Clinical Research Strategy 2022/27

What we will do: 

• Enable more people to engage in public and patient involvement (PPI) and co-production of research
• Provide research opportunities that reflect our patients’ experiences
• Improve patient safety and experience by demonstrating and implementing research results

How we will do it:

• We will seek to understand the logistical, cultural and language barriers which inhibit equitable and inclusive PPI with all the communities we serve. This knowledge will allow us to develop guidance to support, engage and empower underserved communities. Disseminating our learning with our healthcare partners will support best practice that is implemented system-wide.
• We will maximise opportunities in research, that reflect the needs of our patients and communities, by raising awareness and demystifying research through the effective use of different media platforms. Research campaigns and engagement events will maximise the use of environmentally sensitive approaches. Through cross-organisational collaborations we will ensure opportunities to participate in research across the region.
• We will work with our research and PPI partners to ensure research outcomes are disseminated to study participants in appropriate and timely ways. We will work with our colleagues across NBT and the region to implement the outcomes of research to improve health outcomes, whilst avoiding and reducing the environmental costs of repeating unnecessary research studies.
• We will actively use our experience from previous studies to improve the design, deliverability, and efficiency of studies to ensure effective implementation, whilst reducing the negative environmental cost of research and healthcare.

What success will look like

• The demographic profile of staff, patients and public involved in research will better reflect our local community.
• The results of our research will be implemented into clinical care efficiently and within pre-defined timelines.

What we will do:

• Build upon the skills of our workforce and volunteers
• Develop the future workforce
• Develop improved career pathways for all our research staff

How we will do it:

• We will promote research as a dynamic career option, co-designing a suite of training programmes, supporting new starters, optimising delivery expertise, developing new and more effective ways of working and supporting courageous and compassionate leadership through training which is both inclusive and environmentally sensitive.
• We will develop comprehensive career pathways to empower and support emerging talent to help individuals to pursue and access funding, mentorship, and coaching (academic or NHS) to realise their career and research ambitions.
• We will promote opportunities to develop as leaders and lead researchers investing in the researchers of the future to address current issues with innovative solutions and strategies.
• We will seek opportunities to enhance our quality improvement cycles and embed the lessons learned which includes adapting study design and delivery, providing state-of-the art research facilities and using technology proactively.

What success will look like

• Improve our current internationally recognised “Investors in People” accreditation.
• An increased number of non-medical researchers acting as lead researchers.

What we will do:

• Increase awareness of research and its impact on clinical care
• Deliver research that improves healthcare and patient experience
• Embed research in the care pathway of all NBT services

How we will do it:

• We will promote the rights of patients to engage in research, and for staff to understand their opportunities and responsibilities to offer and support appropriate research, irrespective of profession, background, or characteristics. We will ensure patients and staff are supported to engage with research and the research information is easily accessible. All internal funding opportunities will be widely available, and access will be equitable, inclusive, and promoted through multiple media channels
• We will actively engage with clinical divisions and healthcare education programmes to demystify research and promote research as everyone’s right and responsibility. This will enable current and future clinicians to address clinical questions that improve the health and experience of our patients and communities.
• We will work with clinical and leadership teams to focus and embed research within clinical pathways and staff job plans, ensuring results are disseminated through departments and divisions in a timely manner. We will ensure the time our staff invest in our research is recognised and appreciated, helping to raise awareness of the value and contribution research makes in clinical practice.
• We will co-design an adoption process with the Trust Transformation team to facilitate the implementation of research findings at NBT, agreeing targets for implementing research findings and demonstrate the value of evidence-informed and value-based practice across all clinical areas.

What will success look like?

• An increase in research awareness and engagement amongst patients and staff.
• An increase in the number of research findings being implemented at NBT.

What we will do:

• Build on our reputation for cross-system research and innovation to make us the collaborator and centre of choice
• Identify our strengths, clinical priorities, and opportunities to develop and deliver world-leading research
• Ensure efficient resource utilisation for the delivery of NBT and cross-system research

How we will do it:

• We will develop and maintain with our regional partners, a suite of best practice guidance, policies, and agreements to enhance efficient and seamless processes. These will maximise research productivity and income in regionally strategic areas which will also promote inclusivity and be environmentally sensitive.
• We will continue to explore and deploy new research methodologies suitable to pragmatic health and social care research, including working with NBT Information Governance, and Digital Services and Technology to implement and deliver big data projects efficiently and effectively. New approaches will allow us to broaden and diversify our research portfolio focusing on under-represented professions, specialities, and communities.
• We will embed quality improvement in everyday practice to enhance the design and delivery of the research led and delivered by NBT. We will work with regional partners to develop and share best practice, facilities, training, and infrastructure. This will, in turn, improve our efficiency in the way we deliver research thus enabling further investment in our teams and facilities.

What will success look like?

• A comprehensive suite of guidance which supports cross regional research.
• We will lead and implement adaptive pragmatic solutions to delivery challenges.

Helen Lewis-White, Deputy Director Research & Development

We are delighted at how much we have achieved as a research community over the last five years. NBT has offered increasing opportunities for our communities to become involved in research, doubling recruitment into clinical research between 2017-2022.

NBT’s grant success over the last 5 years has been firmly based on high quality Patient & Public Involvement (PPI), ensuring we are seeking the answers to questions most relevant to our patients and the clinical services we deliver. During that time nearly 250 PPI meetings supporting 20+ research groups have worked together to define and refine research ideas, approaches and interventions, and to monitor the progress of studies as members of trial management groups.

During the same five year period, the number of departments offering research grew from 45 to 55 resulting in research taking place across every division of the Trust. In addition 8000 participants were directly recruited at North Bristol NHS Trust. We currently lead over 30 multi-centre studies across 100 Trusts throughout England and the devolved nations, offering new opportunities for patients and participants to engage in research.

The primary role of everyone within the Trust’s research infrastructure is to enable patients and the public to engage in relevant research opportunities, helping to shape healthcare for the future. For some, research may offer a new or additional treatment option, but for many people who participate in research the benefit for them is knowing they are contributing to improving care and outcomes for others.

“It’s clear that the medical community are continually trying to answer new questions, but they can only do this with the help of patients. As a lay member of the public, we don’t understand fancy medical vocabulary, so we have to dream up new ways of describing medical terms. We also have to think of ways to make our research programme interesting and to encourage as many people as possible to sign up.” Public & Patient Involvement Member.

“I know my Alzheimer’s is not going to get better. I decided to take part in research because it might just help people with this disease in the future” Research Participant

The NBT Research & Development team supports all aspects of research activities supporting the different developmental stages of research. From exploration of ideas, through qualitative ‘question finding’, through to the dissemination and implementation of findings from these clinical trials into real world practice for population health benefit.

Research at NBT is a multi-disciplinary and multi-specialist activity incorporating patient and members of the public, whose specialist lived experience provides our teams with essential and unique perspectives. This allows the research teams to work closely with Patient and Public Involvement (PPI) representatives, to co-develop and shape the important research questions, design the most appropriate study format, and to then monitor the progress of studies through to completion. Finally, the teams will then support the wider public dissemination of study findings and appropriate implementation, leading to an improvement in, or a change to, the delivery of clinical services.

NBT currently manages £28 million in research grants with an annual grant income of approximately £2.5 million. During the last five years the breadth and scope of the grants supported and awarded has grown significantly and we are currently leading 60 research grants and partnering on a further 59 externally led grants.

To enable the increase in patient opportunities to participate across the research landscape the NBT research infrastructure has grown from 115 staff members to over 140 individuals. We have also continued our commitment to invest in and develop our team members. In 2019 R&I was awarded an Investors in People Silver accreditation in recognition of the programme of work the R&I infrastructure has undertaken supporting, and improving how we work as individuals, teams and as a department, and developing our leaders now and for the future.

NBT prides itself on the strength of its research collaborations across a wide range of academic affiliations, healthcare settings, and industry partners.

Academic Health Science Centre (AHSC) which focuses on close collaborative system-working across the Bristol, North Somerset, and South Gloucestershire (BNSSG) Integrated Care System (ICS). The partnership enables the best use of the regional academic research infrastructure, combined with the implementation and evaluation expertise and activities led by the West of England Academic Health Science Network, directly informing the work of the BNSSG ICS.

We now aspire to build upon the previous NBT research strategies and our experiences throughout the COVID-19 pandemic, which has driven and shaped how research is now conceived, developed, and delivered.

Our academic links with globally recognised academic research institutions including the University of Bristol, University of Bath, and University of the West of England (UWE) have contributed significantly to our success. Through these collaborations NBT ensures the research we lead is patient centred, clinically important, and pragmatically delivered.

Throughout the last five years, and particularly the last two years during the COVID-19 pandemic, our collaborations have driven our continued strength and growth. Through these collaborations and mutual support NBT helped lead the regional COVID-19 vaccine research response, supporting other Trusts to recruit to COVID-19 pandemic vaccine trials across the West of England region. NBT continues to support and lead the NIHR Comprehensive Research Network: West of England (CRN:WE) and to work with partner Trusts across the region to develop novel quality improvement programmes, innovation in research delivery, and to share best practice.

NBT also benefits from being a leading and founder member of the vibrant and ambitious strategic health research and innovation partnership, Bristol Health Partners

“Generating a research culture requires innovation, creativity, engagement and skill. Here at NBT we are instilling a collaborative research culture across all areas of the Trust to ensure research stays at the heart of what we do.”

Dr Tim Whittlestone, Chief Medical Officer

Below are a few examples of the research achievements at NBT from across the lifespan of our patient population, realised through close collaborative working with our patients and partners.

STAR Programme

The STAR Programme developed and tested a care pathway for the one in five patients who will experience chronic pain three months after knee replacement surgery. STAR identified underlying causes of chronic pain and enabled onward referral for targeted treatment through screening, assessment with an extended scope practitioner, and telephone follow-up over 12 months. STAR demonstrated clinically important improvements in pain and recovery, and is good value for money, reducing hospital admissions and length of stay.

The STAR care pathway was implemented at NBT within six months of the final report to the NIHR, and is now being rolled out nationally, with the potential to improve pain and recovery for over 20,000 patients each year alongside annual NHS cost savings of over £14 million.

ASSIST

The ASSIST trial has tested a new device for assisted vaginal births and is the first potential device for assisted birth since the introduction of the ventouse suction cup, in the 1960s. For this trial a major success has been the use of alternative patient information methods. The study team developed videos to explain the study, demonstrating how the device works on a mannequin doll and including answers to common questions. Women and partners were able to watch the video at their leisure and given another opportunity to ask questions. The use of a freely accessible video combined with both a brief and detailed patient information leaflet was commended by the Research Ethics Committee (REC) for facilitating parents understanding of the study during emotive and challenging times.

CERA: COVID-19 Emergency Response Assessment

In collaboration with the University of Bath the CERA study explored the emotional impact of the COVID-19 pandemic on frontline Emergency Room and Intensive Care Unit medics. It demonstrated the significant psychological toll the COVID-19 pandemic was exerting and helped highlight the need for greater focus on mental health and wellbeing. It was particularly useful in highlighting the challenges medics feel in seeking assistance, and the fear and shame they experience when they admitted their emotional wellbeing is being affected by their role.

AERATOR

Aerator, a collaboration with the University of Bristol, tested the aerolisation of procedures during COVID-19 pandemic in multiple clinical settings. The study design enabled rapid assessment and dissemination. The results of the Aerator study were used extensively to inform the levels of personal protective equipment policy nationally and internationally. This both protected staff and patients but also enabled an evidence base for reducing unnecessary infection control procedures and enabling clinics to increase their capacity and begin to address patient backlogs.

Aerator also made use of innovative mechanisms for engaging clinicians and the public with the results of the study, using a comic strip to explain the issue and the results, ensuring the results were more accessible. https://artibiotics.com/blog/aerator

This new research strategy outlines our ambitions for the next five years. It complements and supports the Trust’s values and underpins the behaviour and principles of every member of staff.

Our strategy will describe what we plan to achieve, the objectives we will need to meet them, and the additional steps we will be undertaking to further embed research within patient pathways and our community. At the same time, it is essential we remain agile to changing priorities as they arise, through constant monitoring of our research portfolio and how it informs and is shaped by health and care delivery across the BNSSG ICS.

While this strategy is specific to clinical research, we recognise a culture of innovation is a key element of ensuring research is converted to clinical change and patient benefit which forms the bedrock of the research cycle.

With empowerment as a core principle of our strategy, we aim to:

• Empower patients and public as co-producers of research
• Empower clinical staff to address questions they believe will improve patient care
• Empower researchers with the skills and knowledge to best deliver the research they undertake and lead on
• Ensure patients and the public are key contributors and collaborators within our research environment
• Empower all our communities to hold us to account and create equity of access and inclusivity whilst ensuring our research is environmentally responsible.

Since 2016 each review of the strategy has been shaped through stakeholders’ consultation exercises, questionnaires, meetings, and conferences. These include the researchers who generate our research, the teams who deliver the strategy and our regional strategic partners and stakeholders. Each year we monitor our progress and report to the Trust Board. In 2020 our primary focus shifted to helping answer critical questions about the spread, prevention, and treatment of COVID-19, noting that the epidemic disrupted many of our other research activities resulting in some objectives not being completed, whilst other key activities became more urgent.

Whilst the Trust and R&I department has achieved so much against the delivery plans for the 2017-2022 strategy, changes to health and social care priorities, technologies and wider social change means the Trust now requires a new strategy to take it through the next five years. To develop the new strategy, we consulted widely with internal and external stakeholders undertaking the following engagement activities:

• A survey distributed across the research teams, research active clinical staff, managers and all NBT Trust email address recipients to ask whether the Vision, Mission and Aims represented the aspirations and commitments of our teams, partners, and stakeholders.
• A series of meetings were held in early 2022 to better understand the objectives, aspirations, and ambitions which we should endeavour to pursue through our strategy.
• The comments and feedback were collated and contributed to the formulation of the Vision, Mission, Aims and Objectives, which were then disseminated for further and wider consultation with internal and external stakeholders.

The last five years has seen substantial changes in societal attitudes and responsibilities in two significant spheres. COVID-19 and the Black Lives Matter movement have both highlighted the lack of progress healthcare and research has made in ensuring inclusivity and representation from all our communities, and the consequential health and wellbeing inequalities. During the same period the NHS and NBT have declared a climate emergency in recognition of the impact on health and wellbeing that environmental factors are causing.

Founding Principles

Following the above consultation and engagement activities, two overarching principles have been included in the new strategy as we seek to embed these attitudes and behaviours in the research developed, supported, and delivered at NBT:

Principle One

In everything we do we will seek true equality and inclusivity.

Principle Two

In everything we do we will seek to minimise the negative environmental impact of our actions.

Internal Stakeholders

• The research infrastructure
• Research Leads
• Research Innovation Group
• Divisional Clinical Directors
• Divisional Directors
• The Trust Equality and Inclusivity forums
• NBT PPI groups
• Southmead Hospital Charity
• The Staff of NBT

External Stakeholders

• University Hospitals Bristol and Weston NHS
• Foundation Trust
• Avon and Wiltshire Mental Health Partnership
• NHS Trust
• University of Bristol
• University of Bath
• University of the West of England
• NIHR Bristol Biomedical Research Centre
• NIHR West of England Clinical Research Network
• NIHR Applied Research Collaboration West
• Bristol Health Partners Academic Health Science Centre
• West of England Academic Health Science Network
• Healthier Together BNSSG Integrated Care System