resourcing issues [ 30 , 31 ]. Many of these issues were removed during the pandemic because of the targeting of resources towards COVID-19 research. On a more practical level, however, our analysis suggests some ways that the research system may be adapted in the future. The potential offered by digital communications to facilitate certain research and PPI activities have led some clinical researchers to question the necessity for research participants and patients to always attend hospital sites for consultations. Trust-level research prioritisation has proved positive in managing finite local resources as effectively as possible, enabling a more holistic view of the research portfolio at a local level as well as take into account national priorities. At the same time, it is clear that the new technologies and new ways of working that were developed to cope with the crisis are not automatically more efficient, and there is a danger that some key steps such as adequate PPI might be overlooked when research pace is increased. Further research and planning will be needed to develop suitable governance processes to facilitate research activities both when on a crisis footing, and in more routine practice. Wider investment in networked digital applications and hardware (such as Trust compliant laptop computers) is needed to facilitate better working from home.

Our study suggests a number of additional lessons for future national emergency planning and policy. Research infrastructure must be better included in advanced planning, both in terms of the personnel, equipment and other resources that can be made available for redeployment as well as the direct impact that research can make. The capacity to develop new treatments and vaccines should be treated as a strategic asset that is a central part of any emergency response. This has been recognised at the national level, and internationally [ 1 – 3 ], but our data suggest that it has not fully translated into Trust-level operations. Planning for future emergencies should include protocols for the rapid establishment of strategic research prioritisation and redeployment of research infrastructure and capacity. Our data also show that throughout the pandemic, there remained a demand for public input in research, which should be included in future emergency planning. Public input is vital in clinical research, especially in an emergency response which requires publics to respond to clinical-expert advice, and planners should recognise it as such.

Future emergency planning must, however, take into account the exhaustion and stress faced by research staff who suddenly found themselves on the front line of a national mobilisation. Research staff experienced the same well-documented stresses experienced by other NHS workers [ 33 , 44 ]. Emergency planning should acknowledge this human cost and find ways to mitigate such costs and provide support for staff as a national priority.

At a global level, the UK response and its specific organisation, as described within this case study Trust, demonstrates some of the benefits of embedding research infrastructures within a national health provider, and how this set up not only enabled a coherent national response, but also provided staff resource to facilitate such research at great speed as well as support the delivery of frontline care. As we look to the future, how we integrate healthcare and research at more national and global levels are important areas for further research and discussion.

Acknowledgments

We are grateful to Christopher McKevitt and Nina Fudge for providing astute comments on drafts of this paper and to our participants who shared their experiences and time with us during this period of unprecedented strain on the NHS.

Funding Statement

DW, RFG, HC and CADW are all funded by the National Institute for Health Research ( http://nihr.ac.uk/ ) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London (Grant number IS‐BRC‐1215‐20006). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Data Availability

• PLoS One. 2021; 16(8): e0256871.

Decision Letter 0

Transfer alert.

This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present.

14 Jul 2021

PONE-D-21-12411

Impacts of COVID-19 on clinical research in the UK: a multi-method qualitative case study

Dear Dr. Wyatt,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The reviewers noted the interest and importance of your research question and strength of your methods, particularly the multiple forms of data collected and triangulated under pandemic conditions. The reviewers have suggested some minor revisions, which I ask that you please address. For readability and an international audience, I would also suggest removing all but the most common acronyms (COVID, NHS, MRI, CT scan etc) especially for organisations or processes and to read through with an eye to things that might need a bit of explanation/context (e.g. the Pando app). I look forward to receiving your revised manuscript.

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Reviewer #1: This is a well undertaken and fortuitous study that explored the impact of the COVID-19 pandemic on clinical research activities in a UK NHS hospital/trust. The research started very soon after the UK entered their First National Lockdown and does well to capture the immediate impact of the pandemic on clinical research. This case study documents the processes followed at one NHS clinical research site and should provide guidance for further research to explore good practices during this pandemic at a National and International level; as well as preparing for future global public health emergencies.

The case study is detailed, well written and explores a range of factors. It is a case study and as such there are no concerns with the methods used. The discussion is in keeping with their findings. They do highlight in the introduction that SLAT is a research active trust. This issue could be further elaborated in their discussion; especially in relation to adding caution to their experiences. Less well-resourced healthcare settings where research was being undertaken prior to the Pandemic may not have managed as well; or may not have been able to support COVID related research as well. The pandemic has highlighted some of the flaws in centralising research activities and resources to a few, larger healthcare settings.

A few very minor issues:

1) Results (Lines 2004-2007): could the authors review the Directive from the DHSC and CMO. The guidance also states: “However, clinical trials or other research studies which are funded or supported by NIHR should continue if discontinuing them will have significant detrimental effects on the ongoing care of individual participants involved in those studies”.

2) Could the authors clarify the data shown in Table 4? It was unclear where the number of 165 clinical research delivery workforce comes from. Is this based on the participants who completed the questionnaire (n=155)? It was also unclear where the number (52) of non-clinical research staff comes from.

Reviewer #2: The research team deserves congratulations for rapidly producing this generally well-written and well-conducted, multi-method, qualitative study that sheds important new light on how the UK health research system mounted what is generally seen as globally the most effective research response to the COVID-19 pandemic. (I believe the explanation of why there are some restrictions on the availability of data seems entirely appropriate in the circumstances).

Particular strengths of the study include the way in which the multi-methods were used in this case study to create a detailed analysis of the various phases of the impacts of COVID-19 on clinical research, and to analyse the impacts on both COVID-19 and non-COVID-19 research.

There is some recent COVID-19 related literature from the health research systems field that might further assist the authors in drawing their conclusions. This point is described, along with a few others, in the numbered comments below which are presented in the order in which they first arise in the text.

1. Line 58: There are obviously some complexities around whether the term UK or England and Wales should be used. In most places in the text, including here, the term UK is used, but on line 198 reference is made to "the research system in England and Wales": perhaps the authors should consider whether it might be useful to add a footnote to explain how the terms are being used in this article?

2. Lines 62/3 and 84: In relation to the "83 nationally prioritised COVID-19 research projects", first, it might be better to state the full period over which they commenced, rather than just "Since January 2020", and second it might be helpful to clarify here whether this category is the same as the studies "classed as Urgent Public Health studies" described on line 84.

3. Lines 80/82: Perhaps the introduction of the abbreviation "SLAT" could be set out slightly more clearly because the first mention, "we provide a detailed exploration of how the embedded research infrastructure in one South London Acute Trust (SLAT)", seems to imply that SLAT refers to a category of trusts, but then on line 82 and elsewhere throughout the text it is clear, of course, that the abbreviation SLAT is being used for a single trust.

4. Lines 335-341, 440, and Discussion: In relation to questions about the speed in which research is produced, reference is made to "The sociological literature", but it might also be useful to refer to the literature that adopts more of a health research systems perspective and analyses how some research has been conducted much more rapidly than usual during the COVID-19 crisis. Some of the analysis includes, for example, discussion of how the usual queues for decisions and resources that cause sometimes seemingly inexplicable delays in research that turns out to have been of considerable importance, were somewhat eliminated by the increased concentration on COVID-19 vaccine research and the increased resources available; see, for example: Hanney, S.R., Wooding, S., Sussex, J. Grant J. From COVID-19 research to vaccine application: why might it take 17 months not 17 years and what are the wider lessons?. Health Res Policy Sys 18, 61 (2020). https://doi.org/10.1186/s12961-020-00571-3

Reviewer #3: Dear Authors. Thanks for this important study focusing on the perspectives of the researchers working with COVID-19. This is an important case giving valuable insights into future challenges. It gives important insights into workload, different ways of working and also preprints that became an issue when media picked up unverified data and never followed up on the studies once peer reviewed. It would be interesting to have your results compared to other countries. Do you know if any similar research have been done that your case can be compared to? I have only a few comments in the attachment.

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Submitted filename: PONE-D-21-12411.pdf

Author response to Decision Letter 0

13 Aug 2021

Dear Editors

We would like to thank the Editor and Reviewers for their time in reviewing our manuscript and their very thoughtful and constructive recommendations, which have helped us strengthen our paper. We very much appreciate this opportunity to revise our manuscript. The document below provides a point-by-point summary of how we have responded to the Editor’s and Reviewers’ comments.

Thank you once again for the opportunity to revise our paper, and we look forward to hearing from you in due course.

With very best wishes

(on behalf of all authors)

Editor Comments:

Editor’s comment 1

Authors’ response:

We have reviewed the reference list, which is formatted using the PLOS Endnote style. We have added references 30 and 31 as a result of the reviewers’ comments and updated reference 5.

Editor’s comment 2

1. Please ensure that your manuscript meets PLOS ONE’s style requirements, including those for file naming. The PLOS ONE style templates can be found at

We have now reformatted the manuscript in line with these style requirements.

Editor’s comment 3

2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study’s minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability .

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data:

http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions . Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

This paper draws on a qualitative research study. As per your guidance for qualitative studies ( http://journals.plos.org/plosone/s/data-availability ), we have made excerpts of the data available within the body of the article and within Box 1. We believe this meets your data availability requirements and counts as the minimal data set.

Editor’s comment 4

We have moved our ethics statement to the Methods section. (Lines 177-178)

Reviewer 1, comment 1

This is a well undertaken and fortuitous study that explored the impact of the COVID-19 pandemic on clinical research activities in a UK NHS hospital/trust. The research started very soon after the UK entered their First National Lockdown and does well to capture the immediate impact of the pandemic on clinical research. This case study documents the processes followed at one NHS clinical research site and should provide guidance for further research to explore good practices during this pandemic at a National and International level; as well as preparing for future global public health emergencies.

Many thanks for taking the time to review our manuscript and for your valuable feedback. We believe the manuscript to be much improved following your input.

We have added sentences to the Discussion to highlight where further research is needed, particularly in hospital settings where there are not vast research resources that can be redeployed to support care and COVID research. We have also warned about the importance of public input. (Lines 653-654, 686-688)

Reviewer 1, comment 2

We have now added an acknowledgement of the potential differences in research and research resourcing across NHS Trusts to the Discussion section. While we can’t comment specifically on how those in NHS Trusts other than SLAT experienced COVID-19 and adapted to deliver care and COVID-19 research, we now acknowledge the value of embedded research infrastructures in facilitating flexibility and pace in emergency situations, which may not be reflected across all NHS Trusts. (Lines 637-663)

Reviewer 1, comment 3

Thank you for this point. We have now updated the manuscript to acknowledge these aspects, highlighting that research could continue when it was the standard of care for patients. (Lines 211-218)

Reviewer 1, comment 4

Thank you for pointing out this potential confusion. We have now relabelled the column titles of Table 4 to stress the two different workforces (those that are clinical (131) and those that are non-clinical (52) that were redeployed) and made it clear in text that 165 is the total number of clinical research staff as at 14 April 2020 (and not the number that participated in our study). (Line 291/Table 4, line 295)

Reviewer 2, comment 1

The research team deserves congratulations for rapidly producing this generally well-written and well-conducted, multi-method, qualitative study that sheds important new light on how the UK health research system mounted what is generally seen as globally the most effective research response to the COVID-19 pandemic. (I believe the explanation of why there are some restrictions on the availability of data seems entirely appropriate in the circumstances).

Many thanks for your thorough review of our manuscript. We have addressed all of your comments and believe the text to be much improved. Please find point by point response to your comments below.

Reviewer 2, comment 2

1. Line 58: There are obviously some complexities around whether the term UK or England and Wales should be used. In most places in the text, including here, the term UK is used, but on line 198 reference is made to “the research system in England and Wales”: perhaps the authors should consider whether it might be useful to add a footnote to explain how the terms are being used in this article?

Thank you for pointing out this complexity. We have now removed England and Wales from line 258. While there is a difference between the devolved nations of the UK, the pausing of research occurred across the UK, so removing reference to England and Wales avoids overcomplicating the point. (deletion on line 205)

Reviewer 2, comment 3

2. Lines 62/3 and 84: In relation to the “83 nationally prioritised COVID-19 research projects”, first, it might be better to state the full period over which they commenced, rather than just “Since January 2020”, and second it might be helpful to clarify here whether this category is the same as the studies “classed as Urgent Public Health studies” described on line 84.

Thank you for this comment. We have amended the text to highlight that these are Urgent Public Health (UPH) studies and removed “Since January 2020” to avoid any confusion. There were no UPH studies before this date. We have also updated the number of studies from 83 to 95 (as further studies have received UPH badging since this reference was added to the manuscript). (Lines 61-62)

Reviewer 2, comment 4

3. Lines 80/82: Perhaps the introduction of the abbreviation “SLAT” could be set out slightly more clearly because the first mention, “we provide a detailed exploration of how the embedded research infrastructure in one South London Acute Trust (SLAT)”, seems to imply that SLAT refers to a category of trusts, but then on line 82 and elsewhere throughout the text it is clear, of course, that the abbreviation SLAT is being used for a single trust.

We have updated the text to make it clear that SLAT is a pseudonym. (Lines 81-82)

Reviewer 2, comment 5

4. Lines 335-341, 440, and Discussion: In relation to questions about the speed in which research is produced, reference is made to “The sociological literature”, but it might also be useful to refer to the literature that adopts more of a health research systems perspective and analyses how some research has been conducted much more rapidly than usual during the COVID-19 crisis. Some of the analysis includes, for example, discussion of how the usual queues for decisions and resources that cause sometimes seemingly inexplicable delays in research that turns out to have been of considerable importance, were somewhat eliminated by the increased concentration on COVID-19 vaccine research and the increased resources available; see, for example: Hanney, S.R., Wooding, S., Sussex, J. Grant J. From COVID-19 research to vaccine application: why might it take 17 months not 17 years and what are the wider lessons?. Health Res Policy Sys 18, 61 (2020). https://doi.org/10.1186/s12961-020-00571-3

Thank you for raising this important point. We have referenced this text and the health services literature within the initial introduction to the pace section. To our Discussion section, we have also now added a text on pace that goes beyond the everyday practices in the hospital, drawing on Hanney et al’s work (as you kindly suggest) and that of Roope et al. (on option value). (Lines 352-353 and 656-663)

Reviewer 3, Comment 1

Dear Authors. Thanks for this important study focusing on the perspectives of the researchers working with COVID-19. This is an important case giving valuable insights into future challenges. It gives important insights into workload, different ways of working and also preprints that became an issue when media picked up unverified data and never followed up on the studies once peer reviewed. It would be interesting to have your results compared to other countries. Do you know if any similar research have been done that your case can be compared to? I have only a few comments in the attachment.

Thank you for your seeing the value of our paper. We are not aware of similar studies in other countries, to date, but hope there are in future.

The attachment noted above was not provided with the original decision email. On the advice of Dr Quinn Grundy, (email dated 9 August 2021, reference: PLOS ONE: PONE-D-21-12411 - [EMID:fd725523776fcf73]), we have revised and submit this manuscript without responses to this feedback.

Submitted filename: Response Letter to reviewers FINAL.docx

Decision Letter 1

18 Aug 2021

PONE-D-21-12411R1

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Acceptance letter

23 Aug 2021

Dear Dr. Wyatt:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact gro.solp@sserpeno .

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Open Access

Peer-reviewed

Research Article

Impacts of COVID-19 on clinical research in the UK: A multi-method qualitative case study

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations School of Population Health and Environmental Sciences, King’s College London, United Kingdom, National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, United Kingdom

Roles Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Writing – original draft, Writing – review & editing

Roles Conceptualization, Funding acquisition, Writing – review & editing

• David Wyatt, 
• Rachel Faulkner-Gurstein, 
• Hannah Cowan, 
• Charles D. A. Wolfe

• Published: August 31, 2021
• https://doi.org/10.1371/journal.pone.0256871
• Peer Review
• Reader Comments

Clinical research has been central to the global response to COVID-19, and the United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out globally for the scale and speed of its COVID-19 research response. This paper explores the impacts of COVID-19 on clinical research in an NHS Trust and how the embedded research system was adapted and repurposed to support the COVID-19 response.

Methods and findings

Using a multi-method qualitative case study of a research-intensive NHS Trust in London UK, we collected data through a questionnaire (n = 170) and semi-structured interviews (n = 24) with research staff working in four areas: research governance; research leadership; research delivery; and patient and public involvement. We also observed key NHS Trust research prioritisation meetings (40 hours) and PPI activity (4.5 hours) and analysed documents produced by the Trust and national organisation relating to COVID-19 research. Data were analysed for a descriptive account of the Trust’s COVID-19 research response and research staff’s experiences. Data were then analysed thematically. Our analysis identifies three core themes: centralisation; pace of work; and new (temporary) work practices. By centralising research prioritisation at both national and Trust levels, halting non-COVID-19 research and redeploying research staff, an increased pace in the setup and delivery of COVID-19-related research was possible. National and Trust-level responses also led to widescale changes in working practices by adapting protocols and developing local processes to maintain and deliver research. These were effective practical solutions borne out of necessity and point to how the research system was able to adapt to the requirements of the pandemic.

The Trust and national COVID-19 response entailed a rapid large-scale reorganisation of research staff, research infrastructures and research priorities. The Trust’s local processes that enabled them to enact national policy prioritising COVID-19 research worked well, especially in managing finite resources, and also demonstrate the importance and adaptability of the research workforce. Such findings are useful as we consider how to adapt our healthcare delivery and research practices both at the national and global level for the future. However, as the pandemic continues, research leaders and policymakers must also take into account the short and long term impact of COVID-19 prioritisation on non-COVID-19 health research and the toll of the emergency response on research staff.

Citation: Wyatt D, Faulkner-Gurstein R, Cowan H, Wolfe CDA (2021) Impacts of COVID-19 on clinical research in the UK: A multi-method qualitative case study. PLoS ONE 16(8): e0256871. https://doi.org/10.1371/journal.pone.0256871

Editor: Quinn Grundy, University of Toronto, CANADA

Received: April 14, 2021; Accepted: August 17, 2021; Published: August 31, 2021

Copyright: © 2021 Wyatt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data from this study take the form of interview transcripts, Hospital Trust and national documents, and observations of closed meetings. These data cannot be shared publicly, but extracts from interviews are presented within the body of the paper that make up the "minimal dataset."

Funding: DW, RFG, HC and CADW are all funded by the National Institute for Health Research ( http://nihr.ac.uk/ ) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London (Grant number IS‐BRC‐1215‐20006). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Competing interests: No

Introduction

Clinical research is a core part of the global response to COVID-19. The United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out by commentators globally for the scale and speed of its COVID-19 research response, particularly in terms of trial recruitment [ 1 – 3 ]. Reporting from within the UK context, Darzi et al. suggest that participating in clinical trials should be part of the clinical pathway for all COVID-19 patients [ 4 ]. To date, 95 nationally prioritised COVID-19 research projects, labelled Urgent Public Health studies, have commenced [ 5 ]. These and a large number of other COVID-19 studies have rapidly been set up and rolled out across UK hospitals. Supporting and facilitating such research has been made possible by the widespread reorganisation of the NHS’ existing embedded research infrastructure. This reorganisation was initiated by the UK’s Department Health and Social Care (DHSC), which on 16 th March 2020 stated that all National Institute for Health Research (NIHR) funded staff should “prioritise nationally-sponsored COVID-19 research activity” [ 6 ]. They later clarified, stating “the NIHR Clinical Research Network is pausing the site set up of any new or ongoing studies at NHS and social care sites that are not nationally prioritised COVID-19 studies [ 6 ].” Such decisions were said to “enable our research workforce to focus on delivering the nationally prioritised COVID-19 studies or enable redeployment to frontline care where necessary [ 6 ].” To date, reports have focused on the outputs of this research, such as the outcomes of vaccine studies or results of treatment trials, and on frontline clinical staffing, healthcare provision and resource strains faced by hospitals and health care systems at national and global levels [ 7 – 12 ]. As yet, there has been no analysis of the organisation of the research response and the broader impact of the reorganisation of hospitals and research facilities that has allowed clinical research and emergency care work to take place during the pandemic.

In this paper we provide a detailed exploration of how the embedded research infrastructure in one NHS Trust in South London. Throughout this paper, we e use the pseudonym South London Acute Trust (SLAT) to avoid direct identification. This Trust was repurposed to support the completion of COVID-19 research and delivery of frontline care. SLAT is one of the UK’s most research-active Trusts, annually recruiting over 19,000 patients to more than 550 studies. Between February and December 2020, SLAT opened over 80 COVID-19 studies, with more than 18 of these classed as Urgent Public Health studies, recruiting over 7,000 participants. Within this context, we ask: what have been the impacts of COVID-19 on SLAT’s clinical research system, and how has the embedded research system been adapted and repurposed to support the COVID-19 response?

Prior to the pandemic, the process of setting up and managing a clinical research study within a UK NHS Trust involved multiple steps and several actors. Decisions on whether or not to open specific studies rested primarily with the relevant clinical directorate who would vet the study for its appropriateness, scientific merit and feasibility. Other processes were centralised by the Trust’s Research and Development (R&D) governance office, like the sponsorship review (that is, deciding whether the Trust will take responsibility for the study and study compliance) or assisting researchers to gain approvals from national regulatory bodies like the Medicines and Healthcare products Regulatory Agency (MHRA) and the Health Research Authority (HRA). With approvals in place, R&D would then assess whether sufficient resources were available to support the study (the capacity and capability review). Completing this process was often both onerous and time consuming. As a result of the COVID-19 pandemic, substantial parts of this process were reconfigured, as we detail below.

This is a case study of how the embedded research infrastructure at one NHS Trust was repurposed to support the delivery of frontline care and COVID-19 research. The case study method allowed us to track how the research system was adapting in real time, and enabled an in-depth look at the processes and mechanisms that have underpinned operational changes [ 13 ]. As an instrumental case study, one that focuses on socially, historically and politically situated issues, we use a single site to examine issues that are also faced by other hospital Trusts [ 14 ]. We employed an online questionnaire of research-involved staff, document analysis of emails and official national and Trust documents, observations of planning meetings and semi-structured interviews. Data were collected from individuals working in four levels of the research infrastructure: (1) central research oversight and governance (including R&D leads and research governance staff); (2) principal investigators (PIs); (3) the research delivery workforce (including research nurses, clinical research practitioners, data analysts and research managers); and (4) Patient and Public Involvement (PPI) managers and PPI representatives. Triangulating these four data sources and four levels allowed us to consider the representativeness of our data across the case. Redeployment figures and wider workforce information were provided through a request to SLAT’s research management office.

Sampling and data collection

Data were collected by DW, RFG and HC over a period of six months, from May to October 2020. In the first stage of research, an online questionnaire was disseminated to all research-involved staff at SLAT (approx. 700) on 18 th May 2020 via pre-existing mailing lists. The questionnaire closed on 10 th June 2020 with 170 responses, yielding a response rate of approximately 24%. Whilst 24% would be an inadequate response rate for statistical analysis [ 15 ], it was not intended as a validated survey, but rather a method to gain a broad understanding of staff’s experiences of the COVID-19 research response, with most questions open-ended. We received completed questionnaires from nearly a quarter of research staff during the pandemic. The questionnaire also enabled us to identify and recruit a maximum variation sample of staff involved in the research response across the four groups to interview. Interviews allowed us to explore in more depth some of the recurring themes first identified in the questionnaire.

Interview participants were also recruited using purposive and snowball sampling with an aim to maximise the representation of a variety of experiences across the case [ 16 ]. Key staff within SLAT were identified based on searching the Trust’s website, reviewing staff lists and by speaking to senior personnel for guidance. Interviews were conducted digitally on Microsoft Teams and were recorded and transcribed verbatim. Interviews focused on participants’ work prior to the pandemic, how this work has changed as a result of COVID-19, and the short and long term impacts of COVID-19 on health research more broadly.

Additionally, we obtained permission to observe the regular research prioritisation meetings convened by the Trust’s Director of R&D. These meetings took place over Microsoft Teams once or twice a week and were attended by an average of 10 senior clinical, research and research delivery leaders per session. We attended the meetings as non-participant observers, taking notes and recording proceedings. Recordings were transcribed verbatim. We also analysed all documents that were produced or circulated in connection to the prioritisation meetings. These included email discussions about specific projects, national directives, Trust protocols as well as the applications submitted by investigators to the prioritisation committee.

Lastly, we attended the handful of PPI meetings that were held by the few active PPI groups during this period. We participated in discussions about specific research projects and heard participants’ experiences of PPI during the pandemic. PPI is a core part of the pre-COVID-19 research and research design process [ 17 ]. It was therefore important that changes to PPI were considered within our study. We were also able to present our research and get feedback from groups about our aims. PPI meetings were not recorded, but detailed notes were taken during each session.

Conducting qualitative research during the COVID-19 pandemic has required us to adapt data collection methods to accommodate restrictions on face-to-face meetings and access to the hospital. Studies note that while video conferencing has many benefits, issues such as the familiarity of participants with online platforms and access to technology and high-speed internet can be barriers to the successful use of these technologies in interviewing [ 18 , 19 ]. We experienced only a handful of technical problems in our interviews. In all but two instances, interviews were conducted with cameras on so that we could observe non-verbal communication [ 20 ].

Our data were managed and analysed through NVivo 12 using a two stage process [ 21 ]. In the first stage, we analysed the data for a descriptive and narrative account, paying attention to the contours of the emerging response to COVID-19, including national and Trust decision-making and action [ 22 ]. In the second stage we used thematic analysis to develop an analytic account based on emerging themes [ 21 , 23 ]. Data were coded for key themes independently by DW, RFG and HC iteratively throughout the data collection process. Codes and core themes were then discussed and verified across the researchers. As part of our analysis process, we also presented initial findings to research staff at SLAT and at another NHS Trust. These methods of challenging our analysis both internally and externally were crucial for ensuring we reflected on our own influences on the data and the data’s utility beyond our specific case [ 24 ].

Ethics approval for the study was granted by North East—Newcastle & North Tyneside 2 REC (reference: 20/NE/0138).

We completed 24 interviews, lasting from 24 to 105 minutes (mean average of 52 minutes), observed approximately 40 hours of research prioritisation meetings and 4.5 hours of PPI meetings, and received 170 responses to the questionnaire. In the results that follow our interview participants are divided into four groups. We identify participants using a letter to denote group and number for interview within this group:—G-n (Governance/R&D staff), R-n (Research leaders/PIs), D-n (Research delivery staff), P-n (PPI managers). 3 participants sit in more than one of these groups due to their multiple roles within the Trust. These participants were interviewed using questions from interview guides for all relevant groups. Questionnaire participants are identified as Q-n, followed by a brief description of their role. See Tables 1 and 2 for a breakdown of participants.

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https://doi.org/10.1371/journal.pone.0256871.t001

https://doi.org/10.1371/journal.pone.0256871.t002

Centralisation: Prioritising COVID-19 research and redeploying research staff

Centralisation within the research apparatus occurred across two levels.

National decision-making.

At the outset of the pandemic, DHSC took steps to assert central control over national research priorities in order to coordinate the national response to COVID-19. This included the shut down or partial shutdown of the normal functioning of the research system. A document circulated throughout the NHS on the 13 th March 2020, which included information from 25 separate Trusts, announced that elements of the UK’s national R&D infrastructure, including the UK Clinical Research Facilities (CRF) and NIHR Clinical Research Network (NIHR CRN) Coordinating Centre were “joining up working to ensure consistency of approach” and that “currently UK NIHR/RC and EU research funding bodies are in the process of selecting research that will be prioritised for approval and delivery across the NHS during the pandemic.” On 16 th March 2020 a directive from the DHSC and the Chief Medical Officer (CMO) ordered the suspension of all non-COVID-19-related research and the reorientation of research capacity towards the effort to develop COVID-19 treatments and vaccines [ 6 ]. Only those studies funded by the NIHR and where “discontinuing them will have significant detrimental effects on the ongoing care of individual participants involved in those studies” were allowed to continue [ 6 ]—in short, those studies where research was the standard of care, for example, with experimental cancer treatments. Decisions on which studies met this threshold were decided at the Trust level. Table 3 documents the scale of the pause in the normal research pipeline at SLAT. Participant G-2 saw this DHSC and CMO directive as an effective way to focus research resources:

I think the really helpful bit was the sort of diktat from Chris Whitty and Louise Wood at DH [Department of Health and Social Care] to say, “Stop everything that’s not COVID.” […] So, to actually have something centrally that said, “No, you’re not actually allowed to do that because we’ve got to focus on the COVID stuff,” was very helpful because people just stopped asking–which was great. And we were freed up to change processes as we needed to.

https://doi.org/10.1371/journal.pone.0256871.t003

Following this directive, a new system of badging certain studies as of Urgent Public Health (UPH) was established, run by DHSC and the CMO. All clinical studies including COVID-19 treatment and vaccine trials that hoped to recruit patients within NHS sites were required to apply for UPH status. An Urgent Public Health Group was convened, chaired by Nick Lemoine, the medical director of the NIHR CRN. The group was responsible for deciding which protocols to label UPH, based on evaluations of scientific merit, feasibility and greatest potential patient benefit [ 25 , 26 ]. Of the 1600 research protocols received by the CMO from March 2020 to February 2021, only 83 were considered national priorities [ 5 , 27 ]. Once a study had received UPH badging, hospital sites like SLAT were required to open them, if resources were available.

This centrally-organised prioritisation of COVID-19-related research removed the authority of individual Trusts and directorates to shape their own research portfolios. This was an unprecedented move by the DHSC, but allowed resources to be concentrated on studies deemed to have the greatest potential impact.

Trust-level decision-making.

In order to enact the DHSC mandate to prioritise COVID-19 research, SLAT created a Trust-level prioritisation process. Twice-weekly prioritisation meetings commenced early April 2020 and were attended by research governance managers, research delivery managers and senior clinicians as well as representatives from the local Clinical Research Network and partner hospitals within the network. The aim of the prioritisation meetings was to protect resources and ensure capacity to undertake UPH-badged research. However, it also ensured effective, timely communication with PIs, helped identify local PIs for new COVID-19 studies led elsewhere, and managed the pause and restart of all non-COVID research. A proforma was introduced to facilitate and standardise prioritisation decision-making. Investigators were asked to provide information summarising their projects, resource requirements and whether they had received UPH badging. Proformas were reviewed during these meetings. By the end of February 2021, this group had reviewed 170 research projects using these proformas across 68 meetings, approving over 80 studies for local setup.

During the first wave of the pandemic, prioritisation group meetings focused mainly on how to open UPH-badged studies, as all other new research had been halted. One important exception was COVID-19 studies that require little or no NHS resource and took place within a single NHS site. These studies were also discussed in these prioritisation group meetings, often with a focus placed on clinical and academic merit. Most of the studies that fitted these criteria and were approved by the prioritisation group involved university researchers analysing patient data collected and pooled in the COVID patient ‘data lake’. This enabled the Trust to maintain research activity in areas not explicitly identified as urgent public health. The research reported in this article was approved through this process.

The joined up approach between national and local decision-making however did cause confusion and frustration. The process of determining whether or not a study would be badged UPH and thus allowed to proceed was initially opaque to Trust researchers and R&D, and the national UPH review process often took weeks from application submission to outcome. Furthermore, the decision to grant a study UPH was and remains out of the hands of the sites that are tasked with delivering this research, even when internally questions were raised about the appropriateness, feasibility or scientific merit of the study. Some researchers designing studies to address key issues in relation to COVID-19 struggled to negotiate the system:

In terms of national COVID studies, we tried to get a number of studies up and going, focusing on older patients. And ran into quite a lot of obstacles and barriers. [..P]eople weren’t certain whether this was research or whether it was quality improvement, audit-type, survey-type work. And that was pretty frustrating, not being able to get clear answers on that from the senior team within R&D. And access to data was very difficult. So, despite lots of conversations about why we really needed to be focusing on older patients, the majority of people with COVID, the biggest impact being in care homes, it was quite frustrating getting hold of people who could actually sign off on studies that we would have like to have done (R-7).

At the Trust level, the prioritisation of research was also important because of the reduction in available research delivery staff. As Table 4 documents, the clinical research delivery workforce, which totalled 165 on 14 th April 2020, was reduced by 79% or 131 staff members during the peak of the first wave due to redeployment to frontline care. A further 52 non-clinical research staff were redeployed to support other Trust activity. With such a reduction of staff, the ability to maintain even those studies which had not been halted was not certain and indeed many studies required changes and protocol deviations as a result. A key point of discussion in all prioritisation meetings was the resourcing requirements of proposed studies and how these requirements might be managed alongside existing commitments. In tandem with these discussions, work was done by the research delivery manager to create a central register of research delivery staff within the Trust. The push to centralise oversite of research delivery staff was initially driven by the requirement to rapidly redeploy staff including nurses and clinical trials practitioners to support the Trust’s emergency response but it was also crucial to the prioritisation group’s understanding of the availability of research resources. Prior to the pandemic, there was no central list of all research delivery staff at the Trust, as D-2 discusses:

A benefit was actually establishing who all the staff are. The systems we have in R&D which relate to where staff sit within the Trust system depends on where they’re funded from. And because research teams have lots of mixed types of funding, some of the staff are visible to me through the systems and some aren’t. So, the only way for me to know who all the staff were, was to manually myself, physically ask. There was no system anywhere that listed who the research staff are.

https://doi.org/10.1371/journal.pone.0256871.t004

In addition to being redeployed to the clinical frontline, research staff were also pulled from across the Trust’s many directorates to form a new dedicated COVID-19 research delivery team. This team became responsible for the rapid set up and roll out of COVID studies of national and international importance, like the Oxford AstraZeneca vaccine trial, among others. Centralising oversight and management of the previously dispersed research delivery workforce enabled SLAT’s research system to react quickly and flexibly to the rapidly evolving clinical demands and research requirements of the pandemic.

While research activity was centrally coordinated within SLAT, R&D were initially left out of Trust emergency planning. An organogram produced by the Trust to represent its emergency response plan did not include R&D or any element of the research system, and a briefing document prepared by SLAT R&D for the Trust’s Gold Tactical Command Unit dated 14 th April 2020 noted this absence, and that there was also no “obvious place in the structure for R&D to naturally sit.” Participant G-3 reflected on what was perceived initially as a failure to consider the role of research:

I think […] the Trust essentially, corporately, hadn’t involved the R&D department in what they were thinking. […] We didn’t have a tactical subgroup where everybody else, every other area in the Trust had a tactical subgroup. […] There was nothing in place. You know, we’ve all voiced this, certainly in meetings at the senior management level–is that, and the words used were, “R&D has been forgotten.” We were forgotten. So, what the Trust had set up and which is, I think, probably a policy or a set of actions that they have for crisis management […] was very militarily organised. […] And we didn’t slot in, nor were we invited on to any of those tactical groups. And didn’t have representation on gold or silver command either. So we were left out of that whole process. […] We had to make real efforts to reach out and offer up. We felt that obligation and we did that.

By late April 2020, R&D were fully integrated into the Trust’s Gold Tactical Command Unit. By this time, however, the prioritisation process had been implemented and oversight of research delivery staff had been centralised, facilitating redeployment to frontline care and COVID-19 research. While the research system contributed staff and other resources to the Trust’s emergency response, it did so at its own initiation.

Pace of work: Shifting gears for the COVID-19 response

One of the most striking aspects of the research infrastructure’s response to the pandemic was the sheer pace of activity and change. The sociological literature on pace suggests that demands for faster productivity are common, and indeed this demand can be seen in the health services literature which often criticises clinical research for not moving fast enough [ 28 – 31 ]. However, the sociological literature also notes the importance of considering where things slow down or even halt [ 28 , 32 ]. In this section we document how pace appeared in participants’ accounts, acknowledging both areas where there were rapid increases in the speed of research work as well as how research work slowed down in other areas.

Increasing pace: Redeployment, research set up and research completion.

Particularly within the first wave, it was the “reserve army” (D-3) of the research delivery workforce who were required to act at speed. As per Table 4 , staff were quickly released from research duties and redeployed to the frontlines to help deliver care. In addition, all NIHR funded staff with clinical training who were not completing COVID-19 research were asked to prioritise frontline care if their employer asked [ 6 ]. Within two weeks, more research delivery staff were redeployed to COVID-19 research teams. Staff were called up one day and told to “come in on the next day” (D-8), and managers were told “they’re going tomorrow. This is their last day with you” (D-4).

As pace of redeployment accelerated, so too did the speed of research. The pace with which researchers demanded studies be delivered and set up was “ten times quicker than normal […] as if someone’s taken a time warp machine to it” (R-2). Those already working in the research infrastructure were aware that research was vital to the pandemic response and, as one participant (D-1) explained:

we needed to start the research while we’re right in the middle of the surge in numbers. And so […] you have studies that come, they need to be set up tomorrow, recruit the first patient by the end of the week.

Such shifts in normal timeframes for work were facilitated in part through centralisation, as noted above. “The real step change,” research manager G-4 suggested, “was having a Prioritisation Group and having [the] team agree a fast-track way of doing things.” Alongside streamlined approval and set-up processes, wider research infrastructures and research practices were adapting at great speed:

I was amazed that, for example, by the end of March, there were–I counted them– 13 granting agencies that, some way or another, had calls on urgent COVID-19 research (R-4).

As a result of these rapid research projects, new knowledge was being produced at an unprecedented rate, as one participant succinctly put it, “science doesn’t usually change that quickly” (D-9). This speed was met with enthusiasm by PIs and research delivery staff alike, but also caused some nervousness. Some were concerned, for example, that PPI had “dropped off the radar” (G-3), whilst others were wary of publication prior to peer review:

the […] thing which is a challenge is that we’re pre-printing research, we’re putting pre-prints out when we’re submitting to journals, because–and we’re rushing to get the pre-prints out. […] And I guess that’s good. But it is also a bit of a–a stresser because […] maybe we haven’t quite got the message right yet (R-1).

Others warned that the pace of research during the first wave of the pandemic came at a human cost. Some researchers had vastly increased workloads, “going at max […] for 5 months” (R-1), where in some cases “there’s not been a single day when [they’ve] not been working in the laboratory including all Sundays and Saturdays, Easter and so on” (R-4). Whilst some enjoyed this fast-paced moment, for those closer to the frontline it has caused anxiety. As one participant (G-5) explained, “we’ve been fire-fighting”, and at least one member of staff, another explained, “can’t come near the hospital. She has panic attacks” (D-3). Whilst it has already been documented that critical care staff’s mental health has suffered in the pandemic, these participants suggest there may also be concern for the staff involved in the research response [ 33 ].

Seeing what is possible within the exceptional circumstances of a global pandemic led some researchers and PPI managers to question the normal slower pace of regulatory approvals and assert, “if you can do it during COVID-19, you can do it any other time” (R-6). The often slow processes such as ethical approvals, data sharing guidelines, funding applications, and study set-up was a common comparator to what has been possible during the COVID-19 pandemic. Yet, as G-1 explained: “The reason [research processes have] been quicker is just because there’s been less studies.” This is evident in SLAT’s own R&D data. Table 5 documents the difference in study numbers and timeframes from initial sponsorship review to final capacity and capability approval (allowing the site set up and recruitment to commence) across 3 financial years. While some approval processes were adapted, generally research governance requirements, both internal to the Trust and at the regulators the MHRA and the Health Research Authority, remained the same. The quick approval processes were possible because no new non-COVID-19 studies were reviewed, COVID-19 studies were processed as quickly as possible and almost all non-COVID-19 related research was halted.

https://doi.org/10.1371/journal.pone.0256871.t005

Slowing or halting non-COVID-19 research.

For some investigators, the halting of non-COVID-19 research led to a slower pace where researchers could play catch up. “People have just been writing up their papers” (R-3), and this period of time “gave […] the opportunity, freed up time” (R-6) to apply for grants. Whilst many tried to set up studies so they were ready to go when restrictions were lifted, they also found that “regulatory bodies have been slower” (R-6) due to their focus on COVID-19. It was apparent that these researchers had more time to engage in PPI whilst putting these grants together–one PPI manager working in cancer (P-3) suggested “PPI activity has probably increased” during the pandemic. Whilst many researchers were understanding of the need to halt research, others found it devastating for patients and the reputation of UK research. These researchers (R-3 and R-6) pointed to other international contexts where they saw standard research continuing. Researcher R-6 was surprised “with the UK being such a […] clinical trials powerhouse”, that decision-makers didn’t “do everything it could to retain that reputation even through the COVID-19 crisis.”

On 21 st May 2020 the DHSC and NIHR circulated a framework for restarting new and paused non-COVID-19 research. Stratifying research studies into three levels of priority, this framework made no distinction between commercial and non-commercial research. Using this framework, the Trust implemented its operational Restart Plan the week commencing 1 st June 2020. Recommendations on which research studies were important or urgent to restart within each directorate was managed a directorate level, with the Prioritisation Group acting as the Trust-level decision making body for the restart plan. The Prioritisation Group continued to meet weekly to approve restart plans for research projects. By mid-summer restart was well underway but the pace of resuming all these studies could not match the pace that research stopped, and researchers were concerned that they “haven’t really been able to pick up our trial recruitment in between [waves], because recovery has been so slow” (R-5). The time of “let’s get back to normal quickly because COVID’s over”, participant R-2 explained soon turned to “actually, let’s not rush back into things because we don’t know what’s coming.” At this point the centralisation of research infrastructures hindered speed rather than aided it–one research governance manager (G-4) suggested that “we need to respect the decision-making of the research managers and matron and the R&D leads now”, but instead studies were “number 507 in the queue”, and having to “wait another week for this prioritisation meeting” whilst “people are really scared about their finances […] frightened about not finishing […] patients are waiting.”

Adopting new and virtual working practices

The response to COVID-19 pandemic has resulted in broad shifts in working patterns across the labour market, and will likely lead to longer term transformations to work practices stemming from these temporary changes [ 34 – 36 ]. In health, research highlights the accelerated adoption of digital and virtual working practices as a result of COVID-19, such as the use of telemedicine in secondary care [ 37 – 39 ]. The implementation of new working practices, taking advantage of digital technologies for communication and the adaptation of existing processes so that they can be completed (at least in part) during the pandemic are also crucial elements of the research response to COVID-19, particularly for facilitating the continuation of research.

Reducing patient visits.

Clinical research is a highly regulated domain, with strict oversight on practices and procedures, and reporting requirements overseen by multiple regulators. While research setup and governance processes became more centralised, the successful conduct of research during the pandemic required a degree of flexibility and creative adaptation. The move to more remote or virtual ways of completing, supporting, regulating, and facilitating research relied on the speedy adoption of new technologies and ways of working.

On 12 th March 2020, the MHRA issued guidance to sites and investigators “regarding protocol compliance during exceptional circumstances” [ 40 ]. The guidance stated that the MHRA recognised “the difficult current situation” and advised on how to manage trials during the pandemic [ 40 ]. The MHRA also noted in this guidance and on the MHRA Inspectorate website that a redistribution of human resources during the pandemic:

may mean certain oversight duties, such as monitoring and quality assurance activities might need to be reassessed and alternative proportionate mechanisms of oversight introduced (such as phone calls, video calls) to ensure ongoing subject safety and well-being. We would advise a brief risk assessment and documentation of the impact of this [ 40 ].

While this guidance came before the formal research shutdown, it remained important, especially for the small amount of research which was allowed to continue because it was the best or only treatment option left available for patients. However, research practices and trial protocols needed to be adapted, particularly as there were restrictions on who could physically visit hospital sites, as G-5 highlights:

If a protocol says that a participant will have a visit at week 1, week 2, week 3 and week 4 and those are protocol visits–it’s unacceptable not to do those visits. They are protocol deviations. However, during the real surge of the pandemic, those visits couldn’t be done. They couldn’t come in and have an MRI scan, and ECG and bloods taken. What they did have was someone contacting them by telephone or by Skype or other formats, media format–to say, “How are you doing? Are you okay? Is there anything you need to report? Keep in touch” (G-5).

Through delaying or adapting follow-up appointment requirements so they could be completed over the telephone or through videoconferencing, many studies were able to maintain some level of continuity. For these research participating patients, other parts of the research process needed sensitive negotiation, as one PI explains in relation to changes in the format of patient consultations:

Some [participants] were actually a bit reluctant and felt a bit fobbed off to be called at home [when] they were due a face-to-face consultation. We had to be a bit careful about that, particularly if we were discontinuing treatment or discharging people from our care. That almost always went badly if we tried to do it remotely. And if we were having a really definitive conversation like that, it was worth–we found, in the end, patients coming up. Other patients were reluctant to come and readily accepted our advice that rather than coming for a CT scan, we just do a chest x-ray when we next saw them. So, there is a difference of approach, which is personal–not particular to their circumstance (R-5).

Balancing the need for face-to-face consultations and the protection offered by telephone or video consultations required thoughtful, individualised decision-making. For other studies however, digital consultation was simply not possible, which lead to investment in supporting people to attend the hospital:

A few studies have been done remotely, but the one that I have taken on, patients really have to come in. So, we had to do a lot of logistic development there, like bringing them in by car, paying for whatever is necessary just to make sure that they continue coming in (D-6).

Working from home.

Another crucial step in facilitating research and frontline care was asking large numbers of staff to complete their work from home. For some participants, working from home lead to greater productivity, but for many others it meant the blurring of home and work lives. Numerous factors impacted on participants’ experiences, from juggling work alongside home schooling and caring responsibilities, to feelings of isolation, through to more practical issues, such as having a space to work at home, having sufficient internet bandwidth and having stable access to Trust systems (see Box 1 ).

Box 1. Indicative questionnaire responses to: What, if any, challenges have you had to face working from home?.

https://doi.org/10.1371/journal.pone.0256871.t006

While research staff were transitioning to working from home, research spaces were transformed to facilitate frontline care. By April, two of the four Clinical Research Facilities (CRFs) in the Trust were repurposed to deliver frontline care and training space for frontline staff. The remaining two CRFs were refocused on supporting COVID-19 research. The vacant R&D department’s office spaces were also used by Trust staff to facilitate socially-distanced meetings and computer work for those who needed to be onsite. Careful repurposing of offices and clinical space provided the Trust with additional, flexible physical space to assist in the emergency response to the pandemic.

Digitalising research processes.

Research work still occurred within the normal parameters of how health research is conducted in the NHS. These practices were, however, done differently to adapt to COVID-19 social distancing measures.

Firstly, researchers initially had to find a workaround for consent to research in COVID-19 wards. Because of infection control protocols no materials, including paper consent forms, could be removed from COVID positive wards. As there were no protocols in place to gain consent digitally, staff developed a local workaround, as D-1 explains:

we managed to get some […] work phones so that we could take a picture of the consent [form]. So, the consent [form] was held up to the window [in the COVID ward], the team outside could take a picture of the consent form and send it directly through on the Pando app, because [Pando] could have patient details. So, it could then be turned into a PDF and printed and put in the patient file.

Another example of a slow but necessary digital solution was with site monitoring. Site monitoring allows commercial companies and other trial sponsors to visit research sites to assess the quality of the data and ensure study protocols are being followed. Despite MHRA instruction that this “should not add extra burden to trial sites” [ 40 ] and that monitors could not be justified as an extra body in the building, these activities are crucial not just for validating data but for hospitals to be able to bill sponsors for the completed research. Workarounds were further limited because of data protection regulations that prevent the digital transfer of patient data or remote access to Trust systems by external individuals. Where site monitors would usually work alone on site, it became a long and arduous process:

a member of the research team within the Trust sits at a screen and shared that screen through Microsoft Teams with the external person. So, no data is held, no recordings are being done, no data is transferred. But it’s very, very labour-intensive. (G-5)

Whilst workarounds were quickly found for some research practices, others took longer. Despite the fact that Patient and Public Involvement in research (PPI) is a core element of contemporary UK health research [ 17 ], there was initially “zero PPI” (G-1). Rather PPI group managers focused on care work: “putting them in touch with local services that could do things like pick up prescriptions for them, get shopping, get the food boxes delivered” (P-1). It was only with time that not only did researchers planning non-COVID research begin to engage more than usual with their PPI groups, but that funders and regulators demanded that PPI should still be prioritised even in emergency research [ 41 , 42 ].

While researchers voiced concerns about the equity of shifting online and assumptions about who will and will not engage with online PPI, this did not appear to be a problem in practice:

There’s often a sort of an ageism about who can–it’s like kind of what you were just saying about older people can’t do PPI. Well, bollocks. I mean actually they’ve been as responsive to this pandemic as anybody else. The rates of use of, you know, technology, has like skyrocketed in the over 65s, because of their need to talk to their grandchildren etc. So, you know, they are adaptive (R-1).

R-1’s experience was echoed by PPI representatives. Reflecting on the move online, these representatives noted some disadvantages, such as the absence of many social aspects of attending PPI meetings, and video fatigue. But participants were generally positive about the potential of virtual PPI for involving those who cannot always travel long distances due to their illnesses, those who work full-time but could attend an hour session online in their lunch break, and representatives in different countries.

In short, the process of realigning and digitalising research practices was not simply one that sped up research and productivity, but it involved a set of necessary, labour-intensive workarounds. It did, however, also bring about possibilities for long term positive effects, such as diversifying involvement in PPI groups.

COVID-19 has brought to the fore the critical importance of the UK’s clinical research infrastructure which has over the past 15 years become increasingly embedded within the NHS. It has enabled NHS hospitals to deliver research of global importance at an unprecedented pace while simultaneously providing critical care for record numbers of acutely ill patients. We provide an analysis of how this was possible through an in-depth case study of the transformations and reconfigurations of the research system at one research-intensive Trust. Our data show that a large-scale reorganisation of research staff, research infrastructures and research priorities took place during the first few weeks and months of the pandemic. We have documented many of the changes in organisational structure, national policy and everyday working practices that facilitated the Trust’s response to COVID-19. These rapid changes have brought about new ways of working, and new perspectives on the role of research which may have far reaching consequences for the future of the clinical research system in the UK.

The pandemic occasioned a large-scale mobilisation of research staff as a “reserve army.” Research staff were crucial in supporting the care-function of NHS hospitals during the first wave of the pandemic. At the same time, the embedded research system helped to streamline, facilitate and deliver rapid COVID-19 research.

Our study documented some of the challenges that the research system has faced in seeking to operate in a COVID-safe manner. At the same time, our participants described instances of improvisation in order to adapt protocols to the COVID-19 environment. Research staff developed effective practical solutions borne out of necessity, rather than the result of prior planning. This points to the resourcefulness of research staff, but also highlights the ways in which the research system was initially largely absent from existing emergency planning within the health system.

Our research was conducted while the Trust we were studying enacted national COVID-19 policy, responded to local care needs and supported clinical research during a global pandemic. This allowed us to observe these events unfolding while gathering data in a COVID-safe manner. But the pandemic created limitations as well, especially impacting the range of methods we were able to use. While working digitally did give us a first-hand experience of how a large proportion of the decision-making infrastructure had to move online, it limited our access to frontline care and everyday research activity.

There are also limitations of looking at a research active Trust like SLAT. While research is increasingly becoming a routine component of all NHS settings, SLATs size and existing research portfolio meant there was a large amount of resource available to redeploy towards COVID-19 care and research delivery. This picture may not be representative of all NHS Trusts, particularly those that are smaller, where less research takes place. Such resource, particularly in the form of biomedical research infrastructures embedded within NHS Trusts, have provided what Roope et al. label ‘option value’ in research, additional capacity to support public good, which in normal times may appear an inefficient use of resource [ 43 ]. Roope et al. highlight that, in comparison to funded, individual research studies, funding research infrastructures allows greater flexibility and speed of response when emergencies arise, such as the COVID-19 pandemic. While the research workforce, funds and infrastructures were used to support other research prior to COVID-19 (as opposed to being excess capacity), the ability of such resource to be reallocated to COVID-19 at such pace underpinned much of the UK’s success in its research response and much of the work described in this paper. It is important to acknowledge, however, that research capacity is distributed unevenly throughout the NHS, and resources such as Clinical Research Facilities and Biomedical Research Centres tend to be situated in major teaching hospitals and trauma centres rather than geographically more localised hospitals. More research is needed to understand how this unequal distribution of resources affected outcomes of care and research during the pandemic.

In documenting how the pace of research work changed dramatically during the pandemic, both in terms of increasing the speed of certain activities and decreasing the speed of others, our paper also contributes to broader discussions of pace in clinical research. In particular, the key question—how do we most effectively streamline the research pipeline, from bench to bedside? Hanney et al. highlight the potential to overlap parts of the translational research pathway to speed up the process, and some of the barriers to this, such as ethical approvals and resourcing issues [ 30 , 31 ]. Many of these issues were removed during the pandemic because of the targeting of resources towards COVID-19 research. On a more practical level, however, our analysis suggests some ways that the research system may be adapted in the future. The potential offered by digital communications to facilitate certain research and PPI activities have led some clinical researchers to question the necessity for research participants and patients to always attend hospital sites for consultations. Trust-level research prioritisation has proved positive in managing finite local resources as effectively as possible, enabling a more holistic view of the research portfolio at a local level as well as take into account national priorities. At the same time, it is clear that the new technologies and new ways of working that were developed to cope with the crisis are not automatically more efficient, and there is a danger that some key steps such as adequate PPI might be overlooked when research pace is increased. Further research and planning will be needed to develop suitable governance processes to facilitate research activities both when on a crisis footing, and in more routine practice. Wider investment in networked digital applications and hardware (such as Trust compliant laptop computers) is needed to facilitate better working from home.

Our study suggests a number of additional lessons for future national emergency planning and policy. Research infrastructure must be better included in advanced planning, both in terms of the personnel, equipment and other resources that can be made available for redeployment as well as the direct impact that research can make. The capacity to develop new treatments and vaccines should be treated as a strategic asset that is a central part of any emergency response. This has been recognised at the national level, and internationally [ 1 – 3 ], but our data suggest that it has not fully translated into Trust-level operations. Planning for future emergencies should include protocols for the rapid establishment of strategic research prioritisation and redeployment of research infrastructure and capacity. Our data also show that throughout the pandemic, there remained a demand for public input in research, which should be included in future emergency planning. Public input is vital in clinical research, especially in an emergency response which requires publics to respond to clinical-expert advice, and planners should recognise it as such.

Future emergency planning must, however, take into account the exhaustion and stress faced by research staff who suddenly found themselves on the front line of a national mobilisation. Research staff experienced the same well-documented stresses experienced by other NHS workers [ 33 , 44 ]. Emergency planning should acknowledge this human cost and find ways to mitigate such costs and provide support for staff as a national priority.

At a global level, the UK response and its specific organisation, as described within this case study Trust, demonstrates some of the benefits of embedding research infrastructures within a national health provider, and how this set up not only enabled a coherent national response, but also provided staff resource to facilitate such research at great speed as well as support the delivery of frontline care. As we look to the future, how we integrate healthcare and research at more national and global levels are important areas for further research and discussion.

Acknowledgments

We are grateful to Christopher McKevitt and Nina Fudge for providing astute comments on drafts of this paper and to our participants who shared their experiences and time with us during this period of unprecedented strain on the NHS.

• View Article
• PubMed/NCBI
• Google Scholar
• 5. National Institute for Health Research. Urgent Public Health COVID-19 Studies 2021 [27/07/2021]. Available from: https://www.nihr.ac.uk/covid-studies/ .
• 6. National Institute for Health Research. DHSC issues guidance on the impact of COVID-19 on research funded or supported by NIHR 2020 [01/05/2020]. Available from: https://www.nihr.ac.uk/news/dhsc-issues-guidance-on-the-impact-on-covid-19-on-research-funded-or-supported-by-nihr/24469 .
• 13. Yin R K. Case study research: Design and methods. 3rd Edition ed. London: Sage; 2003.
• 14. Stake RE. The art of case study research. London: Sage; 1995.
• 16. Quinn Patton M. Qualitative research and evaluation methods. 3rd Edition ed. London: Sage; 2002.
• 17. National Institute for Health Research. National Standards for Public Involvement in Research. 2019.
• 25. National Institute for Health Research. Urgent Public Health Designation Guidance Notes 2020 [03/03/2021]. Available from: https://www.nihr.ac.uk/documents/urgent-public-health-designation-guidance-notes/24992 .
• 26. National Institute for Health Research. Prioritised support for urgent COVID-19 research 2020 [03/03/2021]. Available from: https://www.nihr.ac.uk/covid-19/prioritised-support-for-urgent-covid-19-research.htm .
• 27. Pharmaphorum. Coordinating and delivering research in the pandemic: the UK approach 2021 [01/03/2021]. Available from: https://pharmaphorum.com/webinars/uk-covid-coronavirus-research-nihr/ .
• 28. Sharma S. In the meantime: Temporality and cultural politics. Durham: Duke University Press; 2014.
• 32. Baraitser L. Enduring time. London: Bloomsbury Publishing; 2017.
• 40. MHRA Inspectorate. Advice for Management of Clinical trials in relation to Coronavirus 2020 [03/03/2021]. Available from: https://mhrainspectorate.blog.gov.uk/2020/03/12/advice-for-management-of-clinical-trials-in-relation-to-coronavirus/ .
• 41. National Institute for Health Research. NIHR reaffirms its support for patient and public involvement, engagement and participation during the COVID-19 pandemic 2020 [11/03/2021]. Available from: https://www.nihr.ac.uk/news/nihr-reaffirms-its-support-for-patient-and-public-involvement-engagement-and-participation-during-the-covid-19-pandemic/24641 .
• 42. Health Research Authority. Public involvement in a pandemic: lessons from the UK COVID-19 public involvement matching service. 2021.

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Skin cancer cases reach all-time high

27 May 2024

With warm weather approaching, it’s time to start thinking about staying safe in the sun.  

And that’s just as important than ever, with new analysis showing that melanoma skin cancer rates have increased by almost a third over the past decade.  

In fact, researchers have projected a record high of 20,800 cases this year in the UK.   

This rise may sound alarming, but it’s important to note that around 17,000 cases of melanoma each year are preventable. That’s because almost 9 in 10 cases in the UK are caused by exposure to too much ultraviolet (UV) radiation from the sun and sunbeds.   

These figures highlight the importance of taking precautions to protect your skin from the sun and the dangers of sunbed use.   

What’s behind the rise?

This upward trend in melanoma cases is seen across all age groups, although researchers found that the biggest rise was in adults over the age of 80. This age group has seen an increase in incidence rates of 57% over the past decade.   

Rates are also rising for young adults between the ages of 25-49, with a 7% increase in incidence in the last ten years.   

It is likely that young people today are more aware of the link between UV and skin cancer risk than older generations. This could mean they are more likely to take precautions to stay safe in the sun.   

On the other hand, older groups might have known less about the dangers of tanning in their youth and may have taken advantage of the cheap package holiday boom from the 1960s, likely leading to increased sun exposure.   

But there are also other reasons behind this rise in skin cancer cases, such as the growing and ageing population. Improved awareness of the signs and symptoms of skin cancer likely means more people are visiting their doctor when they notice unusual skin changes, which has also contributed to record numbers of people being diagnosed in the UK.

Staying safe in the sun  

With summer approaching, more people are likely to head outside when the UV level is high. That’s why we’re joining NIVEA Sun in urging people to stay safe when enjoying the sun.  

We recommend three steps to protect your skin and reduce your cancer risk.   

• Spend time in the shade, especially between 11am and 3pm in the UK  
• Cover up with clothes, a wide-brimmed hat and UV-protection sunglasses  
• Apply sunscreen with at least SPF 30 and 4 or 5 stars generously and regularly  

Prevention is key  

Despite increasing cases, the number of deaths from melanoma is projected to continue to fall. This is thanks to research and improvements in early diagnosis and treatment, which have resulted in melanoma survival doubling in the last 50 years.   

“Survival from cancers including melanoma continues to improve, demonstrating the substantial progress made possible by research. But it’s vital that people try to reduce their risk of getting the disease in the first place,” said Michelle Mitchell, chief executive of Cancer Research UK.   

Getting sunburnt just once every two years can triple the risk of developing skin cancer, compared to never being burnt. So, whether you are enjoying the good weather at home or abroad, make sure to protect yourself from too much sun, especially if you burn easily. 

It is also important to remember that sunburn doesn’t only happen when it’s hot – it can happen on cooler or cloudy days too.   

Caroline’s story  

Caroline, now 57, was diagnosed with skin cancer in 2018 after spotting a tiny mole-like blemish on her leg.  

After surgery, she is now living cancer free. 

“I was so scared when I first received the news. I feel really lucky that treatment was successful, but I know others who haven’t been as fortunate as me,” she said.  

“I’ve never been a sunbather, but I have burnt my skin on holiday in the past. Now, I’m so much more careful. I hope my story will encourage people to think about their habits and take care when they’re enjoying the sun.   

“It’s really sad to hear that the numbers of people getting melanoma are still going up, especially when so many cases are preventable. If you see any unusual changes to your skin, make sure to see your GP. It could make all the difference!”  

Staying aware  

If you notice any unusual changes to your skin – whether that’s a new or changing mole, a sore that doesn’t heal, or an area of your skin that looks out of the ordinary, make sure to contact your GP.  

You can find out more about the signs and symptoms of skin cancer on our About Cancer pages .   

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General election 2024: what does this mean for the tobacco and vapes bill, an animal's guide to staying safe in the sun, hpv vaccine slashes cervical cancer rates across society, one to one with penny: volunteering special 1 - that cancer conversation podcast, the ‘mystery’ culprit causing kidney cancer worldwide, proteins in blood could give cancer warning seven years earlier, related topics.

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Melanoma skin cancer cases at all-time high in UK

Cases of melanoma are up across all age groups, but particularly among the elderly, according to new analysis. Cancer Research UK says 17,000 cases each year are preventable.

By Amelia Harper, news correspondent

Monday 27 May 2024 03:22, UK

Melanoma skin cancer cases in the UK are at an all-time high, with 20,800 people expected to be diagnosed this year.

Cancer Research UK says rates of melanoma - skin cancer that can spread - have increased by almost a third over a decade.

Rates have increased from 21 to 28 per 100,000 people between 2007-2009 and 2017-2019.

New analysis has found the upward trend in cases can be seen across all ages, but the biggest rise has occurred in adults over 80 - a 57% rise in cases over the past decade.

In those aged 25 to 49, there was a 7% increase.

Cancer Research UK said around 17,000 melanoma cases every year are preventable, with almost nine in 10 caused by too much ultraviolet (UV) radiation.

UV from the sun, or sunbeds, can damage DNA in skin cells and cause skin cancer.

The charity advises people spend time in the shade, especially between 11am and 3pm; cover up with clothes, a wide-brimmed hat, UV-protection sunglasses and a sunscreen with at least SPF 30 and 4 or 5 stars, applied often.

One of those diagnosed with skin cancer, after spotting a tiny blemish above her knee, is Shrewsbury postmistress Caroline Jones.

Ms Jones first visited her GP after spotting a tiny mole-like blemish on her leg in July 2018.

She told Sky News: "I noticed a tiny but strange mole-type thing, about half the size of a penny, just above my knee on my right thigh and decided I ought to get it checked at the doctors."

The 57-year-old, who is all too familiar with the dangers of cancer after her mother died aged just 49, is urging people to get their skin checked if concerned.

She said: "I sat in the waiting room looking at the pictures on the wall and I could see that my skin looked just like one of the photographs - flat and shiny and black in the middle.

"My mum died of breast cancer when she was just 49 and here was I, aged 52. I honestly thought I was going to die."

The biopsy found it was cancerous two weeks later, before Ms Jones had the mole removed without needing further treatment.

Cancer Research UK's chief executive, Michelle Mitchell, said: "Survival from cancers including melanoma continues to improve, demonstrating the substantial progress made possible by research.

"But it's vital that people try to reduce their risk of getting the disease in the first place.

"Make sure to take care in the sun and contact your GP if you notice any unusual changes to your skin - whether a new or changing mole, a sore that doesn't heal, or an area of your skin that looks out of the ordinary.

"Spotting cancer early can make all the difference."

More people surviving

Figures from the charity show, however, that more people are surviving melanoma, with deaths expected to continue to fall.

Almost nine in 10 adults diagnosed with melanoma in England will now survive their disease for a decade or more.

According to the charity, younger people are more aware of the link between the sun and skin cancer than those who are older, who may have taken advantage of the "cheap package holiday boom" from the 1960s onwards.

Other factors driving up cases include a growing and ageing population and improved awareness of the symptoms of skin cancer.

Read more: Too many patients waiting too long for cancer treatment, data shows Proteins in blood 'could warn of cancer seven years before diagnosis'

Keep up with all the latest news from the UK and around the world by following Sky News

Dr Claire Knight, senior health information manager at Cancer Research UK, said: "Getting sunburnt just once every two years can triple the risk of developing skin cancer, compared to never being burned."

Last month, experts told how the world's first personalised mRNA cancer jab for melanoma , which also has the potential to stop lung, bladder and kidney cancer, is being tested in British patients.

The "gamechanger" jab, which offers hope of a cure, is custom-built for each person in just a few weeks.

A stage-2 trial of the jab, involving pharma firms Moderna and MSD, found it dramatically reduced the risk of the cancer returning in melanoma patients.

A final phase-3 trial is now running, led by University College London Hospitals NHS Foundation Trust (UCLH).

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UK House Price Forecasts: May 2024

The political uncertainty hanging over the UK property market has come into sharper focus since Rishi Sunak announced a general election last week.

In particular, the reform of non dom rules had been causing a degree of hesitation in prime markets since they were proposed in March. Under the old rules, individuals could be resident in the UK without being taxed on their worldwide income.

Chancellor Jeremy Hunt set out plans to limit this period to four years although there were indications he was prepared to loosen the proposals.

Not to be outflanked, Labour devised their own tougher rules, which are still to be fleshed out.

The combination of two different sets of proposals and the uncertainty of a general election has understandably caused hesitation in the property market.

Given the near-term outlook for demand in prime central London (PCL) has deteriorated over the last two months, we have revised our forecast and now expect prices to fall by 1% this year, down from a rise of 1% predicted in January. All revisions to our forecasts were made before the election was called.

As a long-overdue period of price inflation kicks in, we expect cumulative growth of 16.4% in the five years to 2028 in PCL.

Meanwhile, our forecasts for the UK, Greater London, prime outer London, and the prime Country markets have remained the same. These are all markets typically less exposed to political risk that tend to follow economic cycles.

Away from Westminster, the chances of a rate cut in June fell sharply after the release of inflation data for April last week.

Headline inflation fell to 2.3% but services inflation was higher than expected at 5.9%.

In a familiar chain of events, swap rates rose, money markets reduced their rate cut expectations and mortgage lenders, keen to lower their rates, were left feeling frustrated. 

Despite the bad news for buyers or anyone re-mortgaging, we expect demand to strengthen notably once a cut moves onto the agenda, which is what happened in the early weeks of January as sub-4% mortgages made a brief appearance.

The Nationwide UK index topped out at 2.3% in January before falling as mortgage rates began to climb. The Halifax peaked at 1.6% in March, the same month that mortgage approvals reached an 18-month high.

We expect demand will increase as rates begin to fall in the second half of the year. From the summer, there will also be a sharp fall in the number of people rolling off sub-2% mortgages agreed in 2022, as we explore here .

In the lettings market, the normalisation of supply and demand has happened more quickly than we expected in January, which means we have cut our 2024 forecasts for prime London rents.

We now expect average rental value growth to be 2% in prime central London this year (versus 5.5% in January) and 2.5% in prime outer London (versus 4.5%). 

Our rental forecasts between 2025 and 2028 have stayed largely the same or been increased slightly, which is also due to rising political uncertainty.

Some form of Renters Reform Bill is likely to happen in the short-term, tipping the balance of power towards tenants. That is likely to keep supply in check and upwards pressure on rental values.

Our lettings forecasts have also increased marginally for the UK and Greater London.

Strong rental growth has been underpinned by a structural undersupply of rental housing, as well as a competitive jobs market, high immigration, and rising mortgage costs.

At the same time supply levels, while showing some signs of improvement, remain tight. The latest RICS survey confirms that the gap between demand and supply in the rental market is still significant. 

“It is unlikely that rental supply will increase in the next few years at a level that will materially impact headline rental growth,” said Oliver Knight, head of residential development research at Knight Frank. “Private landlords in the buy to let sector continue to feel the pinch from higher interest rates and changes to taxation which have resulted in some exiting the sector. Build to rent supply is increasing, but not fast enough to replace the BTL homes lost.”

In the absence of meaningful government support for first-time buyers, higher interest rates will also keep tenants renting for longer, keeping overall rental demand high.

Knight Frank has launched its spring UK Residential Property Sentiment Survey, we'd be grateful if you could take part , and we'll share the results over the coming weeks.

Photo by Zoe Ella Mumford on Unsplash

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• NEWS EXPLAINER
• 22 May 2024

Singapore Airlines turbulence: why climate change is making flights rougher

• Carissa Wong 0

Carissa Wong is a science journalist in London.

You can also search for this author in PubMed   Google Scholar

Emergency masks were deployed during the Singapore Airlines flight that experienced severe turbulence this week, killing one man. Credit: Reuters

Severe turbulence on a Singapore Airlines flight from London to Singapore has left a 73-year-old man dead and injured more than 70 people. The incident, although rare, is raising questions about what caused such a serious disruption to the flight — and whether climate change will make the strength and frequency of turbulence on planes worse.

The plane, which departed on 20 May, experienced a sudden drop of around more than 1,800 metres that launched people and objects towards the cabin roof. It is the airline’s first fatal incident in 24 years.

“Severe turbulence is the one that turns you into a projectile,” says atmospheric researcher Paul Williams at Reading University, UK. “For anyone not wearing a seatbelt it would have been a bit like being on a rollercoaster without any restraint in place — it would have been terrifying,” he says.

Nature looks at the science of air turbulence and how climate change will influence it.

What causes turbulence in aeroplanes?

Most flights experience some level of turbulence. Near the ground, strong winds around the airport can cause turbulence as planes take off or land. At higher altitudes, up- and downwards flows of air in storm clouds can cause mild to severe turbulence as planes fly through or near them. “Nobody likes flying through a storm,” says Williams.

Air flows that move upwards over mountain ranges can also create turbulence. “As the air blows over the mountain, the plane gets lifted up and can become turbulent,” says Williams. Moreover, turbulence often occurs on the edges of jet streams, which are strong air currents that circle the globe. Any turbulence that occurs outside of clouds is called “clear air” turbulence. It could take weeks to establish what kind of turbulence caused the Singapore Airlines incident, says Williams. “Provisionally, there was a storm nearby, but also the conditions were right for clear air turbulence — we need to do some more digging before we can say,” he says.

Damage in the galley of the Singapore Airlines Boeing 777 aeroplane. Credit: Reuters

Is climate change making turbulence worse and more frequent?

Climate change is making turbulence more frequent and severe, says atmospheric researcher Jung-Hoon Kim at Seoul National University.

In a study published last year 1 , Williams and his colleagues found large increases in clear-air turbulence between 1979 and 2020. Over the North Atlantic, severe clear-air turbulence — which is stronger than Earth’s gravity — became 55% more frequent. There were similar increases in turbulence all over the world, he says. The increase is almost certainly the result of climate change, which is strengthening the jet streams that cause turbulence, says Williams. “We already know it’s having an impact,” he says.

In another study 2 , Williams and his colleagues used a climate model to predict that clear-air turbulence would become more severe and frequent as the climate warms. The researchers estimated that severe turbulence would increase in frequency more than light or moderate levels of turbulence. In line with this, Kim and his colleagues found that clear-air turbulence around clouds and mountains would become more frequent with climate change, in a study published last year.

Despite the probable rise in turbulence, most flights will carry on as they do now — with light or mild turbulence, says Williams. “It is not that we’ll have to stop flying, or planes will start falling out of the sky,” says Williams. “I’m just saying that for every 10 minutes, you’ve spent in severe turbulence in the past, it could be 20 or 30 minutes in the future,” says Williams.

Can we predict and prevent bad turbulence?

Pilots use turbulence projections to plan flight paths. Researchers at weather centres can predict turbulence based on data collected from ground-based sensors and satellites and communicate predictions to pilots. On the plane, pilots use radar to identify storm clouds to avoid. This relies on radiowaves being sent out from the aircraft, which are then reflected back towards sensors that map out the surrounding area.

But radar cannot detect cloudless clear air turbulence. Another technology called LiDAR could help, says Williams. “LiDAR is similar to radar but uses a different wavelength of light,” says Williams, “Unfortunately it’s expensive, and requires a big heavy box, but it can see invisible clear air turbulence.” If the box can be miniaturised and the cost comes down, it could soon be used, he says. “I’ve seen some experimental flights, and you can indeed see clear air turbulence 20 miles, for example, ahead of the aircraft,” he says.

Until then, “I hope that everybody when they travel, please fasten your seat belts,” says Kim.

doi: https://doi.org/10.1038/d41586-024-01542-2

Prosser, M. C., Williams, P. D., Marlton, G. J. & Harrison, R. G. Geophys. Res. Lett. 50 , e2023GL103814 (2023).

Article   Google Scholar  

Storer, L. N., Williams, P. D. & Joshi, M. M. Geophys. Res. Lett . 44 , 9976–9984 (2017).

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