We have joined with funders of medical research in the UK to welcome the focus on supporting research and increasing opportunities for patients to participate in research in the NHS Commissioning Board’s draft mandate.
In a joint response , we have also highlighted where we think objectives could be improved to better embed research as a core role of the NHS.
In the new structure of the NHS, the government has passed the day-to-day running of the NHS over to a new autonomous body, the NHS Commissioning Board. This oversees all the local Clinical Commissioning Groups and commissions some services directly.
The government sets the NHS Commissioning Board objectives which the Board is then in charge of delivering. These objectives take the form of a mandate given to the NHS Commissioning Board by the Department of Health. The mandate will be a multi-year document, revised each year, with objectives rolling forward until they are achieved. The Board’s progress will be measured against the objectives set in the mandate.
As everything is getting up and running, the government is developing the NHS Commissioning Board’s very first mandate. Back in July, the Department of Health published a draft of this mandate and asked for comments.
What have we said?
The NHS now has a duty right across the Secretary of State, NHS Commissioning Board and Clinical Commissioning Groups to promote research and the use of research evidence.
We are really pleased to see this reflected in the draft mandate. It includes a section focused on Research, Innovation and Growth and an objective to:
Objective 17: Ensure that the new commissioning system promotes and supports participation by NHS organisations and NHS patients in research funded by both commercial and non-commercial organisations, to improve patient outcomes and to contribute to economic growth through the life science industries:
– Ensure payment of treatment costs for NHS patients who are taking part in research funded by Government and Research Charity partner organisations; and
– Promote access to clinically appropriate drugs and technologies recommended by NICE, in line with the NHS Constitution
In particular, we’re really pleased to see this commitment to ensure the payment of excess treatment costs associated with research studies. The absence of a clear, consistent mechanism to ensure these are paid often results in long delays and sometimes acts as a barrier to getting research projects off the ground. We’ve included lots of case studies in our response illustrating the scale of this issue. Solving this will have a big impact on funders ability to conduct research trials in the NHS which is good for the NHS, good for research and good for patients.
Research is a core role of the NHS, helping us improve healthcare. As such, research needs to be embedded across the NHS and we have suggested opportunities to do this by including research in other objectives in the mandate, particularly:
- Education and training - The Board has a duty to regard the need to promote education and training so we are a little disappointed there isn’t more detail in the draft mandate on how the government plan for them to do that. Good education and training is key to support the NHS workforce to engage with research and successfully embed a culture of research throughout the workforce. We also need to develop recognised career paths for scientists and clinicians who want to do research within the NHS. There is a great opportunity to do this as the new NHS bodies get up and running so it would be great to have a little more detail on this here.
- Objective 9: Putting mental health on a par with physical health - This also references the Prime Minister’s Challenge on Dementia launched in March. Increasing mental health research taking place in the NHS will be key to delivering on this challenge and improving diagnosis rates, support and treatment for people with dementia and mental health issues.
- Objective 14: Improving information- the Board has a role in collaboration with the Department of Health to set national information standards and support integration of information across the NHS. Safe and secure access to high quality information about patients is valuable for research and lots of work is already under way to improve the recording and safe sharing of information – protecting the confidentiality of patient’s personal information and enabling research. The Board’s national role in setting standards will be really valuable to support this and they should consider the impact on research as they develop these.
- Objective 20: Redesigning services to ensure high quality care - The Board has a responsibility to ensure those delivering NHS services can meet four tests
1)support for proposals from clinical commissioners
2)strong public and patient engagement
3)a clear clinical evidence base, and
4)consistency with current and prospective need for patient choice
supporting them to redesign services where necessary. This is an excellent opportunity for the board to champion steps to embed and support research as services are redesigned.
- Objective 21: The Board’s own commissioning - The Board itself will be responsible for around £20 billion of direct commissioning, particularly for specialised services for patients with rare conditions – this will include research. We’re keen to have more detail on how the Board will commission research. And also its role in implementing national strategies such as the cancer strategy and the UK plan for rare diseases which is expected to be published next year.
Choice – The draft mandate also includes a choice framework, outlining all the choices which patients should be able to expect to have about their healthcare. We’re really pleased to see “choosing to participate in research” included in this – meaning there is an ambition for all patients to have a choice about whether and how they participate in research. We really need to get this right as we know that patients want to be offered opportunities to participate in research and not all of them are being offered these opportunities at the moment. Only 33% of patients taking part in the Cancer Patient Experience Survey 2011/12 said that taking part in research had been discussed with them but of those who were asked, 95% were glad they had had the opportunity.
Assessing progress - The draft mandate also includes detail on how the Board’s progress against its objectives will be assessed. We’re really pleased to see the Board will be assessed on improvements in the payment of excess treatment costs, increased patient recruitment to research in the NHS and improved performance of the NHS in initiating and delivering clinical research. We’ve commented on these measures and further measures we think might be valuable to consider to get a more nuanced picture of how research in the NHS is performing.
Check out our response for lots more detail on all of this.
The Department of Health’s consultation on the draft mandate closed yesterday. They will now be busy reading all our responses and developing the final mandate which will be given to the Board when it gets properly up and running in April 2013.