The Health Services Research Network held its annual symposium in Nottingham on 19-20 June. The event was attended by over 250 delegates, including several members of CLAHRC EoE and its partner organisations, and there was a day and a half programme of plenary sessions, breakfast sessions, parallel presentation streams, poster displays and exhibitor stands.
Val Dunn and I gave presentations on Day 1 in the parallel presentation streams, Val and Chiara Lombardo displayed a poster each and Angela Browne and Lorna Jacobs helped man the NIHR CLAHRCs stand. Overall I thought the symposium was extremely well organised, informative and useful for my research both in terms being able to present and discuss my findings with others as well as the opportunity for general networking and discussion of other, related research topics.
A number of themes were explored throughout the symposium but there were three that particularly stood out for me. The first, raised in the very first plenary session of the symposium, was the issue of research evidence being used, or rather not being used, to inform health services policy. Nick Black, Professor of Health Services Research at the London School of Hygiene and Tropical Medicine argued that, based on the research evidence, hospital-wide mortality rates, such as Hospital Standardised Mortality Rates (HSMR) and Summary Hospital-level Mortality Indicators (SHMI), are misleading and their reporting is harmful to hospitals, managers, clinicians and the families of the deceased. Unfortunately, despite 27 years of criticism from researchers, they remain popular with politicians and the media because they are simple to understand and report. This demonstrates the need to be prepared to criticise established policy while understanding policy makers’ needs and being able to offer them timely solutions that they can use. The issue of policy-making without proper evaluation was subsequently raised on a number of occasions.
The second major theme for me was public and patient involvement (PPI) in health services research. Mary Baker MBE, who is the immediate past president of the European Brain Council, gave an excellent plenary presentation on the patient’s perspective of the importance of applied health research based on her work with brain disorders. Throughout the symposium there was discussion about the importance of PPI and the value that the patient’s voice adds in directing research and getting buy-in from clinicians.
Finally there was the challenge to researchers of how to influence the major changes that the NHS is currently undergoing. This was discussed throughout the symposium and was specifically addressed in a four person panel discussion at the end of Day 1, “HSR: Your Time is Now” and again in the plenary session on Day2, “Integrating Care – What Works?” given by Jennifer Dixon, Chief Executive of the Health Foundation and Martin Roland, Professor of Health Services Research at the University of Cambridge.
Throughout there was broad agreement that: the current design of health services doesn’t make sense to patients; things cannot continue as they are and systems need to be reengineered if future demand is to be met; recent initiatives to manage demand, such as NHS 111 and walk-in centres to ease the pressure on A&E, have not been properly thought through; future system changes should be made with good design, evidence and evaluation; and the safety and quality agenda is critical. The good news for researchers is that: NHS managers recognise the need for change; the responsibility for NHS England and commissioners to support research is written into the NHS Constitution; funding is available; and the AHSNs have been established to connect academics, industry and the health service. In many respects there probably hasn’t been a better time to be a health services researcher. That said there are a number of issues to be overcome, in particular the difficulty of interesting clinicians in health services research. Researchers need to be better at providing clinicians with the research they want, when they want it and packaging it in a form that is readily usable by them, while recognising what is and what isn’t actually “researchable”. Summative evaluations of current practice will be easier. There are a large number of good practices across the health system that need proper evaluation to support their spread. It was seriously suggested that we might stop working on other research until this backlog is cleared and the best practices identified have been widely adopted.
The real challenge for the research community is going to be to promote good systems design practice and rigorous formative evaluations while service changes are actually being made. This needs researchers to be involved from an early stage. Unfortunately responsive funding mechanisms are not well suited to this. The CLAHRCs are, therefore, in a unique position to do this sort of research as they have both funding and the relationships with organisations to get in early in the change process. However, to paraphrase Lisa Simpson, president and chief executive of Academy Health, although this is a great opportunity, it could be our last so we have to deliver!