Allied Health Professions’ Research and Innovation Strategy for England

Formation of the Nottingham Joint Research Office

Dr Vicky Booth, Dr Alison Cowley and Dr Katie Robinson, Nottingham University Hospitals NHS Trust. 

How would you briefly describe your current activity in AHP Research & Innovation? 

Here at Nottingham University Hospitals NHS Trust (NUH) we are committed to AHP led and delivered research through several initiatives and activities. The investment from our Trust to develop our AHP research workforce has been spearheaded by a dedicated leadership post, the Associate Chief AHP in Research & Innovation (R&I), which is job-shared between ourselves Dr Vicky Booth, Dr Alison Cowley and Dr Katie Robinson.  Our appointment is supported by several organisational and strategic led decisions, such as the development of an AHP Strategic Plan by our Chief AHP, the formation of the Nottingham Joint Research Office with the University of Nottingham and the Trust hosting significant research infrastructure in the NIHR Nottingham Biomedical Research Centre and NIHR Nottingham Clinical Research Facility. We would like to share with you our experience as a case study focusing on these strategic aspects to help others in their AHP focused research development. 

What were the key factors that led to this activity? 

There have been many key factors which led to our role and the overall strategic approach adopted by NUH, including:

-Strong leadership from within the AHP and R&I departments at NUH with shared visions to improve AHP research

-Strategic partnerships and joint initiatives with nursing, midwifery, and medical research leaders within NUH, who have led the way in building capacity and capabilities of non-medical research workforce and clinical-academic careers

-Motivated and appropriately qualified AHP clinical academics wanting to build their careers within NUH

-Close and well-established collaborations between NUH and the University of Nottingham led by clinical-academics that had historically worked between the two organisations and were committed to supporting the next generation with their ambitions

-Successful NIHR, HEE and charity funding applications from AHP clinical-academics illustrated a good return on investment

-Clear strategic plan, developed by the AHP clinical-academics, that aligned with multiple performance indicators from a research and clinical/workforce perspective 

What were the expected benefits of this activity? 

The most significant benefit of these strategic activities and initiatives was to improve the research capacity and capability of the AHP workforce to improve patient outcome and experience.  This grand overall ambition was divided into several smaller smart goals by which progress, and benefits could clearly be mapped against.  We anticipated benefits across several layers, including clinical, individual and organisational. 

To illustrate this, we will discuss an example to highlight the strategic or organisational benefits.  One of our goals is to have a certain number of NIHR funded fellowship applications by AHPs each year.  These prestigious fellowships bring funding to support the individual and therefore have benefits to the joint organisations through contributing to multiple strategic aims.  Most of these applications require collaboration between NHS and HEI organisations, which is exactly the purpose of the Nottingham Joint Research Office.  The funding is held by NUH which supports attainment of grant income targets and research conducted by the individual within their fellowship will also support recruitment targets. The secondment of that individual from their substantive post allows for career development of others within their clinical area, and therefore supports organisational objectives from a clinical as well as research perspective.  Many of these applications are by senior AHPs and so provide opportunities for junior or external staff to upskill or share different leadership or management approaches.  These opportunities support the organisation being an attractive place to work, which in turn contributes to recruitment and retention targets in clinical services. As these fellowships involve an educational element, the collaboration with the UoN contributes to student numbers and tuition fees for courses such as masters, MPhils or PHDs.  Each successful application is supported by the research management workforce who are continuously building skills and expertise which can be used for other applications with other individuals.  This workforce works in close collaboration through the Joint Research Office and therefore also contribute to its progress and reputation. 

What challenges and/or surprises have you faced and how did you respond to these?   

There are always unexpected surprises, however, a lot of this work has been built on previous activities within NUH and many of the challenges we have experienced were, to some extent, expected.  One of the biggest, anticipated challenges, has been balancing the development of our own research and clinical-academic careers, as Associate Chief AHP for R&I, alongside the significant workload within our strategic and organisational commitments.  However, it has been these developments and success within our own careers that has helped illustrate the benefits of AHP research.  For example, Dr Vicky Booth has successfully been awarded an NIHR/HEE ICA Clinical Lectureship, Dr Alison Cowley is currently doing a HEEM Post-doctoral Bridging Fellowship and Dr Katie Robinson was awarded a prestigious NIHR Advanced Fellowship. 

Another expected challenge was the integration of two organisations and the subsequent practical difficulties of working within the Joint Research Office.  However, NUH and UoN have worked together for many years and have an established collaborative relationship which is helpful as the Joint Research Office continues to develop.   

It would not be a case study in early 2022 without the mention of the most unexpected challenge to hit healthcare, research and public health in recent history.  The COVID-19 pandemic produced shockwaves within our organisation which are still be felt and navigated today.  As Associate CAHP we have been through the same experiences as our AHP workforce, be that working on critical care or working through the difficult stop and re-start of our research studies.  However, from a strategic perspective the innovation required by the pandemic has led to changes in practice and ways of working.  For example, the use of online platforms for meetings has reduced time inefficiencies and location difficulties for cross-organisational collaborations. 

What has been the impact (so far) on care/services, the wider organisation and your own team/colleagues? 

One of the biggest impacts of our Associate Chief AHP for R&I role and the other strategic activities, has been the development of an alternative career pathway for our AHPs.  Being a role-model for others to pursue a clinical-academic or research career has been instrumental, and has built on similar roles within the organisation for other healthcare professionals such as our nursing and midwifery colleagues.  We have been using data on training qualifications, grant income, and other key performance indicators to illustrate the impact of these strategic activities and initiatives on the wider AHP workforce.  For example, in the 3 years since the role was instigated, there has been a steady increase from 2 to 11 post-doctoral AHPs directly employed by NUH.  It is these research active AHPs who will go on to conduct or implement clinically impactful research to their specific patient populations and care services.  

The next phase of implementation of the NUH AHP Strategic Plan will focus on developing a set of key performance indicators for care and clinical services, to support the further expansion of clinical-academic roles within the organisation. 

What do you see as the next priority for future sustainability or for wider roll-out of this activity? 

Our successes have been built on investment and commitment from NUH.  From our experience, continued investment that has identifiable and organisational specific returns (on that investment) is a key priority for future sustainability of AHP led and delivered research.  Our experience has been based on working within a large, research leading, NHS Trust, and from discussing similar roles and strategic investment at other smaller healthcare organisations, we know the same amount of funding might not be possible.  However, this is where we see joint appointments with Higher Education Institutions (HEI) as key, or further multi-organisation collaborations essential in securing temporary investment that can be built upon.  From our experience, strong leadership that supports these innovative posts and can creatively see different patterns of working or funding has been vital and allowed our ambitious AHPs to pursue their own opportunities.  However, there is still a long way to go and we definitely do not have all the answers.  We see communication and sharing of ideas and developments, from a strategic perspective, as key, and welcome the introduction of the HEE AHP Research Strategy. 

What has been your personal experience, and what advice would you like to share? 

There are many pieces of advice we would like to share from our experiences but to maintain focus will discuss our top three. 

As an AHP, we have worked for many years with patients from many different backgrounds, with lots of different conditions, and in multiple situations.  A key part of our work is always to approach holistically and attempt to understand what the patient wants.  Our biggest piece of advice is to approach research and innovation in the same way, be that attempting to understand what a funder wants, what your organisation needs, or what a patient population prioritises in their care journey.  Taking a holistic approach to research development and innovation, attempting to understand the other perspective, allows you to consider where you can find common ground.  For example, a large acute hospital Trust such as NUH has several organisational outcomes and performance indicators.  Identifying where AHP led or delivered research could contribute to those outcomes would be one step towards finding common ground and potentially developing a post funded by the organisation. 

Seeking balance is another key learning. A balance between the operational pressures and needs of the NHS and developing your clinical-academic career can be challenging. By developing peer support networks across organisations and professions and seeking our mentors can help to address this. Mentors can also come from different professions or organisations, and we have utilised this approach in our careers and for our Associate Chief AHP for R&I role. 

And finally, be bold. Clinical-academic careers for AHPs are still in their infancy and roles are not yet well established within the NHS so having early conversations with key decision makers within your organisation and HEI is essential. This may mean you take short term contracts or secondments and a ‘leap of faith’. We can pave the way for the next generation and develop such roles to be as business as usual and really make a difference to our patients and the care they receive.     

Commissioning of new substantive AHP Professorial posts ​

David McWilliams, Associate Professor of Physiotherapy, University Hospitals Coventry and Warwickshire NHS Trust and Coventry University

How would you briefly describe your current activity in AHP Research & Innovation?

My official role or title is, I’m a clinical-academic physiotherapist, and also an associate professor of AHP Research.

This is a jointly funded post by University Hospitals Coventry and Warwickshire NHS Trust and Coventry University. My role is split between a clinical and an academic footprint. I have a clinical commitment that works within critical care and then also protected time to develop my own research interests and ideas, and also a responsibility to develop research capacity across both organisations.

What were the key factors that led to this activity?

There was a recognition that there were a number of joint aims and strategies in terms of driving forwards patient-first research. And to look at getting clinicians on the ground more actively involved in research themselves, providing the support and infrastructure around them. Also, getting a framework to develop the next generation of clinical academics, and tying those two organisations together.

So, I think there were quite high level meetings and strategies formulated between the two organisations, looking at how they could start to empower clinicians on the floor. And where that really ended up with was the creation of a Centre for Care Excellence, which I believe is the first of its type in the country; with a commitment from both organisations to create four – which has now become five – professor posts, to lead and develop research for nurses, midwives and allied health professions.

What were the expected benefits of this activity?

I think the very heart of this really is about improving patient care: the patient is the heart of everything we do. I think it’s about recognising that the clinicians working on the ground, on the front line in day-to-day practice come up with new ideas, solutions or methods to solve clinical problems.

And also at a higher level, it’s about involving patients in decision-making about their care and about new ways of working; having more collaboration between patient groups for co-design and co-development of research. Having patient care right at the heart of everything that  we do, so that research is relevant, appropriate and very patient-centred.

What challenges and/or surprises have you faced and how did you respond to these?  

I think for me individually as a clinician coming from working 20 years in clinical practice, the move to a more flexible and open post was quite different. Trying to embed yourself within a new clinical service whilst also having other commitments across two different organisations. I think for me the fact that this was a new job, almost a blank sheet of paper with the challenge of what should this look like brings its own challenges.

But actually it was just about engaging with staff. The perception before the centre was created was perhaps that it was an organisational desire for this to happen, but was that replicated on the floor, with people who were already working in very busy posts with high caseloads and very limited time? How could we spread the message that research isn’t something in addition, but it’s actually a core part of peoples’ roles: whether that’s somebody having an awareness of research and evidence-based practice, or wanting to get more actively involved, or to pursue a clinical-academic career.

So it’s about breaking down some of those boundaries and barriers that people see in terms of time, knowledge, understanding of how research can be embedded throughout the entire career pathway and through the organisation.

What has been the impact (so far) on care/services, the wider organisation and your own team/colleagues? 

In terms of impact, we’re looking at what would potentially be called some of the softer elements. So, it could be easy to jump into this kind of role and look only at who’s highly performing, who’s done a Masters or a PhD, where are the big grants. But actually I see them as the fruit on a fruit tree. It’s about laying the foundations and we’re looking at getting engagement with people getting involved in data collection, abstract submissions to conferences, poster presentations for example; looking at personal awards, internships, and to prepare people for applying to the ICA pathway.

So yes, we’re collecting metrics about publications and grants awarded etc, but we’re also looking a lot more at those conference level presentations, people are starting to get more involved in audit, data collection, service evaluation. We’ve started running regular drop-in ‘clinics’ for staff.

So actually this year we’ve had a number of successes, we’ve had people who have submitted abstracts to conferences and won awards, where we’ve never even previously submitted as an organisation. We’ve had people getting places on these internships and putting forward applications for fully funded PhDs. In the future this is something we’ll continue to collect at every level, to make sure we’re not just looking at the cream of the crop at the top. We’re starting to develop a real culture of research throughout the organisation.

What do you see as the next priority for future sustainability or for wider roll-out of this activity?

I think it’s looking both up and down. For me as an associate professor at the moment, I need to start to develop my own CV around PhD supervision and starting to bring in some money so that my post becomes self-sustaining. We’ve been given a five year vision to start to create self-sustainability within the Centre. There’s time and mentorship for me to develop into that role.

As the five professors we’ve each been given a PhD student to supervise and they can also help us to develop our own research and projects.
We’re also starting to develop Champions across different AHP services and a network within the organisation, and across regionally and nationally, and ultimately internationally. We’re looking at building that infrastructure all the way through.

What has been your personal experience, and what advice would you like to share?

It’s really interesting because when we went out to interview they were very clear that they wanted people who were clinically active. We have been fortunate to attract people with a variety of skills, experiences and backgrounds into these posts. We have two who have been appointed who were established as academics for a number of years, and three who were clinically active researchers, two nurses and myself. I think ultimately my biggest learning experience is that it is people who make research and innovation happen. AHP’s have so many great ideas and a passion to improve patient care, but what they really need is the space, time and support to develop them. Having senior leadership and commitment is essential, to no longer feel like you are fighting against the system but rather being supported and recognised for the work that you do.

We’ve had a staggered approach: I’ve been in post for around a year now, and the others joined since then. I think what we’re very cognisant of is the collaborative expertise across the group, and that we each have different skills, different experience and different perspectives. We had an Away Day to look at how we can create these supportive networks, we’re going to run things like a monthly ‘Tea & Cake’ meeting where we can present ideas, get feedback from each other and start to build research collaborations with other people. We’re starting to see the benefit of close working across the group, we have a shared space and we can bounce ideas off each other, we can peer review each other’s work, use each other’s expertise and networks.

This type of peer support is something I’ve never had before. And couple that with the protected time and the vision of the Centre provides such a platform to take things forwards for all the nurses, midwives and AHPs within the region.

From my experience, so much of research across the NHS, or access to research for clinicians is very dependent on the availability of mentorship and supervision, and who you work with. That can be very fragmented and very silo-ed. Something like this Centre provides a strategy across an entire organisation, to give people opportunities they just wouldn’t have otherwise.

Developing a Clinical Collective Research Resource​

Sophie Chambers, Speech and Language Therapist ,Bolton NHS Hospitals Trust and University of Central Lancashire  

How would you briefly describe your current activity in AHP Research & Innovation? 

I’ve called this the “Clinical Collective Research Resource”. It’s a Trust-level searchable electronic repository for sharing research publications across the clinical team. 

I created a template that was all based around our monthly ‘Research Round-Up’ team email. Everyone agreed it would be ideal to have it as a Newsletter, where all of these articles could be shared. It was termed a ‘Newsletter’ but it was literally just an email with a list of resources and references. The transition onto the One Note platform was the new bit; the Newsletter was the first page on One Note. Then as the months go past, all the articles could be archived into their relevant groups, clinical specialties etc. So, for the first time you could find them at a later date; as it’s always the case that six months down the line people say, ‘oh yeah, you shared that really amazing article’; and this was the perfect way that you could search back for it. You can search for a key phrase, it’s a bit like using Control + Find. 

What were the key factors that led to this initiative? 

The clinical team historically always had an interest in gathering research information and disseminating it through emails, sort of ‘oh I’ve read this and it might be of interest’. And I had seen this happen for about three years since I’d been a newly qualified practitioner working in the team and been trying to keep track of these rogue emails that ping into your inbox. 

And I’d thought that it might be quite nice to start gathering those together, because for me personally – and for everyone else – they would get lost, you’d forward it home, you’d try to read it in an evening but you’d never know where you’d put it. It was creating a barrier really to accessing existing literature that you knew was out there. 

What were the expected benefits of this activity? 

I thought with the launch of Microsoft 365 coming into our Trust, it would be an opportunistic moment to have a platform where all of this evidence and published information we find could be put altogether as a collective resource.  

So, I decided to use One Note, although not a lot of people had started using that. Essentially in my mind it was like an electronic level arch file, which is just perfect, because the amount of level arch files in our offices was getting a bit silly, and we absolutely didn’t need another one of those! This was perfect, it had lots of different folders inside it, you could annotate it, you could record on it.  

Another completely unexpected benefit over the past year has been that we could access this remotely when time on the hospital site was so limited except for essential ward work. 

What challenges and/or surprises have you faced and how did you respond to these?   

At first, I think the perception was that this was slightly overwhelming when people saw all of that information; especially when you go into the archives and see all the articles there that have been shared. That can be quite daunting. But the way to counteract that was to keep that first page as the familiar monthly update. And some people don’t want to go delving into the archives, they just want the overview of latest publications; so that is always still there for them. A sort of comfort blanket that they knew. Especially as the launch of 365 across the Trust was challenging to get people on board, and to have both things happening at the same time could have been potentially too much, especially on top of people battling the clinical stuff. That will all take time. 

But there are a few individuals who really like using it, so with them demonstrating it and talking about it, that has had that ripple effect. 

What has been the impact (so far) on care/services, the wider organisation and your own team/colleagues? (Please comment on how you have evaluated this or what is the basis for your comments) 

The majority of the feedback I get about this is informal, verbal comments or via an email. Often it’s a query about something I’ve shared a while ago and they want me to show them how they can access that.  

At the moment it’s only been running for about a year, so it’s hard to say what the impact is, particularly as it’s been over one of the hardest years we’ve ever had. I’ve been thinking about evaluating it more formally, but I think that has to be at the right time, and that’s probably not in these most difficult circumstances when everyone is under so much pressure. 

But we’ve already seen how flexible the system can be, as we’ve already added new sections to compile all the evidence resources for our Acute Covid and our Long Covid services. 

In the recent research climate survey I did there were themes coming out for all our AHPs about accessing the literature. Our library within the Trust are aware of what I’m doing. Anecdotally they’re saying that SLTs in particular make the most requests for access to articles. So for example in the One Note programme they can find the url link, but not all papers are fully open access. They can forward this link to the library services, so this will be another way to evaluate the impact from their perspective of the increase in requests for people to access full papers, and requests for full searches to answer a clinical question. 

What do you see as the next priority for future sustainability or for wider roll-out of this activity? 

This was a Speech Therapy project, but now other teams across the organisation have got wind of using One Note in this way and want to use it for their own specialties. 

I can invite them to use the Notebook to look and see what we’ve created and then make something for their own team. 

It was really nice to be able to write this up as a paper and get that published as well. I’m really proud that was my first single authored paper in an international peer-reviewed journal paper. And I also presented it at the RCSLT professional conference. I could walk people through that journey and it might spark someone else to do something similar. 

What has been your personal experience, and what advice would you like to share? 

The majority of the updates have just been by me, but I do get some requests: can you include this, or can I send you this to put in for me. So there are indications that there will be more people getting involved in the future, especially when they get a bit more confident.  

We all know the barrier of time and that keeps coming up. In the first instance I did take some time within my role to do this, no more than say an hour a month to pull it all together. But of course outside of that as you’re checking emails or browsing you’re flagging articles or doing those low level admin tasks to keep track of relevant publications and resources, but I never kept track of that. Now this has been integrated into my new seconded role I was supported to take a little more time on this, but once it’s set up it takes hardly any time at all really.  

The one thing I always wanted this to be – and it’s in the name – is for a ‘collective’ resource, that people can use. And it should be a shared responsibility among the team, research isn’t just one person’s responsibility, especially when we’re talking about clinical research. So, I think from the outset, having a small group of people who can share that would be a better start, rather than where I’m at trying to recruit people who are all very busy, even though they are willing. That way research becomes seen a s a group activity, which it should always be. I think that would make it easier, more enjoyable, and the impact would be greater as well. 

Mapping the AHP research workforce across Yorkshire ICS partners.

Dr Sally Fowler-Davis and Angela Green, Yorkshire Integrated Care Systems. 

How would you briefly describe your current activity?

Angela Green:

My role is as Lead Clinical Research Therapist within an acute hospital trust. I'm a member of the Humber Coast and Vale AHP Council and I also sit on the North and East Cumbria and Yorkshire AHP Council. I have previously been co-lead of an AHP specialty research network which was supported by the Yorkshire and Humber National Institute for Health Research (NIHR) Clinical Research Network and I am a co-hub lead for Council for Allied Health Professions Research Yorkshire.

Dr Sally Fowler-Davis:

I'm a member of South Yorkshire and Bassetlaw AHP Council and I’m an associate professor for organisation in health and care at Sheffield Hallam University. I am seconded (part-time) to Sheffield Teaching Hospital where I work in a community and acute services specifically to support research development.

In terms of this initiative, our work involves Mapping the AHP research workforce across Yorkshire integrated care systems (ICS) identifying AHPs working as clinical academics. By mapping AHP research capacity, capability, and activity according to disease areas, the project aims to create a knowledge network which enables NIHR research areas. The information will help to build on existing regional AHP research networks and ultimately the development of a Yorkshire AHP research strategy.

What were the key factors that led to this activity?

Research drives improvement in services and better outcomes for patients. Having research active staff makes for better care. Our aim was to demonstrate how allied health professionals are as capable of doing high quality research either as principal investigators in their NHS or Care Organisations or in universities. This really comes back to the desire to, build capacity for larger scale and multidisciplinary research that is visible and contributing to services and benefiting patients

We want to support and develop a research culture across the Region, particularly enabling AHPs to take on new clinical academic roles alongside their practice, leading a portfolio study or writing for publication. By mapping this capability, we can contribute to large scale grants and what’s really pleasing to see is just how many AHPs have identified themselves as continuing to research.

Our local Yorkshire and Humberside Clinical Research Network (CRN) is quite progressive. They recognise that AHPs are interested and able, and that's particularly important. The engagement with the Councils has been important too and partnership with the University Faculties helps to demonstrate a growing interest and participation.

Sheffield Hallam University have led the mapping with the deputy head of the AHP department and data analysts making a contribution alongside AHP and other students undertaking interviews.

What were the expected benefits of this?

We're hoping to be able to create networks or stimulate people with similar interests to create networks. It's easy for researchers to feel very isolated and lost in the system, so being able to link up with people that have similar research interests is important and that can then create mentors and stimulate collaborations. visibility of staff as clinical academics beyond their own organizations, is key. Our CRN funded the project, because they want to enable patient recruitment to studies and enable capacity and capability to open research sites and we're just learning about a whole range of people we never knew.

Not only will we have a better idea of our strengths and perhaps our gaps, but we can also see what the development needs could be, leading to a regional AHP research strategy which would be supportive of the national one. With this we can strategically take AHP research forward.

What challenges and/or surprises have you faced and how did you respond to these?  

There are always challenges to delivering research including workforce challenges, and we also had unexpected high numbers coming forward, but our students were prepared to contact and interview all participants. Each of them was trained up in interview methods including helping them to understand how to identify and consent participants. By using the students who were paid for their time as a research assistant, we are influencing the mindset of our future workforce and really showing them just how important research is.

Our bid for the funding went through the Yorkshire and Humber CRN and we are hoping that in a further round of activity engagement from colleagues in the Northeast and North Cumbria ICS will be possible.

The project was approved by Sheffield Hallam ethics committee and there is the potential of this being published which we hope will share the process and outcomes more widely. 

What has been the impact (so far) on care/services, the wider organisation and your own team/colleagues?

You don't have to do a doctorate to do research in the NHS and social care, and whilst people are interested in progressing their own research awards it is not the only way to progress as a researcher and that’s something we’re seeing in the data. This is still very much work in progress, but we've had a mixture of acute and community trusts, mental health trusts, and a couple of private practitioners. We were rather hoping, and perhaps the CRN was also hoping that we would get people from social services or local authorities and from the third sector because those are areas where we know AHPs are working but these sectors have not so far developed the opportunities or the infrastructure to do research.

It’s a little bit too early to provide a full analysis, but what we are hoping is that this will lead to further work to develop a sustained network. Having a data system right from the beginning to capture the data in a systematic way has really eased our workload and facilitated the analysis. 

What do you see as the next priority for future sustainability or for wider roll-out of this activity?

There is no question that AHPs need visibility and a conjoined infrastructure on which to base their research activity and organisational infrastructure is important. Sustainability is a challenge because this is a six-month funded project. So, we need to develop a strategy and ensure that this work develops and isn't lost.

We want to look at exactly how we ensure that AHP research capacity building can be taken forward in our region.

What has been your personal experience, and what advice would you like to share?

Research is a ‘team sport’, what we mean is that everyone has an important role, and everyone has their own contribution which can be in recruitment or in planning, delivery, or dissemination. Involving the students has been a positive experience and I wonder how often we do park things as clinical AHPs because of pressures when we could be looking to our student body as being facilitators.

And finally, Yorkshire and Humber CRN are really trying to be inclusive, and this project is a testament to that.