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Innovation in healthcare is for patients

Niamh Mullen reports that health research must shift its focus to help deliver better healthcare and contribute to the smart economy

Investment in health research must be geared more towards work that will help patients, deliver better health outcomes, be cost effective and contribute to the economy.

That is according to two new complementary reports. The Government’s Action Plan for Health Research and the Health Research Board’s (HRB) Strategic Business Plan 2010-2014 were published together last week by Health Minister Mary Harney. “Research is a catalyst for positive change, driving innovation that leads to a better standard of living and well-being.

Notwithstanding economic difficulties, the Government remains committed to supporting the research and innovation agenda, because it will support future economic growth and position us to attract investment and jobs to Ireland,” said Minister Harney.

The future of science funding was highlighted when the Report of the Special Group on Public Service Numbers and Expenditure Programmes was published in the summer. It said €100 million could be saved across Government departments and science funding should be the responsibilty of one department. It also said the HRB should be merged with a new ‘single stream science funding’ under the remit of one department.

Action plan
The Action Plan is part of the programme for economic recovery and aims to deliver 50 actions between now and 2013. The actions include having agreed national priorities for health research and joint strategies and funding initiatives across agencies.

The plan points out Ireland lags behind in terms of getting patients involved in clinical trials and says we also need a network of clinical research facilities in our main teaching hospitals. Getting more doctors and other health professionals to undertake research projects is another priority, as well as enhancing partnerships between the health system, academia and industry.

The commercialisation of health research must be better supported to help drive a smart economy, and we must secure increased funding for Irish projects through the European Framework programme. The Seventh Framework Programme (FP7), has a budget of more than €50 billion. It highlights health as a priority and has dedicated 12 per cent (€6.1 billion) to research in the area.

Mechanisms to monitor and evaluate the effectiveness of investment in health research must also be developed, according to the authors.

Expertise is invaluable
The report emphasises healthcare professionals must be actively involved in research. “Their expertise is invaluable to the health research system at all stages of the process from idea generation, technology assessment, new product concept development and through to clinical trials and eventually market uptake and patient treatment,” the report states.

How to fund health research and get value for money are key aspects of both reports. “The impact of the current difficult economic situation, particularly the deteriorating fiscal position, has made it impossible to continue the upward trend in health research funding.” This is reflected in the 16 per cent reduction in funding of the Strategy for Science Technology and Innovation for 2009 compared to the previous year, it said.

Public expenditure on health research was €200 million in 2008. That figure includes €42.7 million provided by the Department of Health through the HRB; €90 million from the Department of Enterprise, Trade and Employment through Science Foundation Ireland (SFI), Enterprise Ireland and the IDA; and €60 million from the Department of Education and Science through the Higher Education Authority, Irish Research Council for Science, Engineering and Technology and the Irish Research Council for the Humanities and Social Sciences. This year the HRB received about €47 million in funding.

Levels of funding
However, levels of funding for research in Ireland remain well below the Organisation for Economic Co-operation and Development (OECD) average. Its latest figures from 2007 show the average OECD spend was 0.12 per cent, while Ireland’s was 0.06 per cent, of GDP. The equivalent spend over the same time period in the UK 0.14 per cent, Sweden 0.16 per cent and the US 0.26 per cent.

Ireland also lags behind in terms of expenditure on health research by the health system as a percentage of the overall health services budget. In Ireland it accounts for just 0.25 per cent (€40 million) of the overall health services budget (€16 billion). In England, health research funding though the National Institute of Health Research accounts for 0.8 per cent (£720 million) of the overall health services budget (£90 billion).

Funding health research was crucial to maximising its potential benefits, it said. “This will require not only greater co-ordination in funding management between the agencies involved but also potentially a re-balancing based upon these new priorities.”

It says some of the actions did not carry costs – for example, clinical trial networks. It acknowledged, however, that others would. “The potential implications for agencies’ existing activities and expenditures, including those outside the health research areas, means that this process will require the support and direction of Government departments,” said the authors.

CEO of the HRB, Enda Connolly, acknowledged the McCarthy report had raised issues that needed consideration. “We have established the right agenda, the challenges and the gaps to be filled.” He added the structure of health research was a matter for the Government.

Avoiding overlap
In its business plan the HRB focused on avoiding overlap with other organisations to ensure ‘duplication does not happen’, developing a coherent structure for health research and making sure we get outcomes from research, he said. “There is an overall shift in the focus of the HRB.”

He added: “Health research has a major role to play in health system innovation and economic development. Our ambition is to put health research at the heart of the health system. This will improve people’s health, change how we deliver patient care, ensure evidence is applied in policy and medical practice and create opportunities for new enterprise to support our economy.”

He said he did not yet know what funding it would get for next year and would not know until December’s Budget. “The economic situation is very bad. Everyone has to do more for less. We have to look at making decisions to achieve our objectives within financial constraints.”

The business plan identified four goals. They were to drive the development of clinical research, including applied biomedical research; build capacity to conduct population health research; work with partners to develop and manage national health information systems; and promote knowledge to support decision-making.

Its targets for 2014 are similar to those of the Action Plan. “The main message is that health research offers extremely large potential for Ireland. It helps innovation in the way we care for people, and in doing that functions as a way to support the economy,” said Connolly.

The report identified a number of major gaps including low levels of funding for research in clinical, health services, population sciences and policy research, as well as technology assessment. It reiterated health research has an important role to play in the delivery of new commercially viable products, therapies, drugs and medical devices.

Like the Action Plan, it stressed research should be clinican-led and networks of clinicians should be developed to get more patients to take part in clinical trials. It pointed out clinical involvement was often ‘dependent on committed individuals operating independently within the health system’.

“The situation is exacerbated by the dominant demands of service delivery,” it said.

Connolly reiterated we needed more front-line health workers doing research because ultimately they were the users of innovations, which would benefit patients.

He added an infrastructure for clinical research was crucial because no doctor had enough patients to conduct clinical trials.

This infrastructure will be developed with the addition of three clinical research facilities (CRFs) – all located on hospital grounds. Connolly stressed several were already in place at Beaumont Hospital, the Mater Hospital, St Vincent’s Hospital with another on the way at St James’s. There are another two in Cork and Galway.

Increasing investment
Another key goal is increasing investment in patient-oriented research. A substantial portion of the HRBs resources will be ploughed into developing population health sciences research and health services research.

The report said over the last 10 years much of the funding in health research focused on basic biomedical or translational research aimed at meeting enterprise or education goals, and patient outcomes were a by-product rather than a primary objective. “We won’t do as much basic underlying research by academics. We are redirecting funding towards more patient-orientated research,” said Connolly.

Track Record
The report said Ireland had a strong track record in publishing findings from research studies and health information systems, many of which provided compelling evidence for a need to implement changes in policy and practice. However, often these changes did not take place, creating a ‘research-to-practice gap’, it added.

As a result the HRB aims to develop evidence-based healthcare in Ireland. It will put in place a framework to ensure data from the HRB national health information systems are used to inform decision-making by policy makers and service planners.

Connolly said this was crucial to delivering better models of care for patients.

Posted in Guests on 13 November 2009
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