Global trends in health research and innovation policy Jonathan Grant Oslo, January 2014
RAND Europe is an independent not-forprofit public policy research institute Not a university or management consultancy but with capabilities of both Part of the global RAND Corporation Work across the breadth and depth of government Strongly held values of quality and objectivity Provider of evidence help improve policy and decisionmaking through research and analysis 2
Working globally on health and biomedical research and innovation issues 3
How to fund science, technology and innovation There is a lack of evidence about scientific funding in research (Nature, 2010) Science of science research can help to identify what works How and who should invest? What are the returns? Increasing attention on the question of whether and how science is going wrong and how we fix it 4
Outline The reform of health research in the UK and the establishment of NIHR Some global trends The need for systems thinking in health research innovation systems Delivering patient benefit translation and acceleration The roles of networks and other mechanisms to coordinate and collaborate Evidence based research policy the Science of Science Demonstrating accountability the social contract Key messages & discussion 5
The history of health R&D policy in the UK Institutionalising science (1911-1945) Period of Promise (1945-1962) The age of reform (1963 to 1978) Disillusion and decline (1979 to 1992) Renaissance (1993 to 2003) System change (2003 to today) Delivering the promise (future) Source: Wilkie 1991; Shergold and Grant, 2008 6
2003 2006: Multiple drivers of change RESEARCH FOR PATIENT BENEFIT WORKING PARTY FINAL REPORT For us, science and research constitute a front-line service, as they too, reduce distress and pain and save lives. (Dr John Reid, Secretary of State for Health, 22 March 2004) 7
2006 review of UK health research funding Pharmaceutical industry was concerned about (over-) regulation leading to unacceptable delays and costs Widespread concerns that it was taking too long for basic science to translate into clinical applications and routine practice The distribution of research funds did not always reflect the burden of disease in the UK, due to the lack of a transparent mechanism for determining research priorities Lack of coordination and supposed inefficiencies between the Medical Research Council (MRC) and the NHS R&D Source: Black, 2006 8
2006 Best Research for Best Health Strategic aim To improve the health and wealth of the nation through research 9
2006 Best Research for Best Health Vision 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 10
2006 Best Research for Best Health Goals Transform research in the NHS Increase the volume of applied health research for the benefit of patients and the public Develop and support the people who conduct and contribute to applied health research 11
2006 Best Research for Best Health Delivered through The creation of the National Institute for Health Research - NIHR 12
Outline The reform of health research in the UK and the establishment of NIHR Some global trends The need for systems thinking in health research innovation systems Delivering patient benefit translation and acceleration The roles of networks and other mechanisms to coordinate and collaborate Evidence based research policy the Science of Science Demonstrating accountability the social contract Key messages & discussion 13
What I am not going to talk about Demand side instruments eg procurement, R&D tax credits, prizes etc User (patient) involvement Innovation and price elasticity of health Innovation and information/data New models of funding: PPPs, social investment bonds, etc Hidden innovation Etc. etc. etc... 14
Outline The reform of health research in the UK and the establishment of NIHR Some global trends The need for systems thinking in health research innovation systems Delivering patient benefit translation and acceleration The roles of networks and other mechanisms to coordinate and collaborate Evidence based research policy the Science of Science Demonstrating accountability the social contract Key messages & discussion 15
Evidence shows we need to think differently about innovation and innovation policy Nelson and Sampat, 2001; Chataway, et al, 2009 16
NIHR Health Research Ecosystem Investigators & Senior Investigators Faculty Trainees Associates Infrastructure Clinical Research Networks Clinical Research Facilities, Centres & Units Universities NHS Trusts Patients & Public Research Research Projects & Programmes Research Schools Research Governance Systems Systems Research Information Systems 17
But we must remember innovation is all about people The bottom line is that Europe needs to innovate its way out of the current crisis, and it needs the Commission to help support and stimulate that innovation. But at the end of the day innovation is about people, not process, and innovators need to operate in a free-thinking, entrepreneurial, risk-taking society to deliver. That means the Commission needs to loosen up. Jonathan Grant and Rebecca Schindler, RAND Europe http://www.rand.org/blog/2013/03/innovating-out-of-a-crisis-how-research-and-innovation.html 18
Outline The reform of health research in the UK and the establishment of NIHR Some global trends The need for systems thinking in health research innovation systems Delivering patient benefit translation and acceleration The roles of networks and other mechanisms to coordinate and collaborate Evidence based research policy the Science of Science Demonstrating accountability the social contract Key messages & discussion 19
It takes a long time (~17 years) for research to translate from bench to bedside Identified 23 papers that quantified time lags Four studies estimate 17 years Grant et al 2000 Balas and Bohen 2000 HERG et al 2008 Wratschko 2009 But few were comparable as different studies used different measures of different things at different time points Source: Morris et al 2011 20
And time matters. The time lag is the most sensitive variable in estimating the economic returns from research Slow adoption of proven interventions is a waste in medical research 21
Khoury et al, 2007 Docherty & Conway, 2008 Westfall et al 2007 Sung et al 2003 The overall time is made of many smaller lags Basic research Clinical research Research synthesis Practice based research Health impact T1: Basic biomedical research to clinical science & knowledge T2: Clinical science & knowledge to improved health T1: Bench to bedside T2: Bedside to practice based research T3: Practice based research to practice T1: Basic biomedical science to clinical efficacy knowledge T2: Clinical efficacy knowledge to clinical effectiveness knowledge T3: Clinical effectiveness knowledge to improved health care quality and value and population health T1: Gene discovery to health application T2: Health application to evidence based guidelines T3: Evidence based guidelines to health practice T4: Health practice to health impact Adapted from Trochim et al 2011 22
So think about bridging translation gaps Basic research Clinical research Research synthesis Practice based research Health impact Biomedical Research Centres Biomedical Research Units Centres for Leadership in Applied Health Research and Care (CLAHRCs) NIHR Evidence Synthesis National Institute for Health and Clinical Evidence (NICE) 23
Centres for Leadership in Applied Health Research and Care (CLAHRCs) Focus on conducting and applying health research that is transferable across the NHS to provide the highest quality of patient care and outcomes Create and embed approaches to research and its dissemination across sectors and across a wide geographical area A new, distributed model across a health community Collaborative partnerships between a university and the surrounding NHS organisations Two rounds of funding 9 CLAHRCs funded in 2008 for five years ( 90m) 13 CLAHRCS funded in 2013 for five years ( 123m) 24
Headlines from CLAHRCs evaluation Combined knowledge transfer and knowledge exchange activities First, significant investment in knowledge mobilisation ( 123m) Academic Health Science Networks Evaluation found that language of gaps and bridging implies linear model: but in practice about multidisciplinary relationship building i.e. ecosystem Evidence of localised cultural change Granted permission to experiment and evaluate Source: Soper et al 2013; Walshe and Davies, 2013 25
Outline The reform of health research in the UK and the establishment of NIHR Some global trends The need for systems thinking in health research innovation systems Delivering patient benefit translation and acceleration The roles of networks and other mechanisms to coordinate and collaborate Evidence based research policy the Science of Science Demonstrating accountability the social contract Key messages & discussion 26
Creating multi-function networks Macro -> National systems of coordination Meso -> Research Networks Micro -> Developing individuals 27
Macro: National networking organisations UKCRC (2004) OSCHR (2007) 28
Meso: NIHR Clinical Research Networks & Schools for Research To ensure that patients and healthcare professionals from all parts of the country are able to participate in and benefit from clinical research To integrate health research and patient care To improve the quality, speed, and co-ordination of clinical research To remove unnecessary barriers to research in the NHS by simplifying, streamlining and strengthening research management To strengthen research collaboration with industry and ensure the NHS can meet the health research needs of industry. 29
NIHR Clinical Research Networks NIHR Dementias & Neurodegenerative Diseases Research Network NIHR Diabetes Research Network NIHR Medicines for Children Research Network NIHR Mental Health Research Network NIHR National Cancer Research Network NIHR Primary Care Research Network NIHR Stroke Research Network NIHR Comprehensive Clinical Research Network 30
NIHR Stroke Research Network Recruitment 31
NIHR Clinical Research Networks key achievements (2011) 564,698 participants recruited to NIHR Clinical Research Networks Portfolio studies - achieved target of doubling recruitment 97% of NHS Trusts participated in CRN Portfolio studies 760 commercial studies adopted 4,610 staff accessed the NIHR CRN taught GCP course 32
NIHR Schools for Research Three Schools Primary Care Research Public Health Research Social Care Research Cover areas other than clinical specialist care To increase the evidence base for effective practice by: conducting research to increase the volume and quality of reliable and relevant evidence; and creating an environment where first class applied research, focused on the needs of the public, can thrive 33
Micro: The NIHR Leadership Programme Aim To assist leaders in NIHR to fulfil the DH R&D strategy, through effective leadership in their employing organisations and across the NIHR Specific objectives To develop individual research leaders leadership style, impact, and self preservation To build research team leadership capability To foster leadership in the wider research community Can leadership be a science policy intervention? 34
Structure and design of the NIHR Leadership Programme Tailored programme at each level (Senior, Development, Trainee) a la carte to structured, group activities Range of activities accompanying and one-to-one coaching biannual learning conferences bespoke 360-degree feedback virtual workshops tailored learning guides phone conversations and conferences on emerging issues BRU/BRC strategy workshops action learning or peer project support team 35
What behaviours are changing? 100% Impact of leadership programme on personal approach to leadership 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 56% 26% 53% 16% Trainee leader Development leader 44% 23% Senior leader No impact Limited Significant Major I give myself space... I don t have to do it all myself Senior leaders Approach role more creatively More able to overcome challenges Building self-confidence Development leaders Building self-confidence Improved confidence in one s actions Approach role more creatively Trainee leaders Ability to influence colleagues Improvements in all aspects 36
Outline The reform of health research in the UK and the establishment of NIHR Some global trends The need for systems thinking in health research innovation systems Delivering patient benefit translation and acceleration The roles of networks and other mechanisms to coordinate and collaborate Evidence based research policy the Science of Science Demonstrating accountability the social contract Key messages & discussion 37
Science of science Advocacy - Make the case for research funding Relating Analysis - What works in in research R&D to innovation any but funding? a general way is a tall order, but not a hopeless one.. This need won t be satisfied by a few grants or workshops, but demands the attention of apeople specialist Allocation - What to fund (institution, field, ) scholarly community. As more economists and social scientists turn to these issues, the effectiveness of science policy will grow, and of science advocacy too Accountability - To taxpayer, donors etc John Marburger, Science, 2005 38
Outline The reform of health research in the UK and the establishment of NIHR Some global trends The need for systems thinking in health research innovation systems Delivering patient benefit translation and acceleration The roles of networks and other mechanisms to coordinate and collaborate Evidence based research policy the Science of Science Demonstrating accountability the social contract Key messages & discussion 39
NIHR Key success factors Principles Transparent Competitive Open Process Clear Fast Delivery-focused with thanks to Russell Hamilton 40
NIHR Key success factors Partnerships Government, Charity and Industry NHS and University Research leaders and research facilitators Different health care professions Different research disciplines Researchers and patients Delivery and momentum maintaining momentum demonstrating the difference maintaining the funding with thanks to Russell Hamilton 41
Take home messages People, processes, places and projects (People, relationships and leadership, systems, physical and virtual location, and funding) Competitive & transparent Don t forget the demand side (procurement, prizes etc.) Take (managed) risk Take an evidence based approach (science of science) 42
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