HSR UK 2019
HSR UK 2019 stuck to its tried and tested formula of sunshine (yes, we know, even in Manchester) combined with a smorgasbord of high quality health services research.
But 2019 also saw a new venue (the Renold building in Manchester), new people (a huge number of first time conference attendees) and new formats (with the introduction of a rapid style poster presentation session). Oh, and cats. Bear with me
Navigating the busy conference schedule is always a bit of a task, so this can only be a personal slice through the high quality content on offer, with a few highlights and reflections
The first session was on impact, and Jo Rycroft Malone gave us another reminder of the new NIHR focus on doing research where the burden exists. This is a real drive throughout NIHR, and how it plays out remains to be seen. Although it will inevitably lead to a focus on where the money goes, this is only part of the equation – because in principle a researcher in any one institution in England can do research in any part of the country (I realise ‘in principle’ is doing some heavy lifting there). It is also not clear how this plays out in health services research, where disease epidemiology is only one driver of research location (see some additional thoughts here). Watch this space
James Wilsdon gave a fascinating overview of the funding landscape, including the low UK base in R&D and the need for more ‘research on research’. His report on the Biomedical Bubble remains well worth a read, and was a useful complement to Dame Cullum’s later comparison of BRC and ARC funding.
Simon Denegri highlighted what could be an urgent challenge for the research community. Public support for research remains high (including charitable donations, political support, participation and passion for co-design). However, that support might not endure unless people see a return on that ‘investment’. He challenged our need to see PPI as ‘an intervention’ (we’ll return to that), suggested greater focus on relationships, and highlighted how we are not great at maintaining those (for example, we prefer a perfunctory acknowledgement of PPI support rather than fuller feedback). He presented a quote which suggested that it was not that people were losing trust in governments, but that governments were failing to trust people. There was a fascinating exchange after his talk about whether greater public involvement in research would lead to a focus on high impact technology in health care, rather than the less shiny world of service delivery. Simon countered that robustly, and a glance at some of the recent James Lind partnership output would support him. We’d come back to those issues in the final plenary
The health services research methods section was a delight for any self-confessed ‘methods nerds’. We saw cancer research using systems level approaches to better model delivery, learned about the problems of outcome reporting in our discipline (not terrible, but room for improvement) and ‘lifted the lid’ on some of the murkier aspects of decision-making in reviews (which can differ a little from the pristine version which makes it into journals). Last year we did a session on the relationship between research activity and organisational outcomes, and it was great to see a talk on the VICTOR research impact tool which helps organisations capture those impacts.
HSR UK partnered with the NIHR Clinical Research Network on their spring symposium on digital evaluation (the slides are available) and it was great to see a similar session at the conference. The GP at Hand evaluation was fascinating, with some common issues (such as the gradual contraction of the scope of the evaluation due to time and data access issues) and some unexpected findings (such as the very high levels of deregistration from this new service - full report).
Anita Charlesworth started Day 2 with a session on workforce. I have something of a personal struggle with workforce research, as I know it is fundamental but I do find it a little ‘vanilla’ – so it was gratifying to hear Professor Peter Griffiths say something along the same lines. I am glad that other colleagues are fascinated by all this, and we were lucky to have three speakers who could breathe life into those numbers – as all made it abundantly clear that all our ‘disruptive innovations’ and ‘complex interventions’ will count for nothing unless we engage with the looming crisis. As well as the usual numbers around the shortfall, there was some fascinating observations about wider issues – including our focus on initial staff training compared to continuing development (risky in fast moving fields) and a thought-provoking observation that we need to understand the effects of innovations we develop on the joy people find in work. Effective, efficient and acceptable to patients is great, but if it sucks the life out of clinical encounters then it’s not necessarily helping. Given that 50% of academic discourse is people complaining about University systems, you’d think we’d take more notice of this fact. Candice Imison presented some fascinating data on the fit between work and workforce, including the fact that hospital case mix is consistent, but consultant workforce is not. There are also a striking proportion of health professionals who feel both over- and under-skilled at present (see the report).
I really need to get more interested in workforce research.
My own contribution was in a session on implementation, where we had a fascinating discussion on the relative merits of prescriptive delivery of ‘active ingredients’ in complex interventions, versus the view that it is about selling a broader theory and letting local implementation vary (‘fidelity of function rather than fidelity of form’, as @Graham_P_Martin eloquently tweeted). Ruth Boaden and others pointed out that the service doesn’t talk about interventions in the way that we do, and that there may be far too much focus on the ‘architecture of interventions’ (I am looking at you, MRC Complex Interventions Framework) and far too little on the workforce (and what a psychotherapy researcher would call common factors, and Balint called ‘the drug, doctor’). This brings us back to Anita and colleagues, and even to Simon Denegri - is it that we don’t trust the workforce? I’m sure someone came up with a snappy answer to this conundrum, but my notes became garbled at this point.
It must be difficult to deliver that final plenary, when the ranks have dwindled and people are glancing at their watches and train timetables, but Scott Greer made me feel sorry for those who left early as he gave a barnstorming talk on populism and the wider political context in which we ply our humble trade. Some of it was depressing, but there were a few sparks of optimism, and for me it brought everything full circle to Simon Denegri’s discussion about trust and our relationship with the public – this is not something to be taken for granted, especially in these febrile times. Everyone was too polite to ask Scott whether he thought last night’s goal was actually offside.
I have barely scratched the surface of the wonderful health services research on display, and can only mention great plenary sessions on social care and patient experience, the newsflashes on the ARCs and Global Health funding, and an inspiring set of posters.
If you have made it this far, you’ll want to know about the cat. Suffice to say that in a conference characterised by diversity of people, methods, disciplines and views – apparently we can all agree that we like cats
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