I am seriously considering entering the transfer market to buy a psychic octopus that can help me predict the implications of the unfolding Coalition Government strategy.
Yesterday saw publication of the much-trailed Health White Paper which I overhead described on yesterday’s edition of ‘The World Tonight’ as the most radical overhaul of the health services since its creation. But is it good for medical and health research?
First, the easy bit, the specific pledges and statements on research in the White Paper text with my take as follows:
“The Government is committed to the promotion and conduct of research as a core NHS role”. (para 3.16)
“Research is vital in providing the new knowledge needed to improve health outcomes and reduce inequalities”. (para 3.16) “The Government believes that outcomes will improve most rapidly when clinicians are engaged, and creativity, research participation and professionalism are allowed to flourish”. (para 3.4)
“Research is even more important when resources are under pressure – it identifies new ways of preventing, diagnosing and treating disease. It is essential if we are to increase the quality and productivity of the NHS, and to support growth in the economy.” (para 3.16)
“To support the development of quality standards, NICE will advise the National Institute for Health Research on research priorities”. (para 3.12)
“The standards….will include information for clinicians and patients on relevant and ongoing research studies that are key to improving evidence for better outcomes”. (para 3.13)
Taken together, these are all important statements of intent and it is good to see the Government continue with the previous administration’s concern to put the research mission at the heart of what the NHS does. Given the Science Minister’s preoccupation with the ‘what value’ question I was struck by the sentences on research return. One hopes the White Paper was in his red box last night.
“The NHS Commissioning Board…will promote involvement in research and the use of research evidence”. (para 4.11)
“Commissioners and providers will focus on implementing best practice to achieve improvements in outcomes, supported by…continued research. (page 45 box)
“The NHS has an increasingly strong focus on evidence-based medicine, supported by internationally respected clinical researchers with funding from the National Institute for Health Research”. (para 1.6)
Continuing with the above theme, it is extremely important any new mechanism for commissioning and running the NHS has research within its remit if it is not seen to be a bit part player and that it’s decision-making will be evidence-led
“Our patient participation levels in cancer research are the highest in the world”. (para 1.6)
I thought this was interesting. Good to see a reference to clinical trials in the document but the cancer network and infrastructure is the longest established of all the networks and the challenge is to see the same pull-through in other disease areas. This statement should be seen in conjunction with the following which have this concern at their heart I think:
“The Government will: Give patients more information on research studies that are relevant to them, and more scope to join in if they wish”.
“Making aggregated, anonymised data available to the university and research sectors also has the potential to suggest new areas of research through medical and scientific analysis”. (para 2.13)
“The forthcoming Health Bill will support the creation of a new Public Health Service…including an increased emphasis on research, analysis and evaluation”. (para 4.15).
Mentioned last week and good to see the commitment repeated. Much work to be done in this area to make public health research help drive policy I feel. I think that this is what Andrew Lansley was really driving at when he criticised Jamie Oliver and got slammed for it.
“This [shared decision-making] is equally true of the partnership between patients and clinicians in research, where those institutions with strong participation in clinical trials tend to have better outcomes”. (para 2.3)
NIHR have been driving the patient involvement line quite hard over the last six months (their impact report produced jointly with INVOLVE in March talks about patient involvement being the norm rather than the exception). Politically, there is also a very strong theme of improving public accountability at all levels in the new system.
“The Department will continue to promote the role of Biomedical Research Centres and Units, Academic Health Science Centres and Collaborations for Leadership in Applied Health Research and Care, to develop research and to unlock synergies between research, education and patient care.” (para 3.16)
I thought this was interesting – these are NIHR’s premium brands if you like and their mention suggests the Government sees no reason to disinvest from them. But I thought they could have bigged-up NIHR as an entity a little more given its success.
“The Government will cut the bureaucracy involved in medical research. We have asked the Academy of Medical Sciences to conduct an independent review of the regulation and governance of medical research. In the light of this review we will consider the legislation affecting medical research, and the bureaucracy that flows from it, and bring forward plans for radical simplification”. (para 5.8)
Music to many people’s ears. I think a condensing of the various quangos and regulators is highly likely. But it is important that this is driven by a focus on better regulation rather than as a means to cut costs.
Looking at the sum of these constituent parts, one leans towards a sense that the White Paper is potentially good news for medical research although personally I would like to see a review of Best Research for Best Health in the mix over the next few months to help us make sense of how well these parts are fitting together and how they are evolving . The overall impression one gets from the White Paper is of consolidation and strengthening rather than new ideas, but this is not necessarily a bad thing. On the other hand medical research operates within a larger system and that is when the concerns or questions come to the fore.
Leaving aside the general noise about the impact of the changes on NHS service provision since it is somewhat off AMRC’s beat, the two main issues that I think need to be thought through from a research perspective are as follows:
First, how will NHS Trusts and other providers be incentivised to participate in research in the new commissioning system being proposed? It is good that research is within the remit of the overall NHS Commissioning Board but if it doesn’t also become part of the bottom-line agenda of providers my concern is that medical and health research will be pushed to one side. That would be a shame given the progress made over the last few years. The answer to my question is not obvious to me and perhaps it is simply a question of clarification. But incentives has always been one of the issues at the heart of the tension that exists between research and how the rest of the service operates and the agenda it is working too.
The second is the impact on research of putting GPs in the driving seats. We have a Primary Care Research Network (PCRN) and very good, research intensive GP practices but my sense is that many GPs fail to see the benefits to patients of making sure they are aware of, and have the opportunity to partake in, ongoing clinical trials and research. It is the sort of cultural barrier that is difficult to shift. But shift we must if patients are truly to be involved more in all aspects of their care including the choice to take part in research.
Until then, their involvement may well be more by luck not judgement.
Simon Denegri's Lay Review 