TRUST RESEARCH STRATEGY

Transcription

1 TRUST RESEARCH STRATEGY October 2015 Final Page 1 of 14

2 INTRODUCTION Overview Nottinghamshire Healthcare is positive about providing integrated healthcare service, including mental health, intellectual disability and physical health services. Over 8,800 dedicated staff provide these services in a variety of settings, ranging from the community through to acute wards, as well as secure settings Rampton Hospital. It also provides healthcare in 13 prisons across the East Midlands and Yorkshire. The services provided by Nottinghamshire Healthcare are delivered by our Local Services Division, our Forensic Division and our Community Services Division. The Local Services Division is responsible for services provided in the community and acute settings. The Forensic Services Division is responsible for providing services to people in contact with forensic services. Health Partnerships deliver physical community healthcare in Nottinghamshire County and Bassetlaw. Research is an integral part of the Trusts strategy over the next five years so to ensure that we deliver the highest possible care and outcomes for our patients. Research active organisations are able to offer leading edge care and also attract high caliber staff. There is research activity throughout the breadth of the Trusts services. Nottinghamshire Healthcare is involved as sponsor, and host/participates in a total of approximately 60 projects a year with a combination of portfolio and non-portfolio research studies. The Institute of Mental Health (IMH) which was launched in 2006 to help transform our understanding and treatment of mental illness, is a partnership between Nottinghamshire Healthcare and the University of Nottingham. The IMH are one of the leading mental health institutes in the UK, offering leadership and innovation backed by world class expertise. The IMH presently has five centres of research excellence; Centre for ADHD and Neurodevelopmental disorders across the lifespan (CANDAL), Centre for Dementia, Centre for Health and Justice, Centre for Social Futures and Centre for Translational Neuroimaging. This structure allows a focus in key themes and programmes for the Trust e.g. recovery, dementia as evidenced by NIHR programme grant submissions in these areas. The Trust are also increasing their portfolio of commercial research activity throughout all of the Trust services, but predominantly in Dementia. The purpose of this strategy is to set out the key aspirations of the Trust over the forthcoming five years, based on the needs of our patients, staff and national/local priorities. We want to ensure that we are maximising the opportunities for our patients to benefit from new advances, including healthcare technology and the evidence base from research. In order to achieve this we need to increase the volume of research within the Trust and increase the speed of translation into clinical practice. We also want to be recognised as a leading research based healthcare organisation with a sustainable and robust infrastructure and active and engaged clinicians. Process to develop the strategy Research has a key role in driving the delivery of high quality innovative clinical services and has always been a key part of the Trusts strategy. Significant work has been undertaken to understand the current barriers and facilitators to research in the Trust through a staff survey and the Executive Leadership Council (ELC) held in May From this the key research strategic aims emerged, which supports the refresh of the Trusts strategy. The Research Governance and Strategy Committee reformed in January 2015, the Committee ensures that the Trust meets and delivers on the requirements of the Research Governance Framework and other related legislation to research delivered within the NHS as well as monitoring the implementation of the previous research strategy. Page 2 of 14

3 THE DRIVERS FOR CHANGE There are a number of drivers for change, national and local, and these have influenced the development of this research strategy. Key drivers are highlighted below: 1. Trust Strategy Develop the Trust through world class research, development, innovation and excellence in education Key strategic projects led by Dr Julie Hankin, Executive Medical Director and Director of Research include: Review and refresh the research strategy Review of our strategic relationships with wider research and higher education community to ensure maximum value back to our staff, patients and service users 2. National drive to raise levels of research and innovation There is a national drive to ensure that searching for and applying innovative approaches to delivering healthcare is an integral part of the NHS doing business. It will significantly improve the quality of care and services for our patients and it will help deliver the productivity savings needed nationally to meet the growing demand for service, and it will also support wealth creation in the UK. Under the coalition government the White Paper: Equity and Excellence: Liberating the NHS (2010) makes extensive reference to the importance of the conduct of research, and the use of research evidence, as key elements of the NHS. "The Government is committed to the promotion and conduct of research as a core NHS role". (Para 3.16). Academic Health Science Networks (AHSN), in particular the East Midlands AHSN s focus is on delivering outcomes more efficiently through the adoption and spread of proven innovations and initiatives at pace and scale. NHS England s Five Year Forward View provides the critical template and strategic context for their business plan. Engaging patients and the public is central to EMAHSN s work, and their establishment of the East Midlands PPI Senate will continue to develop this engagement. Alongside the other AHSNs, they are committed to supporting and driving transformation. For example, all AHSNs will play a role in the implementation of the innovation Test Bed sites for worldwide innovators. Developing new and closer ways of working with industry, and in particular life sciences companies is a vital element of their work. Their industry networking enables them to more rapidly put into practice innovations that can deliver big improvements in patient care, and it also supports a vibrant and successful UK life sciences industry. There is scope for Nottinghamshire Healthcare to develop their relationship with the EM AHSN even further, and building partnerships with the wider networks will be an important component to the research strategy. Page 3 of 14

4 3. National Institute for Health Research (NIHR) Activity and objectives The vision of the NIHR is to improve the health and wealth of the nation through research, the Trust are actively involved in a number of initiatives led by the NIHR. The Trust host a number of staff funded by the East Midlands Clinical Research Network (EMCRN), these staff support the delivery of portfolio research studies across all of the Trust divisions as well as providing the newly formed study support service. The Trust also host staff that support recruitment of participants to primary care research studies, this is as a result of the Service Level Agreement that the Trust have with CCGs in Nottingham City and County and Nottingham CityCare Partnership to provide the research management and governance function. The Partnership Agreement held with the EMCRN and the Trust clearly outlines the objectives of this joint collaboration, the KPIs as a result of this are reported to the Trust Board as required by the agreement. The KPIs are in relation to recruitment to studies, NHS permission times, and recruitment to time and target for example. The Trust are also host to the East Midlands Collaboration for Leadership in Applied Health Research and Care (EMCLAHRC) and a Healthcare Technology Co-operative (HTC), one of eight in the country. MindTech, is the only mental health funded HTC. Both of these research programmes are hosted within the IMH and work with the Trust in supporting the Trusts research agenda. 4. Public Access to clinical research Giving patients access to clinical trials, if they are suitable for them is in the NHS constitution. Patients have the right to be involved in research, both to take part in a clinical study or trial and to get actively involved and have say in how clinical research is done. In particular within the last year the Trust are signed up to Join Dementia Research (Join Dementia Research is a national service that allows you to register your interest in taking part in dementia research studies across the UK. It is funded by the National Institute of Health Research in partnership with Alzheimer s Research UK, Alzheimer s Society and Alzheimer s Scotland). However the Trust needs to further develop this national drive. WHERE ARE WE CURRENTLY WITH RESEARCH Research Activity Overview Nottinghamshire Healthcare intends to build on the research achievements of the past few years which include: Meeting NIHR performance targets for NHS permission times Increased recruitment figures for all research studies (approximately a 50% increase on recruitment between 2013/14 and 2014/15) A total of 59 projects were approved during 2014/ of which were NIHR Portfolio adopted studies and 38 were non-portfolio. 34 studies were approved within the Local Services directorate; 14 studies approved within Forensic; 9 studies approved within Health Partnerships and 2 studies which encompass the entire Trust. Increased involvement of Trust staff in research International reputation in a number of research areas through the Institute of Mental Health NIHR research programmes obtained: East Midlands CLAHRC and the only mental health Healthcare Technology Cooperative (through the IMH) Page 4 of 14

5 Research Funding and Income Nottinghamshire Healthcare receives research income through: EMCRN this funds research delivery staff to support portfolio research studies within the Trust, and also study support service staff. The EM CRN also funds service support costs to clinical services who actively recruit to portfolio research. Commercial research income to deliver commercial studies and to provide capacity funding to R&D and the services to develop research capacity Non-commercial research income to support clinical and support services e.g. pharmacy and phlebotomy in delivering research NIHR Research Capability Funding the funding is to maintain research capacity and capability; support the appointment, development and retention of key staff undertaking or supporting people and patient-based research and contribute towards costs of hosting NIHRfunded or adopted research that are not currently fully covered across NIHR s programmes, and that are not met in other ways Research grant income Potential income not currently generated would be through utilizing Sponsorship Fees, this would be claimed through research grant income to support sponsorship duties undertaken by the R&I team. Key Partnerships Nottinghamshire Healthcare has a number of key partnerships which will support the delivery of the research agenda: EM CLAHRC HEIs EM CRN NHCFT Commercial /Pharma EM AHSN CCGs/Local Authority Page 5 of 14

6 Our strengths, weaknesses, opportunities and threats Strengths Historical levels of recruitment Met relevant research performance metrics to date International reputation for a number of research areas Institute of Mental Health National and International academic partners e.g. University of Nottingham, China, USA, Europe Partnerships with care providers in Europe Motivation and interest of frontline staff Clinical excellence provides potential research areas (e.g. integrated services CYP) Specialist Clinical Services e.g. Forensic Services National Women s Service Patient and Public Involvement in the Forensic Division Improved infrastructure for commercial research Team of highly qualified and experienced research delivery staff EM CLAHRC, EM AHSN and MindTech (Healthcare Technology Cooperative) Weaknesses Systems and processes: research governance, finance and data Dissemination of research evidence/communication Patient and public involvement Barriers: time/capacity, middle management, finance Research Capability of staff Under-exploited research potential in some areas of clinical services Lack of clinical facilities, access to clinical pathology, Biobank, MRI, Lumbar puncture Lack of incorporation of research time into job roles across the Trust Multiple clinical IT systems Research Infrastructure; insufficient clarity of roles and effective utilisation of present resource across the Trust/IMH Opportunities National policy drive Integrated Clinical Pathways Increase collaborations and partnerships with the wider research community NIHR competitive grants other than mental health Commercial - develop further capability for undertaking commercial research Development of CRIS (Clinical Record Interactive Search): evidence, commercial work Research and service evaluation training programme for clinical staff in partnership with the IMH Threats Reduction of research income leading to reduced activity, with associated loss of research active staff and consequent impact on clinical performance Highly competitive environment Loss of clinical services due to tendering processes Insufficient release of clinical time to allow our research active staff to maximise their research potential and thus the income into the Trust Lack of research infrastructure to deliver the strategy Page 6 of 14

7 WHERE WE WANT RESEARCH TO BE The overall vision This is a critical time for the Trust and key partners to jointly develop the research strategy. To take the Trust into next phase of research excellence, the Trust must aspire to be a world class integrated NHS organisation, with developed specialty services, excellence in training and an embedded culture of research. The Trust wants to be in a position where Clear impact for patients, carers and staff is demonstrated from high quality research work which supports provision of the best evidence based services Clinical research is embedded in NHS core business with clear progression from research to practice and clinical staff involvement at all levels Innovation and improved patient outcomes are driven by all staff having the ability to critically appraise current practice and utilize evaluation and improvement methodologies Increased opportunities for patients, carers and service users to be involved in research either by participation, or through collaboration to undertake patient led research within our divisions Routine clinical data readily available for research and service evaluation to demonstrate patient outcomes and drive service improvement i.e. CRIS (Clinical; Record Interactive Search System); case register within Rampton Hospital, comprehensive clinical databases across the Trust Research evidence generated through our projects and data is disseminated widely through our Trust communication pathways and contributes to the overall evidence base by publishing in high impact journals and contributing to NICE guidelines Organisational and corporate research drives and strengthens service improvement Increased collaboration with a wider network of academic, NHS and industry partners Increased commercial research activity, generating income that will improve research opportunities within the Trust Success in winning competitive grants from the NIHR and other bodies that are relevant to our patients and carers across all the Trust divisions Page 7 of 14

8 THE SIX COMPONENTS STRATEGIC OBJECTIVES HOW WILL WE GET THERE In order to achieve the vision these are the key strategic components of the strategy: Develop a culture that places research at the core Establish robust research management policies and procedures Develop our public and patient involvement agenda PATIENTS, SERVICE USERS AND CARERS Develop our commercial research capabilities Promote the implementation of research evidence into practice Develop a wider network of strategic relationships Develop a culture that places research at the core Development of a strong research ethos throughout the organisation in all clinical and managerial areas that will stimulate innovation and support the delivery of high quality clinical services. This will require a shift from the current position where known research activity is concentrated in a relatively small number of individuals or departments whilst other unrecognised activity occurs in ad hoc fashion. Research needs to be viewed as core business, embedded in clinical services. Non-research active clinicians can assist researchers by recognising the value of research to the Trust and facilitating active researchers in many ways. Objectives Provide strong leadership for research in the Trust through: Nominating a Divisional Research Lead and implementing a core research group within the division Organising research priorities at a divisional level and setting divisional research objectives as part of the annual business planning cycle and monitoring performance against them Ensuring all staff understand the role that they can play in developing the research Outcome measures Senior leadership engaged and driving forward the research agenda Strong divisional ownership of the research agenda with clear deliverables Wide ownership of the importance of the research agenda across the Trust Increased participation and recruitment to research studies Page 8 of 14

9 agenda, and provided with the support to do that Actively recruit, develop and retain the highest quality research active staff through: Identifying, developing and maintaining a cohort of active NHS and academic Trust staff who achieve excellence in research Providing training in basic and clinical research for new and developing researchers Establishing performance indicators for NHS staff as well as academic staff and monitor their achievement Rewarding/recognising success in research at all levels through academic promotion, allocated research time and through Trust wide communication A well regarded, research active workforce as measured through: Academic (peer reviewed publications, conference presentations) Number of Trust staff acting as Principal or Chief Investigators or local collaborators Number of Trust staff acting as supervisors for students undertaking academic qualifications Promote the implementation of research evidence into practice Development of an effective communication plan Trust wide using the expertise of the communication team and library services and working with the Institute of Mental Health, CLAHRC and the AHSN in getting research into practice quicker. Objectives Improve dissemination of research findings and translation into clinical practice Raising the profile of research across the three divisions Identification of clinical need and gaps in the evidence base, developing research grant applications which meet divisional priorities and with clear programmes of research activity Providing regular R&I communication with staff, patients and wider community to demonstrate the value, benefit and need for clinical research Quarterly publication of the Trust s research portfolio and outputs Develop a communication strategy with the Trust and the IMH Outcome measures Greater transparency in the research we do Grant applications that meet the needs of services across all divisions within the Trust Faster translation into clinical practice, thereby benefitting patients Contribution to the evidence base by publications in high impact journals and NICE guidance Page 9 of 14

10 Develop a wider network of strategic relationships The Trust is perfectly placed to build a wider network of strategic relationships within the local health economy to maximise research opportunities to benefit patient care. Close collaboration and productive working relationships are essential to encourage more high quality applications to competitive funding bodies, particularly the NIHR. The Trust need to develop further collaborations with relevant HEIs, NHS organisations and also local industry by linking in with the expertise and work already developed by EM CLAHRC and the EM AHSN to improve the quantity of research output. Objectives Increase collaboration between the Trust and the wider community to maximise our research opportunities Identify research priorities for all three divisions Identify key partners to develop new opportunities for innovative research as identified by the divisions Outcome measures Increased number of joint applications to funding bodies Increase funding opportunities for physical health capitalising on the clinical expertise in Health Partnerships Develop our commercial research capabilities The Trust have been satisfactory in partnering with industry to run clinical trials and this has been greatly supported by the research delivery staff funded by the East Midlands Clinical Research Network (EMCRN), however we need to build on this and increase commercial research to provide early access to new therapies to our patients and also to increase commercial income to build on our own research capacity. The Trust have also invested in the Clinical Record Interactive Search (CRIS) which will enhance our capabilities of undertaking commercial research. The Trust will advertise and market its clinical excellence, wide breadth of clinical services and streamlined R&D processes to the pharmaceutical industry. The Trust will aim to establish mutually beneficial relationship s with industry and a reputation of excellence to make Nottinghamshire Healthcare a preferred partner for commercial research and innovation Objectives Increase our capacity to deliver commercial studies Work with divisions to provide suitable accommodation and support for commercial studies Work with pharmacy to provide a clinical trials facility for investigational medicinal products Train our clinicians for the role of Principal Investigator Increase income from commercial clinical trials through proactive work with the pharmaceutical industry to advertise excellence, build links and be responsive to industry needs Outcome measures Success will be tracked by using indicators such as: Achieve an increase in the number of commercially sponsored studies Increased levels of recruitment to commercial trials Achieve an increase in income associated with commercial research Increased number of directorates undertaking commercial research Utilising commercial income to increase our research capabilities and capacity Page 10 of 14

11 Develop marketing material to promote our clinical excellence and capabilities to attract opportunities Work with the EMCRN Industry Team to seek out opportunities Develop links already in place with Trust pharmacy Develop our public and patient involvement agenda Patient and public involvement (PPI) in research is an important part of the research that the NIHR fund as well as being part of their research commissioning and management processes. The NIHR expect researchers to actively involve the public in their research. In addition as part of the NHS constitution that patients can ask about research and should be able to access research studies to take part in. the Trust are actively supporting the national initiative Join Dementia Research, but we need to look to involve our patients more in the development of our research priorities and strategies. The Trust Involvement Centre is pivotal in developing this component of the research strategy and also the Trust need to engage further with the EMAHSN for support that have done significant work in this area. Objectives Develop a public and patient involvement strategy in collaboration with the IMH with the support of the EMAHSN Active role in the development of divisional research priorities Active role in research grant applications Outcome measures Faster implementation of evidence into practice to improve clinical outcomes and patient experience Establish robust research management policies and procedures The NIHR and commercial bodies are setting increased challenging timelines and quality standards for research. In order to meet these standards the Trust will require efficient and transparent governance and financial systems for R&D. In addition as the Trust increase their role as sponsor and continue to undertake an increased number of complex studies, the Trust will need to ensure that the appropriate policies and procedures are in place. With the greater need of transparency and meeting the required quality standards in research, it is important that the work undertaken by the IMH in relation to research grant management and sponsorship and any other Trust related R&D tasks is clearly governed. Objectives Ensure compliance with all regulations surrounding research in the NHS (Research Governance Framework and ICH GCP) e.g. sponsorship roles and responsibilities Outcome measures Systems and processes are compliant and meet regulatory standards Develop an efficient and transparent financial Research income and expenditure can be Page 11 of 14

12 system for research income and expenditure across the Trust including divisional research budgets Maintain a management and information system to record research activity and outputs Develop both internal and external websites for research to provide the relevant information to our staff and our patients/service users, ensuring relevant links into the IMH Develop an efficient and robust system for the management of Intellectual Property as a result of research and innovation developed by the Trust effectively tracked across the Trust DOCUMAS system can be used to develop KPI framework and track progress of research across the Trust Well used, information websites for staff and patients/service users/carers/public Actively advertising relevant national initiatives e.g. Join Dementia Research A robust and comprehensive system for the management of IP Ensure clear roles and responsibilities which define accountabilities and finance/performance metrics An Accountability Framework to effectively demonstrate divisional and IMH against performance and quality standards of research to which the R&D Director is accountable. IMPLEMENTATION: HOW WE ACHIEVE OUR OBJECTIVES The main drivers of this research strategy are to increase the amount of research across the Trust and to engage all our staff at all levels in being curious about their work. We need to harness the enthusiasm and capacity of individuals to do this, supported by a strong infrastructure to deliver. Implementation plans will be developed at Trust and Divisional level and these will be overseen by a restructured Research Strategy Group with regular reports on progress to the Trust Board via the Quality and Risk Committee. A detailed implementation plan will be produced to outline the objectives and milestones. Figure 1 below highlights the research structures within the Trust. Figure 1: Trust Research organisational structures TRUST BOARD QUALITY AND RISK COMMITTEE (via effectiveness group) IMH BOARD RESEARCH STRATEGY GROUP IMH STRATEGY DEVELOPMENT COMMITTEE DIVISIONAL RESEARCH GROUPS RESEARCH OPERATIONS MANAGEMENT GROUP (To be set up) INSTITUTE LEADERSHIP TEAM GROUP Page 12 of 14

13 The IMH will support the implementation of the strategy and the IMH mission (appendix 1) supports the needs of the Trust strategies as well as the University. There is opportunity to further strengthen the work of the IMH by capitalizing on the breadth and depth of clinical activity and the enthusiasm and curiosity of high quality NHS staff to inform research questions, collaborate and deliver high quality research. There will be a clear framework of the roles and responsibilities of Trust R&D which will be supported by the IMH and the Trust R&I team. Roles and responsibilities for both IMH and Trust R&I are highlighted below in Table 1. Table 1: Trust R&D roles and responsibilities TRUST R&D Executive Responsible: Medical Director IMH Research Grant Submissions JOINT Portfolio Research Sponsorship IPP Finance Training Performance Management Research Management Systems Management and Governance of research staff TRUST R&I Commercial Research Non-Portfolio Research Small service evaluation and improvement projects SLA with Nottingham City CCG, Nottinghamshire County CCGs and Nottingham CityCare Partnership Non IMH Research Grant submissions Monitoring performance Annual metrics to evaluate the successful implementation of this research strategy will be developed and reviewed. This will include a set of metrics tailored to each of the divisions and set of high level objectives that will be monitored by the Quality and Risk Committee on behalf of the Trust Board. Review This strategy will be reviewed periodically to ensure that it is still up to date and is delivering the intended outcomes. Page 13 of 14

14 Appendix 1: The Institute of Mental Health Vision/Objectives Mission The mission of the Institute is advancing mental healthcare through excellence in research and education. The Institute will take a multi-disciplinary approach across the age range making the best use of patient and public involvement to improve the experiences of patients (and carers) and to promote innovation, evaluation and clinical excellence across NHS services. The Institute will address the diversity of mental health needs including dementia and learning disability plus health behaviour approaches to improve health including prevention and public health approaches. Further work will incorporate: innovation in research methods and in teaching; implementation of evidence into practice; plus dissemination, impact and policy initiatives. Vision To be acknowledged as the leading centre in the UK for applied mental health research and education, recognised as one of the top five in Europe and widely acclaimed for international and world-leading excellence. The vision will complement and be compatible with the wider vision of the University of Nottingham, and of the Nottinghamshire Healthcare Foundation Trust. The pursuit of this shall include the development of a framework to help identify the priority given to activities with markers of impact, research and education excellence, purpose and value. Income alone may not be sufficient reason to support a specific activity. Activities which have great strengths in terms of impact, research excellence, purpose and value will be given high priority. Strategic Objectives 1. To build the research capacity through attainment of major research grants, PhD students, research fellows, and new academic posts, in conjunction with advances in research methodology, and work to assist in the formulation of research grants including relevant local evaluation. 2. To pursue excellence in research indicated by high impact and other major peer reviewed papers, presentations at major national and international conferences, and other significant academic contributions. 3. To build excellence in education through specific nationally renowned courses, international students, methodology courses, and through supporting relevant University-led courses such as the MSc in Mental Health Research. For University based courses the involvement of the Institute will vary according to circumstances. 4. To produce a sustainable framework for to the long-term future of the Institute taking a prudent and considered approach to financial risks with a view to also generating a development fund for future initiatives including research capacity building. 5. To enhance impact; getting research into practice, delivering and disseminating accessible evidence, international collaborations, policy and practice initiatives, clarity over the image of the Institute and the Centres, and with exemplary work on communication, media and branding. To improve the experiences of service users through; improving mental healthcare, providing opportunities to participate in research, and working with the public, patients and family carers to make the most of their contributions to the research process at all levels. Page 14 of 14