Reading: History of the policy context for knowledge mobilisation

Do you know the history of the policy related to knowledge mobilisation and research utilisation? It’s surprisingly complex, with much more happening in recent years. This covers 1948-2009 only.

• 1948-1991: curiosity-driven research, where “Special Health Authorities were tertiary clinical centres that promoted research, clinical care and education through their alliance with an Institute… allowing clinicians to pursue an academic career and structure a research programme around their patient base (or, tacitly, structure a patient base around their research interests).”(p.15). The creation of the internal market in 1991 required more clarity about the balance between patient care and research – this was not in the purchasers’ remit and research was considered to create cost pressures.

• 1990s: rise of evidence based medicine: explicit methodologies to identify “best evidence” were developed.

• 1991: R&D strategy: Peckham, 1191, p368 cited as saying “The NHS and medical research have been on parallel tracks”, with one of the House of Lords Select Committees stating the need for systematic transfer into the service of research results. 1.5% NHS budget identified for R&D to focus on applied research, set priorities based on disease burdens and public health targets, improve research standards, evaluation, better dissemination and workforce skills review – including health economics (not fixed that one then!).

• 1997: R&D budget: Amalgamation of HTA, SDO, NEAT, research synthesis (inc Cochrane) and RCD.

• 1999: Special Health Authorities: Development of:

o NICE – treatment appraisals and recommendations
o NHS III – support adoption and dissemination of new ways of working and new technology. The report notes that NHS III publications are not freely available to the public.

• 2000: ‘Research and Development for a First Class Service’: 2 new funding streams: NHS Support for Science, and NHS Priorities and Needs R&D funding targeted towards NHS needs and promoting collaboration between researchers and NHS R&D.

• 2001: Cancer Research Network: The NCRN “to provide the NHS with an infrastructure to support prospective trails of cancer treatments and other well-designed studies and to integrate and support research undertaken by cancer charities” (p.18).

• 2004: Science and Innovation Investment Framework 2004-2014: Articulates the ambition for the UK to be second only to USA in R&D excellence rankings – including advocating greater influence and partnership-based delivery with research end-users.

• 2005: UK Clinical Research Networks: Built on Cancer Networks model.

• 2006: Best Research for Best Health (BRfBH), DoH: National Institute of Health Research created as overarching body for all DoH research including HTS, SDO and UKCRN. Deemed to ‘complete the trio’ with NICE and the NHS III. Additional disease networks commissioned including mental health, diabetes, stroke and dementias within the UKCRN Coordinating centre.

• 2006: Biomedical Research Centres (BRCs): 5 comprehensive (including Imperial) and 7 specialist (including Royal Marsden) created aiming to drive innovation, translate research results into patient benefit, and increase international competitiveness.

• 2006: Cooksey – “A review of UK health research funding”: independent review identifying barriers to research being translated into practice:

 The ‘Haldane Principle’ – arms-length between science and government
 The Rothschild Report – undelivered desire for research to have customer-contractor relationship
 ‘Curiosity-driven’ research – dominant practice
 [Dis-]Incentives created by publications and RAE – prestige given to basic research over application
 Influence of peer-review – “not helpful in promoting translational and applied health research programmes” (p.22)
 Career choices – Medics not seeing clinical research as an option
 Institutional and financial barriers – separation of MRC from the NHS research community

o Bench to Bedside: “four discrete activities: knowledge production, knowledge transfer, knowledge reception and knowledge use”. Cooksey identified two gaps in translation:

 T1: from basic research into treatment developments
 T2: from new intervention into everyday practice

o Advised merging the MRC and DH research budgets

• 2007: The Report of the High Level Group on Clinical Effectiveness established by the Chief Medical Officer (DoH 2007): “The Group was asked to review areas of significant variations in the use of evidence and to recommend a programme of action to enhance the effectiveness and efficiency of clinical care. The Group “identified ‘no single bullet’ to address the issue of clinical effectiveness. Instead, systematic, context-specific initiatives are needed, requiring local clinical engagement. Evidence-based medicine should be complemented by evidence-based implementation, demanding attention to education programme from undergraduate studies onward” (p5). Better links between NHS and education formed a primary theme.” (pp23-24)

• 2008: CLAHRC: The NIHR competitively created nine 5 year Collaborations for Leadership in Applied Health Research and Care to “develop an innovative model for conducting applied health research and translating research findings into improved outcomes for patients based on mutually beneficial partnerships between universities and NHS organisations”, predicated on the evidence that practitioner/research interactions bridge the gap in translation. These are being evaluated.

• 2009: Academic Health Science Centres (AHSCs): competitively selected partnerships between a university and healthcare provider intended to link scientist and patient within a defined geography, “to harness better the capacity of higher education to assist with improving the effectiveness of clinical care through promoting the development of new models of community wide ‘academic health centres’ to encourage relevant research, engagement and population focus and embed a critical culture that is more receptive to change” (recommendation by the High Level Group on Clinical Effectiveness DoH, 2007, p.6) cited p.24. Imperial is identified as the first AHSC and the report includes Steve Smith’s vision in full. Within this he highlights the absence of the contribution of private patients to the NHS, a funding stream that is diverted almost entirely to the private sector.

This is as far as the report goes (published in 2010), but since then there have been several other policy initiatives including Academic Health Science Networks, and now the call for a second round of CLAHRCs is open.

What policy do you think should be listed here to bring this summary up to date? – send me a comment or suggestion.

Summarised from…
Reading KM0001: SDO knowledge mobilisation literature review (2)
Crilly T, Jashapara A, Ferlie E (2010) “Research Utilisation & knowledge mobilisation: A scoping review of the literature” Report for the National Institute for Health Research Service Delivery and Organisation programme HMSO