From research to reality

What is the issue?

The government’s focus on developing a 10-Year Plan for health and care aims to respond to serious challenges to NHS sustainability and performance, emphasising three big shifts for the health care system to achieve by 2035: (1) from hospitals to communities, (2) from sickness to prevention and (3) from analogue to digital. RAND Europe's research explores the importance of research and innovation for the NHS, and identifies a need for a fourth big shift: from seeing research and innovation as a ‘nice to have’ to seeing it as essential for transforming the NHS and making it fit for the present and the future. We call this shift: ‘from research to reality’. Healthcare is a knowledge-intensive sector, and if research and innovation are not actively supported and enabled, the gap between what is possible to achieve and what materialises in practice will grow.

How did we help?

RAND Europe’s project, supported by Wellcome, explored the importance of research and innovation in and around the NHS. It aimed to:

1. Examine key evidence on the impact of research and innovation in and around the NHS.
2. Consider impacts more closely through case studies in five key areas of strategic importance to the NHS (genomics, artificial intelligence, digital innovation in mental health, tech-enabled remote monitoring and participatory research).
3. Examine the support mechanisms needed to enable a research-and-innovation-active NHS that can deliver benefits for patients and the public, the NHS, economy and society, and identify what ‘good’ would look like in relation to the support mechanisms in the future.

The work was informed by desk research, literature review, case studies and stakeholder engagement through interviews and a workshop.

The report illustrates the importance of research and innovation for the health system and describes in detail the current landscape, challenges to address and how to achieve a vision for what good looks like in the future, as they relate to seven essential support mechanisms.

What did we find?

The benefits from research and innovation span improving care quality, safety and productivity; job satisfaction and NHS workforce retention; health system resilience; patient health outcomes (e.g. mortality rates) and patient experience; economic and wider academic and societal benefits.

The UK has a strong base in health research to build on in NHS transformation efforts. Commercially sponsored clinical trials are a visible example where collaborative action to address current obstacles would bring both health and economic benefits. But the potential of research and innovation to support NHS transformation extends beyond trials alone and is key to delivering in the three shifts identified by the government.

Research and innovation should provide the evidence, insights and skills that enable change and improvement throughout the NHS. However, the full potential to achieve this is not yet realised. Research and innovation in the NHS remain fragmented, beset by systemic inefficiencies, with weak links between NHS policy priorities and wider industrial strategy.

Mainstreaming research and innovation throughout the NHS is the ‘fourth shift’ that will underpin the 10-Year Plan. Without it, improvements in care quality, patient outcomes and experience, productivity and the sustainability of NHS services cannot be achieved.

What can be done?

We identified seven support mechanisms for mainstreaming research and innovation throughout the NHS, to help achieve success in transformation efforts. The full report discusses practical actions that need to be taken to enact each of them. In summary:

1. Workforce: Training and enabling a research and innovation active NHS workforce is critical for achieving sustainable, high-quality and cost-effective healthcare. NHS staff also need to be given the time, headspace and permission to engage with research and innovation and be rewarded and accountable for engaging with best practice.
2. Data, information and evidence: Improved access to data, information and evidence is essential for ensuring best practice in NHS care and responding to unmet needs.
3. Physical infrastructure: Upgrades to basic physical infrastructure alongside investments in key high-tech facilities are crucial for the NHS to provide safe care, and for patients to access global scientific advances and not be left behind.
4. Funding, commissioning and procurement: More strategic prioritisation of funding is crucial for reducing resource wastage, inefficient and ineffective care.
5. R&D governance and regulation of innovation: Efficient, robust and innovation-friendly R&D governance and regulation that ensures patient safety underpins the ability of research and innovation to translate into NHS, patient and economic benefits at scale.
6. Collaboration and coordination: Closer collaboration and coordination between local, regional and national bodies is pivotal for more efficient and effective progress with research and innovation, and for its translation into best practice and spread throughout the NHS.
7. Patient and public involvement, engagement and participation: Inclusive patient and public involvement, engagement and participation in research and innovation determines whether the UK population have a fair say in shaping what the NHS does and how.

The ecosystem of the support mechanisms we outlined is fundamental to delivering on the shift from seeing research and innovation as ‘a nice to have’ to seeing it as essential, and on the three big shifts signalled by government. Health services and public health research and innovation, including patient access to innovative diagnostics, treatments and cures, need to support feasible and effective, evidence-based policies in the shift of care from hospital to community. The shift from analogue to digital will require innovation in technology and data infrastructure, as well as research and evaluative evidence on workforce, service user, industry supplier and regulatory system determinants of implementation success. The shift from sickness to prevention will need to be informed by public health, health services and biomedical and life sciences research and innovation that can help keep people healthy, while at the same time responding to pressing needs to reduce waiting times and address the post-COVID backlog.

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