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Clinical academic and research careers

Find out why a clinical academic or clinical research career might suit you and the types of clinical research programmes available.

Clinical research provides evidence to inform clinical decisions, which is vital for ensuring the best possible care for patients.

Why should I consider a clinical academic career?

• funded training to gain recognised qualifications, such as a Master's degree or a PhD, is available from NHS, charitable and private organisations
• it can be an academically stimulating career choice, including the opportunity to present at conferences and write articles for academic journals
• you can make a real difference to patient care
• there are opportunities in a variety of roles including nursing and in different settings, including clinical positions with patients, as well as working in a research laboratory

Types of clinical research programmes

• internships
• Master's in clinical research
• clinical doctoral research fellowships
• clinical lectureships
• senior clinical lectureships

See the NHS England's Workforce, Training and Education website for information about its work on clinical academic careers and resources to support you on your journey.

When can I start?

This is usually an option for those with some clinical experience. However, in some cases it is possible to start an academic research career directly after registration. A first step could be an internship, designed to help you prepare for working in a research environment, or a Master's degree.

Find out more about clinical academic careers across all healthcare professions on the Clinical Academic Training and Careers Hub (CATCH) website and see our information below about the HEE/NIHR Integrated Clinical Academic (ICA) Programme .

You can find out more about research generally on the National Institute for Health and Care Research website .

Further information

The Clinical Academic Training and Careers Hub (CATCH) has a website  which showcases and promotes options, as well providing practical advice on starting a career in clinical academia.

The Integrated Clinical Academic (ICA) programme is funded by HEE and managed by the National Institute for Health and Care Research (NIHR). It provides a range of opportunities to undertake fully-funded clinical research, research training and professional development whilst maintaining clinical practice and salary.

It is formed of five elements, plus a mentorship scheme:

• Master's studentships in clinical research
• senior clinical lectureships.

For more information on the awards and resources to support you as a clinical academic, please see the NIHR  website.

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Research and Innovation

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What is clinical research?

Clinical research is the development of improved healthcare, by using evidence to further our knowledge to create new treatments and/or approaches that are both safe and effective. We have around 200 clinical research studies running in our Trust, at various stages of activity; including studies that are open and recruiting patients. Between 1 April 2017 and 13 December 2019 we have recruited 3,452 patients to ethically approved research carried out within the Trust.

Taking part in research is not only about testing new drugs or treatments – we may also carry out research that using information from questionnaires, or laboratory tests. We do this to understand more about the impact of diseases, quality of life, and to discover better ways of understanding the effect of certain treatments.

We could not support hosting clinical research alone. We work in partnership with the National Institute for Health Research (NIHR), who are funded by the Department of Health and Social Care (DHSC). Our Trust is within the geography of the North Thames Clinical Research Network (CRN). We are also grateful to receive on-going support of the King George and Queen’s Hospital Charity .

Our Commitment to Research

The NHS has a legal duty to promote research, and show evidence, whilst finding innovative outcomes to improve patient care, be it to do with new treatments, medicines, processes, or technologies that ultimately lead to an all-round better service provided by the NHS. Our research department commits to the implementation of the NHS long term plan. Research itself is core business in accordance with the NHS constitution, and forms part of the assessment of the well-led aspect of the CQC inspection.

If you have any questions about research, please contact us at [email protected] . We are also on Twitter; you can follow us at @BHRUT_Research

Urgent Public Health and Covid-19

Practical studies.

The Covid-19 pandemic necessitated that research into potential therapies occurred in parallel to the outbreak and, indeed, was part of the treatment options offered to patients. The national research strategy prioritised Covid-19 research and such studies were badged as Urgent Public Health (UPH) research. Every hospital in England was encouraged to participate in these studies.

One of the biggest of these UPH trials we are participating in is  the RECOVERY Trial . This trial evaluated potential emerging therapies that had shown some signs of improving outcomes for patients hospitalised with Covid-19 but needed to be fully assessed in randomised controlled trials to fully ascertain whether there was benefit from their use.

Patients with Covid-19 in our Trust were approached and offered the chance to take part in the trial as it offered them participation in research and access to therapies being evaluated, but also enabled them to help others.

Since the opening of this study at our trust, we have recruited 328 patients to this trial. We are proud to say that we and our patients have taken part in this study and have contributed to discovering treatments such as Dexamethasone and Tocilizumab, which have been proven to save lives. We have also contributed to data that has ruled out futile treatments for Covid-19 such as lopinivir/ritonivir, hydroxychloroquine, colchicine and convalescent plasma. Without this latter research, patients would have continued to be given drugs that carry side effects and do not improve patient outcome.

Some hospitalised patients went on to develop severe Covid-19 and were admitted to intensive care. At this point, these patients were offered the chance to additionally participate in another trial called REMAP-CAP which was aiming to identify therapies specific to those who were critically unwell with Covid-19. Patients were eligible to take part within 24 hours of admission to the intensive care (some ward patients were also eligible for certain aspects of the trial) and were able to have access to multiple therapies being evaluated including steroids, convalescent plasma, blood thinners, and immunotherapy.

The trial looked at how drugs worked in combination and the nature of the trial was such that patients were most likely to be allocated a treatment in the trial that was showing a signal towards benefit. We are proud to have participated in this trial as it has been pivotal to providing evidence for the use of Tocilizumab and therapeutic dose blood thinners in certain subsets of Covid-19 patients. Our recruitment to this trial to date is 19 patients.

We continue to offer the RECOVERY and REMAP-CAP trials to our patients and remain at the forefront with the national effort to discover therapies for Covid-19. Vaccination research is needed to prevent the illness from occurring, but therapies and a better understanding of the disease are needed to help those who go on to develop the illness despite the national vaccination effort.

We must of course thank our principal investigator, Mandeep Phull as well as her research team, and must also pay thanks to the patients who participated and the wonderful ward staff who have been very accommodating and helpful in assisting in the delivery of this research throughout the pandemic.

Observational studies

As well as practical studies, there are also studies that are more observation based, looking through medical history of a patient’s time in hospital, to measure a variety of different things. One Urgent Public Health observational clinical study we have been recently assigned to is known as ISARIC. As it is a matter of Urgent Public Health, patients are not selected for recruitment. In fact, we are required to collect the data from each individual admitted to the hospital who meets the required criteria. To date, we have recorded approximately 2,447 individual admissions to this survey. This number does not reflect the total number of patients admitted to our trust with Covid-19, as patients who have left the hospital but are readmitted at a later date also have the second instance recorded.

The summary of this trial, following the document changes to allow for Covid-19 research on 24/02/2020, reads as follows:

“New infectious agents, such as the SARS coronavirus, new strains of influenza, and HIV, continually appear and require new investigations to understand how the disease works and how it interacts with the person infected. There is an urgent need to conduct coordinated clinical research relating to the Covid-19 outbreak to learn more about the virus and to provide evidence to help decide treatments and to ensure an effective public health response.

"This study will provide rapid, coordinated clinical investigation of patients with confirmed Covid-19 infection. It will look at how the virus reproduces and is excreted by the body, how the body responds to infection and treatment over time and how the immune system responds. The study has been designed to ensure that as much data as possible is collected and shared rapidly in a format that can be easily added together, tabulated and analysed across many different settings globally. It is designed to be flexible to ensure the best acceptance by health care organisations.”

For further information about this trial, head to the ISARIC website .

*Please note – information is accurate at time of recording, May 2021*

Clinical Trials

If you wish to join a research study currently open at our Trust, you must first be under the care of this hospital. You should discuss your wishes to be involved in research with your doctor or clinical team as there are strict criteria for each research study and some studies may be more appropriate for you than others. The decision to participate in a research study remains yours, but you may wish to discuss your participation with your family, friends and/or GP.

Download Internet Trials List 13.08.20 [xlsx] 19KB

To search for Clinical Research Studies nationwide, please use the NIHR’s search below. Please be advised, all clinical research studies have an inclusion/exclusion criteria to ensure patient safety. There may be trials that you feel you could be suitable for but please speak with your nurse or doctor, who will be able to advise you further.

Research champions

Patients and the public are at the heart of everything we do, and who would be better to describe the experience of participating in research than those who have taken part in a study themselves?

What is a research champion?

Research Champions volunteer their time to help spread the word about health and care research to patients and the public, and to help promote across those groups who are currently less likely to take part in research. They also help research and healthcare staff understand more about the experiences of those who take part in research.

Anybody can be a Research Champion; you don’t have to have participated in a research study before. Watch below as Dr. William van’t Hoff, Clinical Director for NHS Engagement, talks about the initiative.

Find out more information about the roles of the NIHR Research Champion and how to take part .

Alternatively, contact Ben Sartoris, [email protected] for further information.

Research Performance

Please follow the link below to see our performance in initiating and delivering on clinical research trials:

https://ccfctp.nihr.ac.uk/public-trustsubmissions/barking-havering-and-redbridge-university-hospitals-nhs-trust-1042

Our research team works over a number of different clinical areas. If you have a question or want to discuss about a certain clinical specialty, please contact the Research and Innovation Department either on: 01708 435 000 ext. 2372 / 2762 or email our generic mailbox:

[email protected]

To read about some of our research team, who participated in our Trust’s ‘In Conversation With...’, please view the links below to read the articles.

• Laura Parker
• Nik Haliasos

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Research Roles Within The NHS

Academics with a specialism in the field of medicine or biology may find employment outside of Higher Education in The National Health Service, which employs over 2.1 million people in the UK in total, including clinical academics. It can be a very rewarding field to work in, with many opportunities for career development and the chance to have a direct impact on healthcare in the community and across the nation.

Careers in the NHS

Those with research experience ( PhD students ) and a strong science or medicine background can find work in clinical research for the NHS, especially in the area of biochemistry and related fields. Healthcare Science in the NHS encompasses a variety of jobs that will likely appeal to academics who want to move away from work in Higher Education. Opportunities in every field of healthcare are available, and a strong science degree is essential if you are to apply.

The NHS operates a graduate training scheme in management. The requirements include a degree with second class honours or a postgraduate qualification. Management in the NHS combines leadership skills with health care management techniques.

Typical jobs in the National Health Service for graduates include:

• Clinical research fellow
• Clinical academic
• Therapist and related roles

Finding a job in the NHS

The NHS website offers a great deal of useful information for potential employees. You might also want to examine your prospects through the ‘ What Can I Do With My Degree? ‘ website. The graduate scheme can be applied for directly .

Research positions are regularly advertised on jobs.ac.uk in the ‘ Health and Medical ‘ section. You can also find out about jobs on the websites of individual hospitals (although most positions will also be advertised on the main NHS website, or external sites such as jobs.ac.uk ).

Benefits of working for the National Health Service

Working in research and scientific roles in the NHS requires making use of the investigative and analytical skills that are gained from PhD study . Many people who have made the move from academia to the NHS cite the direct connection to patient care and the practical nature of the work as being positive factors. It can be rewarding to see theoretical study come to fruition in real terms.

National Health Service salary scales are relatively good; remuneration for a Biomedical Scientist, for example, can rise as high as £65,000 at senior levels, while consultants can expect a salary nearer the £100,000 mark.

Former academics and PhD/Postgraduate students have skills and experience that are prized in NHS roles such as:

• Research experience
• Analytical thinking
• Carrying out work independently
• Handling sensitive information
• Communication skills (writing, presenting findings etc.)

Find your NHS role.

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13th October 2021 at 11:45 am

Hi I have done masters in microbiology (in my home country India-2005 pass out). I did a medical transcription course and worked as a medical transcriptionist (level 1 proofer–in India from 2007-2010). How can I enter nhs? What is the route of entry? Do I need to do any course? If so, what are the best options for me? I am very much interested in Medical summarizer, Health informatics, Medical secretary, health records assistant, health records manager, patient administrative team leader, waiting list co-ordinator. is there any training available to further my studies in microbiology? I am also interested in Pharmacy. Please let me know the career options/training options/courses(within the nhs or outside) available. Thank you.

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Research Support Service

Providing support and advice for health and social care researchers. The RSS can help with developing funding applications and at other stages in the research pathway.

The NIHR Research Support Service (RSS) provides support to researchers to develop applications to national, peer-reviewed research programmes. This covers all NIHR programmes and UK Research Councils, as well as national health and care charities. 

The RSS supports translational, clinical and applied health, public health, and social care research. It can also support applications for fellowships and other personal awards. The RSS does not provide support to global health research, or research that involves discovery. It also cannot support research involving animals or animal tissues.

The service is delivered by eight ‘hubs’. Hubs are a partnership of research groups and Clinical Trials Units (CTUs) with expertise in applied health and care research.  There are also Specialist Centres for Public Health and Social Care, which provide more context-specific expertise. The Public Health Specialist Centres may support applications for local funding opportunities.

The RSS offers collaborative trial delivery through their network of CTUs, and can signpost users to non-RSS UKCRC-accredited CTUs. RSS staff can be collaborators in your research, but will provide advice irrespective of whether staff or partners are collaborators.

The RSS National Collaborative provides strategic leadership to the service and coordinates operational efficiencies. This is hosted by the University of Birmingham.

Where is the RSS located?

The RSS is a national service, and each hub and Specialist Centre is open to researchers based anywhere in England. The RSS can support researchers in the devolved nations if they are working in collaboration with English partners.

What support does the RSS offer researchers?

The RSS can help you to develop your research ideas into competitive funding applications.

All hubs and Specialist Centres can support researchers with advice on:

• finding funding sources
• refining research questions, aims and objectives
• developing appropriate methodological approaches
• planning projects, teams and budgets
• planning for implementation and impact
• writing techniques/pitching an application
• patient, public, service user and community involvement and engagement
• research design to maximise equality, diversity and inclusion

Other support includes advice on project delivery, research approval processes and obtaining ethics approval. The RSS can also provide signposting to other services.

Across the RSS, hubs have expertise to offer advice and support in:

• quantitative expertise, including the statistical aspects of study design, analysis, and reporting; randomised controlled trials (RCTs) including cluster designs and platform trials; and other designs, such as stepped wedge, Bayesian and adaptive approaches
• feasibility and pilot studies
• qualitative study design and analysis
• mixed methods design and analysis
• development, validation and adaptation of outcome measures
• research priority setting, stakeholder involvement and participatory research methods
• behavioural science/ health psychology
• epidemiology
• systematic scoping reviews, qualitative synthesis, systematic reviews and meta-analysis
• health service/implementation research
• expertise developing innovative PPIE approaches with researchers, patients, community organisations and the public
• co-production of interventions with PPIE and stakeholders
• equality, diversity and inclusion
• big data and record/data linkage
• health economics, early economic modelling and evaluation, outcome measurement and cost-effectiveness
• operational support, clinical trials management, and study delivery
• planning pathways to impact

How do I get support from the RSS?

Look through the summary of each hub or specialist centre to find the one that best meets your needs, independent of your location. Once you have decided on a hub or specialist centre, please contact them directly using the contact form linked on their hub page.

Please only contact one hub or specialist centre.

When should I contact the RSS?

Developing a funding application involves considerable planning, time and effort. To ensure the RSS can provide comprehensive support, initial contact should be as early as possible – ideally several months before the funder deadline. Requests for support made less than five working weeks before the submission deadline may influence the quality and nature of the support the RSS can offer.

Clinical Trials Unit support is complex and more likely to need a minimum of three months work up, each CTU has their own guidelines which should be referred to for confirmation.

RSS Hub delivered by University of Birmingham and Partners

Staff have a wide range of methodological expertise, including design and delivery of observational research and trials.

RSS Hub delivered by Imperial College London and Partners

Supports applicants from all disciplines and levels of expertise to design and deliver high quality and efficient research to improve health and social care. 

RSS Hub delivered by King's College London and Partners

Supports research in mental health and brain disorders, across a range of research designs including clinical trials and observational studies. This hub brings together experts in research methodology and clinicians in psychiatry, psychology and neuroscience. 

RSS Hub delivered by Lancaster University and Partners

This hub o ffers a broad range of methodological expertise and research support from world-leading interdisciplinary experts to support the design and delivery of inclusive, co-produced, environmentally sustainable research, on and with under-researched topics and communities.

RSS Hub delivered by University of Leicester and Partners

This hub supports research across the full breadth of specialisms, designs and funders.

RSS Hub delivered by Newcastle University and Partners

Supports research across the full breadth of specialisms, designs, and funders, including studies involving under-researched sectors. 

RSS Hub delivered by University of Southampton and Partners

This hub welcomes support requests from novice through to experienced researchers in all areas of applied health and care research. This hub especially welcomes requests for support in public health research conducted outside of the NHS, and other under-researched areas.

RSS Hub delivered by University of York and Partners

Provides  methodological expertise, research advice and collaboration  across a range of study designs, topics and settings including NHS primary and secondary care, community and third sector.

RSS Specialist Centre for Public Health

The NIHR   RSS Specialist Centre for Public Health works nationally to support the development of research capacity and capability to enable practitioners, researchers and anyone working outside of the NHS to carry out high quality public health research. Their expert team provides pre-award application advice tailored to researchers' needs and post-funding support. They can also offer training, support with governance and ethics and resource to support research in Local Authorities.

RSS Specialist Centre for Social Care

The NIHR RSS Specialist Centre for Social Care brings together world-leading interdisciplinary experts with a broad range of experience in social care research, working nationally to support researchers across the full range of social care services and settings. The centre provides a breadth of methodological expertise and research support to researchers of all levels and experience, to design and deliver innovative social care research that is inclusive, co-produced and environmentally sustainable.

Are you new to NIHR?

Find out more about applying for funding from NIHR

NIHR Study Support Service

The RSS works in partnership with the NIHR Clinical Research Network. Together, we support study design, ensuring studies are optimised for delivery at sites. The RSS will direct the researchers they are supporting to the Study Support Service (SSS) for more delivery-related advice.

Researchers should contact the SSS for support to attribute study activities during the funding stage. This is through the completion of a Schedule of Events Cost Attribution Tool (SoECAT) . This is the national tool which confirms service support and excess treatment attributions. The SSS can also advise on national study feasibility and deliverability in Health and Social Care settings. Once a study has started, continued support from the SSS is available to help alleviate challenges to recruitment and/or delays.

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Clinical academic careers

Research internships.

Research internships offer an introduction to all aspects and roles across clinical academic research from trial design, data management through to undertaking practical research in a clinical environment.

Schemes provide a range of both taught and academically supervised interventions that both engage and expose the intern to the clinical academic research environment, but also provide them with the practical skills to undertake a research project supported by an expert clinical academic supervisor.

By the end of the programme we hope that participants will have the confidence to apply their newly learned skills within their employing Trusts, become research champions and consider a future clinical academic career to include formally accredited education programmes, either within the HEE/NIHR Integrated Clinical Academic Programme, or via other routes. Interns will also benefit from an enhanced ability to apply successfully for further formal research training.

I think I am a more confident practitioner as a result and have a greater understanding of how clinical academic research supports changes in clinical practice with direct patient benefit." Jed Jerwood, Art Psychotherapist, Birmingham and Solihull Mental Health Foundation Trust and John Taylor Hospice.

It has given me the opportunity to include elements of research into my current job and network with, plus get support from experienced researchers." Llewellyn Boucher, Extended Scope Physiotherapy Practitioner, Kent.

Resources and case studies are available to support your decision making and conversations with your manager.

Aims of scheme.

An internship scheme will:

- develop research and research capabilities throughout all levels of the NHS in order to enhance and diffuse evidence based practice (by providing research champions)

- provide the opportunity to develop a network of clinical academics so that learning, best practice and innovation can be shared and disseminated, both regionally and nationally

- support the development of clinical skills as well as research skills

- encourage research into areas related to HEE’s Mandate or to education and training as a whole

- offer an insight into a career in clinical academia and provide experience which would support applications for further formal research training.

Local contacts

For queries regarding research options in our local teams (including internships) please contact the following in your region:

If you are employed in the North West region, find information and contacts here .

If you are employed in the North East and Yorkshire region, find information and contacts here .  

For the Integrated Clinical Academic Programme Internship Scheme information also available on Sheffield Hallam University website.

For all other general queries contact the regional education team .   

Midlands and east

Including; Central Midlands, North Midlands, West Midlands and East of England. 

Contact us.

Clinical Academic Internship Programme information also available on the east of England website and Birmingham health partners website.

Including; North and South London .

Contact us on:  [email protected]

For the Integrated Clinical Academic Programme Internship Scheme information also available on the London South Bank University website (hyperlink to)  Integrated Clinical Academic Schemes | London South Bank University (lsbu.ac.uk)

Including;  Thames Valley ,  Wessex  , South West ,  Kent Surrey and Sussex .

To apply for the internships, candidates must be a registered professional from one of the professions listed in the eligible professions and registered bodies document below. The internships are available to those who have received no formal long term training in research.  If, as part of your registration requirements, you had to complete a diploma or masters you are still eligible to apply.

Applications must have clear potential for benefiting patients and the public and can involve: patients; samples or data from patients; members of the public/carers; health technology assessment; health services research; and research into clinical education and training. We would encourage applications where the research would focus on one of HEE’s Mandate requirements or into education and training.

Applications will be administered and managed by local teams, based on local requirements.

Related Documents

• ICA evaluation infographic (.pdf) 264.63 KB
• HEE.NIHR_.ICA_.INTERNSHIP.3 v2 (.pdf) 139.16 KB

Related Content

The Clinical Academic Careers Framework proposes an over-arching structure to develop the clinical academic workforce for patient benefit and a consolidated programme for non medical health professions. This forms part of our organisation's Research and Innovation Strategy.

Integrated clinical academic (ICA) programme

The ICA programme, funded by Health Education England (HEE) and run by the  National Institute for Health Research  (NIHR) provides a range of opportunities to undertake fully-funded clinical research, research training and professional development, while maint

Bridging scheme

Bridging schemes are a way of providing support to clinical academics to build on their previous academic training and develop proposals for a pre or post-doctoral award, and take the next step on their clinical academic pathway.

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Article Contents

Why we need a revolution in clinical research.

• Article contents
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• Supplementary Data

Masud Husain, Why we need a revolution in clinical research, Brain , Volume 147, Issue 9, September 2024, Pages 2897–2898, https://doi.org/10.1093/brain/awae265

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We are at a pivotal moment for clinical research. In the UK, the system is fundamentally broken as recent reports have alluded to. 1 , 2 In other parts of the world too there are similar issues that are, at the very least, slowing down innovation and research. There are many factors that have been identified as contributing to this sad state of affairs in the UK. One important issue that has not attracted so much attention recently—though it was the subject of a report 3 in 2020—is the relationship between higher educational institutions (mostly universities) and healthcare providers (largely the National Health Service, NHS).

The vast majority of research activity in the UK occurs within the higher education sector, while most patient-related research such as clinical trials relies on NHS infrastructure. And this is where there is a massive disconnect. Each of these systems are huge, cumbersome behemoths, with their own local lumbering administrations focused on aims that are not aligned to the mission of producing rapid results in clinical research. In the university sector, the priorities of leaders are to keep the system financially afloat and minimize potential legal risks. Many institutions in the UK are on the cusp of fiscal ruin and so require grant and other research income to subsidize their existence. In the NHS on the other hand the aim is to cut waiting lists which, post pandemic and doctors’ industrial action, are now very lengthy, and to provide adequate service delivery. Making healthcare research effective and efficient is the last thing on the minds of the leadership of either sector.

But who can blame them? Surely, it’s difficult enough to run either a university or an NHS hospital? Indeed, this seems sufficient explanation—an adequate excuse—for some leaders of both these types of institution for the huge delays in getting any useful research done. Many teams are now waiting over a year to get their grant-funded research off the ground. Remarkably, some trials are failing because they never start, several years after the funding has been awarded. Material or data transfer agreements between universities; slothful legal reviews of contracts and agreements with third parties; calculating overheads to be charged; multiple reviews of research protocols by R&D departments; dragging of feet over costings independently for the university and hospital; sluggish reviews by research services; signing off contracts with the NHS; obtaining honorary contracts for non-clinical personnel; and many other procedures may take months, if not years, to complete. The system is both Byzantine and exasperating to navigate. No wonder that pharmaceutical companies are balking at initiating trials in the UK, their gaze turning instead to countries where they are more serious about getting things done sooner, not later. 1

So how do we get out of this mess? Given the narrow goals that the leaderships of universities and NHS hospitals have, we cannot expect a great deal more from them on this front— unless they are compelled to make changes. In the UK, when the National Institute for Health and Care Research (NIHR) was formed in 2006, many of us were under the impression that its mission really was to ‘create a health research system in which the NHS supports outstanding individuals, working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public’. 4 Clearly though this just hasn’t happened. Otherwise, why the need for recent reports? 1 , 2

One of the key reasons for this failure (we cannot refer it to it as anything else) is the simple fact that universities and NHS infrastructure are not joined up. Many pretend to be, but it is obvious to anyone who works at even the best centres in the UK that this is a sham. At Oxford, one of the hospital networks calls itself the Oxford University Health NHS Foundation Trust, but there really is very little to suggest why ‘University’ should be in its title. The levels of duplication of work and contracting between the university and the hospital make a mockery of the concept of seamless integration between these institutions. It is the same elsewhere too. The result is a growing duopoly of administrations that negotiate with each other, waste time and slow the pace of progress. Even when a research proposal has been approved by a ‘joint’ R&D unit, there needs to be a costings agreement between university and NHS trust.

From a national perspective this makes little sense, either economically or for governance. We are in the bizarre situation where two sets of institution—universities and hospitals—both largely funded by taxpayers are independently setting their (growing) administrative staffs to scrutinize research protocols or haggle over costings on projects that are mostly funded by government or charities. It is even worse for multicentre studies when many different universities and NHS trusts each want a share of the pie. This has a hidden cost in numbers of people employed, researchers’ time dealing with paperwork, and an opportunity cost in terms of time taken to get studies off the ground. Furthermore, there is no incentive to do things better or faster. There is simply a parochial incentive to make money locally and mitigate risks locally . Until the day that universities and hospitals associated with them are compelled to work as one integrated unit, there is very little hope for change. We will be left in the current quagmire of structural indolence. And that is why we need a revolution. Writing more reports on the matter will not help.

It is interesting to reflect on the fact that it was also radical change that was necessary to bring medicine into the modern era—to make it based on observation, clinical examination and the scientific method—in the first place. From the confusing and sometimes bizarre practices that characterized medicine in the 18th century, there emerged a new way of doing things which came about within one generation and in perhaps one of the least advanced places in Europe for clinical science at that time: Paris. From being a backwater, the ‘Paris School of Medicine’ instigated such dramatic change that within 50 years it became the leading international centre for clinical practice, attracting physicians from around the world to learn about the ‘new medicine’. 5

The rise of scientific medicine in Paris depended on systematic correlation of physical examination findings on hundreds of patients with pathological findings at post-mortem; flexibility to revise diagnoses on the basis of these assessments; deployment of statistics, including data on mortality; and most of all on conducting this work and teaching it to medical students in hospitals. 5 What made this possible was reform. Before the French Revolution, control of medical care rested largely with the Church. With the reform of medical education that came after the Revolution, hospitals were centralized and their administration was overseen by the state. Fundamental changes in the way in which faculties of medicine were organized in France led the way for dramatic new ways of learning from patients and disseminating knowledge to clinicians. Medical education was transformed but it needed the convulsive change of a Revolution to make this happen. 6 It required top-down edicts to bring about change because there was no incentive for the old institutions to make those changes themselves.

We are now confronted with a similar problem. The old institutions—universities and hospitals—are used to doing things their way. There is no incentive for them to change unless the state or its organs of power intervene. In the UK, NIHR funds now support Biomedical Research Centres (BRCs) which supposedly cross universities and NHS hospital trusts, but in truth the fiscal support helps to prop up university research personnel with very little going to the NHS. Most importantly, the NIHR has not insisted on BRCs having joined up (i.e. single) integrated, university-NHS systems in place, or for seamless national transfer of approvals across sites without the need for new sets of contractual agreements. Nothing fundamental will change unless it or the new government compels this change. The pursuit of national interests requires national leadership to intervene; we can't rely on local, devolved institutions to make the obvious decisions that are required. This is why we need a revolution in healthcare research.

O’Shaughnessy J . Commercial clinical trials in the UK: The Lord O’Shaughnessy review - final report. Accessed 13 August 2024. https://www.gov.uk/government/publications/commercial-clinical-trials-in-the-uk-the-lord-oshaughnessy-review/commercial-clinical-trials-in-the-uk-the-lord-oshaughnessy-review-final-report

The Academy of Medical Sciences . Future-proofing UK health research: A people-centred, coordinated approach. https://acmedsci.ac.uk/file-download/23875189

The Academy of Medical Sciences . Transforming health through innovation: integrating the NHS and academia. https://acmedsci.ac.uk/file-download/23932583

Department of Health and Social Care . Best research for best health: a new national health research strategy. https://www.gov.uk/government/publications/best-research-for-best-health-a-new-national-health-research-strategy

La Berge A , Hannaway C . Paris medicine: Perspectives past and present . Clio Med . 1998 ; 50 : 1 – 69 .

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Ackerknecht EH . Medicine at the Paris hospital, 1794–1848 . Johns Hopkins University Press ; 1967 .

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Thursday 26 th  September (10:30am- 11:15am )

One of the key agenda items set out by the new health and social care secretary is to “make Britain a powerhouse for life sciences and medical technology”.

“If we can combine the care of the NHS and the genius of our country’s leading scientific minds, we can develop modern treatments for patients and help get Britain’s economy booming,” Wes Streeting said.

There are already research and NHS organisations partnering to deliver healthcare improvements for citizens. This HSJ webinar, in association with Snowflake, will look at the experience in north west London where the integrated care board and a research team based across Imperial College London and Imperial College Healthcare Trust have worked together along with Paddington Health Life Sciences to deliver information which can improve population health. It will ask:

• What sort of system architecture is needed to enable partners to work together like this? How can additional costs be minimised, given the pressure on both revenue and capital in the NHS, without compromising on deliverability?
• What are the technological and other challenges to sharing information between partners?
• What sort of gains can be realised by collaboration and how can they be used to influence population health?
• How can translational data analytics improve the quality of patient care?
• How can this level of partnership work be replicated elsewhere?

Janet Broome, account director NHS, Snowflake

Janet Broome has worked and provided software solutions to the NHS for more than 25 years. Janet has been helping NHS organisations transform healthcare with data including partnering with NHS Digital to deliver the public-facing covid-19 dashboards and learned first-hand the challenges of scaling data. Janet is passionate about improving patient outcomes with data.

Ben Glampson, deputy director, iCARE Digital Collaboration Space

Ben Glampson is a health informatician and deputy director of iCARE digital collaboration space at Imperial College Healthcare Trust. Ben oversees the ICHT secure data environment, and works to deliver the iCARE vision on improving the health and wellbeing of the North West London population by translating data-driven insights and digital interventions into safe, effective, equitable, and person-centred care.

Erik Mayer, clinical reader at Imperial College London and consultant surgeon at Imperial College Healthcare and the Royal Marsden

Erik Mayer is a clinical reader at Imperial College London and a consultant surgeon at Imperial College Healthcare and the Royal Marsden. He is director of Imperial Clinical Analytics, Research & Evaluation, and the Digital Collaboration Space, Paddington Life Sciences.

He is Imperial College Healthcare’s transformation CCIO (Analytics & Informatics). He chairs the NIHR Imperial Academic Health Science Centre research informatics committee and represents Imperial at the UK Health Data Research Alliance Council. He is the theme lead in the NIHR Imperial Biomedical Research Centre (Digital Health) and the NIHR NWL Patient Safety Research Collaborative and is the programme director of the MSc Health Policy, Centre for Health Policy, and Institute of Global Health Innovation.

Kavitha Saravanakumar, data and analytics lead, NHS North West London Integrated Care System

Kavitha Saravanakumar joined North West London ICS in 2015 as assistant director of data management and has progressed to become the director of business intelligence. Kavitha leads on data and digital initiatives in north west London, predominantly the whole systems integrated care which is the population health management platform. Kavitha has helped progress this into a holistic data ecosystem that supports not only population health management use cases but also BI/system planning as well as research and innovation. Kavitha took a leadership role in establishing a real-world evidence hub, Discover-NOW, in collaboration with our health innovation network in NWL. Kavitha has also led the London secure data environment work and is the lead for the London analytics platform which is a core component of the London health data strategy; this involves rolling out the capabilities developed in NWL to the whole of London.

Alison Moore, contributor,  HSJ (webinar chair)

Alison is an  HSJ correspondent covering the South East and ambulance services nationally. She has worked in health journalism, mainly as a freelance, for many years and was previously deputy editor of a magazine for doctors.

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"Nurses are perfectly placed to take part in research." Meet Niamh Bohnacker, senior clinical research nurse 6 Sep 2024

To mark the third series of Channel 4’s Emergency documentary , we’re highlighting the work of some of the people who work in or alongside our major trauma centre.    Niamh Bohnacker is a senior clinical research nurse at Imperial College Healthcare NHS Trust, and leads the Neurosurgery, Emergency and Trauma (NET) research team. Niamh tells us about the vital role nurses play in research and why her biggest inspiration is her patients and colleagues. 

Tell us about your role and work with the major trauma centre. I’m a senior clinical research nurse, and lead the Neurosurgery, Emergency and Trauma (NET) research team. Our small team of six nurses is responsible for delivering clinical research studies in these specialities at the Trust, including across the major trauma pathway. We’re from predominantly emergency and intensive care nursing backgrounds and have a rolling portfolio of 15-20 clinical studies open at any one time.

Niamh Bohnacker "Nurses are perfectly placed to take part in research and deliver it at the bedside."

We help decide which studies the Trust can best support, set studies up, and then provide end-to-end coordination of each active study. For us, it’s ultimately about offering patients or their families the opportunity to get involved in high-quality research and supporting them to reach an informed decision about whether to take part or not. Research is an additional option for patients. It builds on the high-quality care that they already receive, to try and further improve quality of life and propel evidence-based advancements in clinical care. Trauma patients can be extremely vulnerable, both physically and emotionally, and it’s therefore important to have a dedicated team who are adept at managing research within a trauma environment. This protects patients, maintains strong ethical standards and produces reliable data which could inform and improve future care. Trauma research has its own unique challenges, including potential fluctuations in mental capacity of patients due to their injury or due to being sedated and ventilated, and the delivery of time critical care. In such cases, the team are responsible for meeting and proving the threshold for use of emergency waiver of consent and auto-enrolment onto a study. There are ethical approvals in place for this and, in these cases, we always follow-up with the patient to seek their consent retrospectively. I am always proud of how the team manage these often highly emotional and sensitive situations with skill and compassion. We provide time and space for patients to ask questions and fill in gaps that they can’t remember. When their lives have been upturned and taken out of their hands, participating in research can give them a sense of empowerment.  

Do you have a typical working day? Our NET research service runs from 08.00-20.00, Monday to Friday. The day starts with the team attending the Emergency Department (ED) handover and screening the overnight trauma list, ED bedboard, ward and clinic lists for patients that could be eligible for any of our studies. Throughout the day, we attend trauma calls to screen patients in the resuscitation area of ED – and confirm eligibility with the multi-disciplinary team responsible for each patient’s care, as well as senior consultants. We have consenting rounds twice a day. This is where we first approach patients or next of kin to inform them about a study, follow up on any questions they might have, or to seek consent. If a patient consents, we start study procedures, which could include computer-randomisation, delivery of the intervention, safety monitoring of the patient, blood-sampling, or data collection. We also review patients already on studies every morning for safety monitoring, and spend a significant part of each day performing trial management and study training. No two days are the same and, due to the nature of trauma, no day is predictable. In addition to overseeing the team, I help to decide which studies we support, how we are going to do it, and who needs to be involved. Alongside the research and development team and the lead nurse for neuroscience research, I support the completion of feasibility and contracts, governance and stakeholder engagement.

Niamh Bohnacker " No two days are the same and due to the nature of trauma, no day is predictable. "

A big part of the role is integrating research into clinical practice and trying to bring about that culture change – not so easy when you know that your colleagues are already working under extreme pressure and you’re asking them to do something differently. I advocate for research, my clinical colleagues and patients. It’s a fine balance and demands clinical and research knowledge, as well as the ability to lead, negotiate and collaborate. If done well, research should fit smoothly into clinical care.

Why is research so important in neurosurgery, emergency and trauma? 

It’s known that research-active hospitals have better patient outcomes. It goes without saying that all research must be based on a proven intended benefit to the patient. Even if patients don’t benefit from the study themselves in the immediate term, research can question the status quo and generate debate, discussion, collaboration and innovation. All this can ultimately lead to medical breakthroughs which have the power to improve and even save people’s lives.   Whilst it’s an option for patients, research should be a staple for healthcare professionals. The alternative is to stagnate, and that shouldn’t really be an option. Research will also lead to a more efficient and sustainable NHS. Major trauma remains a leading cause of death globally and there is still much to investigate. The creation of the major trauma network in London has improved outcomes by linking up systems and ensuring that all the clinicians you need are in one place. It’s an optimal context for trauma research and it’s important to harness this opportunity at St Mary’s Hospital, as a major trauma and research centre. 

What type of studies do you tend to get involved in? 

Most of the studies we work on are interventional, randomised control trials, that introduce and trial a medicinal product or surgical technique into a patient’s care. Some recent examples are:  

• a study comparing triple immobilisation with movement minimisation in suspected spinal injuries (SIS).
• the MaST study , which investigates the efficacy of anti-seizure medications in traumatic brain injuries.
• a major haemorrhage study (SWIFT) that compares pre-hospital use of whole blood versus standard blood components.
• a study (CoMiTED) where the intervention is conservative management –  not inserting a chest drain – in the management of traumatic pneumothoraces. 
• a surgical interventional study investigating the use of duroplasty in addition to laminectomy for patients who have suffered a traumatic spinal cord injury (DISCUS).  

Are you excited about any upcoming trials?    

There are always fascinating trials ongoing and upcoming. One that’s particularly exciting is the follow-up to the CRASH3 study, which showed that administration of tranexamic acid within three hours following a traumatic brain injury reduced head-injury related death. We’ll soon be recruiting to the CRASH4 study , which investigates the intramuscular administration of tranexamic acid in patients who have suffered a mild to moderate head injury.  

Your background is nursing – how did you first get into nursing and then research? 

Becoming a nurse is one of the best things I’ve ever done, but it certainly wasn’t the plan. Nor was working as a nurse in clinical research. But, I’m really glad it’s now a part of my career.   I actually completed a degree in history and worked in fine art before I decided to become a nurse. I’ve now been qualified for 11 years and my background is in intensive care nursing, which I loved. I joined NET in 2021 and became lead of the team in 2022. I start a master’s degree in neuroscience in the autumn.   As an ICU nurse, you’re responsible for delivering some of the most supportive care to the most unwell patients. I’ve lived and worked abroad in different healthcare systems. I started to wonder about differences in healthcare, what the evidence base was for what I was doing and what else could be done for patients. 

What do you love most about your job?

I love the variety of clinical questions we investigate, how dynamic it is, and also getting to work with so many different and talented people at the Trust and beyond.  

Niam Bohnacker "I feel very lucky to be part of an organisation full of people who come to work, day in and day out, to collectively alleviate suffering. That’s incredibly special."

Research is demanding. It requires perseverance and some courage, especially when you’re going against the grain and trying to take others along with you. It also connects you to some of the best of human nature: curiosity, endeavour and progress. Getting to play a very small part in that, in a profession I love, is what motivates me in my current role.   My biggest inspiration is the people I work with, both patients and colleagues. Patients who are confronted with, and have to overcome, so much, yet still get involved in research. None of it happens without their participation and we’ll all have them to thank when we have research breakthroughs in the future.   I’m always impressed by the clinical expertise of the clinicians I work with and am consistently struck by the depth of their compassion and empathy. I feel very lucky to be part of an organisation full of people who come to work, day in and day out, to collectively alleviate suffering. Everyone in the hospital plays a role in doing that. That’s incredibly special.   Find out how to join Imperial College Healthcare NHS Trust .   Watch Emergency series 3 on Channel 4 in August 2024 . 

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‘The challenges facing nurse education must be tackled’

STEVE FORD, EDITOR

• You are here: Workforce

Revised nursing profiles set to be published in 2025

03 September, 2024 By Ella Devereux

Source:  Rawpixel.com / Shutterstock

The revised national NHS job profiles for nursing and midwifery will not be published until early 2025, to allow time for more bands to be reviewed, it has been announced.

The NHS Staff Council’s job evaluation group (JEG) has been reviewing the profiles for bands 4, 5 and 6 since 2022, after concerns had been raised by unions that they do not reflect the modern nursing and midwifery landscape.

A consultation on proposed revisions to the profiles ran from April to June 2024 and gathered mixed reviews from nurses and midwives.

Some argued that the proposed revisions better reflect the level at which nurses in each band are working, while others said they think it could make it harder for nurses to be renumerated for their work.

The Royal College of Nursing was among those that were unhappy with the new profiles, warning in July that the proposed changes do not go far enough to recognise the skills and expertise of some staff.

In a statement this week , the JEG said it was grateful to all those who had responded to the consultation, and that it was “working its way through the feedback over the coming weeks”.

It noted that the group would begin consulting on revised national profiles for bands 7 and above “later in the autumn”.

The joint chairs of the JEG have agreed that the final revised profiles will now only be published once the review of all the bands, from 4-9, has been completed.

This would likely be in early 2025, the group said.

The NHS job evaluation scheme ensures that all jobs advertised in the health service are matched to nationally evaluated profiles.

These profiles are supposed to reflect the knowledge, skills and responsibilities for common roles in the NHS.

The revised profiles for bands 4-6, first published in draft form by the JEG in April, had included further detail about the remit of jobs, with more current examples of the skills and responsibilities they might have.

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The Salty Snack That Could Reduce Your Risk Of Parkinson’s Disease

Freelance Life Writer, HuffPost UK

Around 145,000 people in the UK have Parkinson’s Disease , according to recent statistics. It’s a disease that results in a tremor, slowness of movement and muscle stiffness, which all worsen over time.

However, according to research released this year, people could soon be able to potentially stave off the condition by tucking into a salty, affordable snack now and then.

Researchers previously discovered that drinking tea can help to reduce the risk of Parkinson’s, thanks to the antioxidant properties in the drink and now, thanks to that discovery, they have been able to determine which other foods and drinks could be beneficial.

The food that could stave off onset of Parkinson’s Disease

Researchers found that antioxidants in the seaweed, which is found in a lot of Asian cuisine such as ramen dishes, as well as being a convenient snack on its own, could be beneficial for those concerned about Parkinson’s onset.

According to the University of New Brunswick : “The emergence of Parkinson’s disease is linked to the misfolding of the protein α-synuclein.

″[Research author] Dr. Chopin and the paper’s other authors found that an extract from the brown seaweed Alaria esculenta can prevent this conversion and, therefore, could be useful in avoiding the onset of the disease or delaying its progress.”

Dr Chopin also highlighted that this discovery could increase seaweed consumption in the western world, saying: ”“[Seaweed] is mostly an Asian story, with more than 97 per cent produced by China, Indonesia, the Philippines, the Republic of Korea, Japan and Malaysia.

“Hopefully, as people in the western world realise more and more the benefits of seaweeds for them and the environment, we will see the emergence of this [resource] right here.”

Health benefits of seaweed

According to BBC Good Food , seaweed could provide these health benefits:

• Rich in iodine, which may support thyroid health
• May support heart health
• May support gut health
• May support immune function
• May balance blood sugar levels to help reduce the risk of type 2 diabetes

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Maximising the benefits of research: Guidance for integrated care systems

England has a vibrant research and development ecosystem, with well-developed research infrastructure and research expertise within our health and care workforce. The value of research in transforming health and care is significant; additionally, staff satisfaction, recruitment and retention is higher among staff who are involved in research. The inception of integrated care systems (ICSs) provides the opportunity for systems to embed research within health and care for the benefit of our population. Supporting this opportunity, a clear research thread runs through ICS strategies and plans, from joint strategic needs assessments and joint health and wellbeing strategies , integrated care strategies , joint forwards plans , integrated care board (ICB) annual reports and the assessment by NHS England of the discharge of duties by ICBs.

The Health and Care Act 2022 (the 2022 Act) sets new legal duties on ICBs around the facilitation and promotion of research in matters relevant to the health service, and the use in the health service of evidence obtained from research. NHS England will assess ICBs for their discharge of these duties. The ICS design framework sets the expectation that in arranging provision of health services, ICBs will facilitate their partners in the health and care system to work together, combining expertise and resources to foster and deploy research and innovations. This guidance supports ICBs in fulfilling their research duties.

ICSs are encouraged to develop a research strategy that aligns to or could be included in their integrated care strategy. This strategy will enable the unification of research across ICS partners, and be consistently embedded to:

• identify and address local research priorities and needs, and work collaboratively to address national research priorities
• improve the quality of health and care and outcomes for all through the evidence generated by research
• increase the quality, quantity and breadth of research undertaken locally
• extend and expand research in settings such as primary care, community care, mental health services, public health and social care
• drive the use of research evidence for quality improvement and evidence-based practice
• influence the national research agenda to better meet local priorities and needs
• improve co-ordination and standardisation within and between localities for the set up and delivery of research
• harness the patient and economic benefits of commercial contract research
• co-ordinate and develop the research workforce across all settings.

1. Introduction

This guidance sets out what good research practice looks like. It supports integrated care systems (ICSs) to maximise the value of their duties around research for the benefit of their population’s health and care and, through co-ordination across ICSs, for national and international impact. It supports integrated care boards (ICBs), integrated care partnerships (ICPs) and their partners to develop a research strategy that aligns to or can be incorporated into their integrated care strategy, and helps them and their workforce to build on existing research initiatives and activities across health and social care to improve sector-wide performance and best practice

• explains the ICB legal duties and other requirements around research and the use of evidence from research, and that research is included in forward planning and reporting
• encourages system leaders to develop a footprint-wide research strategy that aligns to local and national research priorities, develops and supports their workforce, takes the opportunities offered by commercial research and includes plans to embed research in their system’s governance and leadership
• identifies best practice examples and other resources that ICBs may find useful as they develop their research strategies.

This guidance provides comprehensive information for use by:

• those with senior responsibility, including at board level, for research strategy development and/or operationalising research
• managers responsible for developing joint strategic needs assessments, integrated care strategies, joint health and wellbeing strategies, joint forward plans, other linked strategies, or reporting on ICB activities
• research managers
• research and development/innovation leads
• heads of services
• knowledge and library specialists.

It may also be useful to individuals involved in research, education, and partner organisations such as local authorities, social care services, the voluntary, community and social enterprise sector (VCSE) and other providers of healthcare services.

NHS England provides guidance on embedding research in the NHS and secure data environments, and the Office for Life Sciences (OLS ) champions research, innovation and the use of technology to transform health and care service. Other sources of guidance, support and information are signposted in this guidance to support ICSs in aligning to national visions, strategies and plans around research.

1.1 Definition of research

NHS England uses the UK Policy Framework for Health and Social Care Research definition of research:

“… the attempt to derive generalisable or transferable new knowledge to answer or refine relevant questions with scientifically sound methods. This excludes audits of practice and service evaluation. It includes activities that are carried out in preparation for or as a consequence of the interventional part of the research, such as screening potential participants for eligibility, obtaining participants’ consent and publishing results. It also includes non-interventional health and social care research (that is, projects that do not involve any change in standard treatment, care, or other services), projects that aim to generate hypotheses, methodological research and descriptive research”.

This broad definition encompasses the range of types of research:

• clinical trials and other clinical investigations into the safety and effectiveness of medicines, devices and health technologies
• public health research
• observational studies
• discovery science and experimental medicine
• translational research in which results from basic research are developed into results that directly benefit people
• applied research
• research to support policy-making and commissioning
• social care research and research in social care settings
• research into NHS services and care pathways.

1.2 Why research is important

The UK is a world leader for research and invention in healthcare, with around 25% of the world’s top 100 prescription medicines being discovered and developed in the UK ( The impact of collaboration: The value of UK medical research to EU science and health ). Research in the health and care system is important because it underpins all advances in health and care and is the basis for evidence-based practice. Engaging clinicians and healthcare organisations in research is associated with improvements in delivery of healthcare ( Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review) . To benefit service users and the public, the NHS and local government, and achieve return on investment, it is vital that research is disseminated, shared and translated into practice.

The National Institute for Health and Care Research (NIHR) is funded by the Department of Health and Social Care (DHSC) to transform research in the health and social care system, including through support for NHS research. Research led to the first proven treatments for Covid, for example the use of dexamethasone, estimated to have saved over a million lives worldwide . This success was in part due to how research is undertaken in the unique environment of the NHS, innovative trial designs, the support provided by the NIHR, frontline staff enabling research, and the awareness and readiness of the public to support research. We need to learn from these and other successes, and translate this across all health and care settings. ICSs will play a vital role in enabling research to be embedded in evolving patient pathways across their footprints.

Example: PRINCIPLE trial – finding treatments for Covid recovery at home

The Platform Randomised Trial of Treatment in the Community for Epidemic and Pandemic Illnesses (PRINCIPLE) was a UK-wide, clinical study to find Covid treatments for recovery at home without the need to attend hospital. The study was open to all with ongoing Covid symptoms, registration was easy, and the trial was run entirely remotely by delivering ‘participant packs’ to people’s homes. It was one of the first trials in the world to show that azithromycin and doxycycline did not benefit patients with Covid and to identify the effectiveness of a commonly used drug – inhaled budesonide –in reducing time to recovery.

The PRINCIPLE study team demonstrated the integral role that primary, secondary and ambulatory care staff can play in the delivery of studies. Local collaborators were trained in good clinical practice to allow them to assess and confirm the eligibility of potential participants, and were commended specifically for their use of patient data to contact people soon after they received a positive test result. It is this network of local staff contributing to research within their healthcare setting that has enabled over 10,000 people to be recruited onto this study so far – one of the largest at home Covid treatment studies worldwide.

This is an example of a study design that incorporates the vital contributions of healthcare providers across the system.

Policy-makers and commissioners need evidence to support their decision-making around the delivery and system-wide transformation of health and care services, including how health inequalities will be reduced.

There is also evidence that:

• staff involved in research have greater job satisfaction and staff turnover is lower in research active trusts ( Academic factors in medical recruitment: evidence to support improvements in medical recruitment and retention by improving the academic content in medical posts)
• research active hospitals have lower mortality rates, and not just among research participants ( Research activity and the association with mortality )
• 83% of people believe that health research is very important ( Survey of the general public: attitudes towards health research)
• healthcare performance improvements have been seen from the creation of academic research placements ( Experiences of hospital allied health professionals in collaborative student research projects: a qualitative study )
• clinical academic research, and in particular the practice changes resulting from it, is associated with improved patient and carer experiences ( A qualitative systematic review and thematic synthesis exploring the impacts of clinical academic activity by healthcare professionals outside medicine ).

Key to having research embedded in health and care is having staff who can understand, undertake, use and generate new research, and share actionable research finding as part of a pro-research culture. Education and training are therefore critical for research to be sustainably embedded within health and care, and for people to develop careers in research and support it in their clinical or care roles.

DHSC, NHS England, the devolved administrations, NIHR and other partners expect to publish a clinical research workforce strategy in 2023/24 to help the UK realise the national clinical research vision outlined in Saving and Improving Lives: The Future of UK Clinical Research Delivery and deliver the Life Sciences Vision to see research embedded in the NHS as part of health and care pathways.

Research will support ICSs to deliver on their four key aims:

Improving outcomes

The NHS 2023/34 priorities and operational planning guidance emphasises the importance of research in improving patient care, outcomes and experience.

Research evidence will inform commissioning decisions to improve experience and outcomes. Research activities should align with the local health priorities identified through local joint strategic needs assessments, and may be best designed and delivered by collaborating with partners. Research priorities may be best addressed by collaborating with partners nationally to design and deliver research.

Tackling inequalities

Research can give a better understanding of local populations and the wider determinants of health, and with this the steps to maintain health and narrow health inequalities.

Enhancing productivity

The development of ICSs creates the opportunity to consider research delivery within the ICS and across ICS boundaries, increasing flexibility of workforce or recruitment while reducing bureaucracy and improving research productivity and value for money.

Supporting social and economic development

An active research ecosystem working in a co-ordinated way and to national standards brings revenue and jobs to regions. The NIHR Clinical Research Network (CRN) supports service users, the public and health and care organisations across England to participate in high-quality research. The 2019 impact and value report detailed the significant income and cost savings that commercial research generates for NHS trusts. Between 2016/17 and 2018/19 the NHS received on average £9,000 per patient recruited to a commercial clinical trial and saved over £5,800 in drug costs for each of these patients. This equates to income of £355 million and cost savings of £26.8 million in 2018/19.

In 2021 150 members of the Association of Medical Research Charities funded £1.55 billion of medical research, including the salaries of 20,000 researchers. Every £1 million spent by charities on medical research in the UK contributes £1.83 million to the economy.

Example: Research that cut problematic prescribing and generated cost savings in general practice – a local health priority

Analysis of routine patient data identified the need for strategies targeting clinicians and patients to curb rising opioid prescribing. From this, the Campaign to Reduce Opioid Prescription (CROP) was launched in 2016, urging GPs across West Yorkshire to ‘think-twice’ before prescribing opioids. This promoted the NICE guidance on chronic pain , which recommends reducing the use of opioids because there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress, but they can cause harm, including possible addiction.

Over a year 15,000 fewer people were prescribed opioids (a 5.63% relative reduction), a net saving to the NHS of £700,000. The biggest reduction was in people aged over 75, who are at higher risk of opioid-related falls and death, and there was no compensatory rise in the prescribing of other painkillers or referrals to musculoskeletal services.

The CROP campaign, led by researchers at the University of Leeds, has subsequently been rolled out across all ICBs in Yorkshire and the Humber, and the North East and North Cumbria ICB, and the 1,045 practices to which it has been delivered are reporting results similar to the above.

Foy R, Leaman B, McCrorie C, Petty D, House A, Bennett M, et al (2016) Prescribed opioids in primary care: cross-sectional and longitudinal analyses of influence of patient and practice characteristics | BMJ Open 69(5).

Alderson SL, Faragher TM, Willis TA, Carder P, Johnson S, Foy R (2021) The effects of an evidence- and theory-informed feedback intervention on opioid prescribing for non-cancer pain in primary care: A controlled interrupted time series analysis. PLOS Med .

2. ICS, ICP and ICB responsibilities and requirements

ICBs have legal duties and other requirements that relate to research. These are additional to the duties and responsibilities of individual providers within ICS footprints. This section sets out what these duties mean in practical terms and gives examples of how to meet them.

2.1 Legal duties relating to research in the Health and Care Act 2022

Part 1 of the 2022 Act includes specific legal duties for ICBs and NHS England in respect of research. In the Explanatory Notes to the 2022 Act, government sets out how ICBs could discharge their research duty.

Duty to facilitate or otherwise promote research

The ICB duty builds on the previous clinical commissioning group (CCG) duty to promote research, by requiring each ICB, in the exercise of its functions, to facilitate or otherwise promote research on matters relevant to the health service. This duty is intended to include a range of activities to enable research. Section 3 of this guidance outlines ways in which ICBs can do this.

The NHS Constitution also makes clear that patients should be enabled to take part in research: “the NHS pledges … to inform you of research studies in which you may be eligible to participate”.

The Provider Selection Regime (PSR) will be a new set of rules for arranging healthcare services in England, introduced by regulations made under the 2022 Act. The research component should be referred to once the PSR is published.

Duty to facilitate or otherwise promote the use in the health service of evidence obtained from research

This duty similarly builds on the CCG requirement to promote the use of evidence. ICBs must, in the exercise of their functions, facilitate or otherwise promote the use in the health service of evidence obtained from research. For example, ICBs should facilitate or otherwise promote the use of evidence in care, clinical and commissioning decisions.

Duty for ICSs to include research in their joint forward plans and annual reports

Joint forward plans are five-year plans developed by ICBs and their partner NHS trusts and foundation trusts. Systems are encouraged to use the joint forward plan as a shared delivery plan for the integrated care strategy and joint health and wellbeing strategy, aligned to the NHS’s universal commitments. The plan must explain how the ICB will discharge its duties around research, and the ICB must report on the discharge of its research duties in its annual report. These inclusions will raise the profile of research at board level and help embed research as a business-as-usual activity.

The joint forward plan and NHS Oversight Framework guidance set the minimum requirements for what needs to be included in plans and reports.

NHS England duty to include how each ICB is carrying out its duties relating to research in its annual performance assessment of each ICB

NHS England has a new legal duty to annually assess the performance of each ICB and publish a summary of its findings. For 2022/23 NHS England will complete a narrative assessment, identifying areas of good and/or outstanding performance, areas for improvement and any areas that are particularly challenged, drawing on national expertise as required and having regard to relevant guidance. This assessment will include a section considering how effectively the ICB has discharged its duties to facilitate or otherwise promote research and the use of evidence obtained from research.

This, alongside the implementation of the NHS Long Term Plan commitment to develop research metrics for NHS providers, will increase transparency across the system and enable more targeted support for research. Research metrics from NHS England, the Care Quality Commission (CQC) and NIHR will enable the monitoring of progress over time, and are under development with sector colleagues, including providers.

2.2 Legal requirement to work with people and communities

Working with people and communities is a requirement of ICBs, and statutory guidance is available to support them and their partner providers meet this legal duty. A co-ordinated approach across healthcare delivery and research will make it more likely that research reflects what matters to people and communities.

This will also help ICBs to fulfil their legal duty in the 2022 Act to reduce health inequalities in access to health services and the outcomes achieved. Section 3.9 includes links to resources to help guide engagement with underserved communities around research.

The Public Sector Equality Duty also applies and requires equality of opportunities between persons who share a relevant protected characteristic and persons who do not.

2.3 Research governance

While research can address local priorities, it typically operates across ICS boundaries and at national and international levels. Health and social care research is governed by a range of laws, policies, and international, national and professional standards.

The Health Research Authority (HRA ) is responsible for ensuring such regulation is co-ordinated and standardised across the UK to make it easier to do research that people can trust. The HRA is an executive non-departmental public body created by the Care Act 2014 to protect and promote the interests of patients and the public in health and social care research, including by co-ordinating and standardising the practice of research regulation. Local authorities and the NHS are obliged to have regard to its guidance on the management and conduct of research.

Before a research project can start in the NHS in England it must receive approval from the HRA. This includes research taking place in NHS trusts, NHS foundation trusts, ICBs or primary care providers of NHS commissioned services in England, and all research under an NHS duty of care, including that undertaken by NHS staff working in social care or other non-NHS environments.

The HRA schemes indemnify NHS organisations accepting these assurances against any claim covered by the NHS Litigation Authority arising as a result of incorrect assurances. If an NHS organisation duplicates the HRA assessments, it will be liable for any consequences of the decisions it bases on its own checks.

ICBs and partner organisations should have processes for the set up and delivery of research that comply with national laws and systems, and does not duplicate them. Such national systems include confirmation of capacity, National Contract Value Review (NCVR), management of Excess Treatment Costs (ETCs) and contracting arrangements (see section 2.4).

The UK Policy Framework for Health and Social Care sets out the roles and responsibilities of individuals and organisations involved in research.

2.4 Contractual requirements around research

NHS England mandates commissioner use of the NHS Standard Contract for all contracts for healthcare services other than primary care. The contract is updated annually. References to research in the current NHS Standard Contract and service conditions fall into three main areas.

Recruitment of service users and staff into approved research studies

The NHS Standard Contract obliges every provider of NHS-funded services to assist the recruitment of suitable subjects (whether patients or staff) into approved research studies. This requirement aligns to those in the 2022 Act that require ICBs to facilitate or otherwise promote research (see section 2.1). Section 3 considers how this requirement can best be met. Research involving people or their data requires ethical and potentially other approvals (see section 2.3).

National Directive on Commercial Contract Research Studies

Adherence to the National Directive is mandated as part of the NHS Standard Contract. The directive states that providers must:

• Use the unmodified model agreements for sponsor-to-site contracting; HRA and Health and Care Research Wales (HCRW) approval of studies will be dependent on use of these templates.
• Use the standard costing methodology to set prices for commercial contract research undertaken by NHS providers; this is currently in the NIHR interactive costing tool (NIHR iCT).
• Introduce the National Contract Value Review (NCVR) process in line with national rollout. NCVR is a standardised national approach to costing commercial contract research within the NHS. It currently covers acute, specialist and mental health trusts, but the intention is to roll it out to all NHS providers. The creation of ICSs is the ideal opportunity to explore how commercial study set up can be supported across these footprints, reducing the resource needed and time taken.

Comply with HRA/NIHR research reporting guidance

The provider must comply with HRA/NIHR research reporting guidance, as applicable.

2.5 Excess treatment costs

Patients in a research study may receive healthcare that differs from what is standard in the NHS, requires more clinician time or is delivered in a different location. The associated NHS treatment costs may exceed or be less than those of standard treatment. If greater, the difference is referred to as the NHS Excess Treatment Costs (ETCs).

In the case of commercial contract research, the commercial funder will pay the full cost of the study. In the case of non-commercial research, the commissioner of the service in which the study operates is responsible for funding the ETCs.

ICBs as commissioners of services are responsible for ETCs in services that they commission. Guidance for the management of ETCs is available.

DHSC and NIHR are piloting interim arrangements to support non-NHS ETCs for research in public health and social care (non-NHS intervention costs). Please refer to the further detail on the NIHR website .

2.6 Care Quality Commission

The CQC is currently developing its approach for ICS-level assessments, and its new assessment framework will be introduced towards the end of 2023 .

CQC inspection of NHS providers continue, with research assessed as part of the review of the trust-level Well-led framework. Providers are asked:

• Are divisional staff aware of research undertaken in and through the trust, how it contributes to improvement and the service level needed across departments to support it?
• How do senior leaders support internal investigators initiating and managing clinical studies?
• Does the vision and strategy incorporate plans for supporting clinical research activity as a key contributor to best patient care?
• Does the trust have clear internal reporting systems for its research range, volume, activity, safety and performance?
• How are service users and carers given the opportunity to participate in or become actively involved in clinical research studies in the trust?

3. Developing a research strategy

3.1 why develop a research strategy.

Like the health and care system, the research environment is complex. Developing a research strategy will help bring together the legal and other duties around research in a coherent way, and help the ICS understand its local research capability, workforce, activity and needs, set ambitions around research and maximise the benefits associated with commercial research. It will help demonstrate the benefit of research locally, nationally and internationally, and guide the production of clear plans.

Example: Value of research partnerships and integration with ICSs

Bristol Health Partners (BHP) Academic Health Science Centre (AHSC) has a fully integrated relationship as the new Research and Innovation Steering Group for the Bristol, North Somerset and South Gloucestershire (BNSSG) ICS, and reports directly to ICB chief executives.

The group provides the strategic direction and oversight for all research undertaken and delivered across the system. Membership includes directors of research, clinical strategy, public health, social care, senior innovation and education leaders from its core funding partners. It also includes public contributors and senior representatives from primary care, NIHR Applied Research Collaboration West, NIHR CRN West of England, West of England Academic Health Science Network (WEAHSN), Healthier Together ICS, university research institutes and People in Health West of England.

The group has reviewed ICS programmes, identified current and potential research and innovation connections, and begun to establish new connections. It has also supported work with the ICS Ageing Well programme and secured funding for innovative pilots to improve dementia care and increase physical activity for older adults.

Since 2016 BHP has directly contributed an estimated additional £1.1 million to support ICS priorities through Health Integration Team projects and other activities, and has attracted more than £33 million of external research, service redesign and infrastructure into the region.

3.2 General considerations

In developing its research strategy, the ICS may find it helpful to consider these overarching questions alongside the suggested focused content covered in the sections below:

• What do you hope to achieve within a given timeframe?
• Are all the right organisations involved in developing the research strategy?
• How will the health and care workforce be enabled to deliver the research strategy?
• How can research be embedded in existing health and care delivery and pathways?
• What mechanisms are in place to translate actionable research findings into practice and decision-making?
• What inequalities exist in different areas, communities or groups? How will you ensure planning and delivery of research aligns to CORE20plus5 priorities?
• Are you considering equality, diversity and inclusivity and the Public Sector Equality Duty in facilitating and promoting research opportunities for service users and for health and care staff?
• Is the ICS considering the opportunities of developing their commercial research portfolio?
• Is research informing or being informed by population health management?
• How will you plan and deliver research in a sustainable manner, aligning it to the Greener NHS agenda and the ICB’s duties in relation to climate change ?

Buy-in from NHS staff, patients and the public will be vital if ICBs are to discharge their research duties and deliver on their research plans. An important consideration is how to develop sustainable, routine and accessible information flows to ensure the ICB, partners, staff, patients and public can access up-to-date and appropriate information around local research activity, regional, national and international research opportunities and findings, and contact information.

3.3 Leadership and governance across the ICS

Executive leadership.

The Explanatory Notes to the 2022 Act suggest that ICBs have board-level discussions on research activity, the use of the evidence from research, the research workforce and research culture within the ICS. ICSs should refer to the NHS Leadership Competency Framework for board-level leaders at organisation and ICS level for the competencies relating to the research duties of ICSs, once published.

All ICBs are encouraged to have an executive lead responsible for fulfilling the research duties conferred by the 2022 Act. They should help give the ICB a clear understanding of research across the area, regularly reporting on progress towards agreed aims. An executive lead can take responsibility for ensuring clear research ambitions and a research strategy are developed; oversight of organisational research portfolios, diversity in research, alignment to national priorities; promotion of research skills and the need for research skills training; and succession planning.

Senior leaders could engage, consult and be supported by representatives of each registered health and social care professional group when developing strategic plans, and for oversight of training, succession planning, and equality and inclusivity. They could use the capacity and capability of the research and development leads within provider organisations, although established lead roles across social care settings are rare so extra effort may be needed to garner social care research insight.

Research steering group, board or forum

Some CCGs had research steering groups and some of these have expanded with the widening remit of ICBs. ICSs that do not have a such a group should consider adopting a model similar to one in other ICSs where research is effectively embedded in ICS governance structures.

A dedicated steering research group, board and/or forum can:

• provide dedicated time to plan, oversee and report on research
• bring a range of representatives from research infrastructure organisations, patients and the public together with representation from across the ICS, to develop a common aim and objective
• ensure board-level sight of research
• take a cross-ICS approach to research, increasing participation and diversity in research, and reducing bureaucracy.

Example: A dedicated research and innovation subgroup

East and North Hertfordshire Health Care Partnership established a formal research and innovation subgroup to support its objectives to transform services, reduce health inequalities and improve patient health and wellbeing. This subgroup is dedicated to determining and supporting local research priorities and developing an innovation agenda. With effective patient and public involvement, it is working to ensure the local population has access to more research opportunities.

Bringing together the NIHR, academia, industry and local health and care services, the subgroup develops collaborative work plans that support the design, implementation and evaluation of local transformation needs, sharing resources, staff, expertise and facilities. Its work exemplifies a sustainable approach to partnership working and supports Hertfordshire and West Essex ICS’s developing strategy.

HWE ICS Partnership Board 14 September 2021

3.4 Understanding your research activity and working with local and national research infrastructure

Research in NHS and non-NHS settings across an ICS footprint will be supported by different organisations. In some areas networks or collaboratives already exist to bring these organisations together, but in others the links are not as well formed. ICBs would benefit from having a clear map of the research infrastructure and pre-existing local or national investment into research in their area.

It may be valuable to consider:

• Who are the research leaders in your local health and care system, NIHR, higher education institutions, VCSE sector and businesses?
• Are there any pre-existing local or regional research, researcher or research engagement networks?
• What are the opportunities to inform, participate in, collaborate with or lead national and international research efforts in addition to local opportunities?

A list of organisations involved in research including NIHR-funded infrastructure and programmes is included in Annex 1 .

Much of the research undertaken in NHS and other health and care settings is funded though national calls and grants provided by funders such as NIHR, research charities , UK Research and Innovation (UKRI) , including the Medical Research Council (MRC ) and Economic and Social Research Council (ESRC) , and is aligned to national priorities. Other research may include national or international commercial or non-commercial clinical trials funders.

Partners within ICS systems can use NIHR research portfolio data to monitor and plan research activity; however, not all research is included within the NIHR’s portfolio, so this will not give a full picture of the research within the footprint. Mechanisms to map and monitor research more widely could be incorporated in ICB research strategies.

Some local needs may best be addressed through public health or social care research rather than research in primary, secondary or tertiary healthcare settings. Public health and social care research are described in Annex 2 .

Example: Mapping health and care research activity, expertise, interests and infrastructure

The Nottingham and Nottinghamshire Integrated Care System Research Partners Group meets bi-monthly and is chaired by the ICB Head of Research and Evidence. It brings together senior managers from the NHS providers, ICB, two local authorities, two universities and the NIHR CRN East Midlands, providing a forum for ICS-wide research discussions and the development of a system-wide collaborative approach to health and care research across the ICS. Among its aims, the group seeks to increase participation in research at both the organisational and population level, enable equity of access to research opportunities and generate impact on health and care pathways.

The group have mapped health and care research activity, expertise, interests and infrastructure in the constituent organisations. With this the ICS can see the research capabilities, strengths, expertise, and areas of synergy and opportunities for future collaboration that align to its needs and priorities, and also gaps for future development, recognising that organisations are at different stages of research development.

3.5 Understanding local needs

Universal NHS priorities will be reflected in local research needs, and each ICS footprint is likely to have its own specific local research needs. Joint strategic needs assessments (JSNAs) are undertaken jointly by local authorities and ICBs through health and wellbeing boards (HWBs) to identify current health and social care needs of local communities, where more information is needed to do so or to understand how best to address the need. People and communities should be directly involved in identifying local need, including by working with local charities, specific communities or groups who face inequalities in access to, experience of or outcomes from healthcare, eg to target health research at those areas and populations with greatest need.

ICPs are required to develop an integrated care strategy informed by JSNAs and the joint health and wellbeing strategy (JHWS). The integrated care strategy sets out how the assessed needs can be met through the exercise of the functions of the ICB, partner local authorities or NHS England, and is informed by research and practice-based evidence, as stated in the health and wellbeing guidance. In considering where such evidence is lacking, HWBs should identify in JSNAs those research needs that ICBs, local authorities and NHS England could meet through the exercise of their research functions.

Systems are encouraged to use their joint forward plan to develop a shared delivery plan for the Integrated Care Strategy and the JHWS that is supported by the whole system, including local authorities and VCSE partners. ICBs and trusts must also use their Joint Forward Plan to describe how the ICB will discharge its duty in respect of research.

The Explanatory Notes to the 2022 Act suggest how ICBs can discharge their duties around research. These include the articulating local research needs when assessing local needs and how they will be addressed when preparing strategies and plans, and encouraging partner organisations to play an active and collaborative role in pursuing these.

3.6 Supporting delivery of research

Once an ICS has a clear picture of its local research infrastructure it can consider how best to target and support research and the research workforce across its footprint and how research findings will be used. For this, the ICB should ensure that its approaches reflect national approaches to costing, contracting, approvals and information governance, and that they are also informed by learning from effective practices across equivalent ICBs.

As healthcare shifts into communities, ICSs should support the parallel shift in research by embedding research in health and care. Increasing access to research opportunities will give service users earlier access to new treatments, and faster research set up and delivery may provide the evidence needed to support improvements to local care sooner. Inclusive recruitment practices will be needed to ensure that all groups in society have the opportunity to help shape and take part in research, and benefit from research findings.

In developing its research strategy, an ICS has opportunities to reduce bureaucracy, and make research more efficient and effective across its own and with other ICS footprints, and across NHS and non-NHS boundaries, while meeting national regulatory guidance. ICBs will be expected to work with the HRA to co-develop, build on and implement strategies for further co-ordination and standardisation of study set-up and delivery processes. Any regional systems and processes that ICBs do establish must support consistent national practice in relation to the management and regulation of research, and should not duplicate them. The HRA will work with ICBs to address barriers to efficient and rapid study set-up, including model agreements, information governance and R&D office functions.

Other potential areas for streamlining and cross-organisational working include:

• cross-ICS research proposals to identify research needs
• research delivery – identifying how ICS-wide approaches could accelerate patient recruitment and deployment of research delivery staff
• shared data architecture, including the NHS Secure Data Environment for Research Network and its subnational secure data environments (SDEs). Subnational SDEs cover multiple ICSs to achieve access to multimodal data at a scale of approximately 5 million citizens, and over time will achieve technical and governance interoperability
• a greater focus on translation and implementation of research findings into health and care practice, supporting faster improvements
• sharing access to and funding for knowledge and library services
• shared processes and repositories for research assets.

The Explanatory Notes to the 2022 Act suggest that one way an ICB could discharge its research duty would be to have a dedicated research office or team supporting research.

3.7 Enabling cross-provider research

Health and care priorities can often only be addressed with complex, multiorganisational approaches and as such the research to inform these needs to span organisational boundaries. Organisational policies should promote cross-organisational research and dissemination of research findings, including through participation in collaborative research to address national priorities, joint staff posts, honorary contracts, and administratively easier movement of researchers between health and care organisations and other sector partners, including higher education, industry, charities and local authorities.

The HRA and ICS partners are developing national guidance to support cross-provider research.

The NIHR CRN can offer ICSs opportunities to participate in national and international research studies, including those the NIHR, industry and others commission.

3.8 Commercial research

Commercial contract research is research funded solely by industry, where NHS providers are contracted to carry out the research. Most of these research studies in the NHS are interventional clinical trials, such as the NHS-Galleri trial and Astra Zeneca’s COVID-19 vaccine development . Commercial research can give patients access to a wider range of research opportunities, earlier access to novel therapies and treatments, provide drugs free of charge to patients in trials, accelerate the development of new treatments and devices, generate income for providers, and fund NHS staff. It is vitally important for the benefit of patients, the NHS and the UK economy that we create an environment in the NHS that makes it easy and efficient for the NHS to undertake commercial research. This is particularly important when it comes to international commercial research, where companies can place their studies in a number of different countries and consideration of anticipated set up and recruitment times informs where they place trials.

Data gathered during some commercial research is specific to the study and is the property of the company, as is any Intellectual Property (IP) generated. In other cases, where the NHS contributes to the foreground IP – such as through the use of NHS data for research or where NHS expertise provides important contributions to a commercial product – it is important that the NHS shares in the value of IP generated as a consequence of its contributions.

The establishment of ICSs is an ideal opportunity for their creation of ambitions to enable, grow and benefit from commercial research. ICSs should explore how efficient commercial study set up and delivery could be streamlined across sites within their footprint, and should set ambitions around commercial research.

3.9 Involving patients, service users, carers and the public in research

In developing a research strategy ICSs should set out their approach to diverse public and patient involvement (PPI) in relation to research.

Areas where working with people and communities could add value in the context of research include:

• identification of local research needs, including through JSNAs and JHWSs
• designing research proposals in partnership with local or national experts
• raising awareness of research opportunities and recruitment of participants
• developing research outcome reports and identification of how and when participants will be able to access these
• consideration of how members of the public can access the outputs from publicly-funded research
• how volunteers should be involved and what they should be paid.

The UK Standards for Public Involvement sets out the core components of good public involvement. A guide outlining good practice in engaging underserved communities around research is available from NHS England. Resources about good practice around PPI in designing and delivering research, including around incentivisation , are also available from the HRA and NIHR .

It will be useful to link into established community involvement approaches. NIHR infrastructure organisations may have established networks of expert PPI representatives, and ICSs have extensive VCSE Alliances. A co-ordinated community engagement approach across health and care delivery and research will reduce the risk of overburdening communities with organisations wanting to work with them, and will support the identification of under-served communities.

3.10 Ensuring anyone can participate in research

Making research more visible within communities and increasing the public’s understanding of research can ensure greater diversity in research participation. Research findings will then be more generalisable to a broader range of groups or communities, or can be targeted and specific to relevant communities.

ICSs should seek mechanisms to ensure that opportunities to take part in research are available to all. They should consider encouraging patients and members of the public to register on NIHR Be Part of Research (a national registry where people can express their interest in being contacted about research that is relevant to them), widely disseminate research opportunities and make provision for inclusive access for communities to take part in research. Decentralised or virtual trials are remote access trials recruited to and delivered using electronic tools, making it easier for people to participate in some studies without needing to visit a recruiting hospital or attend appointments in person. ICBs should consider ways in which research delivery can increase access to research opportunities for people within their area. ICBs should also advise the public how they can access research outputs.

NIHR and UK Research and Innovation provide resources that help organisations address issues of equality, diversity and inclusion in research settings.

Example: RELIEVE-IBS decentralised trial

In 2020, Newcastle researchers launched RELIEVE-IBS, one of the first interventional decentralised clinical studies in the UK to trial Enterosgel, a new treatment for irritable bowel syndrome with diarrhoea (IBS-D). Decentralised trials are remote access trials that use electronic tools for trial recruitment and delivery, without the patient needing to visit a recruiting hospital site, which could be miles from their homes – a convenient option for patients with IBS-D. By running the trial remotely, researchers could reach beyond the small proportion of those with this condition who attend specialist clinics, as well as save resource for the sponsor.

Not only did this trial embrace technological developments to deliver research, but it empowered more patients to become involved regardless of where they lived. With in-depth patient input, the research team were able to shape the recruitment approach to be highly accessible to participants and were offered feedback on how to refine the trial design by the sponsors. The resulting patient-centric design ensured a good recruitment response when the trial opened.

NIHR (2020) Virtual trial recruits 67% faster led by NIHR Patient Recruitment Centre in Newcastle in collaboration with Enteromed

NIHR (2021) Pushing virtual boundaries to improve patient engagement and accessibility

NIHR (2022) RELIEVE IBS-D trial case study

3.11 Health data in research

Health data generated through care of service users in the NHS can fuel a revolution in the research and development of new diagnostics and treatments, maximising the potential to improve service user outcomes and experiences, support diversity in research, and minimise health inequalities through research. To do this, researchers need access to high quality and timely data to generate insights. The public expect data to be used legally and efficiently to conduct and support research.

National commitments around data for research can be found in Data saves lives: reshaping health and social care with data . This strategy shows how data will be used to bring benefits to all parts of health and social care. To achieve this vision, the NHS will be making a strategic move away from a system of data dissemination to one of data access when making NHS health and social care data available for research and analysis. This will be facilitated by the implementation of secure data environments (SDEs).

SDEs are data storage and access platforms with features that enable organisations to have greater control and oversight over their data. SDEs allow approved users to view and analyse data without it having to leave the environment. The SDE policy guidelines provide a clear signal to the sector that SDEs will become the default way of accessing NHS data for research.

This change is supported by major investments in digital infrastructure through the Data for Research & Development Programme, which is funding the development of national and subnational SDEs. The subnational SDEs will cover the entirety of England and individual platforms will cover several ICS.

ICBs should seek ways to promote and enable the use of these rich data sources for research and include them in their research strategy.

3.12 Using evidence for planning, commissioning and improving health and care

Evidence-based commissioning has advantages for the commissioner, workforce and service users, as it can:

• lead to innovation in service design and delivery
• enhance the quality of health and care provision
• reduce clinical variation between locations and providers
• improve equity of access to services
• improve patient and population outcomes.

As part of the commissioning process, commissioners are expected to use evidence-based clinical policies, as per the Roadmap for integrating specialised services within integrated care systems . Knowledge and library services can help source and interpret evidence.

The Provider Selection Regime will reflect the research duties of the 2022 Act and should be referred to when commissioning provider services, once it has been published.

NHS knowledge and library services provide access to evidence and support for knowledge management; they train people in searching for, handling and publishing information. The Knowledge for Healthcare strategy encourages and equips NHS knowledge and library services to support NHS organisations with the translation of knowledge for the spread and adoption of research and innovation. To fulfil their obligations under the 2022 Act, ICBs could commit to active knowledge translation.

Evidence for commissioning information is available from a number of sources:

• NHS Library and Knowledge Hub
• Health Libraries and Information Services Directory
• NICE guidance
• NIHR evidence
• NHS evidence works toolkit
• Academy of Medical Royal Colleges: Evidence-based Intervention
• A million decisions

The infographic for the role of research and evidence in commissioning also provides sources for evidence-based commissioning.

Example: Evidence mobilisation, knowledge sharing and improving outcomes

The STEMClub (Sustaining Transformation by Evidence Mobilisation) is a network in the North East and North Cumbria that brings together local policy and decision-makers with NHS knowledge and library specialists to facilitate evidence-based decision-making. The input of knowledge specialists ensures timely access to published research and provides knowledge management expertise to shape how soft intelligence is translated into knowledge assets.

As members within the STEMClub network, knowledge and library specialists are providing ongoing detailed evidence reviews and information management expertise to facilitate system-wide working , eg:

• North East North Cumbria Frailty Framework
• North East and North Cumbria Maternity Clinical Network
• a review of optimal patient transfer times in the North East and North Cumbria
• regular evidence summaries for the ICS Mental Health Evidence and Evaluation subgroup.

3.13 The health and care workforce and research

Staff involved in research have greater job satisfaction and research active trusts have lower staff turnover [3] . Clinical academic roles [7] , having research colleagues within services [8] and taking students on research placements [6] are felt to foster an increase in knowledge and skills across the wider staff workforce. The General Medical Council (GMC) and the Royal College of Physicians (RCP) and NIHR have issued position statements and recommendations around research, with additional signatories including UKRI, UKRD, the Academy of Medical Royal Colleges and the Royal College of Surgeons of England. Learning resources, including programmes for ongoing professional development of the research delivery workforce, are available through NIHR Learn.

In developing a research strategy ICSs could ensure that, as part of their people function and approach to workforce planning :

• Staff roles in leading, delivering or facilitating research and in supervising those developing research skills are recognised, supported and enabled across all staff groups and health and care settings as part of a positive research culture.
• The value of evidence is recognised, and education and training around research are facilitated. Opportunities to develop research careers or in overseeing the development of other researchers are enabled; this may include having protected time, inclusion in job plans and joint appointments across health and care providers and academic institutions.
• Ensuring that there is capacity and systems that support research through services like imaging, pathology and pharmacy, as well as finance and human resources.
• Individual organisations do not always have the necessary skills or services to support effective research and its impact, such as IP management, methodological expertise, regulatory compliance, statistical analysis, knowledge mobilisation expertise, genomics expertise, health informatics and data analytics. Mechanisms are needed to ensure that these can readily and rapidly be accessed across other health and care organisations, including from local authorities and other non-NHS care providers.

A UK Clinical Research Workforce Strategy is under development. ICSs should update their approaches to their research workforce once DHSC publishes this in 2023/24.

Example: Investing in the research workforce – developing capacity for chief investigators

Across the West Midlands NIHR CRN, an investment of approximately £750,000 to develop capacity for chief investigators returned additional research grant income of over £18 million in three years. This was achieved primarily by increasing the programme activity for consultants in areas where chief investigators were underrepresented.

The funding was provided through a competitive process and co-supported by the local NIHR CRN, with several local trusts jointly funded these scholars.

Kirk J, Willcocks J, Boyle P, Brocklehurst P, Morris K, Kearney R, et al (2022) Developing chief investigators within the NHS: the West Midlands clinical trials scholars programme. Clin Med 22(2): 149–52.

Kirk J, Reynolds F, Adey E, Boazman M, Brookes M, Brocklehurst P (2022) Developing paediatric chief investigators within the NHS: the Clinical Trials Scholars programme . Arch Dis Child Educ Pract Published online first: 22 February 2022. doi: 10.1136/archdischild-2021-322186

4. References

• Varnai P, Rentel M, Dave A, De Scalzi M, Timmerman W, Rosemberg-Mantes C, Simmonds P, Technopolis Group (2017) The impact of collaboration: The value of UK medical research to EU science and health .
• Boaz A, Hanney S, Jones T, Soper B (2015) Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open 5: e009415. doi:10.1136/ bmjopen-2015-009415 .
• Rees MR, Bracewell M (2019) Academic factors in medical recruitment: evidence to support improvements in medical recruitment and retention by improving the academic content in medical posts. Postgrad Med J 95(1124): 323-327. doi:10.1136/postgradmedj-2019-136501 .
• Ozdemir BA, Karthikesalingham A, Singha S, Poloniecki JD, Hinchliffe RJ, Thompson MM, et al (2015) Research activity and the association with mortality. PLoS ONE 10(2): doi.org/10.1371/journal.pone.0118253 .
• Hunn A (2017) Survey of the general public: attitudes towards health research . Health Research Authority.
• Angus RL, Hattingh HL, Weir KA (2022) Experiences of hospital allied health professionals in collaborative student research projects: a qualitative study. BMC Health Services Research 22(1). Available at: https://doi.org/10.1186/s12913-022-08119-7 .
• Newington L, Wells M, Adonis A, Bolten L, Bolton Saghdaoui L, Coffey M, et al (2021) A qualitative systematic review and thematic synthesis exploring the impacts of clinical academic activity by healthcare professionals outside medicine. BMC Health Serv Res 21(1). Available at: https://doi.org/10.1186/s12913-021-06354-y .
• Wenke RJ, Hickman I, Hulcombe J, Phillips R, Mickan S (2017) Allied health research positions: A qualitative evaluation of their impact. Health Res Policy Syst 15(6). Available at: https://doi.org/10.1186/s12961-016-0166-4

Annex 1 – Organisations that may be involved in regional or local research

• Clinical Research Networks (CRNs) , which will be retendered and renamed regional research delivery networks (RRDNs) from April 2024
• Applied Research Collaborations (ARCs)
• Biomedical Research Centres (BRCs)
• Experimental Cancer Medicine Centres (ECMCs) , jointly funded with Cancer Research UK
• Research Design Services (RDSs) and Clinical Trials Units (CTUs) which will be replaced by the NIHR Research Support Service from 1 October 2023
• Patient Recruitment Centres (PRCs)
• MedTech and In vitro diagnostic Co-operatives (MICs) , which will be replaced with HealthTech research centres from April 2024
• School of Public Health Research, School of Primary Care Research and School of Social Care Research
• Health Determinants Research Collaborations (HDRCs)
• Clinical Research Facilities (CRFs)
• Patient Safety Research Collaborations (PSRCs)
• Translational Research Collaborations (TRCs)
• Academic Health Science Centres (AHSCs)
• university teaching hospitals and all trusts that deliver research activity
• primary care organisations, including GP practices, that deliver research activity
• higher education institutions (HEIs)
• local authorities
• social care partners
• Local Government Association
• local and national charities that fund, collaborate in or support participation in research
• research and development offices in providers or CSUs, including primary care providers and ambulance, community and mental health trusts, and those in the VCSE sector
• UKRD members
• NHS subnational secure data environments for research
• NHS R&D Forum
• NHS Genomic Medicines Service Research Collaborative
• NHS Knowledge and Library Services
• Academic Health Science Networks (AHSNs) are often well linked with research organisations and infrastructure as part of their roles in development, adoption and spread of innovation.

Annex 2 – Public health and social care research

Public health research investigates issues that impact at a population rather than an individual level. This can be done within the NHS with system-level studies, such as secondary prevention of cardiovascular disease and examining the impact on health inequalities of changes to the NHS resource allocation formula, and outside the NHS for the wider determinants of health such as air quality, transport systems and housing. There is a substantial body of public health evidence for the clinical and cost effectiveness of prevention, health protection, health service redesign and addressing health inequalities.

Social care research aims to improve the lives of children and adults who need to draw on personal or practical care and support, and family members or other unpaid carers. It can include research around the introduction, use and impact of technologies, and changing social care interventions, policies and practice. Social care research also examines issues pertaining to the safeguarding of adults and children and workforce, commissioning of services, and questions about organisational and professional practice, including decision-making, training and the quality of care.

Publication reference: PR1662