Research report 01/64
Promoting research in nursing and the allied health professions
2 The demand for research in nursing, midwifery and AHPs
3 Findings from the mapping study
4 Payback from research and comparison with benchmarks
5 Funding and funding models
6 Summary of the business case
1. This report is the culmination of a nine-month study undertaken for HEFCE by a team from the Centre for Policy in Nursing Research, CHEMS Consulting, the Association of Commonwealth Universities, the Higher Education Consultancy Group and the Research Forum for Allied Health Professions.
2. We were asked to map the present position as regards university research in nursing, midwifery, health visiting and the allied health professions (AHPs), to study the demand for such research, and then to explore the case for further investment by HEFCE and the Department of Health.
3. Our findings have been presented in two volumes: this main report focuses on the demand and on the business case, while the Technical Annexe gives our findings as regards research activity in the disciplines concerned.
4. The mapping study used several approaches to collecting data, since it was clear from previous studies that very little data already existed. A wide-ranging questionnaire survey was sent to 121 academic departments. Visits were made to 11 institutions (from which three case studies were developed). A bibliometric analysis was commissioned of the publications for six professions in the Wellcome Trusts research outputs database, and extensive interviews and consultations were held with research councils, NHSE and Department of Health staff, charity officers and members of institutions.
Demand for research
5. The demand for research is rarely identified or quantified, so we decided to categorise it in three ways: policy- and R&D-driven demand, that identified by professional groups, and relative demand compared with other benchmarks.
6. Recent policy changes in the NHS such as the move to more home and community-based care imply an extension in the roles of nurses, midwives and AHPs. Government is now stressing the weight to be given to evidence in all aspects of health and social care, placing the onus on the service and the academic community to deliver such evidence. Recent policy statements have identified a gap between the demand for, and the supply of, research in many areas. Bodies such as the National Institute for Clinical Excellence (NICE) are looking for research evidence in order to inform clinical guidelines for practitioners; evidence is also required for other priority areas such as the National Service Frameworks.
7. The shortage of health service researchers is considered by some to be a threat to the NHSs R&D programme as a whole, and research in primary care is a particular gap. A recent study referred to a vicious circle of disadvantage, in which because there were few well-qualified researchers (and little sustained investment in developing this capacity), the research outcomes were limited in number and quality.
8. Three of the relevant professions (nursing, physiotherapy and occupational therapy) have recently carried out consultation exercises asking their members in which topic areas they thought research was a priority. These findings have been passed on to funders, but have had disappointingly little impact so far. A similarly wide range of opinions is collected by the panels of the Health Technology Assessment (HTA) programme, whose role it is to prioritise topics for later NHS funding. We analysed a sample of the topics put forward and found that 10% were potentially applicable to nursing, midwifery and AHPs. NICE has also been presented with a number of research topics to appraise in the same disciplines.
9. Our survey of demand involved an analysis of research proposals submitted to two NHS Regional Offices; this showed that a significant number of proposals from the relevant professions were not funded (although this may have been due to poor quality). Discussions with the Council of Deans of Nursing and Heads of UK Nursing, Midwifery and Health Visiting and the Research Forum for Allied Health Professions served to confirm both the areas where they thought research was needed and the demand for more research capacity and investment in novice researchers.
10. We compared research activity in nursing, midwifery and AHPs with that in education and social work, two professional areas with similar profiles. In the case of education the weakness in research capacity and outputs was recognised in 1998 by the creation of a special teaching and learning research fund managed for HEFCE by the ESRC. This now has a budget approaching £23m, which is used, inter alia, to enhance the system-wide capacity for research-based practice in teaching and learning.
11. Social work as a discipline shares many of the same concerns as nursing, midwifery and the AHPs no co-ordinating body for funding research, the need for an evidence base to inform practice, and remaining invisible as a discipline as far as many funders are concerned. Despite this, however, its academic departments have succeeded in the RAE, with 16% of departments gaining a rating of 5 or 5* (compared with 3% in nursing and midwifery).
12. A comparison of the 199899 research income between academic departments shows that nursing and AHP departments received the lowest proportions of QR and research council funding of all subjects.
Findings from the mapping study
13. There is evidence that nursing, midwifery and AHP departments are generating increasing research income, since the 50 departments responding to our survey showed an increase from £3m in 199697 to £9.7m in 19992000. The principal funders have been the Department of Health, NHS regional offices and trusts. HEFCE support for research has been £3m a year of QR funding to 11 departments in Unit of Assessment 10 (UOA), which covers nursing and midwifery. Some of the £7m a year which has gone to UOA 11 will have reached AHP departments, although we do not know the proportion.
14. The capacity to do research has also been increasing: over the five-year period to 199899 nursing, midwifery and AHP research staff in universities have grown in number from 97 to 240; however, this represents only 3.9% of the total staff of 6,174. Comparable figures for other benchmark disciplines are from education with 7.6% and social work/studies with 13.3%.
15. In the RAE for 2001 the number of submissions in UOA 10 (which covers nursing, midwifery and health visiting) increased by 19% the second highest of any discipline. In addition, the number of Category A and A* staff increased by 50% over the 1996 figure the second highest percentage of any discipline. However, the number of such staff, at 623, is still low in comparison with the total of full-time teaching staff. In UOA 11 (which includes the allied health professions) the submissions were 10% higher than in 1996 but the number of academic staff increased dramatically by 57% (the highest of any discipline) to 1,066. However, we do not know what part of this increase can be attributed to the AHP disciplines.
16. Postgraduate student numbers in nursing have also grown over the same timescale by 94% and amounted to 3,700 in 199899. All but 435 of these are part time.
17. The bibliometric analysis we commissioned has shown a matching increase in published papers over the last ten years, although the outputs for nursing and midwifery have not increased since 1995. Authors from hospitals and practice account for a substantial minority of the papers in all disciplines.
18. In dietetics, midwifery and speech and language therapy, we found that one in six of the papers had a foreign author (as a sign of international collaboration) and the same disciplines had a high number of authors from different addresses, indicating inter-university collaboration within the UK.
19. A high proportion of published papers revealed no funding source, implying they were self-funded: this percentage was 83% for occupational therapy, 73% for nursing, 71% for physiotherapy, 57% for midwifery, 46% for speech and language therapy and 38% for dietetics. In the NHS as a whole, 47% of funding of published papers is unacknowledged, which means largely unfunded. The UK government provides funding for the research behind 33% of publications in all of biomedicine.
20. Respondents to our questionnaire gave us information on their research outputs, which averaged out at only 1.8 papers over the whole of the last four years for the 1900 staff involved. They also told us the present number of PhDs among their staff, which was an average of 16% of the total number.
21. Finally, our survey enquired about the number and type of collaborative links which nursing and AHP departments had with other departments or institutions. In nursing and midwifery it was usual to have two formal links with other disciplines and two with other institutions, but to have more than five collaborative arrangements with NHS-related organisations. These figures were lower for all the AHP disciplines.
The case for investment
22. We explored some of the arguments for more investment in research and commissioned a brief paper from Dr Steve Hanney, an expert in this area. It is surprising that no serious study has been made of the cost benefit of investing in health research generally. However, Dr Hanneys paper (presented in the Technical Annexe) identified five different arguments for further investment in line with a payback model he and Professor Martin Buxton had earlier developed for health service research in general. The five benefits are: knowledge generation, future research and research use, enhanced executive decision making, cost and effectiveness of different interventions and broader benefits such as economic gain from a healthier workforce.
23. As part of our benchmarking activity we looked at funding for nursing research in the USA and Canada. In the USA, the National Institute for Nursing Research was established as an entity of the National Institutes of Health in 1993 and now receives some $90m annually from Congress. This sum is equivalent to $36 per registered nurse. In Canada, a capacity building exercise has been launched providing research support for ten years for a programme of nursing research and training awards centred on newly-created chairs in institutions. This has been very successful in attracting matching funding from other agencies and sponsors.
24. One chapter in our report reviews the options for providing research funding in future. It is clear that there are partners other than the HEFCE and the Department of Health (DH) that will be willing to share in the programme. Some charities and the Medical Research Council have already expressed interest. In examining funding models we reached the following conclusions:
25. On the basis of calculations that bring research expenditure into line with other disciplines, we suggest that HEFCE and the DH might need to set aside funds of between £6m and £17m.
26. The business case for investment is summed up in Chapter 6 with five arguments: