The NIHR. NIHR: health research in Professor Stephen Smye Specialty Cluster Lead, NIHR CRN, King s College London. Clinical Research Network

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1 The NIHR NIHR: health research in 2030 Professor Stephen Smye Specialty Cluster Lead, NIHR CRN, King s College London

2 Why? trends-in-coronary-heart-disease

3 Why?

4 Impact on the system Better patient outcomes at research-active hospitals A study tested whether hospitals with a high level of participation in bowel cancer trials have improved outcomes for all patients with bowel cancer For patients treated at hospitals with a high level of research the mortality rate was 5%, compared to 6.5% in less research-active hospitals And 44.8% of patients were still alive five years after initial diagnosis, compared to only 41% Even patients who are not involved in the trials benefit from being in hospitals where a large amount of clinical research is taking place: GUT article

5 NIHR impact on clinical trials NIHR established funded by the NIHR HTA programme Responsive commissioned

6 National Institute for Health Research: an integrated health research system Invention Evaluation Adoption Early-phase clinical Research Late-phase clinical Research NIHR Biomedical Research Centres NIHR Clinical Research Facilities Experimental Cancer Medicine Centres > 0.5 billion p.a. investment in relevant infrastructure to support clinical research at all points in development pipeline Health Technology Cooperatives Diagnostic Evidence Cooperatives NIHR Collaboration for Leadership in Applied Health Research and Care

7 30 clinical specialties GUY S AND ST THOMAS NHS FOUNDATION TRUST UNIVERSITY OF LEEDS CONSORTIUM NEWCASTLE UNIVERSITY IMPERIAL COLLEGE LONDON PA CONSULTING ALLIANCE UNIVERSITY OF LIVERPOOL KING S COLLEGE LONDON

8 Breakthrough research Cystic Fibrosis gene therapy study Since 2012, the goal of gene therapy for cystic fibrosis has been to replace the faulty gene in the lung with a healthy one Previous attempts to do this using a virus failed Patients who received gene therapy showed a modest, yet significant benefit in lung function when compared with the placebo group

9 NIHR

10 Key statistics 2016/17 Recruitment into NIHR CRN Portfolio studies in England

11 Europe 15/16 Data source: 1. France UK Germany Spain Italy 863 (All studies received from 01/04/2015 to 31/03/2016 funded by industry and non commercial organisations) Retrieved online on 23/01/2017

12 Trainees

13 Clinical academic careers (women) Medical Dentistry 35% 30% 25% 20% 15% 10% 5% 0% Professors Overall 35% 30% 25% 20% 15% 10% 5% 0% 2004 Professors Overall 2015 following the April 2016 awards round, more than half of medical school departments hold an Athena SWAN Silver award. 1 1 Medical Schools Council (2016) A Survey of Staffing Levels of Medical Clinical Academics in UK Medical Schools as at 31 July 2015

14 Evidence of NHS impact 74% NICE CGs cited NIHR HTA studies ( )

15 Patients and the Public central to NIHR s mission 97% of the public believe it s important the NHS supports research into new treatments Source: Ipsos MORI poll (June 2012) commissioned by the Association of Medical Research Charities, Breast Cancer Campaign and the British Heart Foundation

16 Building on 10 remarkable years The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR plays a key role in the Government s strategy for economic growth, attracting investment by the lifesciences industries through its worldclass infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world.

17 NIHR: health research in science - system - society

18 dcommunity/populationandmigration/populat ionestimates/articles/overviewoftheukpopula tion/july2017

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20 Multimorbidity Barnett et al

21 Public health Obesity Anti-microbial resistance Air pollution

22 Imprecision medicine (Schork NJ, 2015, Nature, 520, )

23 Unravelling the geno- to pheno- type map Nature vol 527, S14-S15, 4 November

24 Comprehensive assessment of phenotype (plus 70M imputed genetic variants) 500, , , ,000 Consent / Questionnaire Cognition Diet Respiratory function 500,000 95,000 Data are available for healthrelated research that is in the public interest: 10, ,000 60,000 Exercise / ECG Multi-modal imaging Physical activity Retinal imaging

25 Building a genomic medicine infrastructure Genomics England Illumina - NHS Genomic Medicine Sequencing Centre in Hinxton UK Data Infrastructure for Genomic Medicine (with MRC) NIHR National Biosample Centre - 24 million state-of-the-art facility to store the samples 13 NHS Genomic Medicine Centres in England to enrol, validate and feedback to patients

26 Precision trials Maughan et al

27 Trials Adaptive..an adaptive design clinical study is defined as a study that includes a prospectively planned opportunity for modification of one or more specified aspects of the study design and hypotheses based on analysis of data (usually interim data) from subjects in the study pdf N-of-1 a key component will be transforming everyday clinical care into solid N-of-1 trials Schork NJ 2015 Nature 520, Real world

28 Big data When you can measure what you are speaking about, and express it in numbers, you know something about it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science. William Thomson, 1st Baron Kelvin

29 Linking routine clinical data University of Leeds and Leeds Teaching Hospitals working with with N&Y Cancer Registry & Information Service and HSCIC Linked cancer registry and HES data Impact of co-morbidity at diagnosis on overall survival and recurrencefree survival All Cancer A Cancer B Courtesy of G Hall, University of Leeds

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31 on.ibm.com/researche r/view_group.php?id= 4384

32 Co-morbidities Hidalogo et al 2009 PLoS Comp Biol

33 Platform science -omics informatics behavioural sciences

34 Interdisciplinarity

35 NIHR: health research in science - system - society

36 Evaluating change at scale stroke services

37 Impact on the system Report by RAND Europe identified 10 high impact studies funded by the NIHR HTA programme which, if implemented, could save the NHS budget 3 billion a year.

38 Improving the system NIHR Dissemination Centre

39 Distribution of need. Dementia in women (L), heart disease (R)

40 Spatial map of number of studies vs chronic disease burden (CCG level) Is research done where the needs are greatest? An analysis of the relationship between NIHR research activity and disease burden E Kontopantelis, P Bower, University of Manchester & NIHR School for Primary Care Research

41 Capacity of the system NIHR academy simplify schemes strategic & responsive modes partnerships with industry NIHR incubators

42 Trainee Engagement

43 NIHR Partnerships

44 Industry

45 Cost of developing novel therapies DiMasi et al 2016 Journal of Health Economics

46 Health & Wealth Health Advanced Research Programme Digital pathology & AI 2000 discovery scientists 50% more trials in 5 years 4 UK companies > 20bn NHS top quartile for adoption

47 NIHR: health research in science - system - society

48 Dialogue

49 Streptokinase for the treatment of acute MI (cumulative meta-analysis)

50 Value of information analysis (VOI) When should we focus on implementing the findings of existing research? When is there enough evidence and further research is not needed? Is a particular research proposal potentially worthwhile? Should it be prioritized over other research topics? Are sufficient resources being devoted to evaluative research compared to providing health care? Ref; Claxton K, Sheldon TS, University of York

51 Patient engagement

52 Global Health

53 Future clinical researchers

54 Platform science -omics informatics behavioural sciences

55 Quantitative "If you want a career in medicine these days you're better off studying mathematics or computing than biology."

56 Trans-disciplinarity

57 Team science

58 Key areas multi-morbidities mental health public health health systems

59 Every patient?

60 Every trainee?

61 NIHR: the next decades Acknowledgements; some material draws on RCP(London) Harveian Oration 2017, by Professor Christopher Whitty, FMedSci