Recognising research: how research improves patient care

Research active institutions help develop physicians and improve patient care, argues Dr William van’t Hoff and Dr Edwin Selvaratnam.

Research has long been supported and recognised by clinicians for its importance in healthcare; it’s one of the main drivers in providing evidence-based improved treatment and care options for patients. However, clinicians feel overstretched and unable to find time for research. In many organisations there is a perception that research is ‘someone else’s business’. 

Since its inception in 2006, the NIHR has made significant progress in facilitating research in hospital and care environments by providing funding and research support to clinicians. In 2016/17 more than 665,000 patients across England took part in around 5,000 research studies on the NIHR Clinical Research Network Portfolio. While this has been a step-change improvement, many hospitals have not been able to really integrate research into clinical care across all their specialties. There are still limited opportunities for patients to participate and for doctors to feel empowered to conduct research. The NIHR has therefore developed a key focus on NHS engagement, aimed at helping NHS and care organisations recognise the importance of research in improving health and patient care. 

Historically, it has been difficult to demonstrate that research not only has academic benefits but is directly associated with improved patient outcomes. A growing body of evidence is now demonstrating that research-active hospitals have better patient outcomes. A recent study of over 200,000 patients with colorectal cancer, in 150 trusts, found that patients treated in hospitals where research participation was high, had a mortality rate in the first 30 days after major surgery of 5%, and a survival rate at five years of over 44%, compared to mortality of over 6% and 5 year survival of 41% for trusts with no / little research activity. This work showed that even patients who are not involved in the trials themselves benefit from being in research-active hospitals. This work showed that even patients who are not involved in the trials themselves benefit from being in research-active hospitals. Similarly, in a review of obstetric and gynaecology studies, women participating in trials had better health outcomes than those cared for outside trials.

There are still limited opportunities for patients to participate and for doctors to feel empowered to conduct research.

These and other evidence led the chief medical officer to recommend in her
 2016 Annual Report that the Care Quality Commission (CQC) should have as one of its characteristics of a ‘Well-Led’ organisation, an assessment of support for opportunities for patients to join cutting-edge research projects and clinical trials. Building on this, the NIHR is working with the Health Research Authority (HRA), the Medicines and Healthcare products Regulatory Agency (MHRA) and the CQC on a 1-year project to integrate indicators of research reflecting quality of care, into CQC’s monitoring and inspection programme. 

The partnership also includes patients and members of the R&D community to ensure
the research indicators are for purpose and relevant to patients. Paul Charlton, an NIHR patient research ambassador collaborating on the project, describes what he hopes this project will bring for patient care: ‘When it’s our own or our families’ care at our local hospital which is in the headlamps, knowing that the best research evidence is informing that care, is a fundamental reassurance. Why wouldn’t we look for assurance that our hospital is engaging with research? It’s just common sense.’ 

Integrating research into assessments is
a new development for CQC but since the partnership began in October 2017, much has already been achieved including: developing 
a range of markers of research opportunities for patients, guidance and prompts on clinical research for inspectors and development of an educational programme for CQC on research.
 A question on research opportunities for patients has been accepted within the Annual Survey of Patient Experience which should really highlight the opportunities for patients and the variation at trust level. 

Reinforcing the relationship between research and quality of care brings with it a responsibility to demonstrate good research activity and processes. 

This work should enable trusts to demonstrate how they both offer patients opportunities 
for research and facilitate research processes. Some trusts have a strong portfolio of research but even for these, are opportunities equitable across all specialties and for all patients? Other trusts have much less research activity and it is hoped that this initiative will help them recognise that research both drives high-quality patient care and is highly rated by participating staff and patients. Reinforcing the relationship between research and quality of care brings with it a responsibility to demonstrate good research activity and processes. 

Initial feedback about the project from 
the research community has been positive, yet there is a natural level of anticipation in what trusts will be expected to demonstrate. The project partners are clear that this work
is designed to be supportive to developing improved opportunities for research, while also highlighting the importance of research to those trusts with less activity. Therefore, in parallel, the NIHR and R&D community are positioning themselves to support all trusts 
to take advantage of this national focus on the relationship between research and quality of care. Professor Margaret Johnson, RCP academic vice president, said: ‘I am pleased to see the fantastic progress that has been made to further embed research in the NHS, yet protected time must be the key issue. 
All patients should be able to benefit from research and we have the clinicians to provide this, if given the time and skills needed. We will work with the NIHR, CQC and others to ensure doctors are able to make research available 
to all.’ 

Dr William van’t Hoff is the clinical director for NHS engagement, National Institute for Health Research’s (NIHR) Clinical Research Network. 

Dr Edwin Selvaratnam is the national medical director’s clinical fellow to chief inspector of hospitals at the Care Quality Commission.

This article will feature in the June edition of Commentary magazine.