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Allied Health Professions Research and Development Action Plan

SECTION 1 BACKGROUND

1.1 Context and drivers of research and development for AHPs

Research, development and evidence-based practice

CSO defines research and development as:

...structured activity which is intended to provide new knowledge which is generalisable (i.e. of value to others in a similar situation) and intended for wider dissemination ( www.show.scot.nhs.uk/cso).

A report on promoting research in the nursing and allied health professions (CPNR et al., 2001) developed a staged approach to defining what research and development mean in practice, an abridged version of which appears in Table 1.

Table 1. Stages of enhancing research and research-led practice (CPNR et al., 2001)

Evidence-based practice in the health services is defined as:

...an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide the option that suits the patient best (Gray, 1997).

It is enacted when:

...decisions that affect the care of patients are taken with due weight accorded to all valid relevant information (Hicks,1997).

In a social care context, evidence-based practice is defined as:

...the conscientious, explicit and judicious use of current best evidence in making decisions regarding the welfare of those in need (Sheldon and Chilvers, 2000).

Policy context and drivers

NHSScotland
NHSScotland is driven by the key priorities at the heart of the Scottish Executive's agenda. These include:

• stepping up action on health improvement

• preventing ill-health

• promoting safer lifestyles

• redesigning health service provision

• increasing patient and public involvement

• developing national service standards

• addressing inequalities in health provision

• improving provision of services

• developing and supporting the workforce (Scottish Executive, 2003a).

Research, development and evidence-based practice have key roles to play in delivering on all parts of this agenda.

Scotland's health white paper, Partnership for Care (SEHD, 2003a), confirmed that the Executive would 'continue to invest in research to underpin health improvement and better health services'. The vehicle for ensuring this investment is appropriately channeled is the Research Strategy for Health and Healthcare (SEHD, 2003b), which sets out to improve the scope, relevance and quality of research to meet the health and healthcare needs of the people of Scotland. The strategy focuses on key research issues such as:

• defining priority areas for research activity

• supporting important research projects outwith the defined priority areas

• strengthening the system of research governance

• supporting local NHSScotland systems in performing and utilising research studies

• developing research partnerships

• increasing research capacity in under-developed areas

• promoting a multi-professional approach to research.

The research agenda closely reflects the wider NHSScotland agenda. Particularly significant in the latter is the drive to improve the health and well-being of the people of Scotland, with a package of measures set out in Improving Health in Scotland: the challenge (Scottish Executive, 2003b), increasing access to health services for all regardless of race, creed, cultural background or ability ( Fair for All: SEHD, 2002c), and the need to increase the involvement of patients and the public in the design, delivery and evaluation of services ( Patient Focus, Public Involvement: SEHD, 2001a).

People now expect to be involved in deciding about their own health care as responsible partners, and Partnership for Care (SEHD, 2003a) emphasises that the Scottish Executive is 'committed to a new culture of patient focus and individual care in the NHS'. This focus must drive not only services, but also research and development activity (SEHD, 2001a).

This is reflected in the CSO approach to patient and public involvement. An involvement group consisting of members of the public has been formed, with members invited to join each of CSO's committees and groups. The members are also involved routinely in a range of research-focused activities.

Social services
Under the Scottish Social Services Council Codes of Practice for social service workers and employers (SSSC, 2003), employers of social service workers are committed to promoting practice-based learning and continuing professional development. By doing so they are ensuring that staff are adequately prepared to provide an effective service. In turn, social service workers must practice in an effective way and take responsibility for ensuring they are adequately prepared so to do.

While the concept of evidence-based social care is an emerging one, there is strong support for the introduction and development of services that are not only user focused and provide best value within a local authority context, but are also evidence based and support users to make informed choices about the services they receive. This is being seen as increasingly important across a wide range of settings, and is an approach already firmly embedded in the Scottish Criminal Justice System.

Other professional groups
The national strategy for research and development for nursing and midwifery, Choices and Challenges (SEHD, 2002b), is another significant driver of the action plan. The strategy sets out a series of recommendations relating to four key areas:

• developing research and development infrastructure

• adopting a focused approach to research and development

• building an evidence-based culture

• promoting dissemination of research and development findings.

It is clear from the consultation process for this action plan that many of the issues faced by AHPs in relation to research and development mirror those faced by a range of other healthcare professions engaged in direct patient care, including nursing and midwifery. As such, the four key areas set out in Choices and Challenges also closely reflect the areas in which action is needed to develop AHP research and development in pursuit of this common agenda.

1.2 Process

Following a recommendation in Building on Success (SEHD, 2002a) to review research and development activity among AHPs in Scotland and develop an action plan, a short-term working group with wide representation from the professions and other relevant stakeholders was convened early in 2003.

The group considered different aspects of AHP research in Scotland, focusing on key issues such as:

• building research capacity

• developing structures and infrastructures to sustain AHP research

• supporting the development of a stronger evidence base to underpin practice.

To assist the group in its work, the AHP Officer, in partnership with the Scottish Higher Education Funding Council (SHEFC), commissioned a national scoping exercise of current research capacity, capability and activity among AHPs in Scotland.

National scoping exercise

The exercise, carried out between March-May 2003, involved a postal questionnaire survey of HEIs and directors of AHPs in NHS Trusts. It did not attempt to compare individual institutions against each other; rather, it set out to gain a 'snapshot' of current AHP research capacity and capability in Scotland.

Key strengths found by the exercise included:

• shared goals between HEIs and NHSScotland, particularly in relation to strengthening joint working

• high levels of motivation to move research and development forward for AHPs

• the discovery of many examples of good and innovative practice.

Two key areas in which development is required were identified:

• the need to increase the cadre of research leaders for AHPs

• the need to increase the research capacity and capability of AHPs.

The information produced by the exercise provides a strong platform on which future AHP research and development activity can be built. A full report will be disseminated by the Scottish Executive Health Department (SEHD) in due course.

1.3 Sources of support for AHP research activity

AHPs require strong systems and structures to support and nurture research and development activity and to maximise their contribution to research and development projects. A number of organisations fulfil key functions in supporting and facilitating research and development across services in Scotland, offering opportunities for AHPs to access networks, advice and support for their research and development activity. They include the organisations listed below.

Chief Scientist Office (CSO)

CSO commissions, funds, encourages and supports research and advises the SEHD on how research contributes to improvements in health and health care. Among its main functions are:

• funding investigator-led research projects

• sponsoring research training initiatives

• defining research priorities

• developing a research strategy for NHSScotland

• promoting dissemination and implementation of research findings

• encouraging strong research ethics appraisal and research governance

• supporting a number of research units across Scotland, including the Nursing, Midwifery and Allied Health Professions Research Unit1

• encouraging multidisciplinary, collaborative research.

CSO supports the infrastructure for research in NHSScotland, enabling NHS practitioners and researchers to participate in a range of externally funded research activities. It also funds the management of research in NHS organisations, often within a Research and Development Office which provides access to facilities and services for research.

CSO funds a broad range of health and healthcare-related research and publishes a quarterly newsletter, Research Matters, which lists all current funded projects, including those being developed in whole or in part by AHPs.

Nursing, Midwifery and Allied Health Professions Research Unit (NMAHPRU)

NMAHPRU was established as the Nursing Research Initiative for Scotland (NRIS) ( see footnote 1) in 1994 to provide a focus within Scotland for direct patient care research. The unit has a multi-professional research remit and its work encompasses all care settings.

Four programmes of research are under way, focusing on:

• stroke (including communication, nutrition and specific needs)

• practice judgement and decision making

• practitioner interventions (involving patients with cancer and those with urogenital problems)

• patient-centred outcomes (focusing on reviews of the literature to identify what patient-centred outcome measures are available and where they are being used).

Funding of this unit is subject to periodic external peer review by a panel which reports to CSO.

NHS Quality Improvement Scotland (NHS QIS)

NHS QIS brought together five separate bodies - the Clinical Standards Board for Scotland (CSBS), the Nursing and Midwifery Practice Development Unit (NMPDU), the Scottish Health Advisory Service (SHAS), the Clinical Research and Audit Group (CRAG) and the Health Technology Board for Scotland (HTBS). NHS QIS has assumed elements of the responsibilities of each of these organisations, including the operation of a national system of quality assurance of clinical services. The Scottish Intercollegiate Guidelines Network (SIGN) will become part of NHS QIS in 2005.

The Practice Development Unit within NHS QIS (formerly the Nursing and Midwifery Practice Development Unit (NMPDU)) is currently reviewing how nurses, midwives and AHPs can work together to develop practice in a collaborative way and build networks of support. This will involve the dissemination of best evidence and clinical guidelines to drive practice and will be supported by the AHP Professional Officer for NHS QIS.

NHS Education for Scotland (NES)

NES was established as a Special Health Board on 1 April 2002. Its aim is to contribute to the highest quality of health and health care in NHSScotland by promoting best practice in the education and lifelong learning of all its staff. The new body builds on the work of the National Board for Nursing, Midwifery and Health Visiting for Scotland (NBS), the Postqualification Education Board for Health Service Pharmacists (PQEB) and the Scottish Council for Postgraduate Medical and Dental Education (SCPMDE) in extending its activities to cover all staff groups. An AHP Professional Officer was appointed to NES during 2003 to lead on specific AHP developments and support interprofessional learning.

Also included within NES is the Scottish School of Primary Care (SSPC), the national organisation promoting research and increasing capacity for research in primary care across Scotland. The School is funded by the SEHD, CSO and SHEFC to provide high quality research evidence to inform decisions made by service users, practitioners, managers and policy makers. It develops research capacity and capability within Scotland through increasing the accessibility of education and training in primary care research.

NHS Health Scotland

Formed through the merger of the Health Education Board for Scotland (HEBS) and the Public Health Institute for Scotland (PHIS), NHS Health is Scotland's health promotion and public health agency. One of its functions is to commission and publish research on key areas affecting people's health and well-being.

Scottish Higher Education Funding Council (SHEFC)

The main strand of the Scottish Executive's support for research in HEIs is administered principally by SHEFC. The council supports research capacity by distributing funding to HEIs selectively according to the quality of research in each institution as measured by the research assessment exercise (RAE). SHEFC funding for research activity also underpins and encourages investment in research projects from other potential funders such as Research Councils, the European Union, research charities and private funding bodies.

Professional bodies

AHP professional bodies have a clearly defined role in ensuring practitioners adopt an evidence-based approach to practice and in funding individual pieces of research. The distinct bodies for the professions have joined together to address this common agenda and provide some focus and direction to support research and development for the AHPs, specifically through the Research and Clinical Effectiveness Forums (Box 1.3.1).

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