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NHS R&D Funding Consultation Paper: Priorities and Needs R&D Funding - Response from theCPHVA

 

Overall, the CPHVA welcomes the clear intention to ensure that high quality research evidence is produced to serve the needs of the NHS and the populations it serves. In particular, we support the plans to ensure that evidence informs decision making in practice and is directly relevant to health care professionals and managers, and users of health services.

2. Guiding Principles

These operational principles will help to ensure that the key R&D requirements of the NHS are met. In addition, the principle of fairness and equity in the deployment and allocation of funding should be emphasised, particularly as some sectors of the health care and health care research community have in the past found it difficult to access R&D funding (including professional groups such as community nurses and health visitors).

Specific comments in relation to the principles are as follows:

2.2/3 Strategic leadership

It is important that consultation with the NHS is open and inclusive, involving both practitioners and users. Professional organisations such as the CPHVA are in a position to gather together the views of different groups of health care professionals to feed into the process of identifying important and urgent researchable questions.

A strategic view is needed, not only to ensure that R&D funding responds to the NHS priorities outlined, but also to ensure equity and fairness. Much of the work undertaken in primary and community care is addressing the ‘broader needs of improving health and the quality of health and social care, and the health priorities of particular populations’. It is therefore important that R&D funding is not solely concentrated on the priorities identified in the National Plan and National Priorities Framework, to the detriment of these broader health needs.

2.4/5 Strategic and collaborative partnerships

The relationship between NHS and academia has historically been different for doctors and for other staff groups. Though we see some successful experimentation with joint appointments at a variety of levels, secondments etc., the reality of a collaborative approach often remains difficult to achieve. Appropriate incentives to both academia and NHS to provide facilitative environments and opportunities for collaboration need to be considered.

2.6/7 R&D for NHS goals; 2.8 High Standards of governance; 2.9 Responsiveness to the needs of decision makers

The CPHVA welcomes the emphasis on the practical application of research and the intention to favour work that involves users and decision makers at all stages of the research process. More detail is required regarding how to ensure that practitioners at a local level are engaged in R&D activities.

2.10/11 Accessible Knowledge

The CPHVA recognise the importance of making research based information widely available in accessible forms, and is able to support and develop dissemination of research within community and primary care.

More detail is required regarding how NHS R&D will support evidence-based practice at the practitioner level. Funding for research training and development, for bursaries and studentships must be made available to build research capacity. This must be concentrated on specific areas and on groups of professionals where funding has been lacking in the past (such as nursing and health visiting in primary care).

2.12 Accountability for delivering results

Whilst we would be in favour of the devolution of strategic leadership where appropriate to NHS and academic groupings, we believe that nursing is likely to be very under-represented in this due to the relatively poor development of research career pathways.

3. Setting priorities and identifying R&D needs

3.1-3.4 Priorities

Although this paper sets out the process for priority setting in the NHS as a whole organisation, there also needs to be a clear mechanism for health care professionals and service users (including potential users) to feed in to the priority setting process at local and national levels. Furthermore, more details are needed explaining how priorities will be widely communicated to all professional groups and the public.

n setting priorities and identifying needs for R&D, we feel that it is important for professional organisations to continue to be included as expert stakeholders. In our own area, of community nursing and health visiting, where practitioners are outnumbered by hospital colleagues, it is particularly important to ensure this. Practitioners as well as managers and academics need to be heard in setting priorities. The CPHVA has members in all these areas, and is able to collate their views.

We are also concerned that despite the proposed involvement of local authorities in setting priorities and identifying needs for R&D, there could be an over-emphasis on a medicalised agenda for R&D. Community nursing and health visiting work is concerned with promoting and sustaining the health of communities and populations, and work is needed to investigate the impact of social and economic inequity in relation to this.

3.5-3.8 Broader NHS needs

The CPHVA welcomes the emphasis on the involvement of PCGs and PCTs in identifying R&D needs and opportunities for local practitioner and user input. We support the intention to gather a broader range of perspectives in order to balance the advocacy of researchers with specific interests. There needs to be clear mechanisms regarding how health care professionals and users can influence local priorities. In particular, we would like to see transparent methods for seeking out the views of practitioners, managers and users and communicating them to researchers.

4. Delivering Knowledge for health

4.1-4.8

Better leadership and support for public health and primary care research and development is crucial for primary health care professionals to take forward the current health care agenda. The CPHVA acknowledges that progress has been made in R&D in primary care, but there is still much work to be done to increase research capacity and engage health care professionals, particularly community nurses and health visitors. We are pleased that Public health R&D will be integrated with NHS R&D funding systems and look forward to opportunities to develop the knowledge base of public health practice, particularly research concentrating on the public health roles of health visitors and school nurses. Such public health research will need to cover all three linked themes (Health of the population, Innovation and Quality of Care) and include a broad range of methodologies, including ‘softer’ qualitative methods.

4.9-4.18 Organisation of NHS Priorities and Needs R&D Funding

As research career pathways are not well developed in nursing and health visiting, the CPHVA would like to see a commitment to multidisciplinary/multiprofessional collaborative groupings, ensuring that nursing and health visiting are represented. Such collaborations must also increase opportunities for user involvement in research.

Many community nurse/health visitor researchers are isolated and would benefit from collaborative research networks. More detail is required regarding how these will be organised and supported.

4.19-4.22 Procurement

A more diverse approach to commissioning is welcomed. Mechanisms must be in place to ensure that practitioners at the client/community interface, and users themselves, are involved in nationally led programmes, as well as programmes delegated to regional and local levels. There still needs to be a strategic view to monitor and enable equity of access to funding, and ensure that groups such as community nurses and health visitors are part of the commissioning process.

4.23-4.24 Standards and Monitoring

It is important that NHS Priorities and Needs R&D funding supports a mixture of research approaches and methodologies, including high quality qualitative research. Much research relating to community nursing and health visiting, and to public health practice, uses qualitative methods and methodologies and should be encouraged and supported by NHS R&D funding programmes.

5. R&D Capacity

5.1-5.2

Effective capacity building at all levels is crucial. A majority of community practitioners and health visitors are now graduates, and an increasing number are undertaking Masters level study. It is important that those practitioners who are interested and have aptitude for research beyond this level are supported to gain greater experience and, where appropriate, to undertake full or part-time study for a research degree. At present the difficulties for such people are 1. In providing an appropriate environment to support research activity when practice demands are heavy and 2 in locating appropriate supervisors and a supportive academic environment sufficiently close at hand. Many, though not all of those who complete doctoral study currently end up moving into academic posts. However, there are currently few funding opportunities for post-doctoral work, and some able people find themselves submerged in teaching. Again the availability of appropriate supervision and a supportive multidisciplinary environment are problematic at present. This is a particular problem for people based in community settings, often distant from academic institutions, and also for professions dominated by women whose family and other commitments may restrict their level of mobility. The current generation of research leaders in community nursing and health visiting will mostly retire in the next 15-20 years. Over that period, more needs to be done to develop the next generation: initiatives such as the career scientist posts for primary care need to be widened, once post-doctoral initiatives have been in place for a while.

6. Knowledge Management

6.1-6.3

As stated earlier, much of the research relevant to community nursing / health visiting and public health practice employs qualitative methodologies and a mixture of qualitative and quantitative methods. There is an urgent need to develop and support ways to bring together, interpret and disseminate the findings of this research in the same way that systematic reviews and meta-analyses bring together the findings of RCT’s and other ‘scientific’ research.

ncreased use of electronically accessible databases is likely to facilitate the dissemination of research evidence into practice as well as more effective research collaboration. However, there is a need to actively address the current limitations of access to up to date IT equipment, appropriate software and the internet for many community practitioners. Centralised facilities via libraries are of limited use to a scattered workforce. There is also the need to further explore the way in which practitioners actually access and use evidence in practice and how this can be improved.

Professional Officer
On behalf of the CPHVA Education and Research Committee
October 2000

 
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