Integrated care systems (ICSs) face a number of challenges in meeting local population needs in their function as place based partnerships. These include increasing numbers of people with complex chronic conditions, health inequalities and elective recovery. Further there is the ongoing challenge of coordination and reconfiguration of systems and approaches to align with different patient and service user pathways. Reliable practical evidence in all these respects is needed to support the effectiveness, productivity and sustainability of services.

All doctors, nurses, allied health professionals and care workers use reliable evidence. It starts with their training and goes on from there. Reliable evidence is generated by systematic health research. This has been the case for years but it has never been so visible as during the pandemic where there has been a race to find the best and safest treatments, approaches and of course effective vaccines. Alongside this ongoing work, as our health system recovers, health research will broaden again to meet the wider and emerging health issues of our times.

Health research is finding out what works best in patient care in specific areas through a ‘study’. A study aims to answer a question, in this case about patient care, using a carefully designed method.

The bulk of all health research activity in England is undertaken where people are, whether this be in intensive care units, care homes, or support services. Labs and academia are a relatively small portion of the total activity of gathering real world evidence for a particular research topic. Further, health research covers a wide breadth of evidence generation whether it is in clinical and social care, public health or health service processes themselves.

As such, research evidence is wide ranging. It does not only relate to the crucial evidence based treatments that clinicians use day-to-day, but also to valuable information that can guide ICS activity and partnership working. Evidence generated is likely to include information related to defining the nature of local health problems, providing explanatory models for cause and effect, cost-effectiveness analyses and implementation studies that identify barriers and facilitators.

The CQC now has a remit to assess how trusts are supporting and using clinical research to improve patient care.

The importance of research is recognised in the new CQC strategy, its Well-Led Framework and in the NHS Long Term Plan. To meet changing healthcare needs, research and care need better integration in practice along the whole service pathway. They go hand in hand. ICSs give us that opportunity as never before.

Research can help you identify effective and cost efficient treatments, processes and systems.

Research can be a mechanism for addressing local health inequalities and ensuring greater inclusion of under-served and marginalised communities. The pandemic has made visible underserved communities and the need to reach them. Even prior to the pandemic, there has been a mismatch between areas of high disease burden and where health research takes place. As such, there is a real opportunity for ICSs to priority set and embed research into healthcare services so that local service challenges and opportunities are better understood. In doing so, ICSs and care providers will be able to make better informed decisions related to their local health systems, commissioning and delivery.

‘The more we concentrate on merely reworking our existing institutions, the more we fail to see or understand the nature of the new challenges that surround us.’ Hilary Cottam, Radical Help.

Approximately 80% of clinical research in England is supported by the National Institute for Health Research funded by the DHSC and is focussed on patient and public benefit. Research does not take up care resources. It has its own funding streams both for research studies themselves and the support needed to undertake them in care environments. Within these environments research activity has been shown to add value not just in producing evidence in the longer term but also to the provider organisations and their immediate users.

A growing body of evidence shows that trusts with high levels of clinical research activity have better patient outcomes (e.g. lower mortality rates).

There is also a strong economic case for health research. A recent independent (KPMG) assessment of the economic impact of research showed that nationally for each £1 invested there was a return of £19 in general economic benefit. As such, priority setting and a focus on research within the ICSs and related local health and care bodies has the potential to bolster their role as anchor institutions. In doing so, they can contribute to the wider social and economic development of the region and wellbeing of the population served.

For patients and service users research is another healthcare choice. Recent surveys show that 90% of patients have a good or better experience of participating in a research study. Many cite better monitoring of their health condition as well as having the opportunity to help future patients with similar issues through their participation.

The NIHR has both a local and national presence. From the support for development of new patient and service user centred studies, to helping to deliver these studies of any size through a national system of study site identification, supporting their timely delivery and the evidence dissemination that follows. There is a mix of organisations in the NIHR that do this, both regionally and nationally.

Regional NIHR with links:

NIHR Local Clinical Research Networks (LCRNs) support patients, the public and health and care organisations across England to participate in high-quality research, thereby advancing knowledge and improving care. The CRN is comprised of 15 Local Clinical Research Networks and 30 Specialties who coordinate and support the delivery of high-quality research both by geography and therapy area. National leadership and coordination is provided through the CRN Coordinating Centre. LCRNs have good NIHR connections across their geographies.

NIHR Research Design Service (RDS) provides support to health and social care researchers across England on all aspects of developing and writing a funding application, including research design, research methods, identifying funding sources and involving patients and the public. Advice is confidential and free of charge.

NIHR Applied Research Collaborations (ARCs) support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. These 15 local partnerships between NHS providers, universities, charities, local authorities, Academic Health Science Networks and other organisations also undertake implementation research to increase the rate at which research findings are implemented into practice.

NIHR Clinical Trials Units (CTUs) are specialist units which have been set up with a specific remit to design, conduct, analyse and publish clinical trials and other well-designed studies. They have the capability to provide specialist expert statistical, epidemiological and other methodological advice and coordination to undertake successful clinical trials. In addition, most CTUs will have expertise in the coordination of trials involving investigational medicinal products which must be conducted in compliance with the UK Regulations governing the conduct of clinical trials resulting from the EU Directive for Clinical Trials.

Other NIHR organisations are national and include:

The NIHR Academy is responsible for the development and coordination of NIHR academic training, career development and research capacity development. The academy plays a pivotal role in attracting, training and supporting the best health and care researchers to tackle the complex challenges of the future. The training and career development awards provided complement the additional NIHR investment in world-class research facilities and a skilled research workforce.

NIHR Centre for Engagement and Dissemination brings together activities in patient and public involvement, engagement and participation with its strengths in research dissemination. Building on the earlier work of the NIHR Dissemination Centre and NIHR INVOLVE, the Centre will lead NIHR’s work to make health and care research representative, relevant and ready for use.

NIHR Digital is the digital development service in the NIHR responsible for implementing an innovative digital strategy across the NIHR to streamline its processes, engage with researchers and most importantly involve patients and the public in its endeavours.

NIHR Funders consist of ten different research programmes that researchers can apply to, each of which funds different types of research.