We all have a stake in research and evidence generation - it makes a difference

As your new VP for Science and Research, Nick introduces his own journey into child health research and what we are doing to increase research capacity and build evidence for improving care.

I’m new to blogging - I expect that’s obvious! I’m also new to my role as Vice President for Science and Research, which I am really enjoying, so thank you for electing me. 

Science and research are changing our world and the children and families we care for. With this in mind, I’d like to use this blog to tell you first a bit about me, and more about what is planned for the next three years.

Science and research are changing our world and the children and families we care for

For those of you who don’t know me, I started as a medical student in Manchester, and worked initially in the North West. My research began with a single baby who died when we thought he was getting better. The need to understand why drove the research, and I moved to Cambridge. The study showed that aluminium contamination of mineral additive solutions in TPN (total parenteral nutrition) was poisoning premature infants, causing problems for the brain - loss of one IQ per day of feeding - and bone. The bone interest took me to Montréal, back to Cambridge and finally to Sheffield where I have been for the last 20 years, working with children with bone diseases.

A lot of the children I care for have complex problems requiring multidisciplinary solutions, which means getting a lot of things right to make meaningful improvements. I’m sure this is a common experience for many of us now.

Getting lots of things right is difficult. The Quality Improvement programmes that the College undertakes - the national audits for diabetes, epilepsy and neonatal care and the National Children and Young People’s Diabetes Quality Programme - all provide evidence about how making small, progressive changes can improve outcomes and also provide a mechanism for sharing best practice. So, thank you to everyone who contributes to those activities; they are making a significant difference to the lives of children and their families. The evidence that those activities provide, and evidence from other sources, underpins the clinical guidelines that the College is constantly reviewing, renewing and creating.

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The cover of our latest diabetes audit report features a painting by Anitra Mae Jorge, winner of our art competition

 

Complexity is increasing in paediatrics; we need to get lots of things right to improve care

Quality Improvement is a relatively easy sell to Trust managers. The clue is in the name. Research is more difficult. Trusts may regard research as ‘not core activity’ and possibly a distraction from delivering vital clinical services. The effect of ‘Calmanisation’ in the mid-1990s was to degrade and remove research as a core activity of newly appointed consultants. We have half the number of clinical academics now than we had pre-Calmanisation and a concentration of those academics into areas that are less general and more often focused on rarer diseases. In the last 10 years, no newly appointed community paediatrician has had time in their job plan for research. So what can we do about it?

We are working with NIHR and a consortium of funders to increase research capacity in paediatrics

We are working with NIHR (National Institute for Health Research) to develop a plan to increase research capacity and activity in general paediatrics and community paediatrics across the country. This has been developed through consultation with multiple groups, starting with RCPCH &Us, and also listening to the CSG (Clinical Solutions Group) Chairs and the College membership. This is not a quick fix, and I expect it will take five to 10 years to achieve in full. 

We want to see the ‘intractable’ issues being addressed. This means working in areas such as obesity, learning disability, mental health and safeguarding that require interdisciplinary - ie not just medical - solutions. The people best placed to deliver research in those areas already have strong multi and interdisciplinary practices, such as general and community paediatricians. This doesn’t mean that we are anticipating people suddenly becoming clinical academics, but more than half of paediatricians when surveyed said they would like to do more research. So how will that happen?

Resources, time and people.

Resources We know that everyone is short of time. We are working to develop resources that can be accessed in bite-sized pieces. This includes information on how to get involved with research - whether for the first time or to rekindle enthusiasm since swamped by the tide of other work. These resources will be made available through the Academic Toolkit. The more participation the better! 

Resources to support consultants to engage again in research will be made available through the Academic Toolkit

Time We want to see culture change in Trusts to support research activity, because we believe that it improves the quality of care and the health outcomes for all children. We will work with NIHR, NHS England and Trusts to promote the inclusion of time for research in every consultant job plan.

We recognise that the modern research landscape is daunting, with so many forms to fill and so much jargon to cope with. We anticipate that connecting those who wish to expand their research activity and linking them to mentors in existing ‘hubs’ will provide the supportive relationships that are a key element of navigating the evolving research landscape. There are some existing networks and groups such as PERUKI, GAPRUKI and the BACD Strategic Research Group that you may already be aware of, or a member of.  We anticipate that these, and others, will act as a strong support for those developing their research.
 
People In 2018 the College launched the Children's Research Fellowship Fund to enable aspiring paediatricians with an interest in research to develop their careers beyond the initial doctoral stage. I am delighted to announce the creation of the postdoctoral Fellowship jointly funded by Newlife, the charity for disabled children, and RCPCH. We hope this will be the first of many such Fellowships. It was great to see so much enthusiasm for research at the College’s recent Conference and exhibition.

CEOs of RCPCH and Newlife celebrate new joint fellowship for postdoctoral research

 

So that’s the outline. There is still a lot of detail to fill in, and I hope to keep you updated on how this develops over the coming months. More information will be available in due course through our bimonthly Research eBulletin.

Thanks for reading this. If you have any ideas about activities or approaches that you think would help increase research capacity and activity, please let me know. I’m keen that this endeavour is one driven by participation. I believe we all need to feel we have a stake in what happens in research and evidence generation, because it will make a difference that we can’t achieve with just our own pair of hands.