Newcastle, North Tyneside and Northumberland Mental Health NHS Trust

1
Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Roles For Psychologists in Research Dr Roger
Paxton

• PLAN
• The Changing environment
• 2. Clarifying roles
• 3. Some organisational solutions
• 4. Roles for Psychologists

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
The Changing Environment

• NHS Environment
• Value for money
• Performance Management
• Shift from process to outcomes information
• NHS Research Environment

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Purposes

• Purpose of the NHS
• To improve the health of the population
• So why does the NHS fund RD?
• To ensure that
• Health and social care policies are based on
  evidence of needs, and what works to meet those
  needs.
• Improved interventions are developed to promote
  health, treat ill health and provide social care.
• Information is available to those responsible for
  health and social care on what works, and on
  methods of improving quality,access and
  efficiency.
• But..

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Strategic Review of RD (DH, 2002)

• Many small unfunded projects
• Many projects not completed
• Few systematic reviews
• Only 2 of mental health projects were RCTs
• Reduction in number of RCTs
• Many important topics neglected (egaccess to
  health and social care, supports for carers)

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Opportunities For Psychologists?

• We are all trained as researchers
  (Scientist-Practitioners)
• Particular needs and opportunities for research
  to support, understand and evaluate wider changes
  above
• So.

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
What About Research By Psychologists?

• We are Scientist-Practitioners (since 1950)
  (Raimy,1950)
• Research orientation in their practice and a
  practice relevance in
• their research.
• Career-long process of psychological
  investigation, assessment and
• intervention.
• Extend simultaneously the boundaries and
  applications of scientific
• knowledge.
• (Belar and
  Perry, 1992)

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Yes, but Few successfully combine research
with practice (Milne et al 1990)

• WHY?
• Research not valued within NHS organisations
• Research not valued by clinical psychology
  profession
• Therefore time rarely allowed for research
• When time is allowed for research it is rarely
  planned and directed as clinical time is
• Therefore isolated researchers attempt
  unsupported small scale projects, time is
  squeezed out, may become demoralised and research
  is extinguished

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Clarifying Roles An Alternative To The
Scientist-Practitioner

• Scientist-Practitioner as the model for a
  profession, not every person
• Range of individual research roles
• 
  
  few
• Leading research.
• Contributing to designing and carrying out
  research.
• Participating in carrying out research (data
  collection).
• Appraising and implementing research (innovative
• evidence-based practice).
• Implementing research (evidence-based practice).
  
• all
  
  
  
  
  
  

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Research Roles In Practice

• 1. Clinical scientist (few)
• Evaluative clinical scientist research and
  practice, including practice-based research
  (some)
• - small N research in clinical practice
• - practice-research networks
• 3. Empirical clinician (all)
• (Milne and
  Paxton, 1998)
• But meanwhile..

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
New Organisational Solutions

• Improved delivery, quality and scale of research
  through
• New funding streams
• New emphasis on clinical-academic collaborations
• New networks
• New strategy

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Organisational Solutions

• New Funding Streams
• Support for Science
• NHS costs of externally funded research
• Priorities and needs
• To support collaborative research programmes
• 7 high priority topic areas (cancer, mental
  health, CHD, older people, public health,
  genetics, diabetes)

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Organisational Solutions (Contd.)

• 2. New Organisational Arrangements
• Priorities and needs programmes, where a
  programme is
• Coherent continuing set of research projects
• Carried out by a collaborative grouping
• Involving academic and service partners
• Researching in priority areas
• Securing external funding
• Delivering research
• Showing clinical and/or service impacts

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Organisational Solutions (Contd.)

• Further Organisational Changes
• National Research Networks (for England), eg
  MHRN
• National Co-ordinating Centre (IOP and Manchester
  University)
• 8 Regional hubs, each with
• Senior Academic Lead
• Deputy Lead
• Social Care and Primary Care Leads
• Full Time Co-ordinator
• Several Clinical Studies Officers
• NHS Partners, covering populations of
  approximately 3million

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Organisational Solutions (Contd.)

• MHRN Aims to
• Support large studies
• Broaden the scope of research
• Identify research needs
• Develop research capacity
• Scottish MHRN?

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Further Organisational Solutions Best Research
for Best Health (DH, 2005)

• New National Health Research Strategy (Out for
  consultation)
• Aims
• Support those who conduct and participate in
  research
• System to support NHS organisations conducting
  research
• Strength and research programmes, especially on
  neglected but important areas
• Main changes proposed
• Virtual National Institute for Health Research
• New funding system, with money following patients
  
• Systems to support researchers and organisations
  in research, including incentives
• 5 new academic medical centres
• Expanding successful NHS RD Programmes and new
  schemes for schemes for responsive funding
• Comments
• More centralising
• Rewarding performance

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Further Organisational Solutions Shifting
Funding Depending On Performance

• Much discussed but little action
• Disinvest in weak programmes/underperforming
  organisations
• To reinvest in strong programmes
• Seems inevitable, but when?

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
Taking Stock

• Needs and opportunities for psychological
  research, but
• More competition, and funding harder to obtain
• Increasing control and less autonomy
• Funding uncertainties for NHS organisations
• Therefore Researchers less motivated and
  recruitment and retention problems
• Other financial pressures in the NHS
• Performance targets drive other NHS actions
• Therefore, Researchers time squeezed and less
  organisational support for research

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
So What Should Psychologists Do?

• 1. We should all be empirical clinicians some
  should be evaluative clinical scientists, and a
  few clinical scientists
• 2. Be aware of these organisational changes note
  opportunities as well as threats
• 3. Collaborate
• 4. Choose the right topic areas
• 5. Disseminate locally as well as through
  Journals, etc.
• 6. Show clinical or service impacts of research
• 7. Develop research programmes not isolated
  projects connect research across time and space
• Raise awareness of the importance and benefits of
  research to the NHS
• Connecting.

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust

• Connecting Within Your Organisation
• RD Office
• RD Strategy
• Clinical Governance
• Library and information services
• Training and development (research training
  strategy)

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
2. Connecting Research and Practice

• Local needs as well as national priorities
• Practice-based research
• Show clinical impacts
• Research implementation
• Connect research and clinical effectiveness

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
3. Connecting Over Time Research designs that
are fit for purpose, eg

• MRC Framework for development and evaluation of
  RCTs for
• complex interventions
• Theory pre-clinical exploration
• Modelling Phase 1 studies to identify components
  of the intervention and underlying mechanisms to
  predict effects and interactions.
• Exploratory trial Phase II comparing the
  intervention and appropriate alternative
• Definitive RCT Phase III study comparing a fully
  defined intervention to an appropriate
  alternative in the study with appropriate
  statistical power.
• 5. Long term surveillance Phase IV studies to
  determine whether others can reliably replication
  the results in uncontrolled settings over the
  long term.

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust
4. Connecting Across Locations eg Practice
Research Networks

• Standardisation of data collection tools and
  enhanced collaboration between practitioners and
  researchers.
• Evidence-based practice and practice-based
  evidence.
• A large number of clinicians who agree to
  collaborate to collect and report data needed to
  conduct a variety of research studies.
• British and American origins.
• Cost-efficient way of providing research,
  development, dissemination and practice review.
• Example Psychological Therapies Research
  Network North (PsyReNN)

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Newcastle, North Tyneside and Northumberland
Mental Health NHS Trust

• CONCLUSIONS
• Needs and opportunities for more psychological
  research and more research that makes a
  difference
• But, rapidly changing environment, so
• Roles for psychologists in health research?
• Clarity
• Collaboration
• Connections
• Completion
• Communication
• RP/JY/Roles for psychologists
  in research/05 10 05