CSP078: Health and Care Services Engagement

Whereas Health and Care Services Engagement is in practice a part of routine operations in the Clinical Research Network, there remain considerable areas for improvement at a range of levels where research and health and care systems interact. These include cultural, strategic as well as operational aspects which affect day to day research delivery and development work. 

Broadly, the remit of this workstream is to build opportunities to integrate research into care given that 'research' and 'care' have historically been considered as two almost entirely separate concerns. Ultimately, we need to establish a common understanding in the NHS, community and social care that research is an essential component of best care and should be a routine pathway choice for health and social care service users. It is now evidenced and recognised that well-led clinical research activity in NHS Trusts contributes to better patient care outcomes and there is also emerging evidence of this being the case in primary care as well.

On the front line in particular we need to increase the understanding of health and care staff about health and care research opportunities and how these relate to their role and the services they provide. Strategic national work being undertaken by the small Health and Care Engagement Team in the CRN Coordinating Centre aims to create a better national environment to increase and shape this understanding, but it is the role of LCRNs to take the opportunities forward through their areas of influence in the local health and care systems.

How we communicate about research is an important part of this context. It is not an end in itself, but a pathway to a reliable evidence base for health and care interventions most likely to help individuals and communities themselves. This is not always intuitive for the people we might want to engage with, because the word 'research' often has historic and cultural connotations that for many do not necessarily connect it to these benefits.

The publication of the 2018 Care Quality Commission (CQC) Well Led Framework (Trusts) with clinical research prompts provided a new strategic foothold for research in NHS Trusts, and this has been followed in the NHS Long Term Plan. With the establishment of Integrated Care Systems (ICSs), The Health and Care Act 2022 set new legal duties for Integrated Care Boards (ICBs) to facilitate and promote  research, including the use of research in planning and reporting, and the use of research evidence in decision making and commissioning. In addition the NHS England (NHSE) ICS Design Framework sets the expectation that ‘in arranging provision of health and social care services, ICBs will facilitate partners in the health and care system to work together, combining their expertise and resources to deliver improvements, fostering and deploying research and innovations’. 

These are all very helpful developments, but there remain considerable cultural and systemic barriers to full integration of research and care for the foreseeable future. It is important for LCRNs to take both an active and reflective leadership role in overcoming some of these barriers. It should not always be assumed that the barriers are in the health and care system alone. The reflective aspect of leadership is a willingness to consider how we in the research system may unwittingly contribute to some of the barriers to a greater or lesser degree.

1. There should be a LCRN Local Health and Care Systems Engagement Plan in place with an identified suitable LCRN lead for the continued engagement of staff, management and leaders in LCRN Host and LCRN partner organisations, primary care and other community based care providers, as well as new local Integrated Care Systems towards greater integration of research and care. This should follow the general principles regarding research established in line with the  in Care Quality Commission (CQC) Strategy and Well Led Framework, the NHS Long Term Plan, and the NHS Constitution for England  and the Health and Care Bill.

1. The role of the CRN is a supportive one in relation to partnership organisations and their obligations in the policy documents listed in this requirement. The health and care services engagement plan can be positioned as a stand alone, but integral and clearly recognisable part of wider LCRN plans, OR as part of an overall operational plan under the LCRN strategy. The focus of the plan should be on a range of innovative activities to better support the successful integration of research for best care in health and care services. Where possible it should also align with local health and care priorities  such as Core20PLUS5.

The health and care services engagement plan should include recognition of the different levels of partnership development which help facilitate an increasingly embedded research culture in health and care services in the geography. In view of these different levels it is an expectation that all LCRN clinical and non-clinical leads, managers, and staff interacting with health and care providers and partners should have a corresponding level of responsibility for carrying forward the objectives of the LCRN Local Health and Care Systems Engagement Plan.

Where possible and practical LCRN plans should consider wider local and national programs of work to build capacity and develop infrastructure and  workforce learning. Examples of these programs are listed below:

• Local Authority Embedded Researchers Programme (DHSC Public Health Prevention Funding)

• Transformation of Research Delivery Programme (DHSC Direct Delivery Team Funding)

• NIHR ENabling Research In Care Homes (ENRICH)

Consideration should be given to the possibility that the LCRN health and care services engagement plan (or elements within it) could be part of a wider partnership plan involving other NIHR organisations across the LCRN geography as well as at Supra network level.  A local ‘whole research’ and research evidence pathway approach, involving other local NIHR organisations, is likely to better serve the principles behind the ICSs and value to the local population. The LCRN contribution to this, whether developmental or operational, will still need to be described within its own organisational plan (note requirement 3).

2. Support the role of an identified or number of identified LCRN Research Engagement Champions as catalysts for high quality local partnership working internally and externally that helps fulfil the LCRN Local Health and Care Systems Engagement Plan and ensure related practical intelligence and innovation sharing across LCRNs and with the CRNCC Health and Care Systems Engagement team. 

2. The LCRN Research Engagement  Champions role was first established in 2019 and has successfully evolved to be responsive to the rapidly changing environment for research and care to help catalyse  a common understanding that research is an essential component of best patient care and should be routine patient pathway choice.  Each LCRN has at least one  Research Engagement Champion.  As a catalytic role it provides elements of coordination and information sharing in this endeavour, working with the LCRN team, partners, and sometimes other local providers and commissioners. 

The Health and Care Engagement Team will host periodic virtual meetings with the Champions to support the sharing of best practice among the 15+ Research Engagement Champions and monitor progress and feedback nationally and locally. The Health and Care Engagement Team have developed a Research Engagement Champion role description and this is occasionally updated with input from the Champions themselves. 

The Research Engagement  Champions should not be expected to have sole responsibility for making the CRN Local Health and Care Systems Engagement Plan happen. This instead should be an LCRN team effort. Historically the champions have been LCRN  RDMs, Deputy COOs, COOs or research nurses but given the establishment of ICSs and multiple levels of engagement needed, consideration should be given to clinical leads also having responsibilities as champions.  The Research Engagement Champion role may or may not be the identified LCRN senior lead responsible for the Plan but where there is more than one Research Engagement Champion, leadership coordination will be critical.

The LCRN should actively support and develop this role in relation to the required plan in (1). 

Further links in the resources section of this document provide additional support for the Research Engagement Champion role.

3. Provide an active local coordinated approach to engaging with the developing Integrated Care Systems (ICSs) working with NIHR and other partners across the LCRN geography and engaging with national coordination provided by the CRNCC. 

3. The ICSs present us with an opportunity as never before for engaging with the wider population and frequently underserved communities. The research community offers both evidence-based solutions to the expected challenges for ICSs in providing integrated health and care as well as a platform for reaching a wider range of potential research participants for studies on  issues affecting population health and well being.  Engagement with ICSs to realise this potential is critical for the benefit of the population. Engagement activities and plans should target all elements of the ICS (see NHSE descriptions below):

• Integrated Care Partnership (ICP) - A statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. The ICP will bring together a broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area. 

• Integrated Care Board (ICB) - A statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The establishment of ICBs resulted in clinical commissioning groups (CCGs) being closed down. 

• Local authorities - Local authorities in the ICS area, which are responsible for social care and public health functions as well as other vital services for local people and businesses.

• Place-based partnerships - Within each ICS, place-based partnerships will lead the detailed design and delivery of integrated services across their localities and neighbourhoods. The partnerships will involve the NHS, local councils, community and voluntary organisations, local residents, people who use services, their carers and representatives and other community partners with a role in supporting the health and wellbeing of the population. 

• Provider collaboratives - Provider collaboratives will bring providers together to achieve the benefits of working at scale across multiple places and one or more ICSs, to improve quality, efficiency and outcomes and address unwarranted variation and inequalities in access and experience across different providers.

• Primary Care Networks - General practice, community pharmacy, dentistry and opticians

It is recommended that the LCRN is proactive in developing or supporting local research partnerships; offering locally relevant opportunities for engagement in research. It is important that the local research interests, represented by LCRNs and other local NIHR infrastructure (and other research partners) are joined up in presenting these opportunities and benefits. 

To facilitate proactive and responsive local working relationships with the statutory ICS commissioners (ICBs and ICPs), a national CRN ICS Engagement Leadership Group has been established (see ICS Engagement Microsite). The ICS Engagement Leadership Group is composed of at least one senior leader representative (ICS Engagement Lead) from each LCRN, the Health and Care Engagement Team, the Deputy Medical Director responsible for ICS Engagement, an NHS England representative and key CRNCC teams whose work is directly linked to development in ICS engagement (please see Terms of Reference).  The Leadership Group aims to share best practice and build intelligence to support the development of an NIHR offer to ICBs and ICPs.

Local engagement of service providers, collaboratives, partnerships and boards within ICSs should inform and be informed by development work that the CRNCC does with organisations like NHS England, the Care Quality Commission,  wider NIHR, and other national organisations with influence in health and care. Learning to continuously improve this engagement locally can be derived from shared experience enhanced by national link up with other LCRNs and the CRNCC, so this is an expectation.

Local ICS Engagement Leads and Research Engagement Champions, alongside Local Specialty Research Leads and delivery professionals involved in business as usual engagement activities will all play a role here. 

A summary of Health and Care Services Engagement related resources to date is available in this brief Adobe Spark Presentation ‘Embedding research in NHS Trusts’, including all relevant links.

The  Research Engagement Collaborative is a frontline research staff learning community. It  includes success stories from across the Network and R&D, links to the successful ‘Lunch and Learn Programme’ sessions, videos on how to embed a research culture, presentations and other tools to support engagement activities, an online forum and a self-assessment tool. The community is hosted on NIHR Learn and can be accessed by those with NIHR and accredited  email accounts. The range of these materials is being continually expanded  particularly as the range of health and care services we engage with as the CRN  is gradually increasing.

The NHS Trust guide 'Best Patient Care, Clinical Research and You' has been published for roll out on the NHS R&D Forum website. Led by the CRNCC Health and Care Engagement Team, the guide is a result of a collaboration between NHS R&D Forum, UKRD, NHSE and NIHR CRN. The guide is designed to be localised on NHS Trust staff intranets/platforms. 

CQC: Care Quality Commission

CRN: Clinical Research Network

DHSC: Department of Health and Social Care

ENRICH: Enabling Research in Care Homes

ICB: Integrated Care Boards

ICP: Integrated Care Partnerships

ICS: Integrated Care Systems

LCRN: Local Clinical Research Network

LCRN COO: Chief Operating Officer

LCRN DCOO: Deputy Chief Operating Officer

NHSE: NHS England

RDM: Regional Delivery Manager

UKRD: R&D in the NHS

Version number: 3.0 

Effective from date: February 2023 

Programme Manager

Jo Mearhart

Head of Health and Care Engagement

Email: jo.mearhart@nihr.ac.uk

Programme Support

Tania Murray

Stakeholder Engagement Support Officer

Email: tania.murray@nihr.ac.uk