During the covid-19 pandemic, the public focus has been on the remarkable performance of the NHS and its dedicated workforce in coping with the huge influx of covid-19 patients, led by centralised clinical guidance and rapid local reorganisation of services. The outpouring of public affection for the NHS has been a welcome and well-deserved recognition of its place at the heart of the nation. Yet there is an equally remarkable, but much less publicised success story to be told—that of the UK research sector’s response to covid-19, partly due to the preparedness of the National Institute for Health Research (NIHR) in England and parallel research systems in Scotland, Wales, and Northern Ireland. 

With 100% of NHS Trusts previously involved in research supported by the NIHR’s Clinical Research Network (CRN), research delivery teams and processes were already in place to support the NHS and enable widespread recruitment for covid-19 studies. Equally, the redirection of NHS services to covid-19 reduced the capacity for non-covid research, much of which had to be paused during the acute phase and is trying to restart now for the benefit of patients and the research funders.

The NIHR CRN activated its pre-existing plan for research in a pandemic, resulting in 640 NHS research sites ready to deliver studies. Urgent Public Health Studies (UPHS) were prioritised by the Chief Medical Officer to yield key evidence. Simplified and pragmatic research design like that of the RECOVERY platform study, enabled NHS staff, even if unfamiliar with research, to rapidly get involved.

Coupled with unparalleled speed in regulatory assessments, over 130,000 participants were recruited to covid-19 studies, including 10,000 patients entered into the RECOVERY study in 8 weeks. This yielded positive results for dexamethasone in patients receiving oxygen/ventilatory support and UK research out-performed other European countries in both publicly-funded and life sciences COVID-19 international studies. [1] Going forward, the UK’s chief medical officers have signalled their intention that every eligible patient is offered enrolment into a covid-19 trial. [2]

A signature feature of the RECOVERY trial recruitment was the disproportionately high contribution of many smaller hospitals supported by clinicians not previously engaged in research. This welcome development is one that we must continue for several reasons. We know that patients fare better in research-active hospitals regardless of other factors, and that clinicians are attracted to roles that have research potential, but need support to be able to fulfil these roles. [3]

Yet there is more that can be done to build from this success, from further top-level direction from NHSE, involving UKRI, the research funders and regulators, building on technological and digital advances to drive the scale and pace of research across the whole country, enabling clinicians to engage in research, and reducing bureaucracy to speed the set-up, delivery and translation of research together.

As the Royal College of Physicians (RCP) publishes its own research strategy, here we look at how we can build on that success outside the framework of covid-19 and support clinicians to be more active in research. [4] 

A recent RCP survey of consultant physicians shows that clinicians working in NHS trusts have a very positive attitude towards participating in research, but struggle to become involved—for over half this was primarily due to a lack of time. [5] 67% of respondents said having dedicated time for research would make them more likely to apply for a role. Other barriers identified were a perceived lack of skills and supportive culture in their organisation.  We need to harness the appreciation that managers, commissioners, and the public have shown for the NHS as a whole during covid-19 to reach into the research culture, because research-active trusts have better patient and staff outcomes.

There are several practical steps to better integrate research into clinical care, as highlighted by the RCP’s research strategy:

1. • Research should be factored into the recovery/reset of clinical services, especially at time of health service reorganisation
   • Organisations should support a highly visible R&D function that coordinates high quality research and clearly explains the different ways clinicians can become involved in research and what support is available
   • Publicise research-focused mentoring and credentialling schemes, especially to those under-represented in research such as women and people from BAME backgrounds
   • Explore viable ways to allow clinicians more time to participate in patient-facing research through job planning, whether this is on an individual or team basis

Finally, covid-19 starkly demonstrated the integral relationships and interdependence of the NHS with the social care and public health sectors. While these sectors are not usually joined-up to traditional health research, we should begin to “think social, think public” when designing and commissioning health service research to maximise the benefit to all who both need and provide care. In that way we can embed an interdependent approach based on supporting, enabling, and empowering clinical staff to deliver. The UK has a global opportunity to demonstrate the interconnectivity of its systems, capitalising on the combined strategies of its life sciences sector.

Covid-19 taught us a lot about the way we manage research in the UK—that we can change cumbersome systems, be more fleet of foot, collaborate more and increase inclusivity—harnessing these improvements will be COVID-19’s valuable legacy to our thriving UK research sector – it will be better for patients, better for clinicians and better for the nation.

Cheng-Hock Toh, Royal College of Physicians, academic vice-president. 

William van’t Hoff, chief executive officer, CRN National Coordinating Centre (CRNCC) and NIHR Clinical Research Network (CRN).

Competing interests: None declared.

References:

1. The Recovery Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report. NEJMoa2021436.
2. Chief Medical Officers for England, Scotland, Wales, Northern Ireland and NHS Medical Director. COVID-19 Research and treatment trials. https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103085 (accessed 21 August 2020).
3. Jonker L, Fisher SJ. The correlation between National Health Service trusts’ clinical trial activity and both mortality rates and Care Quality Commission ratings: a retrospective cross-sectional study. Public Health 2018;157:1–6.
4. RCP, 2020. Research for all: Developing, delivering and driving better research. www.rcplondon.ac.uk/research-strategy
5. RCP, 2020. Unequal Access: an analysis of participation in clinical research. www.rcplondon.ac.uk/research-survey-report