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Research and Development vacancies

Surrey and Borders Partnership NHS Foundation Trust

Senior Clinical Research Practitioner NHS AfC: Band 6 University Hospitals of Leicester NHS Trust Leicester Salary: £35,392 - £42,618 per annum

South Tees Hospitals NHS Foundation Trust

Research Facilitator NHS AfC: Band 4 Great Western Hospitals NHS Foundation Trust Swindon Salary: £25,147 - £27,596 per annum pro rata

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Clinical Research Coordinator - Paediatric Research

St george's healthcare nhs foundation trust london sw17 0re.

Salary: £34,089 to £41,498 a year
Closing date: 29 April 2024
Contract type: Fixed-Term
Working pattern: Full time

Research Nurse/Clinical Research Practitioner

Berkshire healthcare foundation trust reading rg6 6bz.

Salary: £29,828 to £36,311 a year
Closing date: 9 May 2024
Contract type: Permanent

Clinical Research Nurse/Clinical Research Practitioner

Cambridgeshire and peterborough nhs foundation trust fulbourn cb21 5ef.

Salary: £35,392 to £42,618 a year
Closing date: 6 May 2024

Research Nurse- Research & Innovation, Band 5

Gloucestershire hospitals nhs foundation trust gloucestershire gl1 3nn.

Salary: £28,407 to £34,581 a year
Closing date: 7 May 2024
Working pattern: Full time, Part time

Research Nurse

University hospitals bristol and weston nhs foundation trust (uhbw) bristol bs2 8hw.

Closing date: 8 May 2024

Research Fellow

Cumbria, northumberland, tyne and wear (cntw) nhs foundation trust newcastle upon tyne ne4 6be.

Salary: £43,923 to £55,329 a year
Closing date: 2 May 2024
Working pattern: Flexible working, Full time

Research Clinician

Cadbury heath healthcare bristol bs30 8hs.

Salary: Depends on experience
Closing date: 30 April 2024
Working pattern: Flexible working, Part time

University College London Hospitals NHS Foundation Trust London NW1 2BU

Salary: £42,471 to £50,364 a year
Closing date: 28 April 2024

Cardiff and Vale University Health Board Cardiff CF144XW

Salary: £35,922 to £43,257 a year
Closing date: 1 May 2024

Research Administrator

North bristol nhs trust bristol bs10 5nb.

Salary: £22,816 to £24,336 a year
Working pattern: Part time

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Research Roles Within The NHS

Academics with a specialism in the field of medicine or biology may find employment outside of Higher Education in The National Health Service, which employs over 2.1 million people in the UK in total, including clinical academics. It can be a very rewarding field to work in, with many opportunities for career development and the chance to have a direct impact on healthcare in the community and across the nation.

Careers in the NHS

Those with research experience ( PhD students ) and a strong science or medicine background can find work in clinical research for the NHS, especially in the area of biochemistry and related fields. Healthcare Science in the NHS encompasses a variety of jobs that will likely appeal to academics who want to move away from work in Higher Education. Opportunities in every field of healthcare are available, and a strong science degree is essential if you are to apply.

The NHS operates a graduate training scheme in management. The requirements include a degree with second class honours or a postgraduate qualification. Management in the NHS combines leadership skills with health care management techniques.

Typical jobs in the National Health Service for graduates include:

Clinical research fellow
Clinical academic
Therapist and related roles

Finding a job in the NHS

The NHS website offers a great deal of useful information for potential employees. You might also want to examine your prospects through the ‘ What Can I Do With My Degree? ‘ website. The graduate scheme can be applied for directly .

Research positions are regularly advertised on jobs.ac.uk in the ‘ Health and Medical ‘ section. You can also find out about jobs on the websites of individual hospitals (although most positions will also be advertised on the main NHS website, or external sites such as jobs.ac.uk ).

Benefits of working for the National Health Service

Working in research and scientific roles in the NHS requires making use of the investigative and analytical skills that are gained from PhD study . Many people who have made the move from academia to the NHS cite the direct connection to patient care and the practical nature of the work as being positive factors. It can be rewarding to see theoretical study come to fruition in real terms.

National Health Service salary scales are relatively good; remuneration for a Biomedical Scientist, for example, can rise as high as £65,000 at senior levels, while consultants can expect a salary nearer the £100,000 mark.

Former academics and PhD/Postgraduate students have skills and experience that are prized in NHS roles such as:

Research experience
Analytical thinking
Carrying out work independently
Handling sensitive information
Communication skills (writing, presenting findings etc.)

Find your NHS role.

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Involving NHS staff in research

NHS staff live the health system every day. They have much to offer to research about healthcare. Their first-hand experience and insights can help in multiple ways: generating and shaping research questions, gathering and analysing evidence, and spreading research knowledge.

Staff may have an especially valuable role in research about how to improve healthcare. While much research is already led by NHS staff, particularly consultants and clinical academics, the full potential of involving a wider range of NHS staff in healthcare research is yet to be realised. How to realise that potential is the subject of this report.

We explore why and how NHS staff contribute to research, the factors that enable engagement, the impact of engagement on research processes and outcomes, and the implications for future engagement efforts.

This report is informed by a rapid evidence assessment of relevant literature and interviews with experts (listed in the acknowledgements section) [1]. It is primarily concerned with NHS staff actively engaging with research, for example by helping shape research questions or by implementing study designs, rather than considering NHS staff as study participants.

While we are particularly interested in how NHS staff can contribute to research about improving healthcare, we considered evidence on staff involvement in healthcare research more broadly, including health services research and clinical research, for example. We also looked beyond clinical academic and fellowship models to explore the potential for broader engagement.

When we use the term ‘NHS staff’ in this report, we’re referring to people directly and indirectly involved with care delivery – everyone across clinical, managerial, administrative and support roles.

We use the words ‘involvement’ and ‘engagement’ interchangeably to describe interactions with research, reflecting the general terminology used in the wider literature.

Key findings

From shaping research questions, to collecting data and disseminating findings, NHS staff make valuable contributions at every stage of the research process. But their potential is yet to be fully realised.
Opportunities to get involved in research are not evenly available across or within different professions or staff groups. A wider range of healthcare staff could be mobilised.
Efforts to involve NHS staff should be mindful of the reasons why they get involved in research: an interest in the topic of study, the desire to improve healthcare and the potential for career development, for example.
Engagement efforts should also recognise the barriers that can prevent NHS staff from engaging with research, including – first and foremost – not having the time to get involved.
Bringing a wider range of expertise into healthcare research may require new forms of career structures and building in time to conduct research beyond clinical academic and fellowship models.
NHS staff engagement should be based on project needs and feasibility, with contributions considered on a case-by-case basis.
Evidence about how to involve NHS staff in research, and the impact it can have, is fragmented and limited. Further investigation is needed to effectively unlock the full potential of NHS engagement.

Why do NHS staff engage with research?

The NHS comprises many diverse groups of staff, with a wide range of backgrounds and professional experience. Based on our literature review and key interviews, the most important reasons for their seeking to engage with research include:

personal interest in a research or evaluation topic [2-6]
a belief that research and evidence can improve the quality and safety of healthcare, patient experience and patient outcomes [2, 5-7] – which can sometimes be fuelled by frustration with existing practice
a positive prior experience with research [5, 8]
prospects for career development, as well as reputational or financial benefits [4, 6, 9-12]
cultural expectations about research being part of the job, which vary among clinical disciplines, professions and locations

Exposure to research activities and opportunities to engage with research vary from staff group to staff group within healthcare. We found comparatively little evidence on involving NHS staff who do not work in clinical roles. Doctors tend to be offered more research opportunities than nurses [13]. They are also more likely to get research training early in their careers – in part because of the structure of their postgraduate training period – and are more frequently exposed to research and related activities. Many NHS staff are involved in clinical audits and quality improvement projects, but despite some excellent examples, not all of these activities are scientifically rigorous.

Though organisations like the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) and Clinical Research Networks (CRNs) have helped generate more research opportunities for nursing staff and allied health professionals, clinicians in non-academic roles have generally not been engaged to the degree they could be [10, 14]. Opportunities also vary within professions, with certain clinical specialities recognising the importance of research in career development more than others [6]. This translates into more research support through training opportunities, attending conferences and research networks [13]. According to one interview participant:

“If you are training in neurology, it is more likely that you will do a PhD as part of your training. It is similar in renal medicine. However, in geriatrics, it is very unusual for doctors in training to take time out and pursue academic studies.”

For those who do have opportunities, personal interest in the research topic and the belief that research can improve healthcare are among the most common motivators for getting involved. For some, recognition is a valued reward, whether that means being named as an author on research papers, referenced in a newsletter, career development or formal reward schemes [4]. But it is generally not seen as the primary driver. The potential for financial reward – such as pay progression or promotion – is an additional incentive for some [11], and the prestige associated with research plays a role in certain clinical specialties [6]. Feedback on research progress and on the impact of their contributions is also important.

Overall, our research showed that different motivations were relevant to different groups of NHS staff and that opportunities are highly variable. Any initiative to encourage NHS staff to contribute to research should take account of these diverse motivations and opportunities, and understand the importance of forms of recognition that are relevant and meaningful to each group of staff.

How do NHS staff engage with research?

NHS staff can engage with research in a variety of ways. Their contributions span all phases of the research process, from idea to design to dissemination, and include setting priorities, helping draft research protocols and funding applications, collecting and analysing data, and sharing research insights with policymakers.

Our review highlighted the breadth of research projects and tasks undertaken by NHS staff. In one example, healthcare staff were involved in studying and co-producing a standardised nursing bag [15]. Nurses typically bring a bag of supplies with them to visit patients in the community, and the study aimed to understand how the bag and its contents could be improved to better meet nurses’ needs and better support patient care.

A steering group of service improvement managers, community matrons and infection control specialists participated in five workshops to inform the design of the bag, test it, and evaluate it. They brought a unique perspective from their day-to-day working environment and their efforts led to the design of a new bag with the potential for better functionality and patient safety.

Another example saw NHS staff involved in a Delphi exercise aimed at identifying and agreeing upon research priorities in mental healthcare [16]. A total of 35 psychiatrists, psychiatric nurses, clinical psychologists, social workers and occupational therapists were invited to engage by study leads, and asked to name up to five mental health topics they believed were priorities for research. The study found that healthcare professionals were less likely to agree on research priorities than service users and carers, who were also involved in the study.

The wide range of research tasks and activities conducted by NHS staff are summarised below .

Research tasks and activities that may be performed by NHS staff

1. agenda setting.

Structured priority-setting collaborations and partnerships, such as the James Lind Alliance [17, 20, 22, 24]
Membership of steering committees or advisory groups [3, 7, 12, 17, 24]
Responding to researcher-led consultation about research priorities [23]
Peer support and research networks [18, 21]
Direct meetings and discussions with funding bodies as part of panels, committees or advisory groups
Sharing information about research priorities with professional organisations that have influence on the funding landscape [24]

2. Attracting funding

Leading or contributing to the development of research proposals and funding applications [12, 25, 26]

3. Design and procedures

Leading the design of research in collaboration with other researchers and/or as part of a team [18]
Acting as advisors or collaborators to inform project development, for example by specifying research questions or developing data-gathering protocols or research tools [7, 9, 18, 23, 24]
Developing, testing and implementing research frameworks [27]
Collaborating with patients to design a clinical trial [28]

4. Recruitment of study participants

Advising on and being actively involved in the recruitment of patients or others for studies [6, 9, 23, 27]
Promoting surveys and encouraging participation in studies by other healthcare staff or patients [24]

5. Data collection

Collecting data from research participants [7, 9, 24]
Recording information and data [9, 15]
Conducting telephone and online surveys, workshops, interviews and focus groups [18, 20, 24]
Reviewing literature and documentation [15, 17]
Observing patient care as part of research to identify opportunities for improvement [15]
Engaging in consensus-building, for example using Delphi exercises involving a cross-section of practitioners [16, 19]

6. Data analysis

Actively conducting data analysis tasks, either independently or with other stakeholders (eg data from consensus-building exercises, surveys, focus groups, trials, and systematic reviews) [17, 18, 24, 28]
Being involved in the interpretation of data and in establishing recommendations [15, 17, 28, 29]
Evaluating research tools produced by others or interventions for their use in clinical settings [15, 29]

7. Dissemination and facilitating uptake

Being involved in the production of journal outputs or research reports [26]
Disseminating research findings to policymakers [24]
Disseminating research findings to academics and other practitioners [26, 27]

8. Evaluation of research

Critically appraising research outputs [15, 26, 29]
Evaluating service interventions in a practical setting (eg trials, pilots, or full-scale studies)

What is the impact when NHS staff engage with healthcare research?

The previous section described how NHS staff might contribute to the research process, and, in general, their contributions are viewed as valuable. Yet evidence on the impact of involving NHS staff in research is scarce. The literature on staff engagement with research is less developed than the literature on involving patients and the public in research. Though clinical staff have always been involved in some research activities, including recruitment of study participants, the literature includes limited consideration about whether engaging wider groups of NHS staff in research is affordable or practical and what impact it might have.

Our rapid evidence assessment identified one review that assessed whether involving healthcare professionals and provider organisations in research improved healthcare performance [30]. Most literature focuses on the potential benefits of engagement rather than systematically evaluating its impact. We also found a lack of evaluation frameworks that can systematically and effectively guide those who want to assess engagement processes.

From the existing evaluative studies, we categorise four ways NHS staff can potentially impact research and describe them below.

Potential impacts of NHS staff engagement with research

1. impact on research studies.

Setting priorities including identifying and prioritising research topics [17, 23, 24] [7, 15, 17, 24, 29]
Improving research design and methods by making them more relevant to healthcare staff and patients [12, 28, 31]
Helping recruit participants by being ‘on the inside’ [31]
Helping implement studies by providing practical advice and challenging the assumptions of academic researchers (31) [32]
Disseminating findings by providing guidance on how to reach healthcare audiences [6] [31]

2. Impact on the wider research system

Attracting funding for research through research grants, which help healthcare organisations retain talent, knowledge and skills [6]
Increasing the likelihood that healthcare staff use research by increasing their ability to use research and willingness to do so [30]

3. Impact on clinical practice

Contributing to improved healthcare performance enabled by mechanisms such as collaborative and action research [30]
Spreading knowledge and promoting innovation [6, 11] in part because involving practitioners in research contributes to an expanded knowledge base among healthcare staff

4. Impact on individuals

Helping healthcare staff develop new skills and progress their careers which can help them feel fulfilled in their roles and feel they are contributing to health service improvement [2, 4-7, 9-12]

What challenges limit NHS staff engagement with research and how can they be addressed?

NHS staff can make important contributions to research, but enabling those contributions is no easy task. Many barriers stand in the way.

One of the most prominent barriers faced by NHS staff is a lack of time to engage with research. Other challenges include lack of funding to support engagement [3, 7, 12, 33, 34]; lack of knowledge, skills and confidence [5, 8, 11, 26] (often related to a lack of exposure to research); difficulties accessing relevant training or mentorship supports [2, 4, 6, 13, 25, 34]; and lack of support by leadership [4-6, 11-13, 21, 34, 35].

An evidence base on the mechanisms that enable engagement is now emerging. These enablers include organisational factors such as structure, governance, management, and culture [2, 10, 12-14, 20, 25, 34]. For example, it’s important that leadership within organisations and professional networks champion research [4, 5, 20, 30, 34]. NHS staff need to be connected with research collaborators [2, 4, 7, 14, 20, 27, 34] and supported through training, mentorship and feedback [12, 13, 20, 34-36]. It is also helpful when they are guided by organisational policies that value research and make engagement feasible [5, 10, 12-14, 30].

Table 3 summarises the factors that inhibit NHS staff engagement with research as well as those that enable it.

Given these complex challenges and enablers, it is clear that one strategy alone won’t enable engagement. Instead, multiple strategies to encourage engagement are needed [30].

Challenges and enablers of effective NHS staff engagement with research

Governance, management and infrastructure.

Lack of funding for research and/or lack of awareness about how to access it [3, 6, 7, 11, 12, 33, 34]
A weak or opaque governance and management infrastructure –an unclear, inadequate or unwieldy bureaucracy for research and development (R&D) approvals can inhibit research applications [4, 12]
A failure to recognise research contributions in job plans, appraisal systems and career pathways [4, 8, 11, 12]
Lack of clear leadership and defined roles for NHS staff within research projects [21]
No information sharing about research opportunities
Formal roles such as research champions in provider organisations [10, 12, 13]
Clear guidelines and procedures for developing and implementing research [12, 30] [37]
Well-designed time-management systems that recognise research activities of NHS staff [5, 10, 14]
Financial recognition through pay progression [11]
Mechanisms for awareness raising about opportunities for involvement in research and how NHS staff can engage [19]
Accessible funding for research [14, 20, 35]
An enabling research infrastructure (equipment, facilities, information infrastructure) [14, 20, 21, 35]
Organisational practices which free up time and headspace to engage with research [2, 10, 14, 20, 25, 34]

Individual and organisational capacity to be involved in research

Lack of knowledge and skills needed to do research [5, 8, 11, 26]
Lack of access to relevant training [2, 4, 13, 25, 34]
Lack of dedicated time to be involved in research [34]
Integrating research within clinical practice by promoting evidence-based practice and engaging with research in clinical decision-making [4-7]
Access to training for NHS staff to develop their research skills and confidence [12, 13, 20, 34-36]
Mentoring and informal teaching [10, 12, 20, 25]
Collaboration with other organisations and individuals with an active interest in research [2, 4, 7, 14, 20, 27, 34]

Culture, attitudes, values and behaviours

Insufficient support by leadership [4, 5, 11-13, 21, 34, 35] and associated lack of strategic planning for R&D at organisational level [21, 26]
Divergent views among NHS stakeholders about what topics are important to research [13, 20]
A perception that research is a specialist activity and outside the domains of some health professions [12, 13]
A perceived inability to influence practice through research [11]
A perception among health professionals that it can be difficult to work with research teams in academia [5, 11]
Concern that time demands on NHS staff to deliver research tasks can be underestimated by research teams [5, 20]
Organisational leadership and culture, which values and promotes research activity [4, 5, 20, 30, 34]
Recognition and awards for involvement in research [4, 6, 9-12]
Effective mechanisms for disseminating research findings [35]
A compelling narrative about the research [2, 6]
A culture of feedback on the impact of staff contributions to research and wider impacts [6, 13]
Exposure to research training in early career stages

Areas of focus for involving NHS staff in research

The findings from our review of the literature, interviews and input from stakeholders suggested that the knowledge, expertise, energy and commitment of NHS staff in research are invaluable, and might be mobilised through the following strategies:

Preparing to engage NHS staff

Identify the most meaningful contributions for nhs staff on a case-by-case basis.

NHS staff engagement should depend on the project’s needs, how feasible engagement would be, and the operational context. Their contributions may be multiple, ranging for example from consultation, to data gathering, to full co-production of the research and its outputs. Some types of engagement will be conducive to innovative techniques such as citizen science approaches, while others will require more traditional methods of collaboration.

Clearly define research roles and responsibilities at the onset

Lack of role clarity can deter NHS staff from getting involved in research. The purpose, scope and remit of research roles should be clearly communicated from the beginning.

Target specific groups in some cases, engage more widely in others

Some research projects will benefit from involving diverse groups of NHS staff while others will require input from a targeted community. These decisions should be made based on the value and perspectives that different professional groups can add to a research project. Opening up opportunities widely (when appropriate) can have spillover benefits for future engagements, even if opportunities aren’t taken up immediately. Where relevant, consider whether more effort should be put into engaging groups that are not typically involved in research (ie NHS staff who do not work in clinical roles).

Where possible, evaluate the process, outcomes and impacts of NHS staff engagement using sound methods

Generating a better evidence base for staff engagement with research is likely to improve understanding of how, when, what, why and where staff might contribute, and provide insights into costs, benefits, and other resource implications. Evaluation plans should be based on the roles NHS staff are expected to play, the desired outcomes and impacts from their involvement, and how they will be supported to engage effectively . It is also important to share the learning from these evaluations.

Promoting research opportunities

Frame research opportunities to align with what motivates and enables nhs staff engagement.

Communicate how research involvement opportunities relate to their personal and professional interests, and make clear the links between research activity and the potential to improve clinical practice and benefit patients. As one interviewee said, ask yourself: “ Why should a person running a geriatric ward, in Bolton, on a Friday night, be interested ?”

Pay attention to the language and avoid unnecessary jargon

A clear and compelling narrative about how and why NHS staff can contribute is important – it might not be obvious. This should be central to a communications strategy for engagement, and can help change attitudes about who has valuable expertise.

Consider how best to use established networks and organisations when involving healthcare staff in research

Consider working with professional organisations and specialist societies (eg royal colleges, professional societies), regional networks (eg CRNs, CLAHRCs, AHSNs), special interest groups attending health services and quality improvement conferences, and bodies such as NHS Providers, NHS Employers and NHS Confederation to raise awareness and recruit contributors. National policy programmes such as Choosing Wisely, Getting It Right First Time and NHS RightCare may also provide a useful source of helpful contacts and insights, as could influential individuals in policy circles (though independence will always need to be ensured). Recognise that some NHS staff groups will not have established networks and organisations to support them in contributing to research, so alternative means of connection may be needed.

Enabling engagement throughout the research process

Ensure engagement mechanisms are as user-friendly as possible.

NHS staff have multiple demands on their time, so it needs to be as easy as possible for them to contribute to research. Engagement with research should – as far as possible – complement usual practice, rather than disrupt it.

Build links with leadership across hierarchies and professions to help foster a research-supportive environment

Support from senior leadership is critical in setting a research-engaged organisational culture, but it’s not always enough. Consider engaging with executive leadership, middle management and frontline staff on the basis that engagement at all levels is needed to achieve organisational buy-in and supportive organisational environments.

Build on existing organisational efforts and the governance of safety and quality

Ensure that there is communication and coordination between senior leadership and frontline teams underpinned by a shared view of the value of research activities. This will enable research to support wider safety and quality activities.

Engage with health system leaders and stewards to encourage time and headspace for staff to get involved with research

This interaction could also help raise awareness about opportunities for staff to make contributions out of personal interest or for professional development (through citizen science, for example).

Create opportunities for recognition and rewards and communicate them to healthcare professionals

Make clear how contributions will be acknowledged, and how feedback on the progress and impact of research and outcomes of engagement will be communicated. Work with professional bodies to consider benefits and rewards for the career development of a broad range of NHS staff, and ensure that staff who get involved see the impact of their involvement and how much their contributions are valued.

Reflect on the role organisations play in building wider research capacity in the health system

In addition to research project opportunities, share information about training and mentorship support available throughout the system.

Conclusions

NHS staff can and do play a valuable role in every stage of research. Many of them are already shaping research questions, recruiting patients, collecting and analysing data, disseminating findings, facilitating impact and making other important contributions.

But a closer look reveals room for more wide-scale engagement. Not all staff have control over whether they can choose to be involved with research, and a number of challenges can stand in their way. Opportunities to engage with research could be more evenly available to different healthcare professions and specialties, and a broader range of staff groups could be better supported to make contributions to research.

Though evidence about NHS engagement with research and its impact is generally limited, an evidence base on mechanisms that enable engagement is emerging. It suggests that these mechanisms need to be used in combination and must be mindful of the diverse factors that encourage involvement in research and those that discourage it.

Enabling engagement shouldn’t mean launching an endless, unquenchable push for more staff to get involved. The degree to which NHS staff are engaged should be based on a particular research project’s needs, how feasible engagement would be, and the operational context. Wider involvement by NHS staff should be considered on a case-by-case basis.

Mobilising a wider range of NHS staff may require new methods of engagement. Citizen science, for example, can help bring new and diverse voices into the research process. Career structures and research cultures in the NHS may also need to evolve, time to conduct research may need to be built into the system beyond clinical and academic fellowship models, and the academic, education and policy communities may need to work collaboratively with healthcare professionals to make these things happen.

Bold new approaches could offer substantial rewards for building the evidence base on how to improve healthcare. The expertise of NHS staff could lead to a better understanding of what works in healthcare, what doesn’t, and why, and inform meaningful improvements for the people who work in the NHS and they patients they serve.

Acknowledgments

This learning report is based on research conducted by RAND Europe on behalf of The Healthcare Improvement Studies Institute (THIS Institute). The source report, Enabling NHS staff to contribute to research, is available at https://www.rand.org/pubs/research_reports/RR2679.html

We thank Joann Leeding, Andy Paterson and Prof Mary Dixon-Woods from THIS Institute for their continued engagement with our work and Jon Sussex and Marlene Altenhofer from RAND Europe for quality assurance reviews. We also thank Gemma-Claire Ali of RAND Europe for her assistance. We are very grateful to RAND research librarian Jody Larkin for all her help with the search protocol and process. Particular thanks to all the individuals who shared their expertise with us during the interviews conducted for this research: Dr Rose Jarvis and Alastair Henderson (Academy of Medical Royal Colleges), Prof Tim Swanwick (Dean of Education and Leadership Development at Health Education England), Prof Peter Lees (UK Faculty of Medical Leadership and Management), Dr John Dean (Clinical Director Quality Improvement and Patient Safety, Royal College of Physicians), and Prof Gillian Leng (Deputy Chief Executive, National Institute for Health and Care Excellence), and Dr Tony Soteriou, (Deputy Director, Head of NHS Research Infrastructure and Growth, National Institute for Health Research). We also thank Dr Rose Jarvis, Michael Moore (Advanced Clinical Practitioner – Paramedic), Andrew Piggott (Project Manager (Resilience) at NHS Central Sussex and East Surrey Commissioning Alliance), Dr Jocelyn Cornwell (Chief Executive of The Point of Care Foundation), and Dr James McGowan (specialty registrar in public health medicine and NIHR academic clinical fellow, THIS Institute) for providing input that helped shape this report.

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Clinical academic careers

Research internships.

Research internships offer an introduction to all aspects and roles across clinical academic research from trial design, data management through to undertaking practical research in a clinical environment.

Schemes provide a range of both taught and academically supervised interventions that both engage and expose the intern to the clinical academic research environment, but also provide them with the practical skills to undertake a research project supported by an expert clinical academic supervisor.

By the end of the programme we hope that participants will have the confidence to apply their newly learned skills within their employing Trusts, become research champions and consider a future clinical academic career to include formally accredited education programmes, either within the HEE/NIHR Integrated Clinical Academic Programme, or via other routes. Interns will also benefit from an enhanced ability to apply successfully for further formal research training.

I think I am a more confident practitioner as a result and have a greater understanding of how clinical academic research supports changes in clinical practice with direct patient benefit." Jed Jerwood, Art Psychotherapist, Birmingham and Solihull Mental Health Foundation Trust and John Taylor Hospice.

It has given me the opportunity to include elements of research into my current job and network with, plus get support from experienced researchers." Llewellyn Boucher, Extended Scope Physiotherapy Practitioner, Kent.

Resources and case studies are available to support your decision making and conversations with your manager.

Aims of scheme.

An internship scheme will:

- develop research and research capabilities throughout all levels of the NHS in order to enhance and diffuse evidence based practice (by providing research champions)

- provide the opportunity to develop a network of clinical academics so that learning, best practice and innovation can be shared and disseminated, both regionally and nationally

- support the development of clinical skills as well as research skills

- encourage research into areas related to HEE’s Mandate or to education and training as a whole

- offer an insight into a career in clinical academia and provide experience which would support applications for further formal research training.

Local contacts

For queries regarding research options in our local teams (including internships) please contact the following in your region:

If you are employed in the North West region, find information and contacts here .

If you are employed in the North East and Yorkshire region, find information and contacts here .

For the Integrated Clinical Academic Programme Internship Scheme information also available on Sheffield Hallam University website.

For all other general queries contact the regional education team .

Midlands and east

Including; Central Midlands, North Midlands, West Midlands and East of England.

Clinical Academic Internship Programme information also available on the east of England website and Birmingham health partners website.

Including; North and South London .

Including; Thames Valley , Wessex , South West , Kent Surrey and Sussex .

To apply for the internships, candidates must be a registered professional from one of the professions listed in the eligible professions and registered bodies document below. The internships are available to those who have received no formal long term training in research. If, as part of your registration requirements, you had to complete a diploma or masters you are still eligible to apply.

Applications must have clear potential for benefiting patients and the public and can involve: patients; samples or data from patients; members of the public/carers; health technology assessment; health services research; and research into clinical education and training. We would encourage applications where the research would focus on one of HEE’s Mandate requirements or into education and training.

Applications will be administered and managed by local teams, based on local requirements.

Integrated clinical academic (ICA) programme

The ICA programme, funded by Health Education England (HEE) and run by the National Institute for Health Research (NIHR) provides a range of opportunities to undertake fully-funded clinical research, research training and professional development, while maint

Bridging scheme

Bridging schemes are a way of providing support to clinical academics to build on their previous academic training and develop proposals for a pre or post-doctoral award, and take the next step on their clinical academic pathway.

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Learning from a...

Learning from a pandemic: how the post-covid NHS can reach its full potential

Read our latest coverage of the coronavirus outbreak.

Related content
Peer review
Jeremy Marlow , senior adviser 1 ,
James O’Shaughnessy , member of the House of Lords 2 ,
Bruce Keogh , chairman 3 ,
Nitin Chaturvedi , partner 1
1 Bain & Company, London, UK
2 UK Parliament, London, UK
3 Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
Correspondence to: J Marlow jeremy.marlow{at}bain.com

Out of the tragedy of the pandemic, there is a unique opportunity to accelerate reform in the NHS and prepare for a world living with and after covid-19, write Jeremy Marlow and colleagues

The scale and degree of adaptation that the NHS has achieved in the past six months is unprecedented in its 72 year history. The service acted swiftly to bolster its emergency preparedness and resilience and rose to the challenge with innovation, energy, and kindness. But the pandemic has exposed its fragilities.

Questions are arising about how the NHS should plan for the future as well as capture and codify the experience of achieving change in such a fast, agile, and adaptive way. 1 We think that there are three main areas of focus for planning a strategy:

1. Health and care delivery model redesign, including the integration and specialisation of services.

2. A more agile, fluid, multidisciplinary workforce, affecting staffing, training, and leadership requirements.

3. Greater ambition in the NHS on digitalisation, innovation, research and development, and public-private-academic partnerships.

The challenge to practitioners and policy makers alike is to build a consensus about the best practices emerging from the covid-19 response and then to execute a strategy designed to make them a permanent feature of a new NHS model.

Control versus empower

At the peak of the pandemic in the UK, command was centralised with gold (strategic oversight for escalating major issues and resource redeployment decisions) and silver (local tactical coordination of responders for rapid problem solving and support) centres following the NHS’s emergency response framework and in England working closely with the 42 sustainability and transformation plan partners. The extent to which local NHS providers accepted pooling their sovereignty to more collective decision making was varied. It was most effective in some regions and integrated care systems. The role and direction of the NHS London team, for example, has been a major help in coordinating efforts in the capital. But this is a short term model that can only exist in extreme circumstances. The NHS needs to find a steady state that allows rapid, local decision making. Continuing reliance on national command structures is dangerous and will cause atrophy and disempower good organisations.

Nothing shows the urgent need for integration like the effects of covid-19 on the social care sector. 2 Some aspects of the response have shown how well integrated health and social care can perform together. Collaboration to ensure that medically fit patients were transferred out of hospital to home or to step-down care meant that hospitals were able to generate surge capacity and not be overwhelmed. 3 Technology enabled the rapid deployment of carers to achieve 10 000 home visits a day and helped relatives to maintain contact. 4 Providers worked with the government to create a platform for recruiting people from other sectors, vetting them online, providing virtual training, and matching to roles to reduce shortages and provide employment. 5 But the absence of any national infrastructure around the fragmented market of social care providers meant the reciprocal support for them was impossible to achieve in the same way that it was for the NHS.

The absence of coordinated surge support for social care has shown how much needs to be done to attend to fragility in the sector. This gives NHS institutions (such as hospital trusts and primary care networks) the opportunity to work alongside local authorities to act as “anchor organisations” to support social care providers in clinical and infection prevention and control protocols; staff development; data sharing and reporting; and introducing new (digital) technologies.

The sector has been exposed as isolated and precarious, with many providers teetering on the brink of insolvency. The energy of its leaders is focused on staff and residents, but the tragedy of covid-19’s impact on social care must be a tipping point for a consensus on a longer term settlement for social care and new models of provision.

Courage and conviction

The culture of frontline NHS organisations has undoubtedly been tested in the response to covid-19. In many cases, people’s resilience and motivation have strengthened through a visceral realisation of sense of purpose and urgency. There are many stories of frontline staff telling their loved ones that they might never see them again and the tragic situations where those fears have been realised. Values of selflessness, care for colleagues, creativity, and kindness have shone through.

Beyond this courage, new behaviours emerged. Multidisciplinary working flourished, such as surgeons working in intensive care and being excited to be part of the team. The consistency this has given to ward rounds has recaptured the strengths of the old “firm” apprentice model of medical training. Rotas have changed quickly with minimal bureaucracy, putting the interest of the whole system first. An insurgent positive mindset has been the biggest driver of innovation, pace, and common purpose, with eagerness to try new things and the relegation of professional and institutional silos.

Several “field innovations” came from the necessity to achieve best possible outcomes in an unprecedented situation. The clinical, social, and economic benefits of integrating rehabilitation early into the recovery of patients were shown through the rapid development of step-down units for patients in intensive care at Nottingham University Hospitals. Cross discipline clinicians were able to write new protocols and agree new admissions criteria at speed, dramatically changing the way inpatients were treated (Miriam Duffy, personal communication, 2020). During tracheostomy clinicians were able to help patients communicate by enabling the use of speaking valves on their tracheostomy, where appropriate, and by encouraging oral intake as soon as it was safe to do so. These procedures were usually not used outside of Nottingham University Hospital’s therapy led units or in such a high profile environment owing to the perceived risk.

This agility of leadership has accelerated change that previously required time consuming consultative machinery, layers of approvals, and autocratic decision making in small cliques. NHS leaders must now reflect and choose which archetype and style of leadership gives them the best opportunity for achieving the greatest results.

Innovation and ambition

Over the next two years health and care systems will need to experiment and embed new models. We need to plan to live with covid-19 and for life after it. Which innovations do we want to keep, and can they have dual use for treating other diseases? This will be especially important now that infectious disease will be re-established as a major health risk. What lessons can we draw from the covid-19 response to reduce the 10 000 deaths per year from seasonal flu 6 ?

As the NHS and life sciences improve their understanding and practices in response to covid-19, the biggest risk to public satisfaction is the effect covid-19 has had on all the other demands for health and social care services. The longer it takes for the NHS to recover the backlog of unmet demand the more harm will be caused. The number of people being referred for consultant led elective treatment reduced by 69% from pre-covid levels of 1.6 million in February this year to a low point of 0.5 million in April and recovered to 1.1 million by August. Meanwhile, the number of people waiting over one year for treatment has increased at a scale not seen since data started to be collected over a decade ago. In February this year 1600 people were waiting over a year. This number has increased every month since then and by August had grown by 6783% to over 110 000—a level not seen since 2008. 7

Solutions to many of these challenges are at hand. Digital communications and technologies are being embraced at a scale never dreamt of in the NHS—99% of general practices 8 are now capable of delivering care virtually. The triaging of symptoms has been streamlined with technology, with more outpatient consultations being delivered away from hospital settings. 9 Home and personal remote monitoring is being tested for use in the whole population. As the pressures subside, the temptation to revert to the status quo will grow. The expectation should be that most outpatient and follow-up appointments will be virtual by default.

The poor level of understanding of covid-19 has driven an upsurge in research and development activity in the NHS and in conjunction with universities and private companies, including vaccine development (such as the partnership between Oxford and AstraZeneca 10 and the NHS Lighthouse Laboratories with Thermo Fisher) and the rapid trialling of therapeutics. 11 Bearing in mind the government’s determination to increase the UK’s investment in research and development to 2.4% of gross domestic product by 2027, the NHS has shown that it can be a superb platform for translational research and later stage development, complementing our world class science base. This is a golden opportunity to build on. The key questions are how a broader base of institutions can contribute to the effort, as they have in other countries, and how established structures, such as the academic health science networks, can further mobilise to maintain the momentum of academic, private, and hospital collaboration that the pandemic response has generated.

Aiming for full potential

The general scientific consensus is that we will not have a deployable covid-19 vaccine or treatment until 2021. We might never have a completely effective vaccine, and covid-19 will become an endemic disease with seasonal spikes, or it might suddenly disappear. So much is unknown, but for the time being we need to prepare for a prolonged era of living with covid-19. Continuing the momentum of recent innovation and productivity gains will be vital if health and care services are to return to their previous operating capacity and ultimately their full potential.

The demands on leadership are unprecedented, requiring a combination of strategic, tactical, and soft skills. Leadership and decision making responsibilities will have to be more vertically distributed and preserve the “servant leader” mindset of the initial pandemic response, which has shown that anyone can display leadership regardless of their position. As well as showing a different kind of leadership, the crisis response has smashed longstanding barriers between different health and care settings and functions. For those concerned by the fragmentation of services, this might be considered the greatest gain of all. We now have an opportunity to redesign services around user journeys rather than top-down reorganisations or institutional fiefdoms. We need to be more agile and flexible, have more resilience with fewer single points of failure, and harness the understanding of what motivates the frontline and engages the public. Disempowering local leaders in the task of deciding how best to resume services will lose the goodwill and momentum of the past six months and make systems more fragile.

Meanwhile the flourishing of covid-19 related research activity in NHS settings has revealed two important truths. First, there is a huge appetite for research activity among clinical staff if enough time and suitable structures can be found. And second, the suitability and attractiveness of the NHS as a platform for medical research and development once the cultural and financial barriers to partnership with the private sector are lowered.

As difficult as the past six months have been, this period might turn out to be the easiest of many phases that await us. We need adaptable plans that maintain a constant state of readiness. If this can be achieved, the NHS and care systems will come out strengthened and revered, not just as providers of exemplary healthcare but as drivers of economic recovery and wealth creators for the nation.

Biographies

Jeremy Marlow is a senior adviser at Bain & Company and until 2018 was the executive director of operational productivity at NHS Improvement. Before that he was a civil servant in the UK government serving in senior roles in the Department of Health and Social Care, Department for Environment, Food, and Rural Affairs, HM Treasury, and the Cabinet Office.

James O’Shaughnessy served as the parliamentary undersecretary of state at the Department of Health and Social Care between 2016 and 2018. He was made a life peer in 2015. Between 2007 and 2011 he was director of policy for David Cameron. He is currently an adviser to Bain & Company.

Bruce Keogh served as England’s national medical director from 2007 to 2017. Before that, he was a cardiac surgeon. He currently serves as the chair of Birmingham Women’s and Children’s NHS Foundation Trust and is an adviser to Bain & Company.

Nitin Chaturvedi is a partner based in Bain & Company’s London office. He leads the firm’s UK healthcare practice with more than 20 years of consulting experience across healthcare including biopharma, medtech, and providers across the world.

Acknowledgments

We acknowledge the following for their contributions and feedback in the development of this essay subsequent to a roundtable discussion in April 2020: David Behan, David Dalton, Noel Gordon, Jim Mackey, Mahiben Maruthappu, Ian Peters, and Miriam Duffy.

Competing interests: All authors have read the competing interest statement ( https://bmj.com/cgi/content/full/317/7154/291/DC1 ) and declare that the answer to the questions are all No except for Question 1, part vi and Question 2 which are answered Yes. All authors have accepted fees for consulting. JM and NC are employees of Bain & Company providing consulting services to NHS organisations, and JOS and BK are advisers to Bain & Company. This manuscript was born out of a discussion between current and former senior NHS personnel which was convened by Bain & Company, a global consultancy.

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

↵ Edwards N. Here to stay? How the NHS will have to learn to live with coronavirus. Nuffield Trust. 2020 https://www.nuffieldtrust.org.uk/files/2020-06/1591362811_nuffield-trust-here-to-stay-how-the-nhs-will-have-to-learn-to-live-with-coronavirus.pdf .
↵ Care Quality Commission. Sharing insight, asking questions, encouraging collaboration: CQC publishes first insight document on covid-19 pressures. 2020 https://www.cqc.org.uk/news/stories/sharing-insight-asking-questions-encouraging-collaboration-cqc-publishes-first-insight-document-on-covid-19-pressures .
↵ NHS England and NHS Improvement. Important and urgent—next steps on NHS response to covid-19. 17 Mar 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/20200317-NHS-COVID-letter-FINAL.pdf
↵ Exclusive CS. Cera plans to roll out assistive technology this year. Home Care Insight. 21 Apr 2020. https://www.homecareinsight.co.uk/exclusive-cera-plans-assistive-technology-roll-out-this-year/
↵ Department of Health and Social Care. Register here to become a care worker and help change lives. https://www.joinsocialcare.co.uk/
Hardelid P ,
↵ NHS England. Consultant-led referral to treatment waiting times. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/
↵ Bakhai M. The use of online and video consultations during the covid-19 pandemic - delivering the best care to patients. NHSX. 2020 https://www.nhsx.nhs.uk/blogs/use-online-and-video-consultations-during-covid-19-pandemic-delivering-best-care-patients/ .
Schwamm LH ,
Estrada J ,
Erskine A ,
↵ University of Oxford. Oxford University announces landmark partnership with AstraZeneca for the development and potential large-scale distribution of COVID-19 vaccine candidate. 2020. https://www.ox.ac.uk/news/2020-04-30-oxford-university-announces-landmark-partnership-astrazeneca-development-and .
↵ UK Bioindustry Association. Health Secretary pays tribute to UK life sciences companies, as testing ramps up for covid-19. 2020. https://www.bioindustry.org/news-listing/health-secretary-pays-tribute-to-uk-life-sciences-companies-as-testing-ramps-up-for-covid-19.html .

Building back better research post covid-19

During the covid-19 pandemic, the public focus has been on the remarkable performance of the NHS and its dedicated workforce in coping with the huge influx of covid-19 patients, led by centralised clinical guidance and rapid local reorganisation of services. The outpouring of public affection for the NHS has been a welcome and well-deserved recognition of its place at the heart of the nation. Yet there is an equally remarkable, but much less publicised success story to be told—that of the UK research sector’s response to covid-19, partly due to the preparedness of the National Institute for Health Research (NIHR) in England and parallel research systems in Scotland, Wales, and Northern Ireland.

With 100% of NHS Trusts previously involved in research supported by the NIHR’s Clinical Research Network (CRN), research delivery teams and processes were already in place to support the NHS and enable widespread recruitment for covid-19 studies. Equally, the redirection of NHS services to covid-19 reduced the capacity for non-covid research, much of which had to be paused during the acute phase and is trying to restart now for the benefit of patients and the research funders.

The NIHR CRN activated its pre-existing plan for research in a pandemic, resulting in 640 NHS research sites ready to deliver studies. Urgent Public Health Studies (UPHS) were prioritised by the Chief Medical Officer to yield key evidence. Simplified and pragmatic research design like that of the RECOVERY platform study, enabled NHS staff, even if unfamiliar with research, to rapidly get involved.

Coupled with unparalleled speed in regulatory assessments, over 130,000 participants were recruited to covid-19 studies, including 10,000 patients entered into the RECOVERY study in 8 weeks. This yielded positive results for dexamethasone in patients receiving oxygen/ventilatory support and UK research out-performed other European countries in both publicly-funded and life sciences COVID-19 international studies. [1] Going forward, the UK’s chief medical officers have signalled their intention that every eligible patient is offered enrolment into a covid-19 trial. [2]

A signature feature of the RECOVERY trial recruitment was the disproportionately high contribution of many smaller hospitals supported by clinicians not previously engaged in research. This welcome development is one that we must continue for several reasons. We know that patients fare better in research-active hospitals regardless of other factors, and that clinicians are attracted to roles that have research potential, but need support to be able to fulfil these roles. [3]

Yet there is more that can be done to build from this success, from further top-level direction from NHSE, involving UKRI, the research funders and regulators, building on technological and digital advances to drive the scale and pace of research across the whole country, enabling clinicians to engage in research, and reducing bureaucracy to speed the set-up, delivery and translation of research together.

As the Royal College of Physicians (RCP) publishes its own research strategy, here we look at how we can build on that success outside the framework of covid-19 and support clinicians to be more active in research. [4]

A recent RCP survey of consultant physicians shows that clinicians working in NHS trusts have a very positive attitude towards participating in research, but struggle to become involved—for over half this was primarily due to a lack of time. [5] 67% of respondents said having dedicated time for research would make them more likely to apply for a role. Other barriers identified were a perceived lack of skills and supportive culture in their organisation. We need to harness the appreciation that managers, commissioners, and the public have shown for the NHS as a whole during covid-19 to reach into the research culture, because research-active trusts have better patient and staff outcomes.

There are several practical steps to better integrate research into clinical care, as highlighted by the RCP’s research strategy:

Research should be factored into the recovery/reset of clinical services, especially at time of health service reorganisation
Organisations should support a highly visible R&D function that coordinates high quality research and clearly explains the different ways clinicians can become involved in research and what support is available
Publicise research-focused mentoring and credentialling schemes, especially to those under-represented in research such as women and people from BAME backgrounds
Explore viable ways to allow clinicians more time to participate in patient-facing research through job planning, whether this is on an individual or team basis

Finally, covid-19 starkly demonstrated the integral relationships and interdependence of the NHS with the social care and public health sectors. While these sectors are not usually joined-up to traditional health research, we should begin to “think social, think public” when designing and commissioning health service research to maximise the benefit to all who both need and provide care. In that way we can embed an interdependent approach based on supporting, enabling, and empowering clinical staff to deliver. The UK has a global opportunity to demonstrate the interconnectivity of its systems, capitalising on the combined strategies of its life sciences sector.

Covid-19 taught us a lot about the way we manage research in the UK—that we can change cumbersome systems, be more fleet of foot, collaborate more and increase inclusivity—harnessing these improvements will be COVID-19’s valuable legacy to our thriving UK research sector – it will be better for patients, better for clinicians and better for the nation.

Cheng-Hock Toh , Royal College of Physicians, academic vice-president.

William van’t Hoff , chief executive officer, CRN National Coordinating Centre (CRNCC) and NIHR Clinical Research Network (CRN).

Competing interests : None declared.

References:

The Recovery Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report. NEJMoa2021436.
Chief Medical Officers for England, Scotland, Wales, Northern Ireland and NHS Medical Director. COVID-19 Research and treatment trials. https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103085 (accessed 21 August 2020).
Jonker L, Fisher SJ. The correlation between National Health Service trusts’ clinical trial activity and both mortality rates and Care Quality Commission ratings: a retrospective cross-sectional study. Public Health 2018;157:1–6.
RCP, 2020. Research for all: Developing, delivering and driving better research. www.rcplondon.ac.uk/research-strategy
RCP, 2020. Unequal Access: an analysis of participation in clinical research. www.rcplondon.ac.uk/research-survey-report

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Innovation Pathways in the NHS: An Introductory Review

Anmol arora.

1 School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0SP UK

Andrew Wright

2 Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK

Tsz Kin Mark Cheng

3 Department of Medical Sciences, Faculty of Biology, University of Cambridge, Cambridge, UK

Zahra Khwaja

4 Department of Pathology, University of Cambridge, Cambridge, UK

Matthew Seah

5 Department of Surgery, University of Cambridge, Cambridge, UK

Healthcare as an industry is recognised as one of the most innovative. Despite heavy regulation, there is substantial scope for new technologies and care models to not only boost patient outcomes but to do so at reduced cost to healthcare systems and consumers. Promoting innovation within national health systems such as the National Health Service (NHS) in the United Kingdom (UK) has been set as a key target for health care professionals and policy makers. However, while the UK has a world-class biomedical research industry, several reports in the last twenty years have highlighted the difficulties faced by the NHS in encouraging and adopting innovations, with the journey from idea to implementation of health technology often taking years and being very expensive, with a high failure rate. This has led to the establishment of several innovation pathways within and around the NHS, to encourage the invention, development and implementation of cost-effective technologies that improve health care delivery. These pathways span local, regional and national health infrastructure. They operate at different stages of the innovation pipeline, with their scope and work defined by location, technology area or industry sector, based on the specific problem identified when they were set up. In this introductory review, we outline each of the major innovation pathways operating at local, regional and national levels across the NHS, including their history, governance, operating procedures and areas of expertise. The extent to which innovation pathways address current challenges faced by innovators is discussed, as well as areas for improvement and future study.

Introduction

The industry of healthcare is recognised as one of the most innovative, with a record of driving multidisciplinary innovation and fostering the adoption of new technologies. Health innovations tend to drive improvements in patient care as well as making this care increasingly cost-effective. This is of particular interest to healthcare systems such as the National Health Service (NHS) in the United Kingdom (UK), which seek to deliver high-quality care under tight budget constraints. The UK government’s spending on healthcare is approximately 10% of gross domestic product (GDP) and an ageing population coupled with increases in long-term health conditions may only increase this in the foreseeable future [ 1 ]. The moral imperative towards improvements in patient care, and the need for these improvements to be cost-effective, means that facilitating innovation within and around health systems such as the NHS is a key priority for policy makers and clinical leaders. Innovation in healthcare systems such as the NHS, is partly driven by intrapreneurship whereby members of the organisation pursue innovative ideas, but is also largely propelled by entrepreneurs creating ideas and partnering with healthcare partners. The NHS Long Term Plan, published in 2019, highlighted the importance of innovation in the NHS, including the role it has in improving health outcomes, and committed the NHS to developing the infrastructure required for innovations to thrive [ 2 ]. It emphasised genomics as an innovation with potential to benefit both children and adults with rare diseases and/or cancer. Mental health was also highlighted as an area for future innovation efforts particularly in regards to patient reported outcomes.

It has been noted that only a tiny proportion of medicines and medical devices which reach the market succeed and that the journey to market can sometimes cost in the billions of pounds and take over a decade [ 3 ]. In recent years, there have been numerous innovation pathways made accessible to early-stage innovators seeking to incorporate new technologies, services or digital innovations in the NHS. The introduction of these pathways has formed part of the dual strategy of improving health and creating wealth within an expanded British Life Sciences industry, led by the Department of Health and Social Care and the Department for Business, Energy and Industrial Strategy [ 4 – 6 ].

Two key stages in an innovation process are invention and implementation, with an intervening development stage [ 7 ]. The invention stage is largely the responsibility of the 'inventor(s)'; it consists of formulating the idea for an innovation and developing the service or product. By the time the innovator approaches an innovation pathway, the invention stage would normally be resolved. However, it does present a substantial barrier to entry in many cases due to resources needed to develop a viable product. The implementation stage, on the other hand, can be even more resource intensive, expensive and arduous. Since this stage consists of testing the innovation and incorporating it in health systems, access to patients is typically required. Diffusion of innovation is well characterised by the ‘Diffusion of Innovations’ theory proposed by Everett Rogers [ 8 ]. The theory dictates that the rate of adoption of an innovation is initially slow until it reaches a critical mass, after which spread of the innovation is self-sustaining. Therefore, the early period of the implementation stage can be particularly challenging for innovators to navigate, both because of the resources that are required and the need to identify potential early adopters.

It is in this implementation stage that innovation pathways may offer the greatest assistance to innovators. Fundamentally, these innovation pathways (or programmes) would help early-stage innovators find markets for their products. Additionally, they may help them with clinical testing and provide some funding. In some cases, they are comparable to the services that accelerators or venture capital firms might provide to early-stage start-ups but they also provide specialist support to overcome healthcare-specific barriers to entry, such as the need for testing to ensure patient safety. In addition, many innovation pathways focus on forming a network between different stakeholders, simplifying aspects of the innovation pipeline.

These pathways support a wide range of innovations, ranging from medical devices to the development of new therapies. In many cases, the pathways are not specific to a certain type of innovation though there are some which have funding streams dedicated to certain avenues. The advent of industry 4.0 and machine learning, as well as the synergies between different innovations, require that pathways be increasingly open given that the line between hardware and software innovations is increasingly blurred.

This introductory review seeks to offer an overview of innovation pathways available within and around the NHS with a view to provide insight to innovators and map out potential routes to market entry. In doing so, the review also seeks to illustrate any overlap or deficiencies in the current system.

Local Pathways

For innovations which are designed to impact patient care, a key component of their development is the need to test products and services in clinical environments. Local innovation pathways integrated in hospital trusts permit this and offer resources to innovators seeking to implement their devices or services in the NHS. In local systems, there are numerous stakeholders, including clinicians, patients, hospital trusts and Clinical Commissioning Groups (CCGs). CCGs plan health services in their local area and they are responsible for two-thirds of the total NHS budget [ 9 ]. They work closely with hospitals and other healthcare providers in their local area to organise care pathways and may also collaborate with Academic Health Science Networks (AHSNs; see below). The 2021 NHS White Paper set out further integration of local health and care, in the form of Integrated Care Systems (ICSs), which will succeed CCGs [ 10 ]. It is yet unclear how these changes will affect the innovation role of local health systems.

Individual trusts may offer their own services to innovators, such as through the Test Beds programme. The Test Beds programme is a cross-government venture funded centrally to provide hospitals with the resources to support innovations at a local level [ 11 ]. Evidence is generated and evaluated to explore potential for wider implementation within the NHS.

NHS Vanguard

NHS Vanguard test sites are a similar venture to test beds, 50 of which were selected in 2015 to propel development of innovative care models which could then be applied nationally [ 12 ]. Vanguard sites consist of a group of stakeholders in a local area working together to test, measure and evaluate innovative care models. Though Vanguard sites are local pilots they receive national support and are intended to lead innovation at a national level. Vanguard sites operate in a range of fields, including general practice, acute care and care homes [ 13 ].

Academic Health Sciences Centres

Academic Health Sciences Centres (AHSCs) are accredited institutions in the UK which are recognised for their research and clinical expertise. They typically consist of a partnership between a teaching hospital and a university. AHSCs have been established in North America for decades, but have expanded internationally and have been recognised in the United Kingdom since 2007 with the launch of Imperial College London’s AHSC [ 14 ]. AHSCs permit collaboration locally among research institutions and care providers as well as globally between international AHSCs. It has been noted that AHSC partnerships between universities and hospitals may work to streamline approvals for clinical research by combining research infrastructure, for example “Joint Research Offices” [ 14 ].

Regional Pathways

As the 2018 RAND Europe review of UK Healthcare identified [ 15 ], there is a pressing need in the NHS innovation landscape for national policy which supports regional innovation, and for regional success to then shape national policy and implementation. A similar point was emphasised in the 2021 Health and Care White Paper [ 10 ]. Therefore, it is important to consider not only the local and national infrastructure for innovation, but also regional networks.

Academic Health Science Networks

Perhaps the most important regional infrastructure for innovation is the network of AHSNs [ 16 , 17 ]. This network was established in 2013 following a series of policy and academic reports [ 18 ], recommending significant reform in the innovation landscape of England [ 4 , 19 ] with the aim of improving regional health and creating wealth. AHSNs comprise 15 regional bodies (see Fig. 1 ), overseen by NHS England, which aim to coordinate regional NHS trusts, local government, charities and industry, helping to identify and spread health innovations [ 5 , 16 ]. According to a 2016 report compiled by the Office for Life Sciences and Monitor Deloitte [ 20 ], AHSNs represent the only body, regional or national, that has competency across every stage of innovation, from idea to implementation. Their 2018/2019 report [ 17 ] contains more detail on the impact of AHSNs, including work on 3,630 innovations, creating 691 jobs and leveraging over £150million of investment.

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Area map of AHSNs.

The regional nature of AHSNs is important because they are well placed to take advantage of individual academic and industrial strengths of regions, using a range of strategies such as innovation scouts [ 21 ] and close partnership with university research hubs such as AHSCs [ 22 ] to identify and implement innovations. Examples include Digital Health London [ 23 ] delivered by MedCity, London’s AHSNs and AHSCs to develop the capital’s digital health infrastructure. Conversely, the universal coverage across England means that AHSNs can operate as a network to deliver national policy objectives. This includes both central programmes set at the beginning of each financial year [ 24 ] and unexpected challenges, for example implementing digital primary care in the COVID-19 crisis [ 25 ]. The first years of the AHSN network have widely been regarded as a success, and in 2017 NHS England relicensed the networks, with an increase in funding [ 26 ]. There are still challenges to their operation, however. The only current full review of their performance, which covered their operation up to 2016, identified significant variation in the practice of AHSNs [ 18 ]; some work on a looser basis, working with a wider range of companies and institutions, while others work more tightly with fewer institutions. This was partly due to pre-existing NHS structures, such as AHSCs and Collaborations for Leadership in Applied Health Research and Care (CLARHCs, now called ARCs, see below).

Applied Research Collaborations

Applied Research Collaborations (ARCs) are regional programmes funded by the National Institute of Health Research (NIHR). They replaced the CLAHRCs in 2019 [ 27 ]. They are local partnerships between AHSNs, NHS, universities and charities; their 15 regions overlap almost directly with the regions of the AHSNs. From 2019, £135 million will be invested, with the specific aim of increasing the rate at which innovative research is adopted in clinical practice. Each ARC takes a lead on a specific area based on the expertise of their region, with priority areas identified from RAND Europe’s ‘Future of Health (2017)’ [ 28 ] review. The Wessex ARC, for example, has a particular focus on ageing and dementia. Therefore, while the ARC remit is outside the traditional NHS innovation framework, they are a key piece within the regional innovation landscape; UCLPartners (North London AHSN) and the North Thames ARC, for example, have collaborated on a project investigating the long-term physical impacts of COVID-19 [ 29 ].

Regional Medicines Optimisation Committees

Regional Medicines Optimisation Committees (RMOCs) were established in 2016 to optimise the use of medicines across the NHS. Overseen by NHS England, they bring together decision makers, clinicians and patients. According to their 2019 operating model [ 30 ], their role is to share clinical best practice, speed implementation of new medicines, instigate changes in use when evidence base changes, and reduce unwarranted variation in prescribing. There are currently four RMOCs covering England (South, London, Midlands and East, North), but there are plans to expand this number to seven from Autumn 2020. Similar to the ARCs, each RMOC takes a lead on a specific priority area (with these areas decided by NHS England Medicines Value Programme). For example, the London RMOC leads work on polypharmacy [ 31 ]. Each RMOC is also able to propose its own priorities, suggested by local clinical care groups and area prescribing committees, which are then presented to the national priorities panel for consideration. Similar to the AHSN network, this facilitates top-down and bottom-up consideration of innovation priorities and policy changes.

National Pathways

Accelerated access collaborative.

The Accelerated Access Collaborative (AAC), established in May 2019, is the umbrella body across the UK health innovation ecosystem [ 32 ]. It was founded following the Accelerated Access Review led by Lord Darzi, which highlighted major areas of improvement for NHS Innovation [ 33 ]. The unit operates within NHS England and NHS Improvement, with board members representing each of its key partners [ 34 ]. With immediate goals of creating a “single front door to the innovation ecosystem”, including an online portal with information, and support and signposting for innovations, the AAC strives to guide teams across the entire innovation pipeline, ranging from local testing provided by AHSNs, or evidence queries related to National Institute for Health and Care Excellence (NICE) submissions [ 35 ].

Since June 2019, the AAC have focussed on providing support for three categories of early-stage products (those yet to be approved by NICE) [ 36 ]:

Advanced Therapy Medicinal Products
Histology Independent Treatments for Cancer
Artificial Intelligence

The AAC runs and coordinates a number of programmes across the UK innovation ecosystem. Some of these involve existing initiatives (such as AHSNs), some are dedicated AAC programmes such as the Clinical Entrepreneur Training Programme, where AAC provides training to help clinicians bring innovations to market [ 37 ], and some programmes run with other services, such as the NIHR Artificial Intelligence (AI) Scheme [ 38 ].

NHS Digital

Previously known as the Health and Social Care Information Centre [ 39 ], NHS Digital is a public-facing body [ 40 ], providing most web-services, statistical publications, and data management systems used within the NHS [ 41 ]. Their focus is largely centred on the current infrastructure of the NHS, and thus they tend to have a restricted role in early product development; rather, they innovate through continuous improvement of existing services, including NHS websites and the NHS app. That being said, NHS Digital has a specific drive for better data collection and easier patient–clinician interactions. With more than 700,000 users registered to the NHS app at the end of May 2020 [ 42 ], combined with over 90 million demographic records on the NHS Spine system [ 43 ], NHS Digital is an essential component of the innovation pathway, particularly in the evidence generation phase. One example of this is the contribution of NHS Digital to the upcoming AI award, by producing synthetic datasets with the Medicines and Healthcare Products Regulatory Agency (MHRA) to optimise accuracy of algorithms [ 44 ].

In comparison to NHS Digital’s more administrative role, NHSX reports directly to the Department for Health and Social Care and the Chief Executive of NHS England. They act as the oversight organisation to define the digital strategy envisioned by the Health Secretary [ 45 ], and other long-term strategies, including the future remit of NHS Digital [ 46 ]. A specific focus of NHSX is to accelerate digitisation within the NHS by establishing centrally agreed standards and allowing local NHS organisations the freedom of choosing their mode of delivery, if they meet the required open standards for interoperability, accessibility, and security [ 45 ]. They also prioritise cutting time spent by clinicians inputting and accessing data within the NHS system, ease of access to key NHS services by patients on their smartphone and ensuring secure and reliable access to essential diagnostic information in clinic [ 47 ].

The aim of NHSX to establish a data-driven ecosystem will not only allow patients to have easier and wider access to their personal data, but also easier circulation of the collected data between patients, clinicians, and care systems. The increase in interoperability between different health institutes, by better data sharing practices including cloud storage, has the potential to improve patients’ access to services, deliver the right diagnostic information to clinicians, and provide researchers with the healthcare data they need [ 48 ]. It would also provide an innovator friendly environment for easier product testing and initial health system adoptions. Furthermore, it assists in the goal of the AAC of achieving proper ‘demand signalling’, whereby researchers, innovators and funders can more easily understand what the NHS needs [ 49 ].

NIHR Funding Schemes

National Institute for Health Research (NIHR) is a UK government agency which funds research into health and care. It has a wide variety of programmes which support different groups of research, spanning the research innovation pathway from early Minimal Viable Product development to evaluative research, including pragmatic clinical trials. NIHR schemes undergo regular mandated peer review, to ensure appropriate design and methodology.

The NIHR runs many schemes, some of which are specifically aimed at innovators [ 50 ], including the competitive i4i (Invention for Innovation) award [ 51 ]. This has a track record of highly successful adoption and commercialisation, although less than a quarter of applicants are successful per year [ 52 ]. Life sciences companies can apply to most programmes as lead applicants, or in some cases, as co-applicants alongside industry, NHS and academic partners. The i4i programme is a translational funding scheme, aimed at advancing medical technologies and interventions, especially in areas of high or rapidly increasing demand. In 2020 this included the themed call of injuries, accidents, and urgent and emergency care [ 53 ] and more recently, the COVID-19 call [ 54 ]. It is split into three awards, Product Development Award (PDA), Challenge, and Connect, aimed at different stages of development.

With the goals of minimising investment risk and assisting development of translational innovation into real ideas, the awards support both existing ideas, with research funding used to reach the next stage in the developmental pathway, and additional research for newly, CE (certification) marked products, where regulators such as NICE require more evidence before adoption. All awards are aimed at products and services which aim to integrate into the NHS [ 55 ].

While the Challenge award supports assessment of medical innovations in the real-world, the PDA provides all justifiable expenses for translational research proposals [ 51 ]. Connect, on the other hand, is a programme centred on small and medium enterprises, focussing on helping early-stage products to build momentum and reach important business and technological milestones [ 51 ].

NIHR Artificial Intelligence Scheme

In August 2019, NHSX launched an AI Lab, using a £250 million fund from the Department of Health and Social Care [ 56 , 57 ]. £140 million of this has been made available over three years in the Artificial Intelligence in Health and Care Award [ 58 ], as a collaboration between NHSX, the AAC, and the NIHR. The aim of this award is to advance the development of AI technologies which meet the strategic aims of supporting data-driven decision making and optimising interactions between existing systems, as outlined in the NHS Long Term Plan [ 48 ]. The funding focuses on four NHS priority areas: screening, diagnosis, decision support and improving system efficiency [ 58 ]. Support is available across four phases of development (which are similar to the phases of drug development): Phases 1–3 are incorporated into NIHR’s i4i and SBRI (Small Business Research Initiative) award schemes, while Phase 4 is covered by NHSX via the AAC team. A call for applicants is made twice per year. The award provides awardees assistance in navigating issues in the developmental process, highlighted by NHSX’s recent AI report [ 49 ] and digital innovator summary report [ 59 ]. These issues include the vital process of patient data access.

NHSX also runs a number of other projects to drive AI innovation in the NHS, under the umbrella of the NHS AI Lab. In 2020, the NHS AI Lab announced its Skunkworks project to find, fund and resource AI endeavours within the health and care ecosystem [ 60 ]. NHS colleagues can pitch problems with potential AI solutions in pitching-style events to identify real-life problems which can benefit from the expertise of the NHS AI Skunkworks team.

NHS Innovation Accelerator

Launched in 2015, the NHS Innovation Accelerator is an NHS England initiative delivered in partnership with England’s 15 AHSNs and hosted at UCLPartners [ 61 ]. The Innovation Accelerator invites applications from individuals (clinical, industry, academia) as part of an annual international call. Applicants are required to demonstrate their skills and experience to qualify for support, alongside the efficacy and safety of the proposed innovation, as well as a strategy for scaling in the NHS [ 61 ]. The assessment panel is drawn from a wide range of organisations including NHS England and NHS Improvement, AHSNs, NICE and The Health Foundation. Successful Innovation Accelerator fellows receive bespoke support, including access to mentorship from a range of high-profile experts, links with AHSNs and other stakeholder organisations, peer-to-peer learning and support, a dedicated learning programme, and a bursary. Innovations can be of any type, including medical devices, apps, new models of care and artificial intelligence [ 62 ]. While the NHS Innovation Accelerator core team provides day-to-day support, AHSN partners provide signposting, local networking and support on scaling strategies.

The Innovation Accelerator has supported a number of successful innovative solutions during the COVID-19 pandemic, both in response to new demands and exacerbations of existing problems. Examples include ‘Echo’, an app allowing patients to order NHS prescriptions to their home for free, and ‘HaMpton’, which uses an app for home monitoring blood pressure during pregnancy [ 63 ].

Innovate UK

Innovate UK (formerly known as Technology Strategy Board) provides grants to companies that are working on projects that will develop something that can be classed as a “technology innovation”. Innovate UK is part of UK Research and Innovation (UKRI), and supports innovative ideas and business growth through grant funding, loans and procurement [ 64 ].

Innovate UK aims to invest in early-stage innovation projects with high potential as well as focussing on sectors it has identified as priorities. Each funding opportunity has different eligibility requirements but in general, eligible projects are divided into four broad Research and Development (R&D) activities [ 65 ]:

Fundamental research
Feasibility studies
Industrial research
Experimental development

Innovate UK is not a health-specific pathway, but they do operate ‘catapult’ innovation centres, which focus around innovation in specific areas of health, such as the Medicines Discovery Catapult [ 64 ]. They have collaborated with a range of other partners, including the charity LifeArc, the Multiple Sclerosis (MS) Society and The University of Manchester [ 66 ]. The Medicines Discovery Catapult has been particularly active during the COVID-19 pandemic, including through the coordination of the UK Lighthouse Labs Network and in providing leadership to the UK’s drug discovery community [ 67 ].

Medilink UK

Medilink UK is a not-for-profit, professional association and specialist health and life-science consultancy. Its primary focus is on fast tracking the development of Life Science companies by enhancing their connectivity to UK business, clinical, regulatory and finance communities, helping form new partnerships and navigate the increasingly complex health innovation landscape. Other services offered include market research, PR/communications, assistance with market access (including international) and assistance with grant applications [ 68 ].

One of the benefits of Medilink to small and medium enterprises is the access to the NHS. Medlink has links with the regional AHSNs, and they also help companies with NHS market access strategy. For example, their Innovation Surgeries programme starts with an offer to all regional companies, but especially small and medium enterprises who have a product or service that they believe should sell to the NHS and is either close to or on the market but struggling to find buyers. Certain companies may also participate in the aforementioned regional ‘Test Beds’ programme in collaboration with NHS trusts, CCGs and clinical trials units [ 69 ]. An example of a successful venture supported by Medilink UK is Deltex Medical, a company who produce the CardioQ-ODMOesophageal Doppler Monitor (ODM), a minimally invasive Doppler probe that can be inserted nasally or orally to measure circulating blood volume [ 70 ].

NHS Clinical Entrepreneur Programme

The NHS Clinical Entrepreneur Training Programme launched in 2016 as an entrepreneurial workforce development programme to equip participants with the skills, knowledge and experience required to develop innovations within the NHS [ 37 ]. Since the inception of the programme, it has trained over 500 healthcare professionals with mentoring, networking opportunities and teaching [ 37 ]. The programme is available to clinical and non-clinical NHS staff seeking to develop an idea for an innovation which may improve patient care. Such a programme is important in fostering a culture of improvement within the NHS, helping to encourage intrapreneurship and reducing attrition rates of staff leaving to pursue entrepreneurial aspirations.

Alternative Pathways

For those seeking direct commercialisation, there are several other options to support innovations that exist outside normal NHS and government structures. Funding can be provided by angel investors, venture capitalists and family offices. Start-up accelerators provide capital too, often combined with close mentorship and upskilling of the team. Any venture can seek this type of funding, and the process involves a business pitch to the investors in question and often a series of interviews with the start-up team. There is no formal process for obtaining funding from venture capitalists and Angels and the process usually involves cold-communication and networking.

Angel Investors

Angel investors are high net worth individuals who invest into the early formation of a start-up. In return for the provision of funding, angels usually get a stake in the company. Many angels have specific areas of expertise, so they can advise and help build the connections of the venture—this is because angels have a personal responsibility for the start-up’s success. Angels are attractive sources of capital since they afford more flexibility than investment banks (for example) and usually their loan does not have to be paid back if the venture fails. Angels are usually part of a larger network and intermediary agents such as MedCity (the umbrella organisation for London’s AHSCs and several universities [ 71 ]) work to connect them to life-science start-ups. An example of an established angel network is Cambridge Angels [ 72 ], while examples of life-science start-ups showing success from such investment include Eagle Genomics and Smart Target [ 73 ].

Venture Capital

Venture capital is a type of financing invested in start-ups that are usually high risk but have the potential for rapid growth. The investments are usually larger than angels and so the venture should ideally have the management and strategic plan to scale quickly. Different venture capitalists operate at different stages in the venture’s life-cycle (from idea to adoption) [ 74 ]. The clear benefit for businesses is the lack of obligation to pay back lent money. Like angels, venture capitalists have business and institutional knowledge and are well connected, and again like angels, venture capitalists expect a return for their investment, usually through an acquisition or access to intellectual property. Many start-ups are wary of very large investments as they may risk losing management of the company. The oldest venture capitalist in the UK is Abingworth, which boasts a successful portfolio and series of exits [ 75 ].

Start-up Accelerators/Incubators

Start-up accelerators and incubators provide intense training, upskilling and mentorship for select ventures, alongside funding. This is particularly important for early-stage spin-outs (often projects started in university research groups) as it ‘accelerates’ the acquisition of strategic, managerial and commercial acumen. Some pre/seed stage venture capitalists and angels can offer similar help but this is not in the form of a structured programme such as these accelerators. Many are located at life-science venture ‘hot-spots’ such as Cambridge, United Kingdom. An excellent example is Start Codon [ 76 ], which leverages its connections with the biomedical hub in Cambridge to provide seed funding and training for innovators, particularly those taking an idea from academic research into a start-up, in return for an 8% stake in the final product [ 77 ].

Equity Crowdfunding

Crowdfunding is a fairly new model for ventures to secure capital. It allows life-science start-ups raise up to £1 m (and sometimes more) by attracting a small pool of investors. Equity crowdfunding gives more control to the entrepreneurs in terms of later funding and strategic decisions since the capital has been acquired by many individuals rather than one body as in venture capital and angel investing. A great example of a body is Capital Cell and a recent success story is the French Antabio [ 78 ].

Healthcare Leadership Academy

Healthcare Leadership Academy is a social enterprise run privately by medical professionals aimed at providing skill-based support for medics entering the entrepreneurship arena. It has teaching fellows from across the UK clinical, academic and health policy establishment. Similar to the AAC Clinical Entrepreneur Training Programme, it provides training rather than funding, although it operates independently of the NHS [ 79 ].

The goal of making the healthcare sector more efficient and effective in all three stages of innovation (invention, development and implementation) is a primary concern for health companies and governments around the world [ 80 ]. There has been significant emphasis on improving the development and adoption of innovations in the UK since the 2000s, when a series of reports identified significant deficits in healthcare innovation in the NHS [ 4 , 5 , 19 ]. Since then, several pathways have been set up, operating across all stages of the innovation pipeline (Fig. 2 ), with their scope defined by location, technology area or stage of development, based on the specific problem identified when they were set up.

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Innovation pathways in the context of the conventional innovation pipeline.

Despite this strong policy push, there remain significant barriers to achieving the political ambition of making the NHS the most innovative health system in the world [ 81 ]. While one might expect that national policy would be more easily implemented in a relatively unified health system such as the NHS, rather than more fragmented structures, in many areas the UK still lags behind. For example, the UK public are much less likely to use digital health services to track medical conditions compared to European nations, suggesting relatively low integration of digital health within the NHS compared to other health systems [ 82 ]. While academic literature exploring the current innovations pathways is limited, there have been efforts to evaluate the uptake and diffusion of innovation previously, perhaps most notably in the 2012 Innovation, Health and Wealth report, which recommended implementation of AHSNs to align innovation with healthcare delivery and improve patient outcomes [ 83 ]. Since then, it has been suggested that budget silos and a lack of accountability for innovation may be hindering greater success of innovation pathways such as the AHSNs [ 18 , 84 , 85 ].

While the body of this paper has focussed on individual pathways, the following discussion will cover the major challenges for innovation in healthcare, and the extent to which the discussed pathways have addressed these challenges.

Challenges to Implementation: Connecting Stakeholders, NHS Bureaucracy and Interoperability

It is widely recognised that while the NHS, and the UK Life Sciences industry more generally, is world leading in the invention and early development of medical devices [ 86 ], there are significant barriers to implementing these innovations [ 4 ]. One reason for this is the fragmented nature of the NHS, which presents a barrier particularly for small and medium enterprises who may be unaware of impactful regional variations, from digital infrastructure to bureaucratic structures. For example, companies seeking to introduce digital health technology into NHS services will likely gain traction in urban areas such as Greater Manchester and London/South East, but might struggle much more in other parts of the country where primary care remains stubbornly paper-based [ 86 ].This may explain why informal clinical networks, long identified as a key component of innovation adoption [ 87 ], provided by the AHSNs and other regional/local innovation pathways have been so successful. They can guide innovators through the particular landscape of their area, helping them overcome many of the traditional barriers to implementation, from market access to ensuring the continued use and improvement of innovations [ 18 ]. A recent example is the work of Oxford AHSN in aiding a personalised oncology company through the process of product testing and market access [ 88 ]. The need for regionalisation in delivering health services is exemplified in the initial problems faced by the national Track and Trace system for COVID-19 [ 89 , 90 ]. Further regional and local integration will likely arise from the establishment of ICSs as the future of health and care delivery in England, as announced in 2021 [ 10 ]. It is not yet clear how the new integrative ICSs will affect the local and regional economy of innovation, particularly given the other measures to centralise power in the NHS set out in the white paper, but it is expected that they will improve IT integration and enhance the sharing of data. Of course, the aim of interoperability within the NHS (the ability of NHS digital systems to talk to each other) [ 91 ], which is a major goal of NHSX [ 92 ], will allow improvements in local integration to be scaled up to national coordination of care, aligning with the goal set out in the NHS Long Term Plan to streamline and accelerate the innovation pipeline [ 2 ].

A remaining challenge for implementation lies in the overlapping nature of the innovation pathways, which could be described as being disjointed. This is in part due to the patch-work manner in which they were set up. While the recent establishment of the AAC as the parent body of the NHS innovation landscape is a step in the right direction, providing a ‘front door’ to the confusing landscape of pathways, there remains a lot of work to do. The focus of the AAC on ‘demand signalling’, working out what innovation priorities the NHS has, is vital, and it is key that this receives both top-down and bottom-up (from CCGs and AHSNs) input [ 18 ]. This approach has already proved successful for specific services such as the RMOCs, where local bodies are able to suggest specific priorities for the region which are then approved by a national body; this takes into account both regional needs and national priorities [ 30 ]. A key role of the AAC must therefore be the identification of models of best practice, for wider dissemination through the innovation landscape.

Challenges to Development: Prototyping and Testing

While a particular problem for NHS innovation is the confusing process of implementation, a general issue for healthcare innovation is the process of development. Ranging from early clinical testing through to regulatory approval, the necessary safety and quality checks can represent a substantial barrier for innovators lacking connections and funds [ 93 ]. In this regard, local pathways including the NHS Vanguards and CCG Test Beds schemes have provided an invaluable asset to coordinate testing of innovative MedTech, digital health solutions and care models. It is important to note the NHS Long Term plan discusses plans to expand the Tests Beds scheme through to Regional Test Bed Clusters, with an increasing share of the NHS funding spent on real-world testing [ 2 ]. Similarly, the introduction of ICSs will further integration of health and social care, potentially further facilitating real-world evidence generation [ 10 , 94 ]. At a regional level, the ARCs and AHSNs once again provide a crucial link across industry, NHS and academic stakeholders, while at a national level schemes such as the NHS Innovation Accelerator and Medilink allow easier access to the AHSN network. This is particularly key when it comes to generating evidence for the marketing of a product, pre-implementation across the NHS, and for gaining regulatory approval from EU and UK bodies and final adoption hurdle of HTA (Health Technology Assessment, which in England is conducted by NICE), the process of which is often very opaque [ 93 ].

Challenges to Development: Accessing Clinical Data

Another significant barrier in the development stage, on which significant progress has been made, is allowing access to patient data while maintaining patient confidentiality. Ideally data should be homogeneous such that systems can continually improve and be more easily shared between healthcare providers. If data between facets of the NHS is homogeneous this permits interoperability and relatively simple application of the same technology elsewhere. The technology may also be reprogrammed to meet new and emerging needs or integrate with a growing pool of data. Ultimately, if interoperability within a health system is achieved then this ensures that the technology is self-referential. In this way, as more data is acquired the effectiveness of the system increases and network effects begin to emerge, such that once an early adopter hospital takes on the technology the marginal benefit for each successive hospital now increases since the pool of data used to refine the technology continues to grow [ 92 , 95 ].

Since 2019, NHSX has hosted efforts to establish a framework for managing NHS Health Data [ 96 ]. This has been complimented by efforts by Health Data Research UK to build a world-leading health research database for innovation [ 97 ]. However, the active work by NHS Digital and NHSX to improve the interoperability of NHS systems still has a long way to go, and this remains a major barrier to innovation in the UK [ 86 ].

One example of a successful innovation in the field of clinical data within the NHS is the digitalisation the ‘red book’ maternity record for parents to keep a record of their child’s development, including their immunisation records and growth [ 98 ]. This has the potential to be particularly useful in the long-term, with the NHS Long Term Plan noting that this will help children start their lives with a digital Personal Health Record (PHR) [ 48 ].

Challenges to Invention: Accessing Funding and Support

The 2006 Cooksey review identified two translational gaps in the pipeline from laboratory to bedside [ 19 ]; firstly, translating basic research into new products, and secondly new products into clinical practice. Most innovation pathways focus on the latter gap, or later on in the first gap (i.e. from nascent product to tested prototype). Nevertheless, access to funding in the early stages of innovation is an issue, one which there is some support for. Much of this support lies outside traditional innovation pathways, such as venture capital and angel investors. Additionally, grant funding is available from university, government, private firm and EU sources [ 20 ].

The innovation pathways themselves provide help by guiding companies and individuals to funding, similar to how they provide access to testing. NIHR funding schemes also provide some direct funding, or links to investment, such as InnovateUK. This being said, a recent review highlighted the concern from NHS managers that austerity measures limit the amount of initial funding available from AHSNs [ 99 ], and that significant capital needs to be invested in the first place to access the benefits of AHSNs (i.e. the network of academia, clinicians and industry). Therefore, early funding from NHS sources remains a major area for improvement. The NIHR AI fund may provide a model for how NHS or Department of Health and Social Care funding can be used to encourage early-stage innovation in the future. We suggest that coordinating this should be a major role for the AAC going forward, through their Innovation Portal [ 100 ].

Challenges to Invention: Encouraging Innovation

An emerging theme of the innovation pathways is the utility of the AHSN network as an asset for the coordination and guiding of innovators through the highly complex NHS innovation landscape, from the earliest invention stage right through to implementation. However, there is an even earlier stage of innovation that exists that is often ignored, and lies outside the remit of the AHSNs; encouraging clinicians (rather than more traditional academic/industry) to innovate. An example of this is the AAC’s Clinical Entrepreneur Training Programme (see above) [ 37 ], which takes on a cohort of NHS clinicians and teaches them skills which will aid innovation (similar to the Healthcare Leadership Academy [ 79 ]). Alternatively, the NHS Innovation Accelerator aims to seed innovations specific to their themed calls (see above), giving clinicians a chance to develop innovations in areas most needed by the NHS. Applicants submit their credentials and potential ideas within these calls, rather than the more informal process available for other innovations. This is another example of the ‘demand signalling’ necessary to gain innovations that are most useful to the NHS.

Concluding Remarks

Our research indicates that there is a wide array of support available to innovators within the UK healthcare system. However, these support pathways are fragmented and there is notable redundancy among them. We suggest that expanding and clearly defining the leadership role of the AAC in the innovation landscape would go some of the way to removing this fragmentation.

As we tend towards the development of digital innovations, software and artificial intelligence, data homogenisation and interoperability will become increasingly important. Although already a goal of NHSX, we highlight this as a primary target for the NHS, as it could remove many of the current barriers to implementing innovations across regional and local NHS services. We also highlight the need for support for innovators at the earliest stages of the innovation process, invention. A lack of seed funding or support for those with a promising idea can act as a barrier to entry even if later stages of innovation development are well-supported.

While we have been able to provide a broad overview of the innovation landscape in the NHS, our research has been limited by the lack of primary literature on this topic, including few papers with input from innovators and clinicians. There is therefore a pressing need for a high-quality, independently funded review of the innovation landscape, as many of the above pathways have received no review, or if they have, they tended to be reviewed either by their own members, or by reviewers funded by the organisation under scrutiny. This could lead to bias in reporting and evaluation, whether real or perceived [ 101 ]. Such a review would ideally include a survey of relevant stakeholders to gain an insight into practical challenges faced by those who work with the pathways.

Given the broad range of innovation pathways within and around the NHS, it is no surprise that the NHS is a leading force in driving healthcare innovation globally. There is an array of support available for clinical innovators as well as for others seeking to improve patient care. Indeed, there are also opportunities for patients themselves to drive innovation and many of the pathways strongly encourage patient and public involvement. The pace at which these innovation pathways are growing offers an exciting prospect for the future of healthcare delivery in the United Kingdom.

Acknowledgements

We would like to thank Polygeia, a student-led global health think tank, for its support in organising the project. Specifically, we would like to thank Haowen Kwan (Polygeia) and Ananya Manchanda (University of Cambridge). We would also like to thank Elizabeth Evans (Costello Medical, UK) and Dr Simran Chana (NHS) for their advice during the project and for reviewing the manuscript.

Abbreviations

Author contributions.

All named authors contributed substantially to the writing and editing of the manuscript.

Declarations

No funding was received for this research work. Outside of the submitted work, Anmol Arora is a public committee member of the NIHR Artificial Intelligence (AI) Health and Care Award committee. No (other) conflicts of interest.

Anmol Arora, Andrew Wright are co-lead authors.

Contributor Information

Anmol Arora, Email: ku.ca.mac@759aa .

Andrew Wright, Email: ku.ca.batnac@06wpa .

Tsz Kin Mark Cheng, Email: ku.ca.mac@2cmkt .

Zahra Khwaja, Email: ku.ca.batnac@852kz .

Matthew Seah, Email: ku.ca.mac@0432sm .

Open access
Published: 27 August 2022

Allied health professionals’ perceptions of research in the United Kingdom national health service: a survey of research capacity and culture

Christine Comer 1 , 2 ,
Richard Collings 3 ,
Alison McCracken 4 ,
Carol Payne 5 &
Ann Moore 6

BMC Health Services Research volume 22 , Article number: 1094 ( 2022 ) Cite this article

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With growing recognition of the importance of research in allied healthcare, the new Health Education England (HEE) research strategy articulates a need to transform Allied Health Professional (AHP) identities, culture and roles. An understanding of current AHP research capacity and culture is first required.

A cross-sectional survey targeted AHPs working in NHS health and social care settings across the United Kingdom. The validated Research Capacity and Culture tool was modified and distributed through research and professional networks. Aggregate median scores for perceived research success were categorised as adequate, more than, or less than adequate.

Of 3344 participants, 3145 identified as HEE-defined AHPs. Individual- and organisation-level research success was perceived as adequate (median scores 4 (IQR 2 to 6); 4 (IQR 2 to 7) respectively). Team-level research success was rated less than adequate (median score 2 (IQR 1–5)).

Conclusions

In the UK, AHPs working in NHS health and social care perceive individual and organisational level research skill/success to be adequate. In contrast, inadequacies in research skill/support at team level were exposed, which may hinder successful integration of allied health research into everyday health and social care practice. Recommendations are made with reference to the HEE AHP research strategy.

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Introduction

Research is fundamental to health care. A culture of research promotes the expectation that everyday health and social care is based on best available knowledge and research evidence [ 1 ]. Healthcare organisations with a strong research culture identify and develop research questions relevant to their specific healthcare setting and the population they serve [ 2 ], and they understand the importance of generating new knowledge to contribute to the research evidence base [ 3 ]. As a result, research active organisations provide superior health service performance, higher quality of care, improved patient safety, and a better patient experience [ 4 , 5 , 6 ]. Furthermore, they are able to provide greater opportunities for staff development [ 7 ]. In such organisations, research achievements are recognised, there is investment of resources to support research activity, and clinicians are encouraged to and are given the opportunity to develop skills and participate in research-related activities [ 6 ].

All healthcare professions (not just the medical and nursing professions who have traditionally been seen in research roles) are now expected to take an active role in informing, supporting, delivering, implementing and leading clinical research. This expectation is increasingly driven by national healthcare policies and frameworks: The UK Policy Framework for Health and Social Care Research stipulates that research is ‘a core function of health and social care’ [ 8 ], and the National Health Service (NHS) Long Term Plan identifies research as a key driver for all professions to improve future health outcomes [ 9 ]. More explicitly, the Department of Health and Social Care (DHSC) sets out a vision for clinical research to be embedded in the NHS, where a research-positive culture ensures that all health and care staff feel empowered to support and participate in clinical research as part of their job [ 10 ]. Despite this broad vision, no clear benchmark has been established to define a research-positive culture in the AHP workforce. Whilst AHP research activity is noticeably less than in the medical and nursing professions, little is known about how AHPs working across different health and social care settings perceive their current research capacity and culture.

AHPs represent the third largest professional group working in the NHS [ 11 ]. Currently, 220,000 Allied Health Professionals (AHPs) are registered to practice across the United Kingdom (UK), and over 90,000 of these work in the NHS in England alone [ 12 ]. The AHP Research Strategy for 2018–2020 produced by the National Institute for Health and Care Research (NIHR) Clinical Research Network, documented the vital role AHPs can play in the delivery of high-quality patient-centred clinical research [ 13 ]. To improve research readiness in the AHP workforce, the Council of Deans of Health advocates for stronger AHP clinical academic career pathways [ 14 ] and HEE stipulates a requirement for research to be one of the four pillars underpinning Advanced Clinical Practice across all health and care professions [ 15 ].

High quality AHP-led research is needed more than ever to underpin new models of healthcare delivery and to inform AHP roles that are rapidly evolving to meet the changing needs of the population. Without appropriate research, advancing AHP roles may lack the evidence required to attract resources and to optimise effective care pathways for patients. However, with few senior clinical academic AHP leaders and decision-makers [ 16 ] and little focus on building AHP research capacity in NHS health and social care, there are considerable challenges for allied health research. Research growth is hindered by low numbers of AHPs working in clinical academic roles to provide much needed leadership [ 17 ]. Fellowship awards aimed at building research capacity and leadership by developing clinical academics are available through the NIHR. However, a review of these highly competitive schemes found disparities in gaining awards between AHP professional groups, as well as limited uptake of more senior fellowships at postdoctoral level [ 18 ]. Research capacity-building frameworks suggest, therefore, that system-wide, sustained change is needed to address challenges at organisation-, team- and individual-level [ 16 , 19 , 20 , 21 ].

This need for system-wide change is reflected in the recently launched AHP-specific research strategy developed by HEE [ 22 ]. The strategy sets out its multidimensional aims to i) transform AHP professional identities, culture and roles; ii) deliver excellence in research and practice; and iii) ensure inclusion of allied health research and innovation in National strategic research agendas. To inform the implementation and to evaluate the future impact of this strategy, an understanding of current AHP research capacity and culture is required.

Methods and materials

The aim of this study is to generate a UK-wide picture of the perceived level of research capacity and culture within AHP professions working in NHS health care and social care.

The validated Research Capacity and Culture (RCC) questionnaire [ 21 ] was selected as the best available tool to comprehensively measure perceptions of research capacity and culture through self-reported ratings of research success/skill across a range of individual, team- and organisation-level research constructs [ 23 ]. Previously published studies using the RCC tool in the UK have targeted relatively small samples of AHPs from a single healthcare organisation [ 24 , 25 , 26 ]. To our knowledge, this study represents the first to provide a UK-wide perspective across all AHP professions working in health and social care in the UK, exploring their perceptions of the levels of support for research at an organisational and team level as well as their own level of research skill and confidence. The project proposal was classified through the Health Research Authority (HRA) automated system as not requiring ethical approval (IRAS 277,676). Health services research permission was provided by HRA and Care Research Wales (HCRW) (REC 21/HRA/0053), and the study was adopted onto the NIHR portfolio (CPMS ID 47,506). The study was performed in accordance with ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was gained from all participants before completion of the survey.

Specific objectives for this study were to:

gauge perceptions of AHP research support and capacity at organisation and team level

gauge participants’ perceptions of their own research skills/knowledge and confidence

identify key perceived barriers and motivators for research engagement

Study design

A national cross-sectional survey was conducted, targeting AHPs working in all NHS health and social care settings.

The online survey was distributed electronically via NIHR Clinical Research Network (CRN) health services research networks in England, health boards in Scotland, Northern Ireland and Wales, and through AHP professional and research bodies. The survey remained open from its launch on 01–06-21 to closure on 30–09-21 and was publicised intermittently during this period via NIHR CRN channels, AHP professional bodies including Health and Care Professions Council (HCPC), and research organisations including Council for Allied Health Professions Research (CAHPR) via email, written bulletins and social media channels.

The survey tool

The RCC tool [ 27 ] is a questionnaire designed to measure indicators of research capacity and culture at individual-, team- and organisation-level. It has been shown to be reliable and valid in AHP populations [ 21 ]. Research success/ skill level is ranked for each of 48 items on a scale of 1–10. Further questions addressing factors such as barriers and facilitators to research, current research activity and experience use multiple choice options. Free-text response options are offered for participants to provide supplemental details or comments if desired.

For this study, the survey questionnaire (available in supplementary materials 1 ) was modified by the addition of questions that focused on self-reported research engagement level; discussion of research during appraisals; time allocated for research for those who indicated that research was part of their role description; and awareness of national-level research organisations. The survey also integrated a 6-point scale to determine respondents’ self-assessment of their current attainment level in clinical research skills [ 28 ]. This newly developed ‘Skills, Capability, and Organisational Research Readiness’ (SCORR) scale has been recommended for use as an appraisal tool for non-medical registered healthcare professionals working within healthcare.

Demographic data collected from participants in the survey included geographical area of work, professional background, educational history and research experience. No personally identifiable information was collected, and to avoid participant identification during data analysis, no detailed employer details were requested.

Participants and recruitment

AHPs and other healthcare professionals regulated by the Health and Care Professions Council (HCPC), who were working in NHS health care and local authority social care settings in the UK at the time of completing the survey were eligible to participate. The wider allied health workforce governed by HCPC (Clinical Scientists, Biomedical Scientists, Practitioner Psychologists, and Hearing Aid Dispensers, marked below with an asterisk), but not included on the HEE list of AHPs, were also eligible to participate. Eligibility criteria were defined on the opening page of the survey for potential participants as follows:

a qualified/registered Allied Health Professional (AHP) from the following list: Art therapist, Music therapist, Drama therapist, Biomedical scientist*, Chiropodist/ podiatrist, Clinical Scientist*, Dietitian, Hearing aid dispenser*, Operating department practitioner, Orthoptist, Occupational therapist, Osteopath, Paramedic, Physiotherapist, Prosthetist/ Orthotist, Practitioner psychologist*, Radiographer, Speech and language therapist

currently working in the NHS, local authority, or an organisation providing NHS-funded healthcare in the UK (England, Scotland, Wales or Northern Ireland)

Before accessing the survey, potential participants were asked to confirm their eligibility, and that they had read and understood the study information provided on the opening page. They were required to provide informed consent prior to accessing and completing the survey questionnaire. In addition, they were asked to state whether or not they wished their anonymised data to be included in shared data for future research/ strategy development. After piloting within the study team, the survey was estimated to take around 20 min to complete.

Quantitative data were analysed using IBM SPSS Statistics software version 25. Likert-scale items within the RCC tool and additional questions were summarised in accordance with convention for ordinal data using the median and Inter Quartile Range (IQR) for each item within the individual-, team-, and organisation-level domains. Aggregate median scores that combined the scores of all items within each domain were categorised in line with previously published literature [ 29 ], in which scores lower than 4 are interpreted as less than adequate; scores between 4.0 to 6.99 are interpreted as adequate, and scores greater than 6.99 are interpreted as more than adequate. Frequencies and percentages of responses were used to evaluate ‘Unsure’ and ‘Not applicable’ response categories for these items, and for all other categorical questionnaire items.

Free text items were analysed by inductive content analysis [ 30 ]. This included open coding of the narratives and grouping into subcategories. The qualitative data analysis software NVivo (v12.0) facilitated the organization and structuring of the process of coding and grouping and the development of relationships among concepts.

A total of 3344 participants indicated their eligibility and completed the survey, of whom 3276 agreed for their responses to be included as part of an anonymised open-access data set.

Study participants

Participants included 3145 from the 14 HEE listed AHPs. A further 127 participants were from healthcare professions who were invited to participate as part of the wider allied health workforce governed by HCPC (Clinical Scientists, Biomedical Scientists, Practitioner Psychologists, and Hearing Aid dispensers) (Table 1 ). Additionally, 69 respondents completed the survey but indicated within the survey responses that they did not belong to any of these professions, so were excluded from the analyses. For the purposes of our analyses in this manuscript, we included the 3145 participants from HEE listed AHP professions.

The majority of participants were physiotherapists, occupational therapists, or speech and language therapists, almost half with post-graduate qualifications (Table 1 ). Most were from England, with over half working in Acute Hospital Trust settings. Further details are available in supplementary materials 2 .

Research capacity and culture (RCC) tool scores

The aggregate median score for research skill/success at individual-level was 4 (IQR 2 to 6) on a 0–10 scale, representing an ‘adequate’ score (Table 2 ). Highest levels of skill were reported for finding and critically reviewing literature, and lowest levels in securing research funding. The aggregate median score for research skill/ success at team-level fell below the range classed as adequate (median 2, IQR 1–5) with only two items reaching an adequate score (has team leaders that support research; undertakes planning guided by evidence). For organisation-level research skill/ success, aggregate scores reached an adequate level overall (median 4, IQR 2–7), with highest scores for promotion of evidence based clinical practice, and lowest scores for ensuring staff career pathways are available in research, and having software programs for analysing research data.

Individual barriers and motivators to research

Barriers and motivators to research on an individual level were explored by both quantitative multiple-choice question as well as free-text boxes. Quantitative data revealed that the key barriers to research engagement were ‘other work roles take priority’ (cited by 83% of respondents) and ‘lack of time for research’ (80%). Whereas primary motivators were ‘to develop skills’ (80%) and ‘increased job satisfaction’ (63%).

Content analysis of the free text responses revealed two categories: enablers and challenges. The enablers category included four subcategories: perceived benefits, funding opportunities, positive support and internal motivation (Table 3 ). The perceived benefits subcategory emphasised the importance of undertaking research activity to improve patient care and developing an evidence base. Other comments related to the perceived benefits for workforce development and retention whilst improving skills at an individual level. The funding opportunities sub-category highlighted the importance and availability of funding streams as enablers to research activity, although opportunities varied between local (Trust) level and external (National). The sub-category of positive support and culture of the Trust was viewed as being extremely important to enabling research activity, especially when opportunities and encouragement was discussed at appraisals. On an individual basis, a variety of motivational factors for enabling research activity was cited under the sub-category, such as using own initiative to find research and training opportunities, discovering role models to support the journey and linking in with a Higher Educational Institution. The challenges category included four sub-categories: opportunities, system, emotions, and priority (Table 3 ). The sub-category of opportunities cited the lack of time and limited chances to access research training or pursue academic career pathways as main challenges of undertaking research activity. Interestingly, inadequate research skills and feeling ‘rusty’ from lack of regular involvement in research was also reported by some participants. The sub-category of negative emotions highlighted the feeling of despondency and uncertainty on how to undertake research activity. The sub-category of system factors, such as a lack of research infrastructure and understanding of clinical academic roles and responsibilities alongside the absence of an established career pathway were frequently cited by participants. The priority sub-category highlighted that research activity was perceived as a lower priority in the wider provision of health care, especially in terms of amounts of time, support, finance and expertise that is allocated when compared with other NHS activity.

Research activity, engagement, training/development, and appraisal

Engagement in current research reported most frequently by participants included the use of research evidence to inform clinical practice (85%) and involvement in clinical audit/ research to evaluate/ improve clinical services (64%). The least frequently reported research engagement included taking on roles of Chief Investigator/ research leader (7%) or Site Principal Investigator (8%). Seven percent of participants reported no current engagement in research. The most frequent current or recent research-related activities undertaken by participants were collecting data (25%) and writing/ coauthoring research reports/ publications (16%). The least frequent were applying for (8%) and securing (7%) research funding, and submitting ethics applications (7%). The majority (68%) of participants reported that they had not been involved in any specified research activities over the last 12 months.

Thirty-four percent of participants, reported that research-related activities were part of their role description. Of these, 10% reported that more than 75% of their time was formally allocated for research-related activity, 11% were allocated between 25 and 50% of their time, whilst 79% had less than 25% of their time allocated for research-related activity. In addition, 14% participants reported that they were currently enrolled in further higher degree study or other professional development related to research, of which 72% were undertaking postgraduate diploma or masters level study, and 24% were undertaking PhDs.

Eighteen percent of participants reported that research engagement or activity was routinely discussed at their annual appraisal, 50% said that it was only discussed if they brought it up or were currently involved in research, whilst 32% reported that research was not discussed at personal development appraisals on a routine basis. When asked to evaluate themselves on a tool designed to be used during personal development appraisals to rate research engagement, most AHP participants rated themselves as level 2 or level 3 (see Fig. 1 ), where level 2 indicates that they share awareness of new knowledge from research with colleagues, patients and the public and challenge practice to improve patient care, and level 3 indicates that they use research findings to support change and service development and to address clinical challenges. Twenty-one percent rated themselves as level 4 or 5, indicating actively undertaking, delivering or leading research.

The Clinicians’ Skills, Capability, and Organisational Research Readiness (SCORR) Tool. Levels of research skill defined in the SCORR self-appraisal tool [ 28 ]

Awareness of national research support infrastructure

The Council for Allied Health Professions Research (CAHPR) is a UK wide organisation supported by each of the AHP Health Professional bodies. It was launched in 2014 with a mission to ‘develop AHP research, strengthen evidence of the professions’ value and impact for enhancing service user and community care, and enable the professions to speak with one voice on research issues, thereby raising their profile and increasing their influence’. Awareness of CAHPR was low among AHP participants, with 64% reporting that they had little knowledge/ awareness or had never heard of them, with only 32% reporting some/ fairly good knowledge/ awareness.

The National Institute for Health and Care Research (NIHR) was established in 2006 to support health and social care research in and for the NHS. It is funded by the Department of Health and Social Care with a remit to ‘create a health research system in which the NHS supports outstanding individuals, working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public’. Whilst a greater proportion of participants from England reported having ‘some’ or ‘fairly good’ knowledge/ awareness of NIHR (54%), most (74%) had little or no knowledge/ awareness of the NIHR/HEE integrated clinical academic training schemes for AHPs. Levels of awareness of research support infrastructure in England and the devolved nations are presented in Table 4 .

This was the first national survey of AHP’s to explore perceptions of research in NHS health and social care. The study fulfilled the aim of generating a UK-wide picture of the perceived research capacity and culture across AHP professions and a range of health and social care settings. The results will provide a benchmark for individual professions and healthcare organisations. A summary of the study and key findings are provided in infographic form in supplementary materials 3 .

In contrast to our study in which participants rated research success at team level lower than individual-level or organisation-level, two UK-based studies previously reported team-level research success as high as, or higher than, individual-level ratings. The first of these studies surveyed a small sample of AHPs from a tertiary care hospital and the second surveyed a sample that included both AHPs and nurses from a research focused hospital setting [ 24 , 25 ]. Notably, the second study also surveyed a sample working in a non-research focused hospital for comparison, and here team-level research success was rated lowest. These contrasting results suggest that differences in research culture may be most apparent at team level. Moreover, the less than adequate team-level scores of research capacity in our results echo anecdotal evidence that blockages to AHP research engagement and activity are particularly evident at middle-management/team level in organisations [ 24 ]. Low levels of research confidence among healthcare clinical team managers might account for this, combined with a common perception of conflicting push–pull demands on time and resources between patient care and research. Authors who found a similar disparity between team-level success and success at individual and organisation level in an Australian study [ 31 ] concluded that research support at team level does not offer the connection needed between the organisation and the individual. Unfortunately, whilst individual AHPs may feel they have adequate research capability, and whilst research strategies might be produced and endorsed at board level, it falls to middle management to implement such strategies in daily practice and to support research-active individuals within their clinical teams. Team-level ‘middle’ managers therefore have a vital role in implementing evidence-based practice [ 32 ] and supporting their clinical teams in performing research activities’ [ 33 ]. Our results suggest that survey participants believe that their team leaders do support research. However, only if they are equipped with the appropriate knowledge and skills, resources, authority, and sufficient support from senior management [ 34 ] can team-level middle managers effectively operationalize this support to facilitate AHP research engagement [ 35 ]. Of note, a recent Australian study surveying multiple healthcare disciplines suggests that inadequate research skill/ support at team-level may be a problem specific to allied health research [ 36 ]. National research support organisations may therefore need to target resources and efforts specifically towards supporting AHP team managers, ensuring they have access to relevant training, mentorship and support.

Key research motivators and barriers at an individual level identified by AHPs in our study reflect those reported in almost all previous studies for AHPs and other healthcare professionals in and beyond the UK. These suggest that whilst prioritisation of other job roles and lack of time present common barriers, research is almost universally seen as a positive way for clinical staff to develop skills and derive satisfaction from their jobs. Encouraging research development is likely to lead to more motivated and knowledgeable clinical teams [ 7 , 37 ]. This is an important consideration for strategic workforce planning in the post-Covid healthcare system where health services are stretched like never before [ 38 ] and where reversing the trend of NHS staff leaving service is now viewed as a crucial workstream.

Of further interest is our important finding that research is rarely discussed as a routine part of personal development appraisals among participants in our survey; content analysis from free text responses similarly reflected participants’ perceptions of the low priority given to research activity, the lack of research career pathways, and limited or unclear opportunities for research engagement. The recently published SCORR tool has been developed specifically for clinicians as a tool to aid self-appraisal of research engagement levels. It can be used by individuals or by team-level managers as part of a personal development appraisal to initiate and support research discussions and to inform research development needs. Participants in our survey reported a range of research engagement levels using this tool; the majority rated themselves at level 2 or 3 on the scale, indicating engagement as ‘consumers’ of research evidence to improve clinical care or for service development. These levels meet the expected professional standards for evidence-based clinical practice. The higher levels 4 and 5 on the SCORR scale indicate engagement as ‘producers’ of research evidence, either through supporting research delivery, or through conducting or leading research to generate new evidence. Given the need for AHP-led research, it is encouraging to see a suitable proportion of our survey respondents (21%) rating themselves at these higher levels of research attainment. However, we acknowledge that responder bias may mean that this does not reflect the true situation. Disappointingly, most respondents also reported that they had not engaged in any research-related activity over the previous 12 months. Research capability may not therefore translate readily into research engagement and activity. Survey data from free text responses and from a question about research time allocation (supplementary materials 1 , page 6) suggests that this is more likely due to lack of opportunity and time allocated for research rather than lack of aspiration. Using the SCORR tool to support appraisals may help team leaders to identify ‘aspiring researchers’ and ‘research ready’ individuals in their team, and to inform organisation-level discussion around research activity and opportunities.

Mirroring findings from a recent unpublished survey led by CAHPR [ 39 ], participants in our survey reported low levels of awareness of research support infrastructures, including CAHPR and NIHR training schemes for AHPs. Whilst declaring clear intentions to support and increase AHP clinical research, these organisations could potentially play a stronger role in promoting and embedding a research culture in healthcare. In particular, there seems to be a need for them to focus attention on support for AHP clinical team managers. This might include ensuring healthcare managers (as well as individual AHP researchers) have access to research mentorship, support networks, information and resources. Closer links with NHS England/NHS Improvement might help to ensure these organisations are visible, relevant and accessible to those working in crucial roles in NHS health and social care to facilitate research engagement.

Study limitations

The results of this survey should be viewed in the context of several study limitations. Firstly, although the number of participants was significantly greater than any previous studies evaluating research capacity, this still represents only a small proportion of AHPs working in NHS health and social care across the UK. The survey length and ongoing Covid pandemic at the time of survey distribution were potential disincentives for busy clinicians to participate. Based on a random sample of participants, completion times ranging from 9 to 23 min were in line with the estimated completion time of 20 min indicated in the participant information. Despite this potential deterrent, all four UK nations and all 14 AHP professions across a range of healthcare organisations were represented in the survey responses. Furthermore, responses seem to be roughly proportionate with the current balance of professionals in the AHP workforce, reflecting the greater numbers of registered physiotherapist and occupational therapist professionals compared to other professions.

Secondly, with all surveys there is inevitably a risk of self-selection bias towards participants with an interest (and therefore potentially greater engagement) in research, and the proportion of respondents with Masters and PhD level qualifications (49%) and research in their job roles (34%) likely reflects this. It is unclear whether the lower numbers of participants from outside England and from certain professions accurately reflects the proportions of AHPs working in those locations and professions. Alternatively, variation in response rates might be due to different levels of research engagement, or due to other factors such as challenges with the distribution and promotion of the survey. Nevertheless, the number of participants was significantly greater than any previous studies evaluating research capacity and can be considered to provide a fair representation of the views of a wide range of AHPs working across different geographic locations and health and social care settings.

Thirdly, whilst the RCC tool probably represents the best tool currently available for assessing research capacity and capability, it may not be sensitive enough to evaluate all aspects and levels of research capacity. Research capacity frameworks identify factors which might be better evaluated using methods other than self-report questionnaire, such as research partnerships, publications, investment in infrastructure, and planning for sustainability and continuity [ 20 ]. Furthermore, a cross-sectional survey provides a snapshot of perceptions at a single time-point and is not able to identify trends over time. The tool does, however, provide a clear insight into current perceptions among AHPs of the research capacity and culture in the NHS at organisation-, team- and individual-level. The study results might therefore be used as a baseline against which to evaluate the future impact of strategic interventions targeting AHP research capacity and culture.

Finally, in this manuscript, we have only presented topline results from our initial analysis of the data generated in this study. Whilst this provides invaluable information that will inform implementation of national research capacity strategies for AHPs, further in-depth analysis will provide an understanding of differences in research capacity and culture between different regions, professions and healthcare organisations that will be of interest to a variety of stakeholders.

Despite these limitations, this first ever national survey provides an important evaluation of the individual challenges, motivators, and confidence levels in research among AHPs. It also highlights where organisation-level research support is sufficient and where it could be improved, and has exposed the team-level inadequacies that need addressing in order to unblock future AHP research potential.

Conclusions and recommendations

AHPs who responded to this survey indicated that research capacity and culture is adequate at individual and organisational levels, but not at team level. Individuals report feeling motivated to engage in research to develop their skills and increase job satisfaction. However the reality of embedding research into AHP clinical roles and implementing research capacity building strategies at team level poses challenges. Key barriers seem to reflect a lack of prioritisation of research within everyday healthcare, despite recognition of the clear link between research and better outcomes for individuals and the NHS, and acknowledgement that research is the single most important way we can improve our healthcare [ 10 ].

Based on the survey responses, and in the context of the HEE research strategy aim of transforming AHP professional identities, culture and roles, we would make the following recommendations:

at national strategic level: improve visibility of research support organisations, and ensure they are relevant to and provide much needed support targeted at AHP clinical managers to develop a stronger AHP research culture in NHS health and social care teams.

at organisation-level: ensure that organisations include a focus on AHP research posts and career pathways including clinical academic joint contracts in their research strategies, provide administrative support and software resources, and support middle managers in implementing the research strategy.

at team-level: introduce routine discussions focusing on research engagement, including during professional development appraisals, and capitalise on the positive benefits from research activity identified by AHPs (development of skills, job satisfaction) that are likely to impact on staff recruitment and retention

at individual-level: build on existing individual motivation, encourage use of a self-appraisal framework or tool (such as the SCORR tool) to identify research development needs and aspirations that might include generation of new knowledge and implementing research.

The findings from this survey provide a useful baseline against which to measure the impact of future research capacity building initiatives. They also set a national benchmark against which individual professions and healthcare organisations can measure their own research capacity and culture.

Availability of data and materials

The datasets generated and analysed during the current study are available in the Leeds Research Data Repository (RADAR), DOI https://doi.org/10.5518/1140 . The dataset deposited in the repository excludes data from participants who did not provide consent for public sharing of their survey responses.

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Acknowledgements

The study team would like to thank Nikki Cullum and Louise Connell for advice on the study protocol; Anthea Mould for establishing the NIHR/CAHPR AHP research champion scheme and for supporting this study; CAHPR, AHP professional bodies, HCPC, NIHR CRN and the health boards in the devolved nations for distribution and promotion of the survey; the Chartered Society of Physiotherapy and North West Coast NIHR Clinical Research Network for advice on survey distribution and promotion; Leeds Community Healthcare NHS Trust for acting as sponsor for this study, and Thomas Osborn for invaluable assistance with study management.

This research was supported by funding from Council for Allied Health Professions Research (CAHPR small grant award). During the study period CC was funded by a Health Education England/ National Institute for Health Research (NIHR) Clinical Lectureship award (Grant Reference Number ICA-CL-2017–03-015). The views expressed are those of the author(s) and not necessarily those of CAHPR, or of the NIHR, of the National Health Service (NHS), or of the Department of Health and Social Care.

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Leeds Community Healthcare NHS Trust, Stockdale House, Headingley Office Park, 8 Victoria Road, Leeds, UK

Christine Comer

Faculty of Medicine, University of Leeds, Leeds, UK

Torbay and South Devon NHS Foundation Trust, Castle Circus Health Centre, Torquay, UK

Richard Collings

University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK

Alison McCracken

Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK

Carol Payne

Professor Emerita, University of Brighton, Brighton, UK

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Contributions

The study was conceived by CC and co-designed by all authors. All authors also contributed to the design and piloting of the survey questionnaires, and survey distribution. In addition, all contributed to the data analysis, writing, editing and final approval of this manuscript.

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Correspondence to Christine Comer .

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Ethics approval and consent to participate.

The study was approved by HRA (IRAS IS 277676) and was adopted onto the NIHR portfolio adopted (CPMS ID 47506). As no personally identifiable participant data was collected and no patients were involved in this study, formal ethics approval was not required. The study was performed in accordance with ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants provided informed consent. Each participant was required to provide consent electronically after reading the study information provided on the opening page of the survey. The online survey questionnaire could only be accessed and completed after confirming that the study information had been read and understood and after providing consent. In addition, participants were also asked to specify if they wished their data to be excluded from anonymised data shared for future research purposes.

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Supplementary Information

Additional file 1..

AHP Research National Survey Questionnaire.

Additional file 2.

Results summary report for AHP Research National Survey.

Additional file 3.

Infographic summary of survey and key findings.

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Comer, C., Collings, R., McCracken, A. et al. Allied health professionals’ perceptions of research in the United Kingdom national health service: a survey of research capacity and culture. BMC Health Serv Res 22 , 1094 (2022). https://doi.org/10.1186/s12913-022-08465-6

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DOI : https://doi.org/10.1186/s12913-022-08465-6

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Research Process and the NIHR

An introduction to clinical research.

In this section we aim to provide a brief introduction to clinical research and an explanation of the research process. Firstly identifying what clinical research is, and the different types of research that are done.

What is Research?

What is a clinical research study, what is audit, randomised controlled study, setting up a research study, taking part in research, drug development, pre-clinical phase, clinical phases, national institute for health research.

Research as a broad term, is

'a systematic process of investigation, the purpose being to add or contribute to a body of knowledge that shapes and guides academic and/or practice disciplines'

(Tarling & Crofts 2002).

Research may test a hypothesis, answer a research question, develop our understanding and knowledge. Research is done in a huge variety of sciences and industries, for example developing the technology of our mobile phones, testing the aerodynamics of a car, GM food, fire resistant fabrics etc. However, clinical research is subtly different.

The World Health Organisation defines clinical research as:

"Any research study that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes."

( www.who.int/topics/clinical_trials/en/ )

Clinical research is not just restricted to drugs and medication, as many people think, but can include a wide variety of interventions including surgical and radiological procedures, devices (such as pacemakers), behavioural treatments and therapies as well as preventive care.

Clinical research will involve the process of peer review and a favourable opinion from an independent ethics committee before it can commence. It will need the consenting of participants who take part in the research, who will be fully informed about the research and the risks and benefits associated with taking part.

There is often confusion between research and audit.

Audit involves the evaluation of existing projects, care or service delivery and will measure against a standard. Existing data will be analysed but may involve the administration of a simple questionnaire or interview. In the NHS, services are being constantly audited. Ethics is not required for an audit project, although most NHS organisations will have a dedicated audit department and manager, who will monitor the audit projects within their Trust.

In the NHS we have two broad categories of research; observational research and Interventional research. If we are taking blood samples, for genetic analysis or asking people to complete a questionnaire, these would be classified as observational research studies. If the research is looking at treatment or testing a new device this would be interventional research. Most of our interventional studies are further classified as randomised controlled studies, or RCT for short.

The RCT is often considered to be the 'gold star' research. The main features of this type of research are that:

Patients are randomly allocated into different treatment groups.
One treatment group acts as a control against which the intervention can be measured.
No-one has any influence over the treatment allocations
Often the treatments may be 'blinded', which means that neither the clinician or patients knows which treatment they are receiving.
Placebo, or dummy tablet, may be used.

Before a research study in any NHS Trust is started, it goes through vigorous planning and review processes. Careful consideration is given to the study design, and a group of experts will usually be involved in planning a study. The potential risk and benefit to patients is reviewed by an international panel of experts, to ensure that the study is scientifically sound. A protocol is written which outlines all the details of the study and provides background information explaining why the study is being done. Every study has a Sponsor who is legally responsible for the set-up and conduct of the study. A Sponsor may be a drug or device company, it may be a University or an NHS Trust.

The next stage is to submit the study to an independent ethics committee. The ethics committee is an expert group of medical and lay people, who have no links to the sponsor or the hospital. The committees' most important task is to ensure that the rights, safety and well-being of participants are maintained. Approval from the ethics committee is mandatory for any study which involves patients.

If the study involves a medicinal product or a device, an application is made to the Medicines and Health Care products Regulatory Agency (MHRA) for a Clinical Trial Authorisation. Once the research into a new drug is complete, it is the MHRA who is responsible for reviewing all the research data and for issuing a license, for that drug before it is used for patients.

The Sponsor will look for sites, such as a hospital, or local health centre, which has the facilities and suitable patients, to carry out the research. Each site, or hospital, will identify a Principal Investigator (PI), who has the required expertise and knowledge to conduct the study. The PI is responsible for the study at their site. A PI is usually a doctor if the study involves drugs or devices, but otherwise may be an appropriate nurse, or allied health professional. Each study will have a team of professionals working together on the study, recruiting and looking after patients in the study.

Every NHS Trust has an R&D Department which reviews and takes responsibility for the research. The Trust R&D Department is responsible for ensuring that all the required paperwork, applications, approvals and contracts are in place before issuing the local R&D approval. Indemnity and insurance is provided by the Trust or Sponsor, to cover for any unforeseen risk. Only at this point can patients be recruited into a clinical study.

The R&D Department receives money from the NHS, via the Research Networks, to fund the staff and to pay for some of the additional treatments and procedures which may be required in a study. Money received from sponsors (drug or device companies), in relation to recruitment is used for carrying out further research and innovation. Patients who take part in a study may receive payment for expenses only. Very complex, phase 1 clinical trials, are the only studies for which participants receive a direct payment for taking part. All monies generated by the R&D Department support the research programme and cover staff costs. Research in the UK contributes to our health and to our wealth.

It is a difficult and slow process to identify suitable patients to participate in a research study. All studies have a very specific set of patients who need to be recruited, to answer the research question. There are exact inclusion criteria which must all be met, and a set of detailed exclusion criteria, which the patient must not have. The inclusion criteria define the population for the study, for example patients with a heart attack, while the exclusion criteria are mainly concerned with safety issues, for example ensuring that patient's liver is functioning well. A lot of time is spent 'screening,' for suitable patients, and screening is usually done daily. When someone is found who meets the criteria for a study all details are thoroughly checked, and careful consideration is given by the research team, before the patient is approached for the study.

Patients are personally approached by either their doctor, nurse or a member of the research team. A brief outline of the study is discussed. If a patient is interested the 'Patient Information Sheet,' with all the details of the research is given to them to read and to consider if they would like to participate.

The time available for patients to decide whether or not to participate can vary greatly, from days or weeks. We encourage patients to discuss the study with family and friends.

Once a patient's questions have been fully answered, and they are ready and happy to take part, written consent is obtained between the patient and the research team. No study procedures can be done, or information collected, until consent is received from a patient.

The details and requirements of a study will vary, some studies may only last a matter of minutes, or a few weeks, others years. Patients in a study will attend for regular follow-up visits, the requirements for each visit is carefully detailed in the study protocol and patient information sheet. If the study involves medication, blood samples are usually required for safety monitoring. A study patient is always free to change their mind, at anytime, and to withdraw from the research. This withdrawal will not affect their NHS medical treatment and care.

The research evidence demonstrates that for patients who participate in a clinical research, their overall health outcomes are enhanced. This is because they are more closely cared for by medical professionals in a one-to-one relationship.

Drugs have been available in one form or another for thousands of years however it was only at the start of the nineteen century that the pharmaceutical industry began, and it wasn't until the late 1950s that proper clinical testing of new medicines was formalised. Since this time the gold standard for the conduct of trials has been the randomised, controlled clinical trial (RCT). The legislation surrounding drug development has grown exponentially particularly in the past five years.

The process of drug development is lengthy, expensive and highly regulated. There are various estimates regarding the costs of drug development some indicate that a figure of $1.5 - 1.8 billion (Adams & Brantner, 2006) however the rewards of such an investment can be huge. However these returns are often the exception rather than the rule; as for every 10,000 chemicals screened only 1,000 have any biological activity and of this thousand only 10 will ever be submitted for human administration and only one will reach the market to reap any sort of the financial return (Giovanna & Hayes 2001).

The patent life for any drug is normally 15 years from the point of registration. This is often done when the drug is in compound phase, and by the time it reaches the market place it may well have between 5 -10 years left where the pharmaceutical company can maximise profits before generic 'copy' drugs can be marketed by competitors.

There are specific testing phases associated with drug development. These are classified as the pre-clinical phase, and the clinical phase. There are four phases to the clinical phase.

The first phase is the pre clinical testing which includes laboratory development and animal testing including areas such as genotoxicity, oncogenicity, toxicology and reproductive toxicology.

Translational Research

All phase I and non-randomised phase II trials fall under the heading of translational research. This is a term used to define experimental research of new treatments and diagnostic procedures for all diseases. Translational research covers experimentation to develop new treatments, rather than comparing them against a standard treatment. It is of note that many treatments and procedures do not proceed to the next phase.

These are also known as 'First into Man' studies and would normally occur on healthy male volunteers. There are exceptions such as with oncology drug testing where it would be unethical to use healthy volunteers therefore patients who have exhausted known therapies will be asked to take part.

The role of this phase is to look at:

Tolerability
Pharmacokinetics - what the body does to the drug i.e. the absorption, distribution, metabolism and excretion of the drug.
Pharmacodynamics - what the physiological effects of the drug on the body.

The recruitment numbers will be small usually around 20 or so and to assess tolerability a dose escalation regime will be applied however previous results have been analysed before this can take place.

Key points:

Usually paid volunteers
Often healthy people, but can be patients
Small numbers of participants
Specialist units or hospitals
Short term follow-up
Intensive investigations

Normally this will be the first time the drug is tested in a patient disease group. The numbers will be small between 100-200 patients and the study will look at efficacy and tolerability of the drug and may take up to two years.

Small numbers of patients
Mainly in hospitals or specialised units
Aim is to evaluate the dose and regimen for further studies
Looking at the application of the drug
Follow-up usually weeks may be months

About 30% of the drugs investigated at phase II are deemed safe and effective, and consequently progress to Phase III.

This is where real outcomes should be assessed in a variety of patients approximating to 'real life' population of patients who will receive the drug once it has been launched. This is the final stage of testing prior to licensing.

It will focus on the assessment of dosage effects, efficacy and safety of the drug in a large population sample. Numbers will be large usually in the hundreds or thousands of participants. The studies can be national or internationally based with multiple sites.

Safety data will continue to be collected throughout all the phases of the study however it is in phase III that this becomes particularly evident when the drug is exposed to large numbers of more complex patients who will not only just have one disease process. Large numbers are also required to ensure that the results are not chance based and that there is an acceptable degree of confidence in the results (95% Confidence Interval).

Evaluating new treatments in terms of use and safety
Large numbers of patients 100s and 1,000s
Patient group will have multiple problems
Multi-centred
Follow up usually 12 months or more
Results should change or challenge practice

Of the drugs which complete phase III, 70 to 90% of the drugs will go on to be licensed. Licensing can be applied for once all the data has been analysed and the treatment drug has been shown to work.

Phase IV is the post licensing phase of the development, longer term risks and benefits can be focused upon as well as discovering rare side effects which may take place in 1 in 10,000 patients.

Product has how been licensed by the regulatory authorities
Large numbers of patients 1000s and 10,000s
Continued monitoring and safety evaluation
Extension of product license
Usually long term

We hope this section has been useful in providing an explanation and overview of what clinical research may involve and how it is reviewed and put into practice. The next section will explain the role of the National Institute for Health Research, which is the NHS’s arm for research.

The National Institute for Health Research (NIHR) was created as part of the government's research and development strategy to provide a world-class infrastructure for clinical trials in all areas of disease and clinical need within the NHS. The main vision of the NIHR is to improve the health and wealth of the nation through research.

The aims of NIHR are to:

Establish the NHS as an internationally recognised centre of research excellence
Attract, develop and retain the best research professionals to conduct people-based research
Commission research focused on improving health and social care
Strengthen and streamline systems for research management and governance
Increase the opportunities for patients and the public to participate in, and benefit from, research
Promote and protect the interests of patients and the public in health research
Drive faster translation of scientific discoveries into tangible benefits for patients
Maximise the research potential of the NHS to contribute to the economic growth of the country through the life sciences industry
Act as sound custodians of public money for the public good.

In order to achieve these aims, we have 15 different research networks established across the United Kingdom. We are part of the Kent Surrey and Sussex Clinical research Network. The networks provide:

an excellent clinical research infrastructure to support a high quality portfolio of clinical research studies and facilitate patient participation into studies
those NHS Service Support Costs which were previously provided through other NHS R&D funding streams
deploys resources for research management in order to ensure that the research portfolio is delivered to the highest standards of research governance.

Each research network is divided into 6 divisions, made up of the following areas.

Diabetes, Metabolic, Endocrine, Renal, Cardiovascular
Children, Haematology, Reproductive Health and Childbirth
Dementia, Neurogenerative disorders, Neurological disorders, Mental health
Primary Care, Ageing, Health Services, Oral & Dental Health, Dermatology, Musculoskeletal
Anaesthesia, Peri-operative Medicine and Pain Management, Critical Care, Injuries & Emergencies, Surgery, ENT, Infectious Diseases & Microbiology, Ophthalmology, Respiratory, Gastroenterology, Hepatology

There are also 30 specialities in order to ensure that all areas of the health service are comprehensively covered.

To find out more about the NIHR, please visit their website: www.nihr.ac.uk

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NHS staff retention to be investigated in new study

19 April 2024

At a time when NHS staffing has never been more important, a team of researchers from UCL, NIHR and Leicester Biomedical Research Centre will determine which ethnic groups are at greatest risk of leaving the NHS in 2024.

Slightly blurred image of health professions hurrying through a health setting

The I-CARE study will investigate the contexts and reasons why staff from some ethnic groups are more likely to stay, or leave the NHS workforce, compared to white British groups, with the aim of improving retention.

Professor Manish Pareek, one of the lead researchers on the study from the University of Leicester, said: “The NHS is in a workforce crisis compounded by post-pandemic pressures. Nearly a quarter of staff are from ethnic minority groups, including 42% of doctors and 90% of nurses in the lowest grade, but we lack post-pandemic evidence about which groups are at greatest risk of leaving and why.”

Professor Katherine Woolf, one of the lead researchers on the study from UCL Medical School, said: “We will be looking at HR and staff survey data, as well as the results from data collected over the last four years from the UK-REACH study of UK healthcare workers to look for and understand any trends.

“We’ll also carry out new interviews and focus groups with staff and NHS managers, with the ultimate aim of developing interventions with NHS policymakers, staff and patients that encourage valued colleagues to stay.”

The I-CARE study team also includes researchers from the Ethox Centre at Oxford Population Health, the University of Surrey, the University of Glasgow and London North West University Healthcare NHS Trust.

Further information

Prof Kath Woolf academic profile
UCL Medical School

NHS baby check may miss dislocated hips in newborn babies

by University of Oxford

A collaboration between the University of Oxford and University of Leeds, it shows that the tests currently used by doctors can be unreliable. Using data on 27,000 babies, their research , published in JAMA , found the best tests miss over half of abnormal hips—and indicates that for every 1,000 hips screened, four dislocations will be identified, but five will be missed.

Developmental dysplasia of the hip (DDH) is a condition where the "ball and socket" joint of the hip does not properly form in babies and young children . DDH is one of the most common musculoskeletal conditions in infants and around one in every 100 babies are born with the ball of the hip bone dislocated from the socket.

If a dislocated hip is diagnosed early, it can usually be treated with a removable brace that the baby wears over their clothes for a couple of months. However, delayed diagnosis often requires complex surgery, and can lead to early arthritis requiring a hip replacement when the children become young adults.

The NHS baby hip screening checks involve several clinical tests , performed within 72 hours of birth and again between 6-8 weeks. However, researchers highlight there has been some doubt concerning the reliability of these tests, so the study set out to evaluate the diagnostic accuracy of clinical examination in identifying dislocated hips in infants.

Professor Daniel Perry, NIHR Professor at the University of Liverpool and a children's orthopaedic surgeon at Alder Hey Children's Hospital said, "Doctors have known for some time that there are challenges with the newborn hip examination and this study confirms the problem. What brings additional concern is that all hip examinations in this study were conducted by experts in hip disease—which is not usually the case in the NHS—so the true problem may be bigger. Nevertheless, we're determined to make things better.

"NHS England has recently started working with the National Institute for Health and Care Research (NIHR) to begin research to improve hip screening among babies. Earlier this month NHS England launched a change in the hip screening pathway for babies, which will enable the UK to be world leaders in research this area.

"We hope that this could soon mean new tests on the hips of babies, such as artificial intelligence enabled ultrasound. It's heartening to see a new collaboration between NHS England and NIHR which I hope will translate into better care for children and young people."

Dr. Abhinav Singh, Orthopaedic Surgeon and Researcher at NDORMS said, "It is important that doctors are well trained in the hip examination and know which tests can help identify hip abnormalities. However, our findings clearly highlight that examining babies' hips will not identify all dislocations. Emphasizing certain examination maneuvers that can assist in early diagnosis of DDH is of clear benefit to infants, their families and the clinician, but our results also provide evidence of the fallibility of the examination."

The study pooled data from 50, 579 hip joints in 27, 175 infants examined between 1992 to 2021 in screening programs run by experts. Statistical models were used to calculate the sensitivity, specificity and likelihood ratios of different examination maneuvers in identifying a dislocated hip in infants aged three months or younger.

While useful in some children, researchers identified that the clinical examination missed more dislocated hips than it was able to identify. The only part of the test that the authors identified to be useful is called the "Barlow/Ortolani maneuver." The authors concluded that other parts of the test, including limited hip abduction and a clicking sound had no clear diagnostic utility.

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NIH Grants & Funding
Blog Policies

NIH Extramural Nexus

Increases for National Research Service Award Stipends and Childcare Subsidies

We are committed to sustaining the vitality of the future biomedical research workforce, including providing appropriate support and addressing the many challenges faced by postdoctoral scholars in biomedicine. As part of this commitment, we are pleased to announce stipend and childcare subsidy increases for the over 17,000 early career scholars supported on NIH Kirschstein National Research Service Awards (NRSAs) ( NOT-OD-24-104 ). Stipends will be raised by 4% for predoctoral trainees and by 8% for postdoctoral scholars in fiscal year (FY) 2024 compared to last year), the most substantial year over year increase since FY 2017. Additionally, the childcare subsidy will be increased by an additional $500 (from $2500 to $3000) in FY24.

Appropriate support for early career researchers is something we take seriously. The Advisory Committee to the NIH director (ACD) , following thoughtful deliberations on re-envisioning the NIH-supported postdoctoral experience, reiterated that financial concerns were a topmost challenge for postdoctoral scholars. Echoing sentiments made in their final report from last December (see recommendation 1.1), lack of appropriate support dissuades some individuals to pursue a research career because of the negative effects on financial security.

The new stipend levels begin at $61,008 and are upwardly adjusted based on years of experience. In addition to higher stipend levels, there is also a modest $200 increase in training-related expenses and institutional allowances . Tuition and Fees for all educational levels remain unchanged from last year.

This is a significant step given a relatively flat NIH budget (see this recent blog about the interplay between budgets and success rates). The approach allows for an immediate stipend increase without drastic cuts to the number of available awards. As appropriations and budget realities allow, our goal is to reach the ACD recommended stipend levels (around $70,000 per year for postdoctoral scholars) in the coming years.

As we move toward that goal, institutions should note that:

As noted in the NIH Grants Policy Statement (e.g., 11.2.10.1), “Kirschstein-NRSA fellows receive stipends to defray living expenses. Stipends may be supplemented by an institution from non-Federal funds provided this supplementation is without any additional obligation for the fellow.”
Recipient institutions are reminded that they are not prohibited from hiring NRSA trainees and fellows as employees or provide them with benefits consistent with what the institution provides others at similar career stages.

Raising NRSA stipends and childcare subsidies are only two ways we are committed to fostering a strong and robust future workforce. We will continue to assess our policies and procedures. We anticipate releasing a request for information (RFI) in the near future to seek input on specific recommendations from the ACD.

Read the NIH press release for more.

RELATED NEWS

Is this increase only for NRSA fellows or all fellows supported by NIH RO1 grants?

Another unfunded mandate by NIH. Great idea in theory but without also increasing funding this is another hit to an already stressed research climate.

As far as I can tell, the child care subsidy (which is a great idea) is not available to trainees supported by other mechanisms (e.g., R01s). Is that correct? If so, why?

Is this increase only for new awards, or will the new rates be applied to current awards? If applied to current awards, will it be done at the start of a new budget year, or will current awards be revised with the increase?

NIH keeps ignoring the biggest problem facing NRSA F32/T32 recipients: their stipends cannot be used by host institutions as conditions for employment, preventing institutions from offering equal benefits to postdocs who receive these “prestigious” awards. Just change the rule, and if you refuse, then it would honestly be better to get rid of the funding mechanisms and create something new that didn’t have this one ridiculous clause (11.2.9.2) that causes so much pain and frustration. Until this happens, then all other announcements on these awards are mere hand-waving and shadow play.

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Research, powered by NHS Data

Rebecca cosgriff.

Quality improvement

The Data Saves Lives strategy, published summer 2022, set out how NHS data could bring benefits to all parts of health and social care – from care on the frontline to pioneers driving cutting-edge research. As part of delivering the strategy, NHS England’s Data for Research and Development Programme is investing in the NHS Research Secure Data Environment Network to power life-saving research and treatments.

Rebecca Cosgriff, recently appointed as Programme Director for the Data for Research and Development Programme, describes some of the progress to date, welcomes some new team members and, as we go into the new financial year, describes the focus for the future:

We should be proud of the NHS’s position as a research powerhouse. As a nation we have built one of the richest datasets in the world, representing our diverse population and underpinned by a national cradle to grave model. Couple this with clinical and academic expertise in genomics, medical imaging, and digital pathology, the future potential is astounding. Our programme is designed to power life-saving research and treatments, through a network of NHS Research Secure Data Environments (SDE), where researchers come to the data, rather than data leaving the NHS.

The SDE Network uses state of the art tools to enable secure and rapid access to the world’s largest linked health datasets, and bring together data that has previously been fragmented. We are supporting innovative research of all types: including clinical trials, post-market surveillance, epidemiology, translational research, and AI (Artificial Intelligence).

The Network leverages full-system capacity to support as much research activity as possible, and includes the NHS England Secure Data Environment (SDE), which provides national scale coverage of highly curated, high value datasets including cancer and rare diseases; and a small suite of SDEs that collectively cover all of England and provide access to granular, near real-time, multimodal data bolstered by clinical and data science expertise that supports data curation and the translation of research into practice.

The SDE Network is a long-term infrastructure change programme and will evolve over time, but we are proud of the significant progress we have already made. This includes: adopting data standards that are key to interoperability and developing our data pipelines and service catalogue to make data rapidly discoverable through the SDE Network’s Collection on the Health Data Research (HDR) UK Health Data Gateway.

We are also already delivering research impact, with more than 60 active research studies underway, and we are rapidly turning around requests for secure data access within one month. Four of the SDEs now have Confidentiality Advisory Group (CAG) approval to process patient information for research, following collaboration with the Health Research Authority, with others in the network continuing to work towards CAG approval.

Current projects include:

Ethnicity data from health records of over 61 million people were securely studied in detail for the first time as part of a project aiming to reduce bias in AI health prediction models.

Patients with Hepatitis B can be followed up for research, thanks to the Thames Valley and Surrey SDE, which created a multi-site, large and scalable dataset.
The North West SDE has launched a mental health research project with the Mental Health Research for Innovation Centre (M-RIC).
In the Kent, Medway, and Sussex SDE they are doing work to tackle Inequality in Coastal Communities.
The Yorkshire & Humber and North East and North Cumbria SDEs are collaborating to securely use multimodal data to understand haematological cancer.

So that’s what we have been working on, but what’s next? We will be running seven ‘driver projects’ that access data from multiple SDEs by March 2025. They will test the development of a single analytic interface per project, offering a consistent user experience across the SDE Network even where data from multiple SDEs are required.

We cannot do this without the support of the public and patients. Starting in May, we will be engaging the nation to make sure we hear, understand and respond to the view of people – this will complement work done by SDEs across the Network such as the recently published public deliberation that will guide the London SDE, by OneLondon .

We are also investing in our team. I’m delighted to welcome Hilary Fanning as our Senior Responsible Owner. Hilary has previously led the West Midlands SDE, which has reached out to over 550 organisations to engage with a broad range of under-served communities. I’m excited to work with Hilary to realise the vision of the programme over 24/25 and beyond.

The Data for R&D Programme is on a journey that I’m proud to be a part of, as we connect and accelerate secure access to data aimed at improving care, supporting the NHS, and driving innovation.

To find out more, please go to How will Secure Data Environments be delivered? – Secure Data Environments (SDEs) – NHS Transformation Directorate (england.nhs.uk

Photo of Rebecca Cosgriff, Deputy Director, Data for Research and Development at NHS England

Rebecca is part of the senior team leading the Data for Research and Development Programme on its mission to provide rapid, secure access to the world’s largest linked health datasets.

Prior to joining the Programme, Rebecca was Director of Data and Quality Improvement at the Cystic Fibrosis Trust and her experience includes clinical audit in NHS mental health, neurology and ophthalmology.

Google consolidates its DeepMind and Research teams amid AI push

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U.S. chip bans not meant to hobble China's growth, Blinken says

U.S. export controls on sending advanced computing chips to China are not meant to hold back China's economy or technological development, Secretary of State Antony Blinken said during an interview with National Public Radio on Friday.

April 23, 2024

Related Announcements

February 3, 2023 - Ruth L. Kirschstein National Research Service Award (NRSA) Stipends, Tuition/Fees and Other Budgetary Levels Effective for Fiscal Year 2023. See Notice NOT-OD-23-076

Agency for Healthcare Research and Quality ( AHRQ )

Health Resources and Services Administration ( HRSA )

This Notice supersedes NOT-OD-23-076 and establishes stipend levels for fiscal year (FY) 2024 Kirschstein-NRSA awards for undergraduate, predoctoral, and postdoctoral trainees and fellows, as shown in the tables below which reflects the Further Consolidated Appropriations Act, 2024 ( Public Law 118-047 ), signed into law on March 23, 2024. NIH is being responsive, as much as possible given the constrained budget environment, to the Advisory Committee to the Director Working Group on Re-Envisioning NIH-Supported Postdoctoral Training report recommendations. In fact, FY 2024 stipend levels for predoctoral and postdoctoral trainees and fellows represents the largest year-over-year increase in recent history. We are committed to reaching the $70,000 recommendation over the next 3-4 years, as appropriations allow. The Training Related Expenses and Institutional Allowances for predoctoral and postdoctoral trainees and fellows reflect a moderate increase. The Tuition and Fees for all educational levels remain unchanged from the prior budget year. See NIH Funding Strategies for guidance on current NIH Fiscal Operations.

The budgetary categories described in this Notice apply only to Kirschstein-NRSA awards made with FY 2024 funds. All FY 2024 awards previously issued using NOT-OD-23-076 will be revised to adjust funding to the FY 2024 levels. Appointments to institutional training grants that have already been awarded in FY 2024 must be amended to reflect the FY 2024 stipend levels once the training grant award has been adjusted by NIH. Amended appointments must be submitted through xTrain in the eRA Commons. Retroactive adjustments or supplementation of stipends or other budgetary categories with Kirschstein-NRSA funds for an award made prior to October 1, 2023, are not permitted.

Stipends Effective with all Kirschstein-NRSA awards made on or after October 1, 2023, the following annual stipend levels apply to all individuals receiving support through institutional research training grants or individual fellowships.

Undergraduates: For institutional training grants supporting undergraduate trainees (T34, TL4), appointments for undergraduate candidates will continue to be made by distinct categories (i.e., Freshmen/Sophomores and Juniors/Seniors), but the stipend levels for the categories will be the same:

Predoctoral Trainees and Fellows: For institutional training grants (T32, T35, T90, TL1) and individual fellowships (F30, F31), one stipend level is used for all predoctoral candidates, regardless of the level of experience.

Postdoctoral Trainees and Fellows: For institutional training grants (T32, T90, TL1) and individual fellowships (F32), the stipend level for the entire first year of support is determined by the number of full years of relevant postdoctoral experience when the award is issued. Relevant experience may include research experience (including industrial), teaching assistantship, internship, residency, clinical duties, or other time spent in a health-related field beyond that of the qualifying doctoral degree. Once the appropriate stipend level has been determined, the trainee or fellow must be paid at that level for the entire grant year. The stipend for each additional year of Kirschstein-NRSA support is the next level in the stipend structure and does not change mid-year.

Senior Fellows (F33 only): The stipend level must be commensurate with the base salary or remuneration that would have been paid by the institution with which the individual is permanently affiliated when the award is issued but cannot exceed the current Kirschstein-NRSA stipend limit set by the NIH for those with 7 or more years of experience. The level of Kirschstein-NRSA support will take into account concurrent salary support provided by the institution and the policy of the sponsoring institution. NIH support does not provide fringe benefits for senior fellows.

Relevant Policies Current stipend levels are to be used in the preparation of future competing and non-competing NRSA institutional training grant and individual fellowship applications. They will be administratively applied to all applications currently in the review process.

NRSA support is limited to 5 years for predoctoral trainees (6 years for dual-degree training), and 3 years for postdoctoral fellows. The NIH provides eight levels of postdoctoral stipends to accommodate individuals who complete other forms of health-related training prior to accepting a Kirschstein-NRSA supported position. (The presence of eight discrete levels of experience, however, does not constitute an endorsement of extended periods of postdoctoral research training).

It should be noted that the maximum amount that NIH will award to support the compensation package for a graduate student research assistant remains at the zero level postdoctoral stipend, as described in the NIH Grants Policy Statement 2.3.7.9 .

Tuition and Fees, Training Related Expenses, and Institutional Allowance for Kirschstein-NRSA Recipients

The NIH will provide funds for Tuition and Fees, Training Related Expenses, and Institutional Allowance as detailed below.

A. Tuition and Fees

Undergraduate and Predoctoral Trainees and Fellows: For institutional training grants (T32, T34, T35, T90, TL1, TL4) and individual fellowships (F30, F31), an amount per predoctoral trainee or fellow equal to 60% of the actual tuition level at the applicant institution, up to $16,000 per year, will be provided. If the trainee or fellow is enrolled in a program that supports formally combined, dual-degree training (e.g., MD/PhD, DO/PhD, DDS/PhD, AuD/PhD, DVM/PhD), the amount provided per trainee or fellow will be 60% of the actual tuition level, up to $21,000 per year.

Postdoctoral Trainees and Fellows: For institutional training grants (T32, T90, TL1) and individual fellowships (F32, F33), an amount per postdoctoral trainee or fellow equal to 60% of the actual tuition level at the applicant institution, up to $4,500 per year, will be provided. If the trainee or fellow is enrolled in a program that supports postdoctoral individuals in formal degree-granting training, an amount per postdoctoral trainee or fellow equal to 60% of the actual tuition level at the applicant institution, up to $16,000 per year, will be provided.

B. Training Related Expenses on Institutional Training Grants

For institutional training grants (T32, T35, T90, TL1), these expenses (including health insurance costs) for predoctoral and postdoctoral trainees will be paid at the amounts shown below for all competing and non-competing awards made with FY 2024 funds.

Predoctoral Trainees: $4,750
Postdoctoral Trainees: $12,400

C. Institutional Allowance for Individual Fellows

This allowance for predoctoral and postdoctoral fellows will be paid at the amounts shown below for all competing and non-competing awards made with FY 2024 funds.

Institutional Allowance for individual fellows (F30, F31, F32, F33) sponsored by non-Federal Public, Private, and Non-Profit Institutions (Domestic & Foreign, including health insurance):

Predoctoral Fellows: $4,750
Postdoctoral Fellows: $12,400

Institutional Allowance for individual fellows (F30, F31, F32, F33) sponsored by Federal and For-Profit Institutions (including health insurance):

Predoctoral Fellows: $3,650
Postdoctoral Fellows: $11,300

Please direct all inquiries to:

Specific questions concerning this notice or other policies relating to training grants or fellowships should be directed to the grants management office in the appropriate NIH Institute or Center , AHRQ , or HRSA .

General inquiries concerning NRSA stipend and tuition policies should be directed to:

NIH Division of Biomedical Research Workforce Office of Extramural Research National Institutes of Health (NIH) Website: https://researchtraining.nih.gov Email: [email protected] AHRQ Division of Research Education Office of Extramural Research, Education, and Priority Populations Agency for Healthcare Research and Quality (AHRQ) Email: [email protected]

HRSA Paul Jung, M.D. Director, Division of Medicine and Dentistry Bureau of Health Workforce Health Resources and Services Administration (HRSA) Email: [email protected]

Note: For help accessing PDF, RTF, MS Word, Excel, PowerPoint, Audio or Video files, see Help Downloading Files .

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The Special Research story Glitz and Glam will be available to all Trainers for free starting May 1, 2024, at 10:00 a.m. local time! Trainers who complete the Special Research will earn an encounter with the Mythical Pokémon Diancie.* This Special Research will not expire, so you’ll be able to complete it at your own pace!

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At Least Three Women Were Infected With H.I.V. After ‘Vampire Facials’

The women underwent the cosmetic procedure at an unlicensed spa in New Mexico.

A close-up view of a microneedle pen in the gloved hands of a technician being applied to the face of a customer.

By Roni Caryn Rabin

At least three women were infected with H.I.V. during cosmetic “vampire facial” procedures at an unlicensed spa in Albuquerque, federal officials said Thursday. It is the first time that H.I.V. transmission through cosmetic injection services has been documented, they said.

The three were among a cluster of five people sharing highly similar H.I.V. strains, four of whom had undergone a procedure called platelet-rich plasma microneedling at the spa. The fifth individual, a man, had a sexual relationship with one of the women.

Investigators still do not know the precise source of the contamination. A 2018 H.I.V. diagnosis in a patron who reported having no behavioral risk factors led to a public health investigation when the woman said she had received a cosmetic treatment involving needles, called a platelet-rich plasma microneedling facial.

An inspection of the spa found unlabeled tubes of blood lying on a kitchen counter, others stored along with food in a refrigerator, and unwrapped syringes in drawers and trash cans.

The facility also appeared to be reusing disposable equipment intended for single use only, according to a report from the Centers for Disease Control and Prevention.

The report comes on the heels of an announcement by health officials earlier this month that they are investigating a string of illnesses tied to counterfeit or improperly injected Botox containing high amounts of the botulinum toxin, which is used in small doses to smooth wrinkles.

“If people are concerned — and I’ve had friends ask me, ‘What would you do?’— the first step is to check that your provider is licensed to provide cosmetic injection services,” said Anna M. Stadelman-Behar, an epidemiologist with the C.D.C. who is the lead author of the H.I.V. report.

“If they’re licensed, then they have had infection-control training and know the correct procedures, and are bound by law to follow proper infection-control practices.”

Overall, she noted, the risk of infection during cosmetic procedures is generally low. “If you have any concern, go and get an H.I.V. test,” Dr. Stadelman-Behar said. “The C.D.C. recommends all adults between 13 and 64 get tested at least once as part of routine medical care and know their status.”

The so-called vampire facials involve drawing a patient’s own blood, putting it in a centrifuge to separate out platelet-rich plasma, and then using very fine, short needles to puncture the skin.

This is said to prompt the skin to produce elastic and collagen, and to create openings for the plasma, which is applied topically to help with skin repair. The procedure is promoted for reducing signs of aging, acne scarring and sun damage.

The New Mexico Department of Health, which was notified of the unusual H.I.V. infection in 2018 when the first woman was diagnosed, opened an investigation of the spa. Over time officials identified four former clients and a sexual partner who had received H.I.V. diagnoses between 2018 and 2023, despite reporting few risks associated with infection, such as injection drug use, blood transfusion or sexual contact with a new partner.

The spa closed in the fall of 2018, shortly after the identification of the first unusual infection. But the investigation, as well as attempts to notify clients and former clients that they may have been exposed to H.I.V., was hampered by the spa’s poor records.

Eventually, investigators managed to put together a list of names and phone numbers from consent forms that clients had signed, handwritten appointment records and phone contacts. They identified 59 clients who were at risk for infection, including 20 who received “vampire facials” and 39 who got other services, like Botox, between the spring and fall of 2018.

Public health investigators also reached out to the community about the risks to former clients of the spa. Overall, 198 former spa clients and their sexual partners were tested for H.I.V. between 2018 and 2023.

Five people carrying viruses that were highly similar were confirmed to have spa-related cases. But two of them — a woman who had been a client and her male partner — had advanced H.I.V. disease that investigators said most likely resulted from earlier infections, prior to their spa treatments.

The report said that two individuals in the cluster had tested positive during rapid H.I.V. tests done when they applied for life insurance, including one who was tested in 2016, before receiving treatment at the spa, and one in the fall of 2018.

Only one had been notified of the positive test result, however, and had the diagnosis confirmed by a primary care provider in 2019.

Investigators said they never identified the exact route of contamination at the spa during the spring and summer of 2018.

“When we did the inspection at the spa, it was clear that needles were being reused, and also clear that blood specimens were being reused,” Dr. Stadelman-Behar said. “We found vials with no label, no date of birth, no date of collection, that had been punctured multiple times.”

She advised people who receive these kinds of cosmetic procedures to ask providers to open syringes and vials in front of them, and to make sure that when their blood is drawn, the vials are properly labeled with their name, date of birth and date of collection.

“But the biggest takeaway is that licensing is super important,” she said.

Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine. More about Roni Caryn Rabin

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NHSJobs.com: Nursing Services: Research vacancies
Clinical Research Fellow/Senior Clinical Research Fellow. University College London. London. Salary: £43,619 - £59,836 per annum (including London Allowance) ... £42,471 - £50,364 Pa Inclusive. Critical Care Research Nurse. NHS AfC: Band 6. Great Ormond Street Hospital for Children NHS Foundation Trust. London. Salary: £42,471 - £50,364 ...
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317 02 Royal Victoria Infirmary. Salary: £25,147 - £27,596 per annum. Research Development Officer (ALLIANCE Study Manager) Band 6. Norfolk and Suffolk NHS Foundation Trust. Norwich. Salary: £35,392 - £42,618 gross per annum (pro rata)
Clinical academic and research careers
Types of clinical research programmes. internships. Master's in clinical research. clinical doctoral research fellowships. clinical lectureships. senior clinical lectureships. See the NHS England's Workforce, Training and Education website for information about its work on clinical academic careers and resources to support you on your journey.
Job search results
St George's Healthcare NHS Foundation Trust. London SW17 0RE. Salary: £34,089 to £41,498 a year. Closing date: 29 April 2024. Contract type: Fixed-Term. Working pattern: Full time.
Be Part of Research
This year our NHS has its 75th birthday. We're celebrating how NIHR research contributes to the NHS, saving lives and money - and how research can shape the NHS of the future. Listen to our latest podcast as we explore the world of public health research - what it is and how it can help people to live healthier and longer lives.
Research Roles Within The NHS
National Health Service salary scales are relatively good; remuneration for a Biomedical Scientist, for example, can rise as high as £65,000 at senior levels, while consultants can expect a salary nearer the £100,000 mark. Former academics and PhD/Postgraduate students have skills and experience that are prized in NHS roles such as: Research ...
Enabling NHS Staff to Contribute to Research: Reflecting on Current
Further, while many organisations make an important contribution to research capacity in the health system through clinical academic posts and research fellowships, this review outlines how the capacity of a wider NHS workforce can be mobilised effectively and through innovative channels.
Embedding research in the NHS
The NHS also benefits financially from delivering research. The purpose of the Embedding Research team in NHS England is to enable the NHS to increase the scale, pace and diversity of those taking part in research and to provide system guidance and assurance. Guidance is available to help integrated care systems to maximise the benefits of ...
Be Part of Research now available through the NHS App
Published: 06 February 2023. Be Part of Research, the online service that makes it easy for people to find and take part in health and care research, is now available through the NHS App in England. The service, run by the NIHR, helps members of the public understand what research is, what it might mean to take part, as well as showing what ...
PDF 12 actions to support and apply research in the NHS
6. In April this year NHS England set initial goals to support research. Since then, NHS England has been working with the National Institute for Health Research, the Office for Life Sciences, the Health Research Authority and other partners to flesh out a set of practical steps. Together we now commit to the twelve specific actions below:
Embedding a research culture
A skilled research delivery workforce, ready for the complex health and care challenges of the future, is crucial to making research happen in the NHS and other health and social care settings. There are currently over 10,000 front-line research delivery staff working throughout the NHS who are funded or part-funded by the NIHR.
Strengthening research in the NHS
The potential is there, we just need to unlock it NHS research is outstanding. A recent review concluded that "the UK punches above its weight internationally,"1 supported by NHS England, the National Institute for Health Research (NIHR), the emerging UK Research and Innovation, medical research charities such as the Wellcome Trust, our university partners, and industry. What is less well ...
NHS England » What does the new clinical research vision mean for NHS
It includes research into NHS services and care pathways, leading to improvements in the way those services are set up and run, impacting quality, efficiency and cost effectiveness of services, and of course improving the experience of people using those services. Research provides the most reliable data to put evidence-based practice into action.
Involving NHS staff in research
NHS staff live the health system every day. They have much to offer to research about healthcare. Their first-hand experience and insights can help in multiple ways: generating and shaping research questions, gathering and analysing evidence, and spreading research knowledge. Staff may have an especially valuable role in research about how to ...
Research internships
Research internships offer an introduction to all aspects and roles across clinical academic research from trial design, data management through to undertaking practical research in a clinical environment. Schemes provide a range of both taught and academically supervised interventions that both engage and expose the intern to the clinical ...
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Out of the tragedy of the pandemic, there is a unique opportunity to accelerate reform in the NHS and prepare for a world living with and after covid-19, write Jeremy Marlow and colleagues The scale and degree of adaptation that the NHS has achieved in the past six months is unprecedented in its 72 year history. The service acted swiftly to bolster its emergency preparedness and resilience and ...
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Building back better research post covid-19. During the covid-19 pandemic, the public focus has been on the remarkable performance of the NHS and its dedicated workforce in coping with the huge influx of covid-19 patients, led by centralised clinical guidance and rapid local reorganisation of services. The outpouring of public affection for the ...
National Institute for Health and Care Research
NIHR launches new climate health and sustainability commitments. These commitments set out key steps the NIHR will take to engage in climate, health and sustainability research and capacity building. The NIHR is also committing to reduce its carbon footprint and the footprint of the wider research community. Read the full news story here.
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Phase IV is the post licensing phase of the development, longer term risks and benefits can be focused upon as well as discovering rare side effects which may take place in 1 in 10,000 patients. ... Maximise the research potential of the NHS to contribute to the economic growth of the country through the life sciences industry; Act as sound ...
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As part of this commitment, we are pleased to announce stipend and childcare subsidy increases for the over 17,000 early career scholars supported on NIH Kirschstein National Research Service Awards (NRSAs) (NOT-OD-24-104). Stipends will be raised by 4% for predoctoral trainees and by 8% for postdoctoral scholars in fiscal year (FY) 2024 ...
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Research, powered by NHS Data. 4 April 2024. Rebecca Cosgriff. Quality improvement. The Data Saves Lives strategy, published summer 2022, set out how NHS data could bring benefits to all parts of health and social care - from care on the frontline to pioneers driving cutting-edge research. As part of delivering the strategy, NHS England's ...
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Alphabet-owned Google said on Thursday it would consolidate teams that focus on building artificial intelligence models across its Research and DeepMind divisions in its latest push to develop its ...
NOT-OD-24-104: Ruth L. Kirschstein National Research Service Award
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Diancie enters the spotlight in Special Research available to all
The Special Research story Glitz and Glam will be available to all Trainers for free starting May 1, 2024, at 10:00 a.m. local time! Trainers who complete the Special Research will earn an encounter with the Mythical Pokémon Diancie.*. This Special Research will not expire, so you'll be able to complete it at your own pace! *If you have ...
At Least Three Women Were Infected With H.I.V. After 'Vampire Facials'
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Involving NHS staff in research

Key findings

Why do NHS staff engage with research?

How do NHS staff engage with research?

Research tasks and activities that may be performed by NHS staff

2. Attracting funding

3. Design and procedures

4. Recruitment of study participants

5. Data collection

6. Data analysis

7. Dissemination and facilitating uptake

8. Evaluation of research

What is the impact when NHS staff engage with healthcare research?

Potential impacts of NHS staff engagement with research

2. Impact on the wider research system

3. Impact on clinical practice

4. Impact on individuals

What challenges limit NHS staff engagement with research and how can they be addressed?

Challenges and enablers of effective NHS staff engagement with research

Individual and organisational capacity to be involved in research

Culture, attitudes, values and behaviours

Areas of focus for involving NHS staff in research

Preparing to engage NHS staff

Clearly define research roles and responsibilities at the onset

Target specific groups in some cases, engage more widely in others

Where possible, evaluate the process, outcomes and impacts of NHS staff engagement using sound methods

Promoting research opportunities

Pay attention to the language and avoid unnecessary jargon

Consider how best to use established networks and organisations when involving healthcare staff in research

Enabling engagement throughout the research process

Build links with leadership across hierarchies and professions to help foster a research-supportive environment

Build on existing organisational efforts and the governance of safety and quality

Engage with health system leaders and stewards to encourage time and headspace for staff to get involved with research

Create opportunities for recognition and rewards and communicate them to healthcare professionals

Reflect on the role organisations play in building wider research capacity in the health system

Conclusions

Acknowledgments

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