Big role for research and innovation in the NHS Long-term plan

#NHSLongTermPlan 

https://www.longtermplan.nhs.uk/

The NHS Long-term plan published on Monday, January 7th includes extensive commitments to research.

The Plan sets out how the £20.5bn annual budget increase promised by prime minister Theresa May will be spent, and sets out priorities and targets for the service for the next ten years. A big focus will be on prevention and early detection of illness and disease with a view to taking pressure off hospital services.

Other big priorities for the Service include mental health and obesity, with GPs, mental health and community care receiving investment that will grow faster than the rest of the overall NHS budget.

The NHS Long Term Plan will also:

  • Open a digital ‘front door’ to the health service, allowing patients to be able to access health care at the touch of a button
  • Provide genetic testing for a quarter of people with dangerously high inherited cholesterol, reaching around 30,000 people
  • Give mental health help to 345,000 more children and young people through the expansion of community based services, including in schools
  • Use cutting edge scans and technology, including the potential use of artificial intelligence, to help provide the best stroke care in Europe with over 100,000 more people each year accessing new, better services
  • Invest in earlier detection and better treatment of respiratory conditions to prevent 80,000 hospital admissions and smart inhalers will be piloted so patients can easily monitor their condition, regardless of where they are
  • Ensure every hospital with a major A&E department has ‘same day emergency care’ in place so that patients can be treated and discharged with the right package of support, without needing an overnight stay.

It includes a section highlighting the role of research and innovation in enabling breakthroughs, prevention of illness, earlier diagnosis, more effective treatments, better outcomes and faster recovery. Some measures relating to research in the plan include:

  • NHS endorsement of recently announced Life Sciences Sector deal and recognition that research and innovation are important for patients and the UK economy
  • Increasing the number of people registering to participate in health research to one million by 2023/24
  • A commitment to innovation and ensuring it reaches patients faster with a simpler, clearer system for drugs, medtech and digital uptake

In an effort to strengthen the ability of patients, professionals and the public to contribute to improving the Service an NHS Assembly will be established in early 2019. The Assembly, consisting of national clinical, patient and staff organisations; the Voluntary, Community and Social Enterprise (VCSE) sector; the NHS Arm’s length bodies (ALBs); and frontline leaders from ICSs, STPs, trusts, CCGs and local authorities will advise the boards of NHS England and NHS Improvement as part of the ‘guiding coalition’ to implement this Long Term Plan.

Read reactions to, and summaries of the plan from vaious organisations

Healthy London Partnership; 
https://www.healthylondon.org/resource/the-nhs-long-term-plan-summary/

Association of Medical Research Charities
https://www.amrc.org.uk/research-and-innovation-in-nhs-englands-long-term-plan
KIng’s Fund
https://www.kingsfund.org.uk/press/press-releases/kings-fund-response-nhs-long-term-plan
Nuffield Trust:
https://www.nuffieldtrust.org.uk/event/learning-from-history

Professor Rosalind Raine

In the last 5 years Rosalind Raine has been awarded £16M (as PI and co-applicant) in AHR grants from NIHR, MRC, Wellcome Trust and other funders. Her research is of value to policy makers due to its diversity (spans acute & chronic conditions and all NHS settings), representativeness (national datasets,long time periods) and applied nature, allowing direct policy translation.

Her analyses have influenced national inequalities policies, EU policy makers, the Cabinet Office, the GLA, LAs and PCTs. She has held national leadership positions including the National Chair of the Heads of Academic Departments of Public Health (2010-2014). Her commitment to internationally competitive research which makes a major contribution to NHS, patients and the public is demonstrated by her membership of the: REF2014 Sub Panel for Public Health, Health Services Research and Primary Care; MRC Career Development Panels (2005-12); NIHR Programme Grant Experts Panel (2007-12) and the MRC Health Services & Public Health Research Board (2005-8). As National and Regional Chair of the UK Clinical Research Network (CRN) NIHR Health Services Research (HSR) Speciality Group (2009-11), she established networks of applied researchers across London Universities to promote research collaborations.

Nationally she worked with the CRN to achieve more appropriate inclusion of HSR in the CRN. Raine’s effective leadership and commitment to capacity building, led her to being asked to establish and lead the UCL Department of Applied Health Research (2012-). Current grants in the Department total £59.3M (as lead and co-applicants).

 

Prof Mike Roberts

Mike Roberts is an NHS Consultant Respiratory Physician at The Princess Alexandra Hospital and Community Services for West Essex. He also holds posts as Clinical Academic Lead for Population Health for UCLParters Academic Health Science Network, Clinical Director of the National Asthma and COPD Audit Programmes, and is hosted within the Institute of Primary Care and Population Health at Queen Mary University of London.

From theoretically informed to theoretically informative improvement research

A new BMJ Quality and Safety editorial by Dr Roman Kislov, Senior Research Fellow at the Alliance Manchester Business School, has highlighted CLAHRC work as an example of successful engagement with management theory by researchers.

Dr Kislov’s research focus is the processes and practices of knowledge mobilisation, and his editorial highlights our recent paper on how different NHS Boards implement a quality improvement intervention – the QUASER guide.

He cites the paper as “an example of successfully deployed theoretically informative approach, highlighting some practical tips for researchers who aspire to move from merely applying theory towards entering into dialogue with it and, through doing so, refining its assumptions.

Read the editorial

Engaging with theory: from theoretically informed to theoretically informative improvement research

Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1-4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of

Read the iQUASER paper

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

Background Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Read our BITE sized summary of the iQUASER paper

Complications following hip or knee surgery are more likely for people with long-term illness, but benefits are still worthwhile

The work of CLAHRC researcher Dr Bélène Podmore has been highlighted as “high quality” by the National Institute for Health Research. Bélène’s work, recently published in BMJ Open investigated how having a long-term condition impacts access to and benefit from hip and knee surgery. The research was promoted by NIHR via their “Signals” service. NIHR Signals summarise the latest important research on health care, public health and social care, along with implications for practice.

Joint replacement benefits and harms for people with other illness

Why was this study needed? In the UK, over 210,000 hip and knee replacements were performed in 2017 at an average age of 68 for hips and 69 for knees. One in six of these people had an illness affecting their day to day life.

Read the paper

Podmore B, Hutchings A, van der Meulen J, et al
Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis
BMJ Open 2018;8:e021784. doi: 10.1136/bmjopen-2018-021784

 

Dr Elena Pizzo

Elena is a Senior Health Economics. She holds a PhD in Economics and Management from Padua University, a Master degree in Economics and Management of Health Care Services from Ferrara University and a first degree in Economics from Padua University.

Prior to coming to UCL she was a Research Associate at the Imperial College Business School, working on the economic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London.

She previously held a research post at the Department of Economics, Ferrara University, where she collaborated to a multi-year research project and undertook an economic evaluation of a Regional Colorectal Cancer Screening Program.

Capturing the views of patients in emergency care

CLAHRC researchers highlight potential to use patient-reported outcomes for emergency admissions.

Patient-reported outcome measures or PROMs are a well-established method of capturing the views of NHS patients, allowing the service to assess the quality of care delivered, from the patient perspective.

PROMs use pre- and post-operative surveys completed by patients to calculate their health gains after surgical treatment.

While there is an extensive PROM programme across the English NHS, they have yet to be used in emergency admissions. These account for nearly 40% of all hospital admissions and are an area of increasing demand. However, this is also an area where the NHS knows least about;

  • the quality of patient outcomes,
  • whether resources are being used effectively,
  • and whether there are unexpected variation between different providers

CLAHRC researcher and PhD Dr Esther Kwong investigated how to use PROMs to evaluate the quality of acute and emergency hospital care in the NHS. Esther developed and tested PROMS with patients who underwent emergency admissions, establishing that it is feasible to use PROMS in this clinical area.

They are presented in four new CLAHRC BITEs – postcard summaries of Esther’s published academic papers.

Can Patient Reported Outcomes Measures (PROMs) be used in emergency admissions?

Feasibility of collecting retrospective patient reported outcome measures (PROMs) in emergency hospital admissions

Using patient-reported outcome measures (PROMs) for primary percutaneous coronary intervention

Assessing Patient Reported Outcomes (PROMS) for emergency admissions: laparotomy for gastrointestinal conditions