research in practice response to:

Best Research for Best Health: A New National Health Research Strategy

1. research in practice network

1.1 research in practice actively supports a network of over 100 public and voluntary sector agencies across England and Wales that are striving to use an evidence-informed approach to improve services and outcomes for vulnerable children and families. While our work initially developed within the children’s social care sector, our inter-professional work is well established and our partnership continually diversifying. We use the term evidence-informed practice to describe the combining of the best available research evidence with the practice expertise of professionals informed by the experience and preferences of service users.

1.2 The following comments are informed by our partnership’s knowledge and experience of working in an evidence-informed way, developed over the last nine years of intensive work.

2. Introduction

2.1 research in practice welcome the commitment from the Department of Health to high-quality research to inform better practice to underline the continued focus on patient-centred healthcare. At research in practice we believe that improved outcomes for (in terms of our work) children and families requires a sustained evidence-informed approach that is supported by well-evaluated good practice. It is through this approach that better services, and better outcomes, will follow.

2.2 research in practice has grown from a network of primarily social care agencies to one that now encompasses staff and partners from the health and education sectors. This both reflects the current focus on inter-agency working and anticipates sustained future work across disciplines to rise to potential challenges. It is because of this that research in practice has prepared this response.

2.3 research in practice use the term evidence-informed practice (EIP) as opposed to evidence-based practice (EBP). We define it as ‘the practice of a range of professionals whose decisions are grounded in a sound knowledge of the needs of a service user’. We feel evidence-informed practice better describes the appropriate emphasis to place on research.

2.4 This response is informed by the Every Child Matters agenda, in particular the ‘Be Healthy’ outcome.

3. Challenges

3.1 We welcome the DH’s ultimate aim of better health through research-informed knowledge. research in practice acknowledge that EBP evolved in healthcare in the early 1990s from the recognition that organisations and practitioners were continuing to practice in familiar ways despite research evidence highlighting more effective interventions. Many important advances were made in using evidence to inform healthcare practice, and these have been a significant influence on the social care sector. However, the acknowledgement in the consultation that there is currently a low “applied” research base is key. Great strides have been made in social care to encourage use of EIP, and we would suggest that there is now a need for its wider awareness throughout the NHS. Without a fundamental cultural shift there is a danger that any moves to streamline and increase research output will not lead to the hoped-for front-line benefits. An example of good practice in this area is ScHARR (http://www.shef.ac.uk/scharr/) - consistently seeking to build bridges between health and social care via the use of EIP.

3.2 The reduction of health inequalities is one of the biggest challenges in healthcare. Research has gone a long way in informing the choices both health professionals and patients make in relation to their care. It is crucial that the reduction of health inequalities remains central to informing better health, and that areas of unmet need are the prime ones targeted for improved and sustained research.

3.3 All the other challenges mentioned in the document are correctly and lucidly identified.

4. National Institute for Health Research

4.1 In terms of identity and ownership, the virtual institute idea is a sound one. However, the DH needs to be mindful of local flexibility. The differences between national and regional issues are of supreme importance – for instance, projects on a similar issue may have very different results according to geography. This can be seen in children’s services very clearly in the different needs of children in rural and urban settings.

4.2 In terms of the faculty, there should, as rightfully noted, be proper and sustained assistance for all engaged with research from the centre. This, however, should not be at the expense of local support.

4.3 There is concern at the language used to refer to Senior Investigators. While appreciating the need for high-quality research staff, the DH is positioning the post as part of a “select group”, running the risk of charges of elitism. This appears to contradict the statement in the introduction that the DH wishes to break down the barriers between “pure” research and “applied” research. By having an exalted group who are removed from frontline practice the DH runs the risk of perpetuating this view of applied research.

4.4 The document does not make clear the career progression for Junior Investigators to Senior level. Considering the light in which the DH has cast the document (4.7 refers to “the problems that have existed with the career paths for all professions in research”), this is an issue that needs to be addressed. We also believe that the provision for attendance at just one meeting a year is not sufficient, and does not meet the aim of substantial support. Junior Investigators should have significant scope to attend meetings and conferences relevant to their field.

4.5 We welcome the inclusion of Faculty Associates as an official grouping. At research in practice we work closely with our network to ensure the dissemination of good practice through publications and projects like TEAMWISE (http://www.rip.org.uk/changeprojects/teams.asp) and it is crucial to have a hub such as a Faculty Associate at grassroots level to encourage the fostering of a research-informed culture. We would like to see this role highlighted and developed much more. Significant support should be extended to Faculty Associates and their line managers, including some mandates on protected time. This is an idea that is used in social care, particularly with the requirement for social work post-registration training. It is believed that short-term investment in terms of protected time for staff development yields real longer-term benefits if staff are committed to disseminating this research amongst their colleagues. Faculty Associates will also be a means to ensure that research undertaken is locally responsive.

4.6 It will enhance the reputation of NHS research by having NHS funded staff in universities, and will contribute significantly to the fostering of an evidence-informed culture. However, funding should not be the only way in which research time is protected. It needs to be complemented by a genuine commitment to fostering EIP.

5. Infrastructure

5.1 The idea that money follows patient involvement in studies is welcomed but care should be taken in its implementation. It needs to be ensured that this is a thorough process that involves not just “expert” patients but those from traditionally hard-to-reach groups. Simply asking patient opinion is easy whereas assessing real effectiveness on patient care is not. This needs to be made clearer or Support for Patient Research runs the risk of propping up the very health inequalities it is designed to address.

5.2 The Academic Medical Centres offer potential for raising the profile of NHS research, but sustainability needs to be further considered. This would be an ideal opportunity to involve Junior Investigators and Faculty Associates as a commitment to invest in the future.

5.3 We are also concerned at the concept of Leadership Funding. The document does not make clear the purpose of this money, and this does not comply with the stated aims of transparency. The rationale and use of this money should be much more strictly defined. research in practice has recently completed a project on Leading Evidence Informed Practice (http://www.rip.org.uk/changeprojects/leadership.asp) providing valuable insights for leaders who want to create services where research evidence more actively informs working practices and decision-making. We believe that tools such as this are of relevance across disciplines and practitioners in health looking for guidance on leading EIP would find this a useful resource. For more details, see the above link or contact Elizabeth Cooke at research in practice .

5.4 However, we would also suggest as well as joint research with universities that the infrastructure makes allowances for closer work with social care agencies on certain issues. Interagency working, in our experience of children and families, can really improve outcomes. The infrastructure needs to be open to this possibility. We strongly endorse moves towards effective partnership working in EIP and would encourage the DH to create an infrastructure that values contributions from social care.

5.5 All other proposals for infrastructure are valid points. We welcome the recognition that infrastructure can be a significant barrier to transparent research.

6. Research Programmes and Networks

6.1 Both of these have the potential for a solid mix of innovation, applied research and local flexibility. In particular we welcome the visibility of research in primary care that Research Networks will foster.

6.2 The idea of a “medicines for children” research network should be expanded into one for child health. The “Be Healthy” outcomes of the Every Child Matters agenda highlight the many and varied health challenges facing children and young people and it is to link these outcomes under a separate network. If they are not, these issues risk being relegated in discussions about adult health on the topic and we know, for instance in mental health, that children’s issues are clearly distinct from those of adults.

7. Bureaucracy 'Busting'

7.1 This is one of the most important areas of the document. Acknowledgement of the hurdles NHS staff have to jump to become more engaged with research is a candid diagnosis of the problem and is welcomed. However, it should be noted that a varied “interpretation of roles” within the NHS should continue to have local flexibility, while, as the document rightly says, accountability should not. The concern is that Faculty Associates may continue to face significant barriers in this way as they would be removed from the central research body. This would need to be carefully monitored.

7.2 Identified in 13.3 is a telephone helpline. If this is to be a viable prospect it needs much more direction. Expansion of this helpline into something offering support into all aspects of conducting research may be helpful. If, as you propose, there will be more scope for non-academic NHS staff to engage in research via the post of Faculty Associate, a centralized telephone support system would provide invaluable help.

7.3 There is also concern that a new single IT system may generate significant admin support needs in the short term. This should not be underestimated.

8. Transparency

8.1 It is extremely important that the research carried out and its funding is allocated transparently. There should also be sustainability, responsiveness and support at every level.

Conclusion

research in practice welcomes the moves by the DH towards an NHS greater informed by research. However, the strategy needs to be tightened up with areas of ambiguity removed to create a solid base of support for all practitioners who wish to utilise these new opportunities for applied research. It is only through this that a new culture can be fostered where evidence is at the heart of healthcare provision.

research in practice

research in practice is a creative partnership between the Association of Directors of Social Services, the Dartington Hall Trust, the University of Sheffield, and 100 participating agencies, including local authorities, voluntary organisations, Local Strategic Partnerships and Primary Care Trusts. Our services are designed to improve access to research and to support its understanding and adoption through the promotion of evidence-informed practice

research in practice works to support our network of agencies and the wider, multi-disciplinary child care community in their determination to become more research minded as they strive to improve children’s lives. research in practice is a developmental network, connecting research and practice, advancing research based improvement via the World Wide Web, organising exchanges, projects and conferences, producing publications and supporting professional development work. We do this by working with ambitious agencies – those that have a vision and strategy for change. Together, we are discerning about methods of innovation and evaluation and aim to test out these methods, which can be adopted and replicated elsewhere.

More detail on this, and our services and network, can be found in our Annual Reports and Workplans

Contacts for this response:

Jeanette Leech, Development Officer (Health), research in practice

j.a.leech@sheffield.ac.uk

tel: 0114 2226474

research in practice Department of Sociological Studies, University of Sheffield, 343 Fulwood Road, Sheffield, S10 3BQ

Director:

Celia Atherton, research in practice , Blacklers, Park Road, Dartington, Totnes, Devon TQ9 6EQ

celia@rip.org.uk

tel: 01803 867692

October 2005