The Health and Care Act 2022: challenges and priorities for embedding research in the NHS

The Health and Care Bill received Royal Assent and became an Act of the UK Parliament on April 28, 2022.¹ Aimed at rebuilding the National Health Service (NHS) in the context of the continuing impacts of the COVID-19 pandemic, the Health and Care Act 2022 incorporates a valuable lesson learnt from the pandemic: the extraordinary value a research-active NHS can deliver. Embedding research in the NHS to improve outcomes for patients is now on a statutory footing. Yet whether the Act will address other challenges for the UK's health system is uncertain. The absence of commitment to regular workforce forecasts within the Act will be problematic because of existing NHS staff shortages, which will leave the UK Government struggling to deliver across its ambitions, including for research.² A key challenge is the pressure for an overstretched and exhausted workforce of dealing with the rising demand for NHS services after the acute stages of the COVID-19 pandemic, which will leave little room to do more despite the opportunity that research brings to improve patient outcomes and reduce inequalities.

Even before COVID-19, there was growing evidence of the benefits of embedding research in the NHS. Research-active NHS trusts delivered improved survival rates, provided better care experiences, and found it easier to recruit and retain staff.3, 4 Patients report added satisfaction when involved in research studies aligned with their clinical care.⁵ Clinicians value research as important to their job satisfaction, but are hampered by time pressures, an NHS culture that disregards research as core business despite research being a key part of the NHS Constitution, and an increasing research skills gap.⁶ These barriers are acute for women, staff who work part time, and those in non-teaching hospitals.⁶ What will not work is simply adding research to an already congested job plan and overstretched service. Embedding research in clinicians' everyday practice will challenge NHS trusts to rebalance priorities in job planning and appraisals; in creating supportive research infrastructures and incentives; and in shifting the emphasis of quality improvement from applying evidence-based knowledge to addressing aspects of care where reliable evidence is scarce and current practice might even be harmful.7, 8

Priority actions to embed clinical research in the NHS are shown in the panel . Research needs to be made easier for patients and clinicians. In a health system that will remain overwhelmed for some time, there is a need to focus on clinical trials that are simple to recruit to and aligned to clinical practice. Practice-changing research through large, inclusive, and pragmatic clinical trials, such as RECOVERY, is a lesson learnt during the COVID-19 pandemic and such research needs to be extended to other areas, including under-researched health conditions,⁹ going forwards. Trial regulation also needs to change in parallel to focus on the scientific principles of randomised controlled trials (RCT) in a risk-proportionate way. The added value is the opportunity for increased global collaborations in NHS research efforts and for initiatives such as the Good Clinical Trials Collaborative to improve RCTs globally.

Panel. Priority actions to embed clinical research in the NHS.

Culture change

• •Improve the visibility of research in the NHS—the value of integrating research into patient care needs to be normalised in delivering effective services
• •Reverse the mindset that research needs to “pay its way” and unblock the resourcing to enable trusts to become more research active
• •Create the right package of incentives and levers towards research for all in the NHS, including incorporation of research metrics into care quality measures
• •Raise awareness among clinicians of their responsibility as gatekeepers to patient involvement in research and that research is not separate from clinical work
• •Reposition clinical research as a platform to advance equity and equality, given its potential to deliver improved outcomes for populations in areas with the worst health inequalities and economic disadvantage

Capacity building

• •Build research into job plans with protected time to develop and deliver projects and include this in workforce planning
• •Expand the skill mix with multidisciplinary team involvement in research, including new parts of the workforce (eg, physician associates)
• •Make research easier for clinicians by improving the support from NHS trust infrastructure and proportionate reconfiguration of Good Clinical Practice guidelines
• •Prioritise practice-changing research studies that are easy to incorporate into service delivery and address the most common conditions that are under-researched
• •Update research regulation to be fit for 21st-century clinical trials

Capability advancement

• •Increase flexibility of entry into research, especially to those under-represented in research such as women, underserved groups, and clinicians in hospitals that are not linked to academic centres
• •Expand access to research skills training, in an inclusive, diverse, and equitable way
• •Improve interoperability between information technology systems and their governance to enable efficient reusing of data across commissioning, direct care, public health, service improvement, and research
• •Establish governance of integrated care systems to support and drive research activity towards addressing the greatest health and care needs in their regions
• •Shared unity between the NHS, the National Institute for Health and Care Research, regulators, the royal medical colleges, and education bodies in strategically developing a sustainable and supported workforce that develops and delivers best evidenced care for patients

NHS=National Health Service.

The increase in accessible data linkages during the COVID-19 pandemic needs to accelerate to enable electronic health and administrative records to be safely and securely made available for research. Such routinely collected data provide an opportunity to redesign clinical trials to be both higher quality and more efficient. Increasing interoperability between information technology systems and rationalising information governance processes would optimise reusability of data to shift the NHS towards evidence generation and proficient, data-informed change.¹⁰ Beyond the benefits of developing successful treatments and innovations, NHS trusts can use such data to tailor services to meet the needs of their communities.

If research is designed carefully, it can have minimal impact on the operation of the NHS, but this requires an inclusive approach. All staff will need to be aware of the opportunities that research presents to them and their patients. But research governance needs to be proportionate and existing schemes to encourage research in diverse professional groups and trainees, many of which have been developed by the National Institute for Health and Care Research, should be more easily accessible. The challenge of increasing research capacity and capability requires joined-up contributions from multiple stakeholders, including research funders, professional regulators, and the royal medical colleges.

If the UK Government is to also achieve its ambition of 5 years' extra healthy life expectancy by 2035 at a time when life expectancy is worsening for some groups, this is a timely opportunity to embed research while rebuilding services, especially in areas with the highest disease burdens and levels of deprivation.¹¹ COVID-19 research took place in teaching and non-teaching hospitals across the UK. With implementation of integrated care systems within the Health and Care Act, a truly integrated and equitable delivery of research could reduce health inequalities. Embedding research properly into NHS clinical practice requires substantial changes, but these will be justified by the sustainable benefits to the health and care system—most importantly, to its staff and patients.

CHT receives research funding from the National Institute for Health and Care Research (NIHR), the British Heart Foundation, the Newton Fund, and Innovate UK. RH receives research funding from UK Research and Innovation, NIHR, Boehringer-Ingelheim, and Novartis and is an investigator for the RECOVERY trial. We declare no other competing interests.