On 1 April the NHS will enter its second year as reimagined in the Health and Social Care Act 2012. For the first time NHS England will include research in the 2014/15 "standard contract" they provide NHS organisations for use when commissioning services. And research has also been included in planning guidance issued by NHS England to Providers and Commissioners to ensure they understand the importance of research to delivering high quality care. These are two great steps that should really help embed research as a core priority for the NHS, something AMRC has been calling for.
The Health and Social Care Act 2012 introduced, for the first time, a duty on the Secretary of State, the NHS Commissioning Board (now NHS England) and Clinical Commissioning Groups (CCGs) to “promote research on matters relevant to the health service, and the use in the health service of evidence obtained from research.” We strongly welcomed this ambition to embed research throughout the NHS. But there needs to be practical and detailed mechanisms in place to ensure this policy becomes a reality on the front line of the NHS.
NHS England has responsibility for ensuring that all 211 CCGs are meeting their responsibilities set out in legislation and delivering the highest possible standards of care. They do this in part by producing guidance on contracts and other technicalities of commissioning and by setting criteria against which CCGs can be measured, assessed and held to account. By including research in these they can send a clear message that research matters.
Recognising that it is important we all work with the NHS to achieve this, last year we brought together partners supporting research, patients and clinicians to develop Our vision for research in the NHS. Under each of the ambitions in our vision we set out practical steps that we can all take to achieve them.
What has NHS England done?
For the first time, the NHS Standard Contract 2014/15 issued by NHS England covers research. This is a potentially pivotal development since all Commissioners are mandated by NHS England to use the NHS Standard Contract for all healthcare services other than primary care. The NHS Standard Contract now requires the following:
The Provider must put arrangements in place to facilitate recruitment of Service Users and Staff as appropriate into Approved Research Studies. [Service Condition 26.3] (see below for what "Approved Research Studies are)
In respect of any Approved Research Study the Parties [i.e. the Commissioner and the Provider] must have regard, as applicable, to NHS Treatment Costs Guidance (these are covered by AcoRD, which AMRC helped develop, and HSG (97) 32). [Service Conditions 26.4]
The Parties must abide by and promote awareness of the NHS Constitution, including the rights and pledges set out in it. The Provider must ensure that all Sub-Contractors and all Staff abide by the NHS Constitution. [Service Conditions 1.3]
The General Conditions (which are basically accompanying notes to the contract) define “Approved Research Study” as a clinical research study:
(i) which is of clear value to the NHS;
(ii) which is subject to high quality peer review (commensurate with the size and complexity of the study);
(iii) which is subject to NHS research ethics committee approval where relevant;
(iv) which meets all the requirements of any relevant Regulatory or Supervisory Body; and
(v) in respect of which research funding is in place compliant with NHS Treatment Costs Guidance
The second great thing that NHS England has done is to include research in its NHS planning guidance issued by NHS England, Everyone Counts: Planning for Patients 2014/15 to 2018/19. This highlights the importance of research to Providers and Commissioners as a means of delivering high-quality care for all. The section “Maintaining the Focus on the Essentials” identifies research as one of the “essential elements that will apply to all of the characteristics of every successful and sustainable health economy”. On page 23 it says:
Research and evaluation across the whole patient pathway including with partners in local government and Public Health England will contribute to improving outcomes and spreading innovation and economic growth. A marker of quality within NHS organisations is those with research activity able to demonstrate evidence of improved patient outcomes and health service delivery. Commissioners should actively seek out research opportunities, understand where research is taking place within the Providers with whom they contract and support that activity wherever possible, through their commissioning decisions.
For Commissioners to demonstrate to NHS England that their plans sufficiently cover this they must include these key features:
- how they fulfil their statutory responsibilities to support research
- how they are ensuring that specialised services in their area are connecting actively to and maximising the opportunities of working with research and teaching
- how they will use Academic Health Science Networks to promote research
- how they will adopt innovative approaches using the delivery agenda set out in Innovation Health and Wealth: accelerating adoption and diffusion in the NHS
What does this mean?
It's great to see NHS England taking research seriously and setting measurable criteria against which Commissioners and service Providers can be assessed. It will take concerted action by many people to ensure that these developments are translated into more high quality research taking place in the NHS and better adoption and diffusion of innovation throughout the service. But if achieved we could potentially see a real step change in the way the NHS operates, and that will bring true benefit to patients.
There is of course more that the NHS could do and we will continue to work with them on this. We need to make sure this ambition spreads throughout all parts of the NHS (the Standard Contract doesn't cover primary care for example) and we need to keep an eye on how these criteria are being measured and failures being followed up on. Monitor will have an important part to play in this and we will be working with them. We also shouldn't forget to recognise and reward those in the NHS that are achieving and going beyond these ambitions - perhaps that's where charities can really play a powerful role!