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A vision for the future of clinical research

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This week the UK government published new guidance setting out plans for the future of clinical research across the country.

Saving and improving lives: the future of UK clinical research delivery notes that research is crucial in improving healthcare – including in determining what doesn’t work, as well as what does. It comes hot on the heels of a report from Cancer Research UK (CRUK) last month, Creating time for research; both documents acknowledge the value of the increased public recognition of the importance of innovative research in the NHS, with the CRUK document calling thisan unprecedented opportunity for a paradigm shift’ whereby where research becomes an integral part of healthcare delivery.

Embedding clinical research and supporting staff

The government paper recognises the issue highlighted by the PHG Foundation in submissions to the NHS Long Term Plan and Topol Review consultations: that normal NHS staff are hard-pressed to deliver clinical research, which is largely the preserve of specialised ‘clinician researchers’ with dual academic and clinical appointments. Many health professionals support research efforts (and indeed, the development of policy, clinical guidance and other vital measures to translate research findings into clinical practice) in their own time, with no formal recognition for this extraordinary dedication. This clearly needs to change.

We called for a much wider range of health professionals to be given protected time away from clinical duties to take part in research, and the professional recognition of the value such activity brings to the NHS.

Saying that ‘delivering research is everyone’s business across the NHS’, the government promises to deliver a ‘research positive culture’ where staff ‘feel empowered and supported to participate in clinical research delivery as part of their job’. This is very promising, although at this stage no detail is given as to how this will be achieved in a generally under-staffed and over-stretched workforce: probably not overnight. The CRUK report similarly observed that: ‘Addressing chronic staff shortages in the NHS is a critical issue, one that requires a sustained and comprehensive response’

Policy makers would perhaps do well to take the CRUK recommendations into account in shaping detailed plans. These included:

  • Fully funded pilot programmes that offer a proportion of health service staff contracts that include dedicated time for research.
  • Long-term funding for health research that keep pace with inflation
  • Regional reviews of clinical research activity and additional funding for increased research engagement in underserved regions
  • Local increases in the visibility and accessibility of dedicated time for research to expand research engagement amongst staff, especially under-represented professions.

The government paper does also include proposals for ‘new non-clinical research delivery roles’, and career paths within the NHS, and for support for healthcare professionals ‘to develop research skills relevant to their clinical role’, which are positives.

Centring patients and participants

The report recognises that access to involvement in clinical research is varied across the UK, and that patients, families and carers need support to consider opportunities for involvement in relevant research. It calls for the integration of research in day-to-day care, and combining new technologies with minimal in-person visits to make participation as easy as possible. The new Integrated Care Systems in England are highlighted as one vehicle to drive research aimed at local population needs and ensure equal access to that research from across that population. There is also an emphasis on the involvement of patients and service-users in the design of clinical research, to align the aims and study designs with the priorities and needs of participants

A new blog by NHS England Deputy Director of Research Alison Austin similarly notes that research is ‘not limited to big teaching hospitals with links to universities’ and that enabling a much wider geographical spread and diversity of people who get involved in research will be strongly beneficial.

Streamlined for success?

During the pandemic, we saw rapid but robust research delivery and regulatory oversight delivered at scale and at speed in a whole range of different areas – new tests and treatments, equipment, management approaches. The government is now keen to keep up the pace, building on these unquestionable successes to make the UK ‘the best place in the world to conduct streamlined, efficient and innovative clinical research’.

One important element in this is acknowledged to be digital systems to collect and share ‘accessible, interoperable and high-quality health data’ and enable effective research, from recruitment and engagement through to delivery and analysis. Now the report sets out plans to ‘unleash the true potential of data-enabled clinical research delivery’ by improving interoperability between major data assets, including UK BioBank, the NIHR Bioresource, Genomics England and many more.

The bigger picture

This latest government document forms just one part of many related policy ambitions and plans, including those set out in the NHS Long Term PlanLife Science Sector Deals, National Data Strategy (NDS)Genome UK Strategy. No doubt it will also align with the forthcoming NHSX Health and Social Care Data Strategy and major research initiatives such as Our Future Health, already pioneering trusted research environments and innovative public engagement approaches.

There’s little room for doubt that there is an ongoing drive towards improving health and wealth in the UK through world-leading clinical research and practice. This has been ten years in development already, and with the right will and the right execution, ten years from now could see a complete transformation.

However, execution will inevitably require clear and consistent national leadership (coordinated across the devolved administrations, as is explicitly intended) combined with real boosts to funding and staffing. This would be a challenge to any government, let alone one faced with the massive economic impact of the COVID-19 pandemic will. Concern is also growing over expected cuts to scientific research funding in the light of these financial pressures. It seems that clinical research is likely to be protected, but until more details emerge, the immediate prospects for these positive plans remain uncertain.

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