The National Institute for Health Research

The National Institute for Health Research Healer Network, York 17 September 2009 Justin Riordan-Jones R&D Information Manager

Why does the Department of Health want a Research Intensive NHS? Evidence for better health & care Quality gains from the research process International position in Science

Drivers for change There is now a substantial gulf between basic discoveries and converting such discoveries into innovations that directly benefit patients or prevent disease

Drivers for change The UK has the opportunity, through the NHS, to transform the efficiency and effectiveness of clinical trials conducted here Improving National Health; Increasing National Wealth

Drivers for change RESEARCH FOR PATIENT BENEFIT WORKING PARTY FINAL REPORT For us, science and research constitute a front-line service, as they too, reduce distress and pain and save lives. (Dr John Reid, Secretary of State for Health, 22 March 2004) The most significant contribution that the NHS can make to R&D lies in the applied domain, such as trials, clinical effectiveness, service delivery research, and public health. It is critical that incentives exist to reward R&D in the applied domain, which is not the case today.

Drivers for change 100m increase in NHS R&D funding to achieve effective and efficient translation of scientific advances into patient care

Drivers for change We want Britain to be the most attractive location in the world for science

Consultation 2005 New Government Strategy 2006

Vision To improve the health and wealth of the nation through research. To create a health research system in which the NHS supports outstanding individuals, working in worldclass facilities, conducting leading-edge research, focused on the needs of patients and the public.

Our Goals within Best Research for Best Health / NIHR are to: transform research in the NHS increase the volume of applied health research for the benefit of patients and the public develop and support the people who conduct and contribute to applied health research Delivered through: The creation of the National Institute for Health Research (NIHR)

The NHS Constitution..

Handbook to the NHS Constitution Research is a core part of the NHS because it enables the NHS to improve the current and future health of the population. Therefore, the NHS will do all it can to give patients, from every part of the country, with any illness or disease, a right to know about research that is of particular relevance to them and, if they choose, to take part in approved medical research that is appropriate for them.

The Next Stage Review: High Quality Care for All

The NHS Operating Framework The NHS must play its full part in supporting health research. All providers of NHS care will need to increase their participation in research. The national ambition is to double the number of patients taking part in clinical trials and other well-designed research studies within five years. SHAs are expected to ensure that NHS trusts work with the National Institute for Health Research Clinical Research Network locally to contribute to this progressive increase.

Quality Accounts Subject to Parliamentary approval, all NHS providers will be required by law to publish Quality Accounts NHS providers who conduct research will be required to include in their Quality Accounts: the number of patients recruited in the previous year to clinical research (i.e. research which has received Research Ethics Committee approval)

SHA Duty to Promote Innovation SHAs will produce an Annual Innovation Report which sets out progress including: the actions the SHA has taken to support the work of the NIHR Clinical Research Networks locally and to develop the collaborative capacity of the NHS to join in research studies and trials.

Embedding Research in the NHS Primary Care Trusts The NHS Strategic Health Authorities NHS Patients NHS Providers NHS Constitution NHS commitment to the promotion and conduct of research NHS Operating Framework NHS must play its full part in supporting research; National ambition to double the number of patients in clinical research NHS Operating Framework SHAs to ensure that NHS trusts work with NIHR Clinical Research Network locally to contribute to the increased numbers of patients in clinical research Duty to Promote Innovation SHAs to support NIHR Clinical Research Networks locally;shas to develop the capacity of the NHS to support research NHS Operating Framework All providers to increase their participation in research Quality Accounts All providers to report on the number of patients in clinical research Handbook to NHS Constitution The NHS will do all it can to ensure that patients are made aware of research that is of particular relevance to them

A Health Research System Investigators & Senior Investigators Faculty Trainees Associates Infrastructure Clinical Research Networks Clinical Research Facilities & Centres Universities NHS Trusts Patients & Public Research Research Projects & Programmes Research Units & Schools Research Governance Systems Systems Research Information Systems

Change embedded by using programme management Implementation Plans published on the web and updated with any significant change All updated every 6 months Next global update January 2010

A research intensive NHS is a partnership with academia Academics lead research Academic clinicians & NHS staff join in the delivery of research The NHS funds more than just service delivery: Medical Schools Council (2008) Clinical Academic Staffing Levels in UK Medical Schools as at 31 July 2007

Investigators & Senior Investigators Faculty Trainees Associates Infrastructure Clinical Research Networks Clinical Research Facilities & Centres Universities NHS Trusts Patients & Public Research Research Projects & Programmes Research Units & Schools Research Governance Systems Systems Research Information Systems

Infrastructure Clinical Research Networks Clinical Research Facilities & Centres the support and facilities the NHS needs for first class research

Infrastructure Clinical Research Networks Clinical Research Facilities & Centres Clinical Research Networks Clinical Research Facilities Experimental Medicine Facilities Biomedical Research Centres & Units Research Centres for Patient Safety and Quality Research Design Service

NIHR Biomedical Research Centres * Specialist BRCs Manchester* Liverpool* Oxford Marsden* Newcastle* Maudsley* Cambridge Imperial University College Great Ormond St* Moorfields* Guy s & St Thomas NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) Leeds, York & Bradford Greater Manchester Birmingham & Black Country South West Peninsula South Yorkshire Nottinghamshire, Derbyshire & Lincolnshire, Leicestershire, Northamptonshire & Rutland Cambridgeshire & Peterborough North West London NIHR Biomedical Research Units Leeds Musculoskeletal Liverpool Gastrointestinal Sheffield Cardiovascular Musculoskeletal Birmingham Gastrointestinal Bristol Cardiovascular NIHR-supported Clinical Research Facilities Manchester Cancer Millennium CRF CRII CRF NIHR CRF Liverpool Cancer Development Birmingham Cancer Millennium CRF CRII CRF Oxford Cancer CRII CRF Peninsula NIHR CRF Southampton Nutrition, Diet, Lifestyle Respiratory Southampton Cancer Millennium CRF Newcastle Cancer CRII CRF NIHR CRF Brighton NIHR CRF Nottingham Hearing Respiratory Gastrointestinal Oxford Musculoskeletal Imperial Cardiovascular Respiratory Barts & London Cardiovascular Leeds Cancer Hull/York NIHR CRF Sheffield Cancer Development Leicester Cancer Cambridge Cancer Millennium CRF CRII CRF London Cancer x 5 CRII CRFx 4

NIHR Clinical Research Networks

MHRN, recruitment to target Studies ended October 07-08 1.6 1.2 RCTs Randomised Controlled Trials 0.8 0.4 0 Caddy QOF TAS Track Course Dr-Pt communicate PAC-man GenPod IPCRESS Matisse PACT Respond MIDAS-ADHD Gendep Track Choices RCT Target Achieved Til Wykes 2008

Early recruitment to target International RCT of a medicinal product RU-486 70 60 50 40 30 20 10 0 Apr-05 Jun-05 Aug-05 Oct-05 Dec-05 Feb-06 Apr-06 Jun-06 Aug-06 Oct-06 Dec-06 Feb-07 Apr-07 Jun-07 Aug-07 Intended Actual Funder: Stanley Foundation - USA Til Wykes 2008

NIHR Comprehensive Research Network From April 2009 most funding will be activity based

Infrastructure Clinical Research Networks Clinical Research Facilities & Centres NIHR Support for researchers in the NHS Research Design Service Additional CTU support

Investigators & Senior Investigators Faculty Trainees Associates outstanding individuals

Investigators & Senior Investigators Faculty Trainees Associates NIHR Trainees (1) NIHR Fellowships Doctoral Research Fellowships Postdoctoral Fellowships Career Development Fellowships Senior Fellowships NIHR Clinician Scientist Fellowship

Investigators & Senior Investigators Faculty Trainees Associates NIHR Trainees (2) NIHR Integrated Academic Training Scheme Academic Clinical Fellowships Clinical Lectureships

Investigators & Senior Investigators NIHR Trainees Faculty Trainees Associates Increased funding for existing NIHR Training Schemes Increased funding for Clinician Scientist Fellowships and Research Training Fellowships Increased support for project costs in most Fellowships Launch of new NIHR Training Schemes NIHR Clinical Academic Training Pathway for Nurses, Midwives and AHPs NIHR Healthcare Scientists Fellowships NIHR Research Methods Programme Research Capacity Development for the NIHR SDO Programme

Investigators & Senior Investigators Faculty Trainees Associates NIHR Senior Investigators First 163 appointed Directory on www.nihr.ac.uk Selected by independent peer review panel Selection criteria: Quality and volume of internationally-excellent research Relevance of the research portfolio to the health of patients and the public Impact of the research on improvements in healthcare and public health Leadership of the individual in patient and public research

Research leading-edge research focused on the needs of patients and the public Research Projects & Programmes Research Units & Schools

Research for Patient Benefit response-mode projects Evaluations & Trials HTA commissioned projects HTA commissioned systematic reviews response-mode trials Public Health HSR EME for MRC Service Delivery & Organisation Commissioned & responsive projects Research for Innovation Speculation and Creativity (RISC) response-mode projects Invention for Innovation NEAT HTD Health Technology Collaboratives Programme Grants for Applied Research response-mode programmes Research Research Projects & Programmes Research Units & Schools

HTA Budget Developments Increased funding under Best Research for Best Health Increased funding from recent CSR M 100 80 60 40 20 0 2006 2007 2008 2009 2010 Core BrfBH post Cooksey CSR Total

Clinical Trials funded by the NIHR HTA programme 25 20 15 RCTs Responsive commissioned 10 5 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year

School for Primary Care Research School for Social Care Research Research Units Clinical Trial Units Collaborative Public Health Initiatives National Prevention Research Initiative UKCRC Public Health Research Centres of Excellence UKCRC Translational Infection Research Initiative MRC / NIHR cohorts Research Research Projects & Programmes Research Units & Schools

facilitating research and safeguarding patients Research Governance Systems Systems Research Information Systems

Integrated Research Application System (IRAS) Research Capability Programme NIHR Coordinated system for gaining NHS permission National Research Ethics Service & UK Regulatory and Governance Advice Service Research Passports Model Clinical Trials Agreements Research governance and management as an integral part of the NIHR Clinical Research Network Research Governance Systems Systems Research Information Systems

The Innovation Pathway INVENTION EVALUATION ADOPTION DIFFUSION Creation new things new ideas new techniques new approaches Assessment new things new ideas new techniques new approaches Uptake new things new ideas new techniques new approaches Spread new things new ideas new techniques new approaches Basic Research Applied Research Commissioning Patient Care MRC NIHR PCTs NHS Providers

INVENTION EVALUATION ADOPTION DIFFUSION Basic Research Development Pathway Funding MRC Efficacy & Mechanism Evaluation Invention for Innovation Biomedical Research Centres National Institute for Health Research Biomedical Research Units Patient Safety and Quality Research Centres Research for Innovation, Speculation & Creativity Research for Patient Benefit Health Services Research Programme Grants for Applied Research Public Health Research Service Delivery & Organisation Health Technology Assessment This pathway covers the full range of interventions - pharmaceuticals, biologicals, biotechnologies, procedures, therapies and practices - for the full range of health and health care delivery - prevention, detection, diagnosis, prognosis, treatment, care. Collabs for Ldrshp in Appl Hlth Res and Care Ctr for Reviews & Dissemination, Cochrane, TARs NHS Purchasing & Supplies Agency Centre for Evidence-based Purchasing National Institute for Health & Clinical Excellence Guidance on Health & Healthcare NHS Evidence Access to Evidence NHS Institute for Innovation & Improvement Support for the NHS Strategic Health Authorities Duty of Innovation Primary Care Trusts Healthcare Commissioning NHS Providers Patient Care

The Innovation Pathway INVENTION EVALUATION ADOPTION DIFFUSION Creation Assessment Uptake Spread Basic Research Applied Research Commissioning Patient Care total hip replacement invented evidence that hip replacement is clinically and cost effective NICE guidance on hip replacement 97,000 hip replacements performed in England in 2007/08 Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model

National and local approaches to speed up translation INVENTION EVALUATION ADOPTION DIFFUSION Biomedical Research Centres Biomedical Research Units Clinical Research Facilities Experimental Cancer Research Centres Centres for Leadership in Applied Health Research and Care NIHR Evidence Synthesis National Institute for Health and Clinical Excellence NIHR Evidence Synthesis NHS Evidence Academic Health Science Centres Health Innovation Education Clusters

1b + 100m 2005 2006 2011

www.nihr.ac.uk NIHR portal for information & delivering the research:

NIHR is designed to deliver a research intensive NHS NHS Industry NIHR Universities MRC Charities The new emphasis on quality & innovation are key

With thanks to all who have helped get us this far

Indicative funding for health research in the UK 2010-11 Commercial/Private Public Investment/Innovation Donation Taxation Industry 5,100 million Research Charities 830 million Government Funding 2,813 million Science Budget DIUS/DAs Departmental R&D Programmes HE Funding Councils 620 million (mainly for medical schools) Research Councils 890 million (mainly MRC) Department of Health 1,053 million Other Government Departments 250 million

The Cooksey Review strongly supported the strategy of Best Research for Best Health & implementation of NIHR December 2006

Innovation landscape hard wiring of innovation into leadership curricula Implement specific measures to support better forward planning & new ways to measure uptake of pharmaceuticals Empowering staff with incentives such as funds, prizes, tarrifs and education Quicker diffusion & rapid adoption

2 0 legislation SHA legal duty to innovate Guidance to support implementation Directions on how to create changes in attitudes and behaviours to break down barriers to innovative thinking, experimentation & adoption & diffusion of new ideas SHAs will produce an annual innovation report (AIR)

Increased CSR funding for health research through NIHR and MRC

Total funding for health research through NIHR and MRC

So, now that I ve experienced the NHS first hand, I m well placed to make some helpful suggestions on how the service might be improved. And you know what? I m a bit stumped. If I were running the NHS, frankly, I d give everyone a hearty slap on the back, fire a few managers and tell everyone to carry on. Come quick, nurse - the NHS is going frightfully green Jeremy Clarkson From The Sunday Times February 1, 2009

The NIHR Progress Report 2008/09