CSO Health Research Strategy

CHAPTER 5 - INVESTING IN THE FUTURE

NHS Research Capacity

5.1 The capacity of NHS clinicians to undertake research is a key area if we are to see the planned increase in research activity. The combination of many research active clinicians approaching retirement age and new consultants finding it difficult to have time allocated for research is a specific concern. To address the latter, CSO introduced a programme of NRS Career Resarch Fellowships in 2011, designed to support early stage clinicians participate in research. Three rounds of Fellowships have now been awarded, investing £6m over a four year period in support of 74 Fellows.

5.2 The 74 active Fellows are engaged in activities across the clinical spectrum from stroke to motor neuron disease to cancer to paediatric surgery, and all have been chosen both for their personal career intentions regarding NRS and the potential for their research to have a real impact on patient care.

5.3 CSO aims to maintain active NRS Fellows at this level for the forseeable future.

5.4 One clinical area in which CSO has historically invested significant funds to develop capacity is Primary Care. From the Research Practice Scheme (1996 to 2004) to the Scottish School of Primary Care (2000 to 2010) and the Primary Care Research Career Awards (2003 to present). The Primary Care Research Career Award enabled some of the most successful researchers whose talents were originally nurtured through the Research Practice Scheme to acquire further research experience and training, and indeed some have gone on to obtain professional appointments. Demand for this scheme has dropped over recent years and the scheme has not run in the last "two" due to lack of interest. Ensuring that research is both developed and carried out in the primary care setting of NHSScotland is still a relevant aim and CSO will therefore consider whether to maintain this scheme in its present form.

Question 16: Is the Primary Care Research Career Award scheme suitably focused to attract suitable high quality applicants? If not, what would a revised focus be?

Clinical Academic Capacity Building

5.5 Clinical academics are a valuable resource for Scotland, and complement the capacity building activity within the NHS. As University employees who spend at least half of their working week delivering and developing clinical services for the NHS, clinical academics undertake research that not only improves Scotland's health and healthcare, but also drives economic growth through the burgeoning Scottish Life Sciences industry. There is currently a risk that carefully nurtured early-career clinical academics may be attracted to long-term career posts outside Scotland.

5.6 In a strategic intervention aimed at retaining clinical academics at the crucial career initiation stage, in 2008 the Scottish Funding Council invested £7.7m in a pathfinder scheme to appoint 19 senior clinical fellows over a five-year period. The objective was to identify, recruit and retain the very best early-career clinical academics in Scotland; to this end universities guaranteed permanent posts for those appointed through a rigorous process. In 2011, following a very positive evaluation of the first three years of appointment to the Scottish Senior Clinical Fellowship (SSCF) scheme, SFC support was confirmed to October 2013 and so allow two further rounds of appointment to this field-leading scheme in 2012 and 2013. A key marker of success has been that of 15 Senior Fellows appointed so far, only one has left Scotland; furthermore, no fewer than six Fellows have already been awarded professorial status by their host university.

5.7 The CSO is supportive of renewal of the SSCF Scheme to ensure that Scotland is able to recruit and retain the very best early-career clinical academics who will play a crucial role in improving the health, healthcare and wealth of our nation. We will work with key partners to deliver on this aim.

5.8 Ensuring the development of a strong cadre of researchers who can, in future, contribute to the evidence in the areas of health services and public health remains a key focus for CSO. Our Personal Fellowships in HSPHR have evolved over time to address key needs in the research community, and we are currently supporting 15 individuals through these Fellowships. We intend to continue to support excellent early stage investigators through our PhD and Postdoctoral Fellowships in this area, considering key strategic issues as they arise. We will continue to ensure that the translatability of the research that these Fellows conduct is a key part of the selection process.

5.9 More generally, CSO funds a number of other personal and capacity building schemes but funds do not permit matching all schemes in place in neighbouring countries. Since many of these schemes have been in place for a number of years, they may not be optimalls focused on our future priority needs.

Question 17 : Are the current CSO personal award schemes targeted to meet our future needs? If not, should CSO conduct a wider review of its capacity building schemes?

A Biomedical Informatics Research Strategy for Scotland

5.10 Scotland has long been a pioneer in the use of linked health service data for research. Data linkage is a highly efficient way to evaluate the capacity of interventions to deliver patient and population health benefit. It allows us to measure long term outcomes in clinical trials, assess the safety of new and existing medicines and healthcare interventions, and to evaluate the impact of interventions across the whole population.

5.11 Using our existing linkage capability, researchers in Scotland have shown, for example, that cholesterol lowering drugs can reduce the risk of heart attacks for up to 15 years after beginning treatment, that early term deliveries account for a larger share of cases of special educational needs than do preterm deliveries, and that banning smoking in public places can reduce hospital admissions for acute coronary syndrome and asthma, and the incidence of a range of pregnancy complications.

5.12 Record linkage capability is developing rapidly, and Scotland must work hard to remain at the international forefront.

The Ambition

5.13 Much has been done already by way of key investments to improve the quality of the NHS datasets and develop the infrastructure for their utilisation. Key developments to date include:

• The Scottish Health Informatics Programme (SHIP)
• e-Health Informatics Research Centre (e-HIRC)
• The Farr Institute
• Health Informatics Research Advisory Group (HIRAG)

5.14 However there is an overarching need to ensure that these investments are appropriately coordinated and focused on providing a coherent and structured informatics policy to direct activity and future investment across Scotland. Scotland cannot rely only on past success, and must consider how to maximise the economic return on this internationally competitive research strength, by consolidating and expanding the role of the biomedical informatics industry as a dynamic contributor to Scotland's economic growth and social wellbeing.

Recent developments

5.15 We therefore plan to publish the health and bio-informatics research strategy in 2014, and then move quickly to implement its key recommendations, so that the benefits of a more efficient system of governance and a strong, flexible federal network of safe havens begin to flow as soon as possible, and the returns on the investment in the e-HIRCS, Farr, ADRC and national data linkage service are maximised.

NRS Stratified Medicine Applied Research Programme

5.16 Many of the investments through the NRS Infrastructure funding are designed to support new areas of research. One such area is stratified medicine, where using NHS data, tissue and imaging analysis has the capacity to radically transform the way treatments are provided to patients. If the ambition of providing a patient with the right treatment the first time is to be realised, then there is a need to evidence the economic benefit to the NHS of such an approach in addition to the obvious benefit to the patient.

5.17 CSO will therefore fund a £1.2m NHS Stratified Medicine Applied Research Programme designed to evidence the value of adopting a stratified approach. Focused on evidencing the value of existing yet unadopted stratified approaches, rather than seeking to develop new ones, we anticipate that it will provide the health economic evidence base for the subsequent adoption of the technology or process