Benefits of HS&DR for the NHS
An Update
Professor Sue Bale
Assistant Nurse Director (R&D)
Aneurin Bevan Health Board
Overview
Putting the NHS in the centre:
• Developed in the context of a transformed research system
NISCHR
• Health Services and Delivery Research (HS&DR) is a strategic
priority aim that cuts across the other priority aims for
SEWAHSP
• Pace and progress – already seeing benefits to the NHS
• Integrating with existing systems for improvement in the NHS
New context for NHS research in Wales NISCHR
Past 3 years have seen a huge transformation in the NHS:
•
Changes to funding has enabled the NHS organisations to provide their staff and
departments with a functional infrastructure, though these are small in comparison to
the size of the organisations
•
Through competitive bids have now got funding to directly support access to pharmacy,
radiology and pathology for research
•
Through competitive bids have access to protected research sessions for NHS staff
•
Have now got access to research methodologists
•
The Academic Health Science Collaboration has been instrumental uniting the Wales
research communities and has strengthened existing collaborations
•
The 3 hubs has enabled a Regional approach
•
SEWAHSP is an important forum to the NHS organisations in the SE Wales region
Where did HS&DR come from and why?
•
Strong hub lead for the SEWAHSP
•
Considerable support from AHSC lead
•
Quickly engendered a sense of community
•
The NHS an equal partner
•
Health service delivery core business in the NHS
•
HS&DR core area of research in Universities
•
HS&DR Group first met to scope out interests and expertise
•
HS&DR Group first met to explore how we could work together
Working in partnership
We envisage that the NHS partners:
• Will do different projects
• Can share projects between any of the NHS organisations in SE
Wales
• Can work with 1 HEI or a combination of HEIs
• Any combination of NHS organisations and HEIs is possible
A flavour of what has been
achieved to date
Developing the Infra-structure support for
R&D across South East Wales
•
•
Following discussion and agreement, a needs assessment across the SEW
Region resulted in a funding application submitted to the AHSC
Application on behalf of all SEWAHSP and HS&DR Group members
This was successful and funding was secured for 3 years for:
•
•
•
1 wte statistician
1 wte health economist
0.5 wte psychometrician
•
•
Direct access to research design expertise for the NHS
Posts specifically to support the NHS, accessed through Research Design and
Conduct Service (RDCS)
Provide clinics and individual advice in the NHS of study design, particularly for
CRP
•
Proposed Collaborative HS&DR projects
and the NHS in South East Wales
Gathered pace already:
•
NHS working with Cardiff University (SOCSI) Alison Bullock
•
Better understanding Knowledge Transfer in NHS managers is of key
importance
•
Managers uptake and utilisation of research will be essential in developing and
delivering the best evidence-based services in the NHS
•
NHS working with Cardiff University (Mathematics Department, Operational
Research) Paul Harper
•
Mathematical modelling is of key importance in understanding services,
identifying issues and then solving them
Knowledge Transfer and the
NHS in South East Wales
• Knowledge Transfer project with Alison Bullock
• ABHB has identified a researcher for the pilot project
• ABHB has applied for funding to undertake the pilot
• 2 Health Boards are planning to support the pilot through access to
staff and funding
• ……more from Alison later
Mathematical modelling and the
NHS in South East Wales
Operational Research at the School of Mathematics, Cardiff University:
• Sees challenges to the NHS as ‘bringing people processes and technology
together in an integrated way to plan, develop and deliver better health
services’
• OR Group is recognised as a leading group in the UK
• 22 staff and PhD students
• Research income £3m (Science and Innovation award for 2008-2013)
Mathematical modelling cont’d
Recognises that the NHS has to become more efficient and patient
centred. Focuses on improving:
• Queuing systems (where are they and how to eliminate them) by
predicting individual patient resource needs and outcomes
• Facility location (have developed scenario modelling simulation
frameworks) to work out the sites for services
• Behavioural modelling (game theory and theory of planned
behaviour) helps understand the importance of human behaviour in
healthcare simulations
• Important for an evolving NHS in Wales
Mathematical modelling and the
NHS in South East Wales
• C&V, WAST and now ABHB previously working with HEI in isolation from each
other
• The HS&DR Group has enabled the value and possibilities of such mathematical
research to be discussed and explored together
• The HS&DR Group has enabled mathematical research to be further spread across
SE Wales
• HS&DR will be the forum for sharing, learning and collating these projects
• C&V funds from corporate funds (£65k and £55k)
• ABHB funds from corporate funds (£150k)
• WAST funds from external EPSRC through CU
OR work in ABHB
• MSc student project operational research project in dermatology
• Joint appointments of 4 post doctoral OR mathematicians (2 in January 2013 and
2 in April 2013)
• Will be part of the ABCi – more later
• Will work on the Clinical Futures programmes
• Especially for centralising Specialist Critical Care services and community based
services
• Provide a cohort of expertise
• Spend 1 day a week at the Maths Department
• Will be integral to developing future services
OR work in Cardiff & Vale
• Continuous funding of PhD students
• Modelling in Emergency Unit led to identifying bottlenecks, reconfiguring
services, improving patient flow
• More than half way through a 3-year plan of implementation and has already
saved £1m
• Automated scheduling of physiotherapy at the neurological rehabilitation centre
(Rookwood)
• Implemented since January 2011 it has transformed bookings and released
clinician time
• Physiotherapy treatments are tailored to patient need
• Lengths of stay have been optimised
• Improved quality of life for patients
Cardiff & Vale University Health Board
In partnership with CU we have developed funding mechanisms to that
focus on optimising healthcare delivery:
• Co-Principle Investigators for MAGIC (Making Good decisions In Collaboration) – a
Health Foundation Grant evaluating mechanisms that support the implementation of
Shared Decision Making in the NHS setting
• SHINE Award 2011: Hysteroscopy move from GA to LA outpatient procedure.
Evaluation performed in partnership with CEDAR:
- 90% procedural success; well tolerated by patients
- Saving of £651 per procedure and 100 hours of theatre time
• Collaborative study with School of Mathematics, reached final adjudication stage of a
SHINE application for study employing operational research modelling to determine
the value components associated with service transfer (secondary to community care
setting)
C&V Faculty for Quality Improvement
In partnership with CU we have developed a Faculty for QI.
The purpose is to bridge the gap between bench and bedside
and foster an improvement and innovation culture.
Collaborative and
partnership
relationships, to
advance and
promote innovation
Increase quality
reliability and
effectiveness of care
Best
health
Best
value
Eliminate harm,
variation and waste
Best for
Patients
&
Citizens
Best
care
Best
place to
Develop a culture of
work
continuous improvement
and capacity building
Adapted from AQuA Alliance 2010
Cwm Taf Health Board
Investment and Successful funding applications has lead to
increased R&D Infra structure to support HS&DR
• x2 AHSC Clinical Research fellowships:
a) Anaesthetics and Critical Care Medicine (Sepsis)
b) Endocrinology (Thyroid Disease)
Undertaking Collaborative Research with Cardiff University in
respective fields and supporting projects on the NISCHR CRP
• x1 Clinical Trials Pharmacist + Support
• x1 Clinical Research Scientist + Support
• Health Board currently reviewing potential HS&DR /pathway to
portfolio projects in Therapies, Medicines Management, Public
Health Medicine, Knowledge Transfer (with CU) and Medicine
(NISCHR RS&PD Allocation)
Aneurin Bevan Centre for improvement (ABCi)
– integrating R&D into existing systems
Functions of ABCi:
•
•
•
•
Developing leaders and supporting leadership
Train staff in a range of improvement methodologies
Support projects for improvement
Innovation, resources and knowledge management
• Will continue strong links with 1000 Lives Plus, NLIAH, Delivery
& Support, IHI and Patient Groups
• Collaboration with Paul Harper (Mathematical modelling) and
Alison Bullock (Knowledge Transfer) are very important
In Summary:
• HS&DR collaborative projects are being developed and gathering
momentum
• Benefits of sharing resources are coming to fruition
• Boundaries between NHS service delivery and academic research
being removed
• Partnerships are clearly symbiotic
• Opportunity to facilitate evidence based changes in NHS service
delivery through better understanding Knowledge Transfer now
available
………………… Now over to Alison