Conducting Research in the UK National Health Service

Dr Stephen Brett

Reader In Critical Care

The National Health Service

£127.5bn in 2012-2013

Funded from general taxationAdditional 10% private

Free at point of delivery

Treatment based entirely on need- with caveats

Major budgets now held by primary care

Purchaser provider split

Research

Types

Epidemiological

Basic science

Observational

Clinical trials

Outcomes

Health services research

Qualitative/social science

Funding

Unfunded

Charities• Local• National- Wellcome, Dunhill,

ICF, Cancer Research UK BHF

Government• Medical Research Council• National Institute for Health

Research

Intensive care

Sickest patients in hospitals

Emergencies*** and major elective surgery

Specialist medical, nursing and AHP staff

Equipment for support of failing organs• Cardiovascular, respiratory, renal………

In theory for people who can benefit

Mortality 20-25% ITU Discharge

Significant long term consequences for patient and family• Health and non-health related

Context

1. Primary duty to patient care

2. Academic healthcare is better healthcare

3. Innovation to improve outcomes and efficiencies

4. Drive for patient safety

5. Focus on health economics

6. Encourage macroeconomic growth

7. Strict rules about patient confidentiality and data handling

8. Robust framework for both clinical and research governance

Imperial College Healthcare NHS Trust

Imperial College Healthcare NHS Trust

Why conduct research in medicine?

1. New knowledge to improve health of individuals and populations

2. Innovation

3. Health- and macro- economic benefit

4. Excitement of new knowledge

5. Career advancement

6. Academic healthcare is better healthcareIncrease environment data richnessMore specialisation and knowledgeMore resourcesHawthorne effectAll-around Increased motivation

Research questions

Learn aboutDisease natural history

What does the disease do?How does it do it?Who has it?How do we diagnose it and monitor it?What does it cost us- human and financial?

TreatmentWhat to give?How to give it?How to monitor its effect?

SystemHow to deliver care?

Publication type

Original primaryBasic scienceClinical

ObservationalInterventional

EpidemiologicalQualitative

Systematic reviewMeta analysisGuidelinesCommentary

EditorialCase reportsEducational thingsetc