Benefits of HS DR for the NHS An Update

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 Ph. D students • Research income £ 3 m (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 (£ 65 k and £ 55 k) • ABHB funds from corporate funds (£ 150 k) • 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 Ph. D 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 £ 1 m • 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.

Cwm Taf Health Board Investment and Successful funding applications has lead to increased R&D Infra structure to support HS&DR • x 2 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 • x 1 Clinical Trials Pharmacist + Support • x 1 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