conducting research in the uk national health service

Conducting Research in the UK National Health Service

Dr Stephen BrettReader 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

EpidemiologicalBasic scienceObservationalClinical trialsOutcomesHealth services researchQualitative/social science

Funding

UnfundedCharities

• Local• National- Wellcome, Dunhill,

ICF, Cancer Research UK BHF

Government• Medical Research Council• National Institute for Health

Research

Intensive care

Sickest patients in hospitalsEmergencies*** and major elective surgerySpecialist medical, nursing and AHP staffEquipment for support of failing organs

• Cardiovascular, respiratory, renal………In theory for people who can benefitMortality 20-25% ITU DischargeSignificant long term consequences for patient and

family• Health and non-health related

Context

1. Primary duty to patient care2. Academic healthcare is better healthcare3. Innovation to improve outcomes and efficiencies4. Drive for patient safety5. Focus on health economics6. Encourage macroeconomic growth7. Strict rules about patient confidentiality and data

handling8. 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 populations2. Innovation3. Health- and macro- economic benefit4. Excitement of new knowledge5. Career advancement6. Academic healthcare is better healthcare

Increase 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