Frequently Asked Questions
It is a 'Collaboration for Leadership in Applied Health Research and Care'.
Nine CLAHRCs have been established by the National Institute for Health Research (NIHR). Each has three specific and related arms to the organisation: carrying out high-quality applied health research focused on the needs of patients, supporting the translation of research evidence into practice in the NHS, and increasing research capacity in the NHS.
A CLAHRC is a collaborative partnership between a university and surrounding NHS and social care organisations. CLAHRC-NDL is a collaboration between The University of Nottingham, the NHS and local authority organisations across Nottinghamshire, Derbyshire and Lincolnshire.
Within the local structure, researchers, service users, managers, commissioners and clinicians work together.
The National Institute of Health Research (NIHR)
is part of the Department of Health and one of four national organisations through which government funding for health research is channelled.
NIHR's key objective is to improve the quality, relevance, and focus of research in the NHS and social care by distributing funds in a transparent way, after open competition and peer review. This objective sits within the Government's strategy 'Best Research for Best Health', with a goal to create a health research system in which the NHS supports outstanding individuals, working in world class facilities, conducting leading edge research focused on the needs of patients and the public.
NIHR led the call for applications to be a CLAHRC, as part of carrying out the Government's strategy 'Best Research for Best Health', and decided which applications would be carried forward to receive funding to be a CLAHRC.
When the NIHR were assessing the CLAHRC applications particular value was placed on research targeted at chronic disease and public health interventions. There was also particular interest in activities to support the translation of research evidence into practice, including the trialling and evaluation of initiatives to encourage adoption of evidence based practice or clinical effectiveness. The Nottingham bid was particularly favourably received because of the implementation component.
NIHR is a key funder, so the logo appears on CLAHRC-NDL documents.
All nine CLAHRCs operate within structures and processes defined by NIHR.
The idea for CLAHRCs grew from two key reports.
Firstly, in 2006 Sir David Cooksey produced a government commissioned report, 'A Review of UK Health Research Funding'. He identified the "second gap in translation", the difficulty of getting research into practice.
Secondly, in 2007 the Chief Medical Officer reported from the High Level Group on Clinical Effectiveness (HLG) commissioned by Ministers to address the issue of variation in clinical practice and in the treatments that patients receive, for some of which there is no evidence, also a failure to provide services shown to be effective.
The group found that this is a complex issue with no 'single bullet' to improve clinical effectiveness. The report makes a number of recommendations on:
aligning national activities and support
promoting local ownership
ensuring clinical engagement
harnessing the capacities of academia
the research agenda
CLAHRCs are designed to draw practice and research closer together, in order to provide evidence based care for users of services within the NHS and social care.
Particular value was placed by NIHR on research targeted at chronic disease and public health interventions.
The lead NHS organisation for CLAHRC-NDL is Nottinghamshire Healthcare NHS Trust
(and there is already an existing partnership between the Healthcare Trust and the University of Nottingham in the Institute for Mental Health
) so it was inevitable that there would be an emphasis on mental health research.
Non mental health themes and projects grew from research ideas that were under discussion at the time of the call for CLAHRC applications.
The NIHR particularly liked the organisational approach to implementation, researching facilitators and barriers alongside the conduct of clinical research.
The nine CLAHRCs receive funding through the NIHR and that funding is conditional on being matched by local funding. It lasts for five years, from October 2008 to September 2013.
The total amount of NIHR funding awarded is £88m over five years. Each of the nine CLAHRCs will receive funding of up to £10 million over five years from NIHR.
Every CLAHRC has had to attract additional matched funding to equal the NIHR funding. CLAHRC-NDL received £8.7m from NIHR and a further £10million from partners.
The funding from the NIHR can only be used to support:
the conduct of high-quality applied health research focused on the needs of patients
activities to support the translation of research evidence into practice in the NHS for the benefit of patients, including the trialling and evaluation of initiatives to encourage adoption of evidence based practice or clinical effectiveness
activities to encourage research and the use of evidence in NHS working practice.
Including CLAHRC-NDL, there are 9 CLAHRCs in England:
There are ambitious aims for the overall CLAHRC initiative:
To develop an innovative model for conducting applied health research and translating research findings into improved outcomes for patients.
To create a new, distributed model for the conduct and application of applied health research that links those who conduct applied health research with all those who use it in practice across the health community covered by the CLAHRC.
To create and embed approaches to research and its dissemination that are specifically designed to take account of the way that health care is increasingly delivered across sectors and across a wide geographical area.
To increase the country’s capacity to conduct high quality applied health research focused on the needs of patients, and particularly research targeted at chronic disease and public health interventions.
To improve patient outcomes across the geographic area covered by the CLAHRC.
The application to be a CLAHRC was made on the basis of three things:
A body of researchers who were keen to conduct research and be affiliated to the additional expectations around taking research to the next stage, implementation. That, together with the lead NHS organisation being the Nottinghamshire Healthcare NHS Trust, led to the particular clinical themes and projects.
A belief that there is a gap in knowledge about how best to overcome the difficulties of turning research into practice, so Implementation Science is included as an element
A belief that part of translating evidence to practice depends on better communication, so there is a focus on Engagement and Dissemination
CLAHRC-NDL first received funding in October 2008 and began to recruit to the project, including recruiting partner organisations to put in funding and become involved.
Over time it is anticipated that projects that started locally will be able to build on partnerships right across Nottinghamshire, Derbyshire and Lincolnshire to increase the area covered by the clinical projects.
CLAHRC-NDL is being evaluated externally and internally.
An external evaluation of all of the 9 CLAHRCs is taking place, by other research teams.
CLAHRC-NDL is being evaluated by a team from Innovation, Knowledge and Organisational Networks research unit (IKON) at Warwick Business School, University of Warwick.
They will be looking at how the work
undertaken in CLAHRC –NDL has helped to build networks and communities.
An internal evaluation of the work taking place in CLAHRC-NDL is also being carried out. There are 3 parts to this:
i) all of the 16 clinical studies have an in-built evaluative component – comparing what happened before the intervention (or research) took place, and what happens after
ii) the role of the Diffusion Fellow – unique to CLAHRC-NDL is being evaluated, through annual reflective interviews that will enable us to learn from DFs’ experiences and develop the role further
iii) all of the 16 clinical studies will have their service user and carer involvement evaluated. The CLAHRC-NDL participation tool has been developed by our own service user and carer reference group, and will be used to examine the extent of user involvement in research design.
What difference will CLAHRC make for patients/service users?
One of the key aims of CLAHRC is to increase the take up of evidence based treatments and practices, assuming that it will improve patient care and make health care more effective and efficient.
CLAHRCs are intended to be part of the solution to some long standing and intractable problems of translating evidence to practice.
The CLAHRC-NDL proposal was built on existing knowledge about translating knowledge into change, but knowing that the existing knowledge has not been able to create the amount of change needed.
So CLAHRC is an experiment in itself, one which it is hoped will achieve beneficial change as well as increased knowledge.
Academics are constantly bidding for research funding, so there may be further opportunities to research areas connected to CLAHRC-NDL.
Funding for all CLAHRCs ceases in 2013.
However, embedding the ideas and practices of CLARHC into research and NHS practice is fundamental to the CLAHRC initiative.
Sustaining new ways of working has always been a challenge and CLAHRCs are addressing sustainability as an issue, chiefly through encouraging the development of Communities of Practice