Health and Care Research Wales

Last week I had the opportunity to join colleagues at the Millennium Stadium for the launch of Health and Care Research Wales. This is the new name for what was, until very recently, the National Institute for Social Care and Health Research (NISCHR).

I’ve written before about the reorganisation of the research infrastructure here in Wales (see here and here), and Thursday’s event was an important unveiling of the outcome of recent deliberations. For a shortcut, here’s the public information video:

And, for a single-page diagram of how everything is fitting together, follow this link. As this shows, one of the things Health and Care Research Wales has done is to (re)commission a number of Centres and Units, an example of the former being the National Centre for Mental Health (NCMH).

By the looks of things, funding streams are to remain much as they were under NISCHR, with opportunities for PhD, post-doctoral and project awards to follow. Researchers in Wales can continue applying for support to many (but not all) of the National Institute for Health Research (NIHR) programmes. This is vital, because it is through this mechanism that funding is available for studies into health services and delivery (amongst other things). This is an area of research in which Wales has no dedicated funding stream of its own, and in which the new Centres and Units may be interested to varying degrees. 

Finally, a word on a Welsh Government centrepiece, HealthWise Wales. This is aiming to prospectively, and electronically, recruit many thousands of people into future health and social care research. 


Research away day and MHNAUK meet-up

Lots of interesting things to report from a packed week. Monday took me to a meet-up with research-minded nurses from Cardiff and Vale UHB, the first of a series of events organised by Professor Lesley Lowes aimed at supporting research capacity and engagement amongst practitioners. Here’s the flyer:

Lesley's event

In her presentation, Bridie Evans made use of a segment from a NISCHR CRC video introducing the work of Involving People. This has been uploaded to the NISCHR CRC YouTube channel, where the part Bridie used begins at around the 1:53 mark:

Yesterday was the first Mental Health Nurse Academics UK meeting of the 2014-15 academic year. We convened in Manchester, with public involvement and engagement in mental health research and education the theme for the pre-business part of the day. Lauren Walker and Lindsey Cree led with an excellent presentation drawing on their service user and carer researcher experiences working on the Enhancing the Quality of User Involved Care Planning in Mental Health Services (EQUIP) study. Steven Pryjmachuk and I talked about our experiences of involving young people in research, drawing on Steven’s self-care project and our shared RiSC study. John Baker closed this part of the day with an impressive University of Manchester case study of how public and patient involvement in research and education can be embedded at institutional level.

Elsewhere in yesterday’s MHNAUK meeting there was a lively discussion around the promotion of physical health and well-being in people using mental health services, and a review of this year’s NPNR conference. Plans are also being laid for next year’s event, with opportunities about to be notified for people interested in becoming more involved via membership of the conference organising committee.

Building research capacity

Last night I enjoyed an evening event in Cardiff with other past, and present, members of the RCBC (Research Capacity Building Collaboration) Wales Community of Scholars. This is a collaborative venture supported by higher education institutions, with funds now coming from NISCHR. Since coming into being in 2006 the RCBC programme has sought to develop research capacity across nursing, midwifery and the allied health professions. I’ve written about the scheme on this blog before (see here and here), and am personally grateful for the support I received as an RCBC Post-Doctoral Fellow which enabled me to complete my study into the work and system impact of crisis resolution and home treatment teams. For more on what I found in that project, check out these green open access articles saved in Cardiff University’s ORCA repository:

Hannigan B. and Coffey M. (2011) Where the wicked problems are: the case of mental health. Health Policy 101 (3) 220-227

Hannigan B. (2014) ‘There’s a lot of tasks that can be done by any’: findings from an ethnographic study into work and organisation in UK community crisis resolution and home treatment services. Health: an Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 18 (4) 406-421

Hannigan B. and Evans N. (2013) Critical junctures in health and social care: service user experiences, work and system connections. Social Theory & Health 11 (4) 428-444

Hannigan B. (2013) Connections and consequences in complex systems: insights from a case study of the emergence and local impact of crisis resolution and home treatment services. Social Science & Medicine 93 212-219

Last night began with a talk from Tina Donnelly, Director of RCN Wales and Commanding Officer of the 203 Welsh Field Hospital. In introducing Tina, RCBC Grant Holder Professor Donna Mead (from the University of South Wales) shared the news that the RCBC scheme has received confirmation from NISCHR of continued funding. That’s good, and means we can look forward to more doctoral (and hopefully, post-doctoral) opportunities in the coming months and years.


Mental health research priorities for Wales

The National Centre for Mental Health (NCMH), a NISCHR-funded research centre, has opened a consultation on future mental health research priorities for Wales. For more information, and instructions on how to make a contribution, follow this link. I see the NCMH is also planning a live Twitter discussion on Thursday August 21st 2014, between 7pm and 8pm. The hashtag pulling all of this together is #TellNCMH.

Here are my priorities, as submitted this morning:

  • How do we make mental health services more person-centred and collaborative, particularly at a time of financial constraint and cuts to public services?
  • What do service users need to promote recovery, and how can services be organised and provided in ways which reflect this?
  • What is shared decision-making in mental health, what are its effects, and what can be done to improve it?
  • New roles in mental health, including peer support: what is the impact on users, workers and organisations?
  • Understanding and improving the experiences of organising, providing and receiving mental health care across system interfaces (eg, transitions from home to community crisis services, or community crisis services to inpatient care, or from hospital to home, or from community CAMHS to inpatient CAMHS, or from 18-65 to older people’s services, or across interprofessional interfaces, etc).

In my response I made the additional point that parity of esteem means investing in mental health services and also in mental health research (see my recent post here). More generally, I suggested we need research into the causes of mental ill-health and distress and into actions and interventions (physical, psychological, social) which help, and research into the experiences of people receiving and working in services, and research into the organisation and delivery of services.


Parity of esteem?

Today’s Guardian interview with Professor Simon Wessely, President of the Royal College of Psychiatrists, reveals how large the mental health care and treatment gap has become. Professor Wessely draws comparisons between mental health and cancer services, saying:

“People are still routinely waiting for – well, we don’t really know, but certainly more than 18 weeks, possibly up to two years, for their treatment and that is routine in some parts of the country. Some children aren’t getting any treatment at all – literally none. That’s what’s happening. So although we have the aspiration, the gap is now so big and yet there is no more money,” he said.

Wessely said there would be a public outcry if those who went without treatment were cancer patients rather than people with mental health problems. Imagine, he told the Guardian, the reaction if he gave a talk that began: “‘So, we have a problem in cancer service at the moment. Only 30% of people with cancer are getting treatment, so 70% of them don’t get any treatment for their cancer at all and it’s not even recognised.”

NHS England places considerable emphasis on ‘parity of esteem‘, with the Improving Access to Psychological Therapies (IAPT) programme intended to be a one, key, part of making this happen. Evidence like Simon Wessely’s, combined with (for example) BBC/Community Care investigatory evidence of cuts in services, points to a chasm between the stated intention and the frontline reality.

This lack of parity extends to research. Within the last week or so the Liberal Democrats made a promise to include in their general election manifesto a commitment to increase mental health research funding by £50m each year. It has often struck me how poorly funded mental health research is. Mental health researchers can apply for support to bodies like the NIHR and NISCHR, and many do with some success (see all my previous posts on this site relating to COCAPP, RiSC and Plan4Recovery, for example). But unlike most other areas of health care the mental health field has no large-scale, dedicated, charitable research funding. Mental Health Research UK was founded in 2008 as (it says on its website) the UK’s first charity devoted specifically to raising funds to support research into the causes and treatments of mental illness. And that’s about it, I think: unless someone is able to tell me differently?


Reviewing health and social care research in Wales (reprise)

Time this morning, before I head off for a second day of MMI-ing, to draw attention to revised restructuring proposals from (and for) the National Institute for Social Care and Health Research here in Wales. I’ve written about the NISCHR review in this earlier post, and this latest document is the version which has gone out for external peer review.

I’m pleased to see that NISCHR proposes a continuation of its support for research capacity building in nursing and the allied health professions. Here’s a snip from the new document:

Research Capacity Building Collaboration (RCBC) – RCBC was established in 2006 as a collaboration between six universities in Wales to increase research capacity in nursing/midwifery and the allied health professions in Wales. It does this through a number of funding schemes including PhD Studentships and Post-doctoral Fellowships.
v. It is proposed that a new specification is developed for an application for renewal of RCBC/ a new initiative to increase research capacity in nursing/midwifery and the allied health professions in Wales.

For those not familiar with the RCBC scheme I recommend a visit to this website.

Elsewhere, I see that NISCHR proposes pressing ahead with its plans to close the gap between its funded Registered Research Groups, Biomedical Research Centres and Biomedical Research Units. It says:

There is a need to further integrate the functions of the BRC, BRUs and RRGs into the NISCHR infrastructure and to provide clear objectives and indicators to ensure NISCHR funding makes a real difference and contributes to future outcomes. There is also a need to avoid duplication and address the perception of NISCHR’s infrastructure being unnecessarily complicated.
b. It is proposed to create new entities known as NISCHR Centres and Units. These will replace BRCs, BRUs and RRGs and become central pillars of the NISCHR infrastructure to create a more streamlined and integrated structure, improve cost-effectiveness and foster collaboration across sectors to facilitate translation.
c. It is proposed that NISCHR Centres will have responsibility for portfolio development and delivery in their areas across the translational spectrum, in collaboration with other elements of the infrastructure. In some instances they may also provide elements of infrastructure support themselves.
d. It is proposed that NISCHR Units will be smaller entities than NISCHR Centres and focus on specific points of the translational spectrum, specific activities, or represent emerging areas of research strength with aspirations to become NISCHR Centres in the future.
e. It is proposed that a competition is held for NISCHR Centres and Units; the existing BRC, BRUs and RRGs will be able to apply and be encouraged to consider how best to augment existing functions and strengths to become more integrated entities in the future. They may also incorporate the functions of other elements of the existing infrastructure. The NISCHR Centres and Units will have a Director, Operational Manager and Leads for specific specialties/areas. They will be multi-professional and multidisciplinary, including Public and Patient, NHS, HEI, Industry and Social Care representation as appropriate.

This is a significant, if not unexpected, proposal. As future arrangements begin to become clearer I’ll be looking for ways to make sure that research into mental health systems and services continues to be supported. Plenty to think about, then, as I head for the train.

Activity based funding and student research in the NHS

Yesterday I spent time with a group of MSc students, talking about research review processes. I’ve written on this blog in the past about my experiences of seeking approvals for my PhD, and in Monday’s session I urged people to be exceptionally cautious about planning NHS-related research in pursuit of their Master’s degrees.

Preparing for and securing NHS research ethics committee and R&D office approvals takes time. In this part of the world at least, some healthcare organisations are also likely to ask researchers to cover the costs to the NHS of supporting studies which are not portfolio adopted. Here I’m thinking of, for example, the costs arising when staff leave the workplace to participate in interviews or join focus groups, or suchlike.

The relatively new practice of directly seeking payment from research teams for the costs of studies which are not eligible for portfolio registration has appeared with the shift to activity-based funding. Here in Wales, the National Institute for Social Care and Health Research (NISCHR) has published criteria for entry to its portfolio, which are summarised here and are elaborated on here. It is from this second document that I have snipped the following:

A research study is a structured activity which is intended to provide new knowledge which is generalisable (ie of value to others in a similar situation) and intended for wider dissemination.

Studies eligible for the NISCHR portfolio should involve face to face contact with NHS patients, social care service users or people involved with their care. Studies must be led from and/or recruiting participants from Wales. All studies must already have research funding before they can be included in the Portfolio.  Research Costs cannot be provided by NISCHR CRC.

The following types of study are not eligible for inclusion in the NISCHR Portfolio:

  • audit,
  • needs assessments,
  • quality improvement projects,
  • directly commissioned studies,
  • secondary research such as systematic reviews,
  • purely laboratory based studies,
  • routine biobanking of samples would not be eligible but a hypothesis based sample collection would be if appropriately peer reviewed and funded,
  • own account funded studies,
  • studies closed to recruitment.

MSc projects invariably do not meet these criteria, meaning that numbers of taught postgraduate students get to cut their dissertation teeth on non-NHS research studies or (where academic regulations allow) on other types of project altogether. Examples are service or quality improvements, service evaluations and systematic reviews. And, in my view, these are sufficiently testing options for students working at MSc level, with some (like local quality improvements) having the added advantage of immediately and obviously benefiting the NHS and those who use its services.

However, a problem arises in the case of postgraduate research degrees. In some disciplines, including nursing, these are often undertaken part-time and are carried out with limited or no external grant income. Opportunities for studentships are relatively rare, and where they are available may be financially unattractive to practitioners who have already built careers in the health service. As with MSc projects, ‘own account’ doctorates will struggle to get onto the portfolio. They therefore run the risk (in some circumstances) of not being supported by organisations within the NHS unless their associated costs are explicitly met. One way of achieving this may be for local NHS managers to agree to carry the costs of non-portfolio studies which it is planned will take place within their services. But securing this kind of support is not straightforward, and for would-be research students the added challenge of finding a means of paying costs is hardly an encouragement. And, where MSc students can usually opt for non-research projects this is not so for those aiming for PhDs or Professional Doctorates. These are awards made only to those who generate new knowledge using sound and defensible research methods.

So what does all this mean? It’s early days, but one likely outcome may be a reduction in small-scale research projects within the NHS, along with an increase in the preparations and negotiations which precede data generation. Another may be the proliferation of non-portfolio projects which are explicitly designed to meet ‘research’ criteria for academic award purposes, but which are constructed to be something else (typically ‘service evaluation’) within the context of NHS research governance. A reasonable, longer-term, concern is that research capacity-building in fields like nursing may falter as potential students rethink their plans. And that, in my view, would be a big step backwards.

Catching up post

Plenty going on in the last week or so. I had the chance to join pre-registration mental health nurses and occupational therapists for a second day as they made preparations for an interprofessional event scheduled for early December. Some of these students have also been giving me drafts of assessed work to comment on, but as the deadline for receipt of these is first thing next week I expect a deluge then. ’twas ever thus.

Elsewhere there has been RiSC reviewing to crack on with, assignment marking, and peer review reports to both consider and write. I’ve also put myself in the frame to act as a reviewer for another university’s proposed new MSc mental health programme, this being the kind of curriculum work I haven’t had the chance to do for a while.

I’m not normally one for formal, suit-and-boot, events, but made an exception last Wednesday (November 27th) to join a posse of colleagues from the School of Healthcare Sciences at the RCN Wales Nurse of the Year awards. These took place at Cardiff City Hall, and the overall winner was Cardiff and Vale UHB ward sister Ruth Owens. Congratulations, Ruth. Congratulations, too, to the individual category winners: including Andy Lodwick (also from Cardiff and Vale) for picking up the Mental Health and Learning Disabilities award and Dr Carolyn Middleton, doctoral graduate from what was the Cardiff School of Nursing and Midwifery Studies, for winning the Research in Nursing award.

This week also brought me to a meeting of the MHRNC Service User and Carer Partnership Research Development Group and, yesterday morning, to the Cardiff City Stadium for an open meeting to discuss NISCHR’s infrastructure and programme funding review. Both were lively events, and on the NISCHR front I see big changes ahead from 2015.

And to close this summary post: via the twitter grapevine I see that the RCN is now giving early notification of the Network for Psychiatric Nursing Research 2014 conference. This will take place at Warwick University on the 18th and 19th of September. I’ll post a link to the call for abstracts once this appears, but for now will reproduce this extract from the event website:

This year [2014] is the 20th international NPNR conference and it’s going to be a celebration.

We wish to celebrate and promote some of the outstanding mental health nursing research that shapes mental health policy and nursing practice across the world. We will also acknowledge some of the best psychiatric and mental health nursing research that helped create the strong foundation for our work today. And we will invite delegates to look ahead to map out the future for mental health nursing research, education and practice.

Reviewing health and social care research in Wales

Here in Wales, a month or so ago the National Institute for Social Care and Health Research (NISCHR) published a document outlining ideas for its restructuring, and opened a discussion on how research should be prioritised, organised and supported in the future. NISCHR says that it:

[…] proposes to engage its stakeholders, including patients, the public, the NHS, social care organisations, universities, industry, the third sector and other government departments to review the infrastructure and programmes it currently funds and help determine what changes should be made.

Now, details of a series of open meetings have appeared. I’ve registered for the November 29th meeting taking place at the Cardiff City Stadium. I will also be offering up some ideas for the School of Healthcare Sciences’ collective response.

A number of things are currently brought together under the NISCHR umbrella. Funding is provided for national-level registered research groups (RRGs), regionally based academic health science collaborations (or partnerships) and a biomedical research centre and series of biomedical research units. Social care research is assisted through capacity-building funding. Support is also provided for Involving People, and for all-Wales training in research governance and related matters. Studies on the NISCHR portfolio are eligible for funded, in-the-field, help via a network of clinical studies officers and research nurses. NISCHR also oversees approval processes for NHS research, funds a number of trials units and has (this year) launched a faculty. There is also the small matter of NISCHR’s competitive funding schemes, which provide project-by-project support for high-quality studies of importance to health and social care in Wales.

Given all of this, NISCHR’s review is, I think, an important process to be contributing to. One of the NISCHR schemes mentioned in the review document is the Research Capacity Building Collaboration for Nursing and Allied Health Professionals (RCBC Wales). This has been an excellent initiative, entirely delivering (so far as I can tell) on its ambitions to develop capacity. As such, it deserves to be continued (and better still, expanded). I have to declare an interest here, of course, being an alumni of the RCBC Wales scheme having secured a postdoctoral fellowship in 2006. This was the funding which allowed me to investigate the establishment, work and wider system impact of crisis resolution and home treatment services, as I’ve variously blogged about in the past here, here and here.

The NISCHR document also draws attention to the use of Welsh health and social care research funds to support NIHR NETSCC Programmes. This paves the way for researchers in Wales to apply, on an equal footing to colleagues in England, for support from the HS&DR Programme, the HTA Programme and others. This mechanism facilitates cross-UK collaboration, which has to be a good thing. It is only through this support that Wales-based colleagues and I have been able to work on the COCAPP and RiSC projects.

I also see mention by NISCHR of an ongoing review of the operation of R&D offices, and in this regard I hope that a way is found to further rationalise approval and governance processes. The NHS research passport system could be better (it’s not really much of a ‘passport’ at all), and there are variations still in the ways different R&D offices process applications.

It is also clear that NISCHR is considering the level and type of support it offers to its all-Wales RRGs, and the connections these might have with biomedical research centres and biomedical research units working in overlapping areas. NISCHR is, if I understand this correctly, thinking through how organisations like the Mental Health Research Network Cymru and the National Centre for Mental Health might relate.

So, there we have it: evidence that changes to health and social care research organisation and funding in Wales are on the cards, with plenty of time remaining for people with an interest to get involved in shaping future arrangements.