Title: NIHR Applied Research Collaboration South West Peninsula
Funder: Department of Health and Social Care

Abstract: The fundamental objective is to improve health outcomes through the conduct and translation of patient-focused applied health research, embracing both clinical and cost-effectiveness as well as evidence-based implementation, aiming for national as well as regional impact. Long-term aims: To produce a step change in the generation of patient-focused research To improve health outcomes through effective use of evidence. To increase the capacity of health and social care staff to use and generate research evidence. To generate wealth by increasing service effectiveness thus saving resources, working with the third and private sectors to identify solutions to health problems, and by increasing productivity through preventing or ameliorating disease. Short and Medium-term aims: Engage organisations commissioning and providing NHS services, clinicians, and members of the public in identifying and prioritising information needs and translate these into clearly delineated questions amenable to research. Lead and contribute to programmes of work in areas of national priority To undertake research and improvement work to address identified priorities, where appropriate gaining external funding. With partners, including the AHSN, mobilise evidence to achieve service improvement and conduct research into effective methods for doing so. Build receptivity in the health workforce to research and innovation. Ensure effective links across the landscape of health and social care providers and commissioners, including local authorities. Gain the maximum impact from current PenCLAHRC projects. Overall strategy The CMO s High Level Group on Clinical Effectiveness, whose recommendations led to CLAHRCs, identified a need for the NHS and academia to work together more effectively to promote clinical effectiveness. Since 2008 PenCLAHRC has developed the &ldquo;Engagement by Design&rdquo; approach (Fig.1), a framework for partnership between academics and decision makers (clinicians, managers and members of the public). The model hinges on enabling decision makers to identify and shape the research questions that matter most and work with academics to ensure effective synthesis and generation of evidence. This requires significant changes in approach, with decision makers using evidence more explicitly and academics increasing their focus on applied health questions. The apparently linear nature of this simplified figure should not obscure the complex iterative and circular processes involved, nor the importance of underlying relationships to our ability to deliver. We will continue a process of co-production, working closely with clinicians, managers and, most of all, the public which has driven innovation in response to specific needs. The approach depends on identifying key uncertainties and working with stakeholders to prioritise against explicit criteria, including the potential for health gain, tractability, and fit with local expertise. This is an iterative, non-linear process in which relationships are as important as structures and activities such as capacity building can make a significant contribution to the delivery of research and service improvement. As well as continuing to elicit uncertainties from local stakeholders and building programmes of work relating to recurring issues, we will seek to respond to nationally identified priorities. This process will be facilitated by our Tri-ARC network (with North Thames and Yorkshire and Humber ARCs) offering access to a range of populations and health systems and by building on existing relationships with ARCs and AHSNs in other regions. We see research and service improvement as intrinsically linked, with social and organisational context important in shaping the nature of evidence and determining its use. Our aim is to ensure that evidence is constructed and mobilised coherently for end users. We reject the view that in most circumstances the production and implementation of evidence are separate processes, that basic science produces evidence that is the object of a separate linear process of implementation. We believe that co-production is crucial at every stage &ndash; identifying the need for evidence, obtaining evidence and, crucially, understanding how and why interventions will be used in practice. The benefits from this approach include: development of innovations, generation of high-quality research, impact on patient outcomes, and development of capacity to understand, use and influence research. The involvement of decision makers throughout this process results in interventions that are more acceptable and feasible to use in practice. Partnerships with local organisations, especially the AHSN, have been crucial to achieving service change and improving health outcomes. We will continue to nurture these relationships through responsive approaches and capacity building and through the evaluation function we are developing with SW AHSN. We currently work with a number of CLAHRCs and AHSNs in other regions and will strengthen this activity as part of our drive to increase national impact. In particular, working with the Tri-ARC network will increase the applicability of our research by collaboration in programmes of research of national importance, evaluating interventions in our demographically different geographies and by facilitating local implementation of each other s successful interventions. Use of resources The limited resources available to ARCs would curb potential impact if deployed to directly address research questions. We plan to continue the approach adopted within PenCLAHRC - investing in human infrastructure to build the systems, skills and relationships to underpin research and improvement. These teams will work with our partners to address key researchable problems, often through gaining external funding; support researchers within partner organisations to tackle important health and social care issues; and enhance the capacity of health and social care organisations to bridge the gaps between research, evaluation, innovation and implementation. Evaluating success We will evaluate the ARC against our key objectives. This evaluation will include conventional measures of research success, external grant income, and high impact publications. We will seek to document the impact and cost of specific interventions on services, where possible equating this to health gain and assessing the consequences for equity. We will assess the effects of our programmes on capacity amongst health and social care staff and members of the public who work with us including documenting the degree to which we are successful in promoting increased involvement in research. Our close relationships with our partner organisations will be the basis for continuing formative evaluation to ensure that we remain responsive to their needs.

Lay abstract: High quality research evidence, leading to changes in treatments, services and health promotion, has contributed to improving the quality and duration of peoples lives. It is widely acknowledged that there remain substantial delays in the uptake of the lessons of research into practice and a failure to address many important questions, especially those arising from the need to promote health and to care for an ageing population. NIHR introduced CLAHRCs in 2008 to attempt to address these problems. Applied Research Collaborations are intended to take this further, with increased emphasis on achieving national impact. At the heart of our approach is working in partnership with key decision makers &ndash; service users and members of the public, clinicians, and NHS and social care organisations &ndash; to identify key areas of uncertainty and carry out research together to address these. We believe that this approach ensures that we address the most relevant questions, and that results are more likely to influence practice. This will remain the core of the new ARC. We will sustain our substantial investment in effective engagement with the public and patients who will continue to shape our work through our management structure and through direct involvement in projects. We will continue the system developed within NIHR PenCLAHRC to identify and prioritise important uncertainties in practice, investing in staff to work with decision-makers, to translate uncertainties into questions and support teams to conduct research, often with external funding. Where we identify sufficient existing evidence, we work with decision-makers to translate this into practice and conduct research which allows us to learn about effective ways of using evidence. Where there are substantial gaps in evidence we will conduct research, often with external funding, seeking to produce &ldquo;implementable&rdquo; solutions. We will help to develop the capacity to generate and use evidence in the local health economy. Our experience suggests these activities are beneficial in themselves and have helped to build relationships which have facilitated impactful programmes. We will continue to provide a programme offering a wide range of opportunities for partners, including public collaborators, to develop the skills they need. We will continue to contribute to the economy, working with the private sector to identify effective solutions to health problems to directly generate economic benefits, saving public resources by increasing service effectiveness, and by helping to prevent or reduce the effects of disease in order to increase productivity, activities where we have a significant track record. Our partners include all providers and commissioners of health services in the region, ensuring that we focus on the right questions to underpin effective and sustainable services. Partnership with the AHSN is core to PenARC with shared goals, posts, and projects. We will underpin our drive for increased national impact including through our Tri-ARC network and ARCs in other regions. Integral to the ARC will be a well-resourced partnership with patients and public who are involved in everything we do &ndash; selecting topics, designing, conducting and disseminating research, and in all of our management processes.

Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE