The NHS research infrastructure can be a complex place for charities involving multiple bodies, networks and organisations. It can be particularly difficult to know how to work with new institutions and ensure research findings can be taken up and used to improve practice. In our Vision for research in the NHS, we set out practical steps to embed research throughout the NHS - including supporting all NHS staff - commissioners and managers as well as clinicians - to see the importance of research and its findings to improve the care they can give to their patients.
A new report on CLAHRCs (Collaborations for Leadership in Applied Health Research and Care), which work as partnerships between local universities and the surrounding NHS organisations, shows that they are beginning to have some success in doing just this, bringing together researchers and patients with their local NHS trusts to translate applied health research into clinical practice more effectively.
What are CLAHRCs?
CLAHRCs encourage collaboration between the academic community and the NHS to improve health and social care by teaming health researchers in universities with local NHS clinicians and managers. The main aim of the CLAHRCs is to improve patient outcomes by identifying and solving problems within the NHS. In 2008, nine CLAHRCs were set up across England, each with a clearly defined geographical area and developing dependent on the needs of the local community.
This study looked at two of these CLAHRCs (CLAHRC-CP specialised in mental health, whereas PenCLAHRC looked at a broad range of conditions), to see whether they supported local health research, how they achieved this and whether collaboration between the NHS and academics brought about any patient benefit.
What they found:
The study was positive about the work of the CLAHRCs, noting that their flexible approach to collaboration had allowed them to build successful relationships with different partners including patients, NHS staff, commissioners and managers and externally with charities and local authorities. They praised the considerable impact of their projects on the local community. The study concluded that CLAHRCs can play a key role in wider NHS initiatives to promote innovation and bring about wholesale improvements in local health care.
The CLAHRCs started out recognising that clinicians often find it difficult to apply research findings to their work as they do not provide solutions to the specific problems that NHS staff tend to deal with and looked to address this. They experienced some initial resistance from individuals within the NHS unconvinced of their value, but both successfully overcame this to improve engagement with research:
- Both CLAHRCs were able to encourage clinicians and NHS managers focused on health and social care to engage with research through workshops and research fellowship schemes. Doing this successfully relied on frequent personal interactions and the willingness of those working in and for CLAHRCs to act as knowledge brokers to bridge the 'know-do gap', promoting the uptake of research findings into practice.
over time there was a clear change in attitude by some NHS management staff, one of whom was described as initially ‘aggressive and quite cynical’…[and then]… ‘completely turned around’ (Interviewee 2) and saw the value of the work for local services.
CLAHRC-CP talked about ‘the gradual enlightenment on the part of our local authority, voluntary sector and clinical colleagues of the potential value of high quality research to their work’
One senior NHS-affiliated member recounted a talk given by one chief executive of a local trust, where he described ‘why I was originally very indifferent to PenCLAHRC and why I’m now persuaded of its importance’.
- PenCLAHRC focused on patient and public involvement in research with considerable success, leading to more patient-focused research
One of PenCLAHRC's successes has been to engage patients and the public; almost 15% of projects have been initiated by patients and carers who have also been involved throughout the projects and have attended meetings and training courses. One patient described all these possibilities as an ‘Aladdin’s Cave’ of opportunity.
Three commitments underpinned this work:
- funding public and patient involvement adequately
- building on what was already there
- and getting patients to help develop the partnership.
What also contributed was an on-going evaluation to assess levels and types of engagement which demonstrated that initial concerns about whether patients would make a valuable contribution have been completely overturned. There was recognition among academics and NHS staff that their CLAHRC has helped patients and the public become better informed about research and its benefits and has produced more patient-focused research.
One of the major challenges to encouraging the NHS to improve healthcare by being more innovative is the lack of adoption of research findings into clinical practice. Our Vision includes a research charter for commissioners, suggesting that commissioners should work closely with CLAHRCs, local higher education institutions and other relevant bodies to help shape research priorities and ensure the questions they want answers to get asked and findings are interpreted to help them apply the results. This study highlights how effectively this can work:
Another hard-to-reach group was NHS commissioners, not least as primary care trusts (PCTs) were to be replaced by Clinical Commissioning Groups. But what did work well was a CLAHRC arrangement with a consortium of local PCTs that provided them with rapid local assessments of new drugs that could be used to inform commissioning decisions. This had a direct impact locally on the quality of specific commissioning. PenCLAHRC is also collaborating with NICE and with local clinicians, commissioners and patients on a pilot project to identify ineffective procedures which the NHS should stop supporting, prior to national roll-out.
The study also found that even where a CLAHRC is working very successfully, they may not be able to achieve change alone, sometimes coming up against barriers beyond their control:
For example, one project on falls prevention among older people involved changes in the treatments delivered by numerous health care professions in multiple settings, and it proved impossible to align the competing requirements of different service providers and different patient groups.
What does this mean for charities?
As CLAHRCs promote better working relationships between researchers and the NHS, and are also focused on building relationships with local universities, local authorities and charities, they represent another way for charities to become involved in research within the NHS and overcome practical barriers to research findings being used to improve practice.
Some charities have already successfully collaborated with CLAHRCs. The study highlights one charity which provided the initial funding for a pilot health scheme in schools. This allowed a CLAHRC to work with school children, their parents and teachers to tackle obesity by influencing their lifestyles in a practical but enjoyable way. The scheme is already showing signs of success, with initial results suggesting that in the two years following the intervention the risk of obesity in 12 year old children has been substantially reduced.
This year NIHR announced that they are expanding to fund 13 CLAHRCs across the UK which focus on a wide range of health issues including dementia, mental health, stroke and diabetes. This is an encouraging development for any charities which may be looking to fund NHS research in these areas.
Prof. Derek Bell, from the Northwest London CLAHRC is joining us to speak at next month’s annual conference and AGM.