During the pandemic the value of research shot to the top of Boardroom agendas. But as the impact of Covid-19 receded and priorities shifted to address different but equally seismic challenges, the role that research could be playing to drive wider quality and improvement, started to slip off the radar. 

Board-level visibility of research as a standard part of the care pathway has always been challenging, but a new UK strategy following the pandemic provided an opportunity for Wales, with its devolved health service, to create its own solution to increasing the influence of research both locally and nationally. 

In March 2021, all four nations of the UK signed up to a new 10 year vision – Saving and Improving Lives: The Future of UK Clinical Research Delivery – which outlined the ambition to create a world-leading UK clinical research environment. 

One of the strategy’s key features was the embedding of research across the NHS – to create a research-positive culture in which all health and care staff feel empowered to support and participate in clinical research as part of their job.

In developing Wales’s implementation of the strategy Health and Care Research Wales, part of the Welsh Government’s Science Research and Evidence division, and the then Wales Chief Medical Officer Dr Frank Atherton took the bold step of mandating greater governance of research in all NHS organisations by telling all Chairs to nominate one of their Non-Executive Directors on the Board to champion research specifically as part of their portfolio of responsibilities. 

The dispatch of a Welsh Health Circular (a policy mandate issued by Welsh Government to instruct health and care organisations in Wales to comply with a standard) now means a Board ‘champion’ for research is an embedded part of research governance within the NHS in Wales and the responsibility is a core part of the NHS R&D Framework in Wales, which outlines what ‘research excellence looks like’. 

Carolyn Donoghue, the NED champion for research in Cwm Taf Morgannwg University Health Board, which covers the populations of Rhondda Cynon Taf and Bridgend, said the role had given her a new sense of responsibility and legitimacy to speak up about research. 

“As a NED you have to have an overview of everything that’s going on and as the ‘University’ representative it’s sometimes difficult to explain what the role means but research has helped articulate it. The new NHS R&D Framework which is a clear structure for what should be delivered for research in the NHS has also been excellent in helping us to get a handle on the key issues and use it to cut through.”

The role of the Board champion involves developing an understanding of the importance of research as a key driver for good health and social care services, supporting the promotion of national research initiatives, as well as engaging with the lead Executive Director and Director of R&D to ensure research activity in their organisation is promoted and supported, monitored and reported effectively at Board.

While it remains a work in progress NEDs say it gives them a chance to ‘stand up’ for their R&D teams. They are also being creative in their scrutiny. As a collective group which meets regularly supported by Health and Care Research Wales they have identified levers such as the Welsh Government’s Duty of Quality in healthcare legislation to persuade their Boards that investment in research and evidence is the ultimate foundation of better patient outcomes, as well as service efficiencies.

The NEDs are also helping to influence discussions about how it should be the golden thread through all clinical service provision through inclusion in the NHS planning bible, the Integrated Medium Term Plan (IMTP). Carolyn said: “I’ve got to the point now where people know what I am going to say and almost pre-empt it with ‘yes, yes, we have considered research!’, whereas before, research was at best an after-thought.”

So, could this be implemented elsewhere? Absolutely. There is currently no national requirement across the rest of the UK that NHS Boards should have a Non-Executive Director (NED) specifically responsible for research. The presence of such a role varies by organisation, and while some organisations appoint NEDs with university, research or innovation portfolios, it is not mandated across the system.

But the success of the initiative in Wales has not just been down to the intervention of the CMO or the size of its health service, but the willingness of NHS chairs and chief executives, and the commitment of NEDs to see the benefits that a research active organisation brings not only to its patients and quality of care, as well as its efficiency and bottom line. 

Embedding research within the responsibilities of the Board with accountability driven by an Executive as well as Non-Executive Director are ultimately what will systematically change research culture in NHS organisations – whatever the daily pressures or seismic changes Boards may face now and in the future.

Key themes that have emerged from the Research Board Champions initiative:

• Their independent leadership role is strengthening accountability and is moving boards towards a more research-active culture 
• They are developing a new narrative to influence Board decision-making about the quality of care – ‘Quality of care depends on the best evidence and research underpins evidence’
• As a group who meet regularly, supported by Health and Care Research Wales, they are amplifying the “One Wales” approach bringing cohesion to research policy messaging and practice nationally
• While there may be different governance structures within their organisations they are identifying and navigating these to ensure research is adequately scrutinised all the way up to Board 
• Growing awareness of their roles is positioning the Welsh model as an international exemplar of board-level leadership transforming a national research system

Author

Felicity Waters

Felicity Waters is a former health correspondent and broadcast journalist. After 5 years as the head of communications for one of Wales’s health boards and an award-winning campaigner, she joined Health and Care Research Wales as their National Head of Communications and Engagement. Residing in Penarth, near Cardiff she is a firm believer you can make things happen by building collaborations and connections.

Declaration of Interests

No interests to disclose.