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Atkinson P, Sheard S, Walley T. 'All the stars were aligned'? The origins of England's National Institute for Health Research. Health Res Policy Syst 2019; 17:95. [PMID: 31801552 PMCID: PMC6894247 DOI: 10.1186/s12961-019-0491-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2006, the research and development (R&D) activity of England's national healthcare system, the National Health Service, was reformed. A National Institute for Health Research (NIHR) was established within the Department of Health, the first body to manage this activity as an integrated system, unlocking significant increases in government funding. This article investigates how the NIHR came to be set up, and why it took the form it did. Our goal was a better understanding of 'how we got here'. METHODS We conducted oral history interviews with 38 key witnesses, held a witness seminar, and examined published and unpublished documents. RESULTS We conclude that the most important forces shaping the origin of NIHR were the growing impact of evidence-based medicine on service policies, the growth of New Public Management ways of thinking, economic policies favouring investment in health R&D and buoyant public funding for healthcare. We note the strong two-way interaction between the health research system and the healthcare system - while beneficial for the use of research, challenges for healthcare (such as stop-go funding) could also produce challenges for health research. CONCLUSIONS Understanding how and why England came to have a centralised health service research system alongside a long-established funder of biomedical research (the Medical Research Council) helps us interpret the significance of the English health research experience for other countries and helps English policy-makers better understand their present options. Learning lessons from the features of the English health research system calls for an understanding of the processes which shaped it. Firstly, the publicly funded, nationally organised character of healthcare promoted government interest in evidence-based medicine, made research prioritisation simpler and helped promote the implementation of findings. Secondly, the essential role of leadership by a group who valued research for its health impact ensured that new management methods (such as metrics and competitive tendering) were harnessed to patient benefit, rather than as an end in themselves. A policy window of government willingness to invest in R&D for wider economic goals and buoyant funding of the health system were also effectively exploited.
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Affiliation(s)
- Paul Atkinson
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB United Kingdom
| | - Sally Sheard
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB United Kingdom
| | - Tom Walley
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB United Kingdom
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Moran R, Butt J, Heller S, Hinks J, Kerridge L, Samuels M, Hanney S. Health research systems in change: the case of 'Push the Pace' in the National Institute for Health Research. Health Res Policy Syst 2019; 17:37. [PMID: 30961621 PMCID: PMC6454738 DOI: 10.1186/s12961-019-0433-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Those running well-organised health research systems are likely to be alert for ways in which they might increase the quality of the services they provide and address any problems identified. This is important because the efficiency of the research system can have a major impact on how long it takes for new treatments to be developed and reach patients. This opinion piece reflects on the experience and learning of the United Kingdom-based National Institute for Health Research (NIHR) when it implemented continuous improvement activity to improve its processes. DISCUSSION This paper describes the structure and work of the NIHR and why, despite is successes as a health research system and ongoing local continuous improvement, it believed in the value of an organisation-wide continuous improvement activity. It did this by implementing an approach called 'Push the Pace'. Initially, the organisation focused on reducing the amount of time it took for research to transition from an early concept to evidence that changes lives. This scrutiny enabled the NIHR to realise further areas of improvement it could make - additional goals were increased transparency, process simplification, and improved customer and stakeholder experience. We discuss our experience of Push the Pace with reference to literature on continuous improvement. CONCLUSION Continuous improvement is a cycle, an activity that is done constantly and over time, rather than an act or linear activity (such as Push the Pace). We believe that the work of Push the Pace has initiated a strong commitment to a culture of continuous improvement in the NIHR. This is significant because culture change is widely recognised as immensely challenging, particularly in such a large and distributed organisation. However, our biggest challenge will be to enable all staff and stakeholders of the NIHR to participate in the continuous improvement cycle.
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Affiliation(s)
- Rebecca Moran
- NIHR Evaluation, Trials and Studies Coordinating Centre, Alpha House, Enterprise Road, Chilworth, Southampton, SO17 1BJ,, United Kingdom.
| | - Jennifer Butt
- NIHR Evaluation, Trials and Studies Coordinating Centre, Alpha House, Enterprise Road, Chilworth, Southampton, SO17 1BJ,, United Kingdom
| | - Simon Heller
- Department of Oncology & Metabolism, University of Sheffield Medical School, Room EU38, E Floor, Beech Hill Road, Sheffield, S10 2RX,, United Kingdom
| | - Jeremy Hinks
- NIHR Evaluation, Trials and Studies Coordinating Centre, Alpha House, Enterprise Road, Chilworth, Southampton, SO17 1BJ,, United Kingdom
| | - Lynn Kerridge
- NIHR Evaluation, Trials and Studies Coordinating Centre, Alpha House, Enterprise Road, Chilworth, Southampton, SO17 1BJ,, United Kingdom
| | - Mark Samuels
- Medicines Discovery Catapult, Mereside, Alderley Park, Alderley Edge, Cheshire, SK10 4TG,, United Kingdom
| | - Stephen Hanney
- Health Economics Research Group, Brunel University London, Uxbridge, United Kingdom
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Affiliation(s)
- S Birch
- Critical Care Department, King's College Hospital NHS Foundation Trust, London, UK
| | - C Harris
- Critical Care Department, King's College Hospital NHS Foundation Trust, London, UK
| | - P Hopkins
- Research Lead for King's College Hospital Critical Care Department, Clinical Research Network Lead (London South) for Critical Care Speciality Group, Critical Care Consultant at King's College Hospital NHS Foundation Trust, London, UK.,King's Critical Care & CRN Lead (London South) for Critical Care Specialty Group, Critical Care Consultant, King's College Hospital NHS Foundation Trust, London, UK
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Chinnery F, Bashevoy G, Blatch-Jones A, Douet L, Puddicombe S, Raftery J. National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme research funding and UK burden of disease. Trials 2018; 19:87. [PMID: 29394905 DOI: 10.1186/s13063-018-2489-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HTA Programme funding is governed by the need for evidence and scientific quality, reflecting funding of the National Institute for Health Research (NIHR) by the NHS. The need criterion incorporates covering the spectrum of diseases, but also taking account of research supported by other funders. This study compared the NIHR HTA Programme portfolio of research with the UK burden of disease as measured by Disability-adjusted Life Years (DALYs). METHODS A retrospective cross-sectional study using a cohort of all funded primary research and evidence syntheses projects received by the HTA Programme from April 2011 to March 2016 (n = 363); to determine the proportion of spend by disease compared with burden of disease in the UK calculated using 2015 UK DALY data. RESULTS The programme costing just under £44 million broadly reflected UK DALY burden by disease. Spend was lower than disease burden for cancer, cardiovascular and musculoskeletal diseases, which may reflect the importance of other funders, notably medical charities, which concentrate on these diseases. CONCLUSION The HTA Programme spend, adjusted for other relevant funders, broadly matches disease burden in the UK; no diseases are being neglected.
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Greenhalgh T, Ovseiko PV, Fahy N, Shaw S, Kerr P, Rushforth AD, Channon KM, Kiparoglou V. Maximising value from a United Kingdom Biomedical Research Centre: study protocol. Health Res Policy Syst 2017; 15:70. [PMID: 28806989 PMCID: PMC5556344 DOI: 10.1186/s12961-017-0237-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/28/2017] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Biomedical Research Centres (BRCs) are partnerships between healthcare organisations and universities in England. Their mission is to generate novel treatments, technologies, diagnostics and other interventions that increase the country's international competitiveness, to rapidly translate these innovations into benefits for patients, and to improve efficiency and reduce waste in healthcare. As NIHR Oxford BRC (Oxford BRC) enters its third 5-year funding period, we seek to (1) apply the evidence base on how best to support the various partnerships in this large, multi-stakeholder research system and (2) research how these partnerships play out in a new, ambitious programme of translational research. METHODS Organisational case study, informed by the principles of action research. A cross-cutting theme, 'Partnerships for Health, Wealth and Innovation' has been established with multiple sub-themes (drug development, device development, business support and commercialisation, research methodology and statistics, health economics, bioethics, patient and public involvement and engagement, knowledge translation, and education and training) to support individual BRC research themes and generate cross-theme learning. The 'Partnerships' theme will support the BRC's goals by facilitating six types of partnership (with patients and citizens, clinical services, industry, across the NIHR infrastructure, across academic disciplines, and with policymakers and payers) through a range of engagement platforms and activities. We will develop a longitudinal progress narrative centred around exemplar case studies, and apply theoretical models from innovation studies (Triple Helix), sociology of science (Mode 2 knowledge production) and business studies (Value Co-creation). Data sources will be the empirical research studies within individual BRC research themes (who will apply separately for NHS ethics approval), plus documentary analysis and interviews and ethnography with research stakeholders. This study has received ethics clearance through the University of Oxford Central University Research Ethics Committee. DISCUSSION We anticipate that this work will add significant value to Oxford BRC. We predict accelerated knowledge translation; closer alignment of the innovation process with patient priorities and the principles of responsible, ethical research; reduction in research waste; new knowledge about the governance and activities of multi-stakeholder research partnerships and the contexts in which they operate; and capacity-building that reflects the future needs of a rapidly-evolving health research system.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Pavel V. Ovseiko
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
| | - Nick Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Polly Kerr
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Alexander D. Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Keith M. Channon
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
| | - Vasiliki Kiparoglou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
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Lythgoe H, Price V, Poustie V, Attar S, Hawcutt D, Preston J, Beresford MW. NIHR Clinical Research Networks: what they do and how they help paediatric research. Arch Dis Child 2017; 102:755-759. [PMID: 28096102 DOI: 10.1136/archdischild-2016-311057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/03/2022]
Abstract
This review provides paediatricians with an update on the new structure of the National Institute for Health Research's (NIHR) Clinical Research Network (CRN): Children and its role within the wider NIHR infrastructure. The network supports delivery of high-quality research within the NHS in England and supports researchers, through provision of staff and resources, with feasibility, site set-up, patient recruitment and study management. Since 2013, over 80% of commercial contract studies running within the UK sat within the UKCRN Portfolio. Of the diverse, increasing portfolio of studies supported by the network, many studies are interventional, with 33% being randomised controlled studies. Recruitment to studies supported by the network through the Children's Portfolio has consistently improved. Over 200 000 participants have been recruited to the Children's Portfolio studies to date, and there are currently approximately 500 studies open to recruitment. The CRN: Children has successfully involved patients and the public in all aspects of study design and delivery, including through the work of Generation R. Challenges remain in conducting paediatric research and the network is committed to supporting Children's research and further building on its achievements to date. Education and engagement of paediatricians within the network and research is important to further improving quality and delivery of paediatric research.
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Affiliation(s)
- Hanna Lythgoe
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Victoria Price
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Vanessa Poustie
- NIHR CRN: Children, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sabah Attar
- NIHR CRN: Children, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Daniel Hawcutt
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jennifer Preston
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,NIHR CRN: Children, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Hanney SR, González-Block MA. Building health research systems: WHO is generating global perspectives, and who's celebrating national successes? Health Res Policy Syst 2016; 14:90. [PMID: 28031041 PMCID: PMC5198495 DOI: 10.1186/s12961-016-0160-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 11/21/2022] Open
Abstract
In 2016, England’s National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients’ needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service. In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR’s progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes. The NIHR’s overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO’s recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions.
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Affiliation(s)
- Stephen R Hanney
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.
| | - Miguel A González-Block
- Universidad Anáhuac, Av. Universidad Anáhuac 46, Lomas Anáhuac, 52786, Huixquilucan, Mexico City, Mexico
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Rajasekhar P, Rees C, Rutter M, Hungin P. Developing a clinical research network: the Northern Region Endoscopy Group experience. Clin Med (Lond) 2014; 14:107-12. [PMID: 24715118 PMCID: PMC4953278 DOI: 10.7861/clinmedicine.14-2-107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research is central to the National Health Service. Clinical trial recruitment has been aided by the National Institute for Health Research's Comprehensive Research Network but these networks do not support development of research. The Northern Region Endoscopy Group (NREG) was founded in 2007, encompasses 17 endoscopy units and has become a highly successful collaborative research network. The network is now a major contributor to UK trials, has published over 20 papers (>60 abstracts) and holds grants totalling more than £1.5 million. The NREG provides an exemplar model of how collaborative working can contribute significantly to biomedical research.
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Affiliation(s)
- Praveen Rajasekhar
- Gastroenterology, South Tyneside District Hospital, South Tyneside NHS Foundation Trust, Tyne and Wear, UK, The Northern Region Endoscopy Group, South Shields, UK and School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - Colin Rees
- Gastroenterology, South Tyneside District Hospital, South Tyneside NHS Foundation Trust, Tyne and Wear, UK and The Northern Region Endoscopy Group, South Shields, UK and School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - Matthew Rutter
- Gastroenterology, University Hospital North Tees, Stockton-on-Tees, UK, The Northern Region Endoscopy Group, South Shields, UK and School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - Pali Hungin
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK and The Northern Region Endoscopy Group, South Shields, UK
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Evans TW, Gower J, Neilson J, Wass J. Report of a Royal College of Physicians and National Institute for Health Research workshop - developing research capacity to ensure successful study development and delivery. Clin Med (Lond) 2013; 13:431-3. [PMID: 24115694 PMCID: PMC4953788 DOI: 10.7861/clinmedicine.13-5-431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The landscape and opportunities for clinical research have changed significantly following the creation of the National Institute for Health Research (NIHR) in 2006. This article describes the scale and impact of the NIHR network infrastructure for clinical research and identifies areas for future development in partnership with the National Health Service (NHS), clinicians and research funders.
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Affiliation(s)
- TW Evans
- Research and Academic Medicine Committee, Royal College of Physicians, London, UK
| | - J Gower
- National Institute for Health Research Comprehensive Clinical Research Network, UK
| | - J Neilson
- National Institute for Health Research Comprehensive Clinical Research Network, UK
| | - J Wass
- Research and Academic Medicine Committee, Royal College of Physicians, London, UK
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