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9 February 2012 NIHR-funded Surgical Research: NIHR PGfPG Award Holder Mr Peter McCulloch.

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Presentation on theme: "9 February 2012 NIHR-funded Surgical Research: NIHR PGfPG Award Holder Mr Peter McCulloch."— Presentation transcript:

1 9 February 2012 NIHR-funded Surgical Research: NIHR PGfPG Award Holder Mr Peter McCulloch

2 Who are we? Quality, Reliability, Safety & Teamwork Unit (QRSTU) Research unit focussed on INTERVENTIONS to improve SAFETY in SURGERY Based in Nuffield Dept of Surgical Science, Oxford University Multidisciplinary team includes clinicians, ergonomists, aviation teamwork experts, specialist in systems improvement, knowledge translation, statistics and health economics

3 Safer Surgical Services Programme of studies to evaluate INTERVENTIONS to improve safety and quality in surgery Looking at SYNERGY between approaches and effects of CONTEXT and CULTURE on success Based on a 3 dimensional model of safety (system, culture and technology) Uses learning from non-medical experience eg CRM, Lean, Ergonomics 3 Trusts over 3.5 years, mainly Orthopaedics

4 Application Process Dates and timelines – 2 years from start to go. 5/9/08 Final Draft 1.3 Notes on reviews 28/11/08 Response to review 8/01/09 Response to further reviews 19/01/09 Full application 09/06/09 Resubmission 25/08/09 Final resubmission 22/09/09 Outline, full application & revision so 3 submissions Further revisions x3 and contract signing 1/11/09 Difficulties around NHS budget holding & sponsorship for academic partners

5 Overall Impressions of Application Process Two stage process pointless where HEI involved, and causes delay Review process thorough and professional (- overly so?) CCF staff superb Rules a disincentive to career academics Online forms not optimal

6 Pointers for Applicants Referees showed strong focus on TEAM and ENVIRONMENT Strong track record with relevant pilot data essential Patience and flexibility required

7 Setting Up Agreeing Contract after award can take time Ethics – vastly improved in last 5 years Permissions to enter hospitals – challenging!!

8 Delays (n = 24) Mean 7.8 weeks Median 8 weeks Range 3 – 18 weeks Achieving permission Issues Difficulty in determining what is needed – HC, OC, RP ? Multiple steps required = time and money Multiplies chance of delay Justification for several steps unclear CRB Medical Director sign-off Occ Health at each Trust Clearance for Letter of Access

9 Budgetary control Subcontracting awkward – NHS, University and NIHR accounting systems Generally flexible and sensible in day to day running Good interaction with CCF staff – availability and ability Interpretation of rules for funding NHS support costs seems difficult – and narrow.

10 Reporting Requirements light and not onerous Requirement for permission to publish irritating No real feedback on reports

11 Dealing with NHS R&D Offices at Trust Level Urgent and serious problem which is damaging research Access Ethics Amendments Protocols Sponsorship Perverse incentives Staff justify existence by activity not results No targets or deadlines (? Look at Ethics model)

12 Patient & Public Involvement Principle not easy to implement PALS Patients Association Special interest groups More support needed?

13 Summary The Good Generous support, vitally needed and unique Very thorough and fair reviewing process Superb staff interface at CCF - very helpful prompt and professional advice Financial and Reporting structures effective and not onerous

14 Summary The not so good Two stage application process Iterations in contract negotiation NHS R&D Offices at Trust level a serious problem Dissemination and PPI obligations could do with more help Lack of rigorous mid-stage evaluation

15 Conclusions Vital and important funding for clinically relevant research Innovative on a world scale Slow and bureaucratic selection and contracting NHS budget holding a problem Major problems with Trust research governance Effective and helpful day to day management Need to put more into PPI and reporting

16 Thank You NIHR! Peter McCulloch* Ken Catchpole* Lauren Morgan* Eleanor Robertson* Julia Matthews* Beth Bosiak* Sarah Wills* Sharon Pickering* Mohammed Hadi* Damien Griffin Steve New* Trevor Dale* Alastair Gray* Oliver Rivera* Doug Altman* Gary Collins* Crispin Jenkinson Renee Lyons Alison Kitson Tony Berendt Karen Barker*

17 9 February 2012 Thank you

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