Establishing Research Ecosystems in Local Government: Ten lessons from the front line of the first year of the NIHR Health Determinants Research Collaborations (HDRCs)
Year: 2024
Type: report
Abstract: Establishing Research Ecosystems in Local Government: Ten lessons from the front line of the first year of the NIHR Health Determinants Research Collaborations (HDRCs). Newbury-Birch D1, Harbin, K2. Adamson A3, Asthana S4, Batey C5, Buffardi A6, Curley J7, Dezateux C8, Divers A1, Fitzsimmons E9, Forbes L10, Frossell S11, Goyder E12, Hampshaw S13, Humphreys E14, O’Malley E15, Maiden H16, Marks D17, Murchie M18, Paranjothy S19,20, Ramsay SE3, Sheldon T8, Shore R21, Simpson A16,22, Speight A16, Wallace G9, Whelan M23, Whiting D10,24, Woolfe I25,26, Ferguson B27. On behalf of the 13 NIHR PHR Health Determinants Research Collaborations funded in 2022/2023. School of Social Sciences, Humanities and Law, Teesside University (HDRC South Tees) HDRC South Tees, Middlesbrough Council Population Health Sciences Institute, Newcastle University (HDRC Gateshead and HDRC Newcastle) Centre for Health Technology, University of Plymouth (HDRC Plymouth) HDRC Newcastle, Newcastle City Council HDRC Islington, Public Health Department, London Borough of Islington HDRC Lambeth, Public Health, London Borough of Lambeth Wolfson Institute of Population Health, Queen Mary University of London (HDRC Tower Hamlets) HDRC Plymouth, Plymouth City Council Centre for Health Services Studies, University of Kent (HDRC Medway) HDRC Coventry, People Directorate, Coventry City Council Sheffield Centre for Health and Related Research, Division of Population Health, University of Sheffield (HDRC Doncaster) HDRC Doncaster, City of Doncaster Council HDRC Tower Hamlets, Health & Adult Social Care Directorate, London Borough of Tower Hamlets HDRC Gateshead, Public Health & Wellbeing, Gateshead Council HDRC Blackpool, Blackpool Council Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine (HDRC Islington) HDRC Aberdeen, Aberdeen City Council NHS Grampian (HDRC Aberdeen) Institute of Applied Health Sciences, University of Aberdeen (HDRC Aberdeen) HDRC Bradford, City of Bradford Metropolitan District Council Lancaster University (HDRC Blackpool) Coventry University (HDRC Coventry) HDRC Medway, Public Health, Medway Council Department of Women’s and Children’s Health, King’s College London (HDRC Lambeth) Evelina London Children’s Hospital (HDRC Lambeth) Department of Health Sciences, University of York Health inequalities are where we see differences in health across the population, and between different groups in society, that are systematic, unfair and avoidable (1). They need a long-term systemic response to support people to value their health and wellbeing (2). These social, economic environmental, cultural and commercial factors, known as the wider determinants of health, are unequally distributed across the UK population (3). This is despite numerous attempts to address them at a local, national and internationally (4, 5). Both the Marmot review and the Dame Carol Black review highlighted the huge economic costs of failing to act on the wider determinants of health (4-6). Local public health leaders are in a strong position to develop a whole system approach to reducing health inequalities that puts communities at its heart (10). Thirteen Local Authorities (LAs) were awarded funding by the National Institute for Health and Care Research (NIHR) in October 2022 to develop HDRCs. Ten of them as full HDRCs (HDRC Tower Hamlets, HDRC Newcastle, HDRC Doncaster, HDRC Aberdeen, HDRC Bradford, HDRC Plymouth, HDRC Gateshead, HDRC Blackpool, HDRC Coventry and HDRC Lambeth). Three were given a further year to develop their plans and became full HDRCs in October 2023 (HDRC South Tees, HDRC Medway, HDRC Islington). Eleven more full HDRCs were announced in December 2023 and are due to start January 2024 (HDRC Ealing, HDRC Sandwell, HDRC Wakefield, HDRC Southampton, HDRC Rhondda Cynon Taf, HDRC Liverpool, HDRC Somerset, HDRC Cumberland, HDRC Cornwall, HDRC Essex, HDRC North Yorkshire). As in round one there were a number of areas given a year to develop their work further (HDRC Manchester, HDRC Portsmouth, HDRC Torfaen, HDRC Leicestershire, HDRC Glasgow, HDRC Surrey) (11). The aim of the HDRCs is to embed a culture of evidence-based decision-making within Local Government. The HDRCs will help to stimulate economic growth, particularly in some of the most deprived areas of the country and contribute to the Government’s plans to act for the longer-term resilience of the health and wealth of the country (12). This article examines the key learning from the first year of the wave one HDRCs and give advice to new HDRCs starting their journeys in 2024. Between April and October 2023, the lead author asked for at least one person from each of the LAs and one academic/other partner involved in HDRCs to complete a small survey with open ended questions which took about ten-minutes to complete. The survey was conducted using Jisc online surveys. Data was downloaded and open-ended questions were coded by DNB and KH. All data was downloaded and analysed using an inductive approach (13). Twenty-seven people responded with representation from all the 13 HDRCs. Below we identify ten key things to consider when starting the journey. Recruit to posts early Recruitment was a colossal problem for both LAs and universities. Bureaucratic hold ups and slow HR processes hindering progress were apparent as well as issues recruiting staff with the right skills, appropriate expertise and at the right time. The precarious financial climate of Local Government also needed to be navigated with care, with jobs being created for the HDRCs against job losses elsewhere. "£5 million funding creating 10+ new jobs has arrived against the backdrop of recent job cuts. We have to be cognisant of this. Developing relationships with teams within the council with similar objectives to HDRC, against the backdrop of funding pressures and job insecurity" (LA) Think about capacity Capacity proved to be significantly stretched during the first year. Academic colleagues reported working well beyond their intended HDRC costed time to counterbalance the time constraints felt by LAs in recruiting staff. These pressures saw a slowing of momentum, research culture change, relationship building and “buy in”. “We found that the extent to which LA Finance and HR systems struggle to accept and contract out funding, difficulties in back filling people's time” (LA) Consider priorities The main thing is to expect a slow start and don’t underestimate the size of the task at hand. Treat recruitment as a priority and think about job descriptions straight away. Build a cohesive team with strong leadership whose sole focus is on the HDRC, helping to get through the early legal and bureaucratic hassles. Take time to get to know key staff across all sectors and the community, utilising and nurturing relationships. Leadership is vital Ensure that you have good leadership at both the LA and University. Project management is essential. “Appoint a competent project manager to help get through legal and bureaucratic hassles; give researchers time to bed in and understand cultures of both LA and University” (University) Create a plan Create a clear plan, giving individuals time to bed in and understand the diverse cultures of both LAs and Universities. Use the plan to quickly establish priority areas, costing LA and academic staff appropriately. Fully think through each milestone and any potential barriers ensuring to collect baseline data as soon as objectives are set and have robust monitoring processes throughout. But be prepared for fast-paced learning and a constant change of the plan. Be flexible and change your bid/plan as needed. Don’t underestimate the size of the job to align organisations Aligning the needs and motivations of the HDRC within LAs was shown to be a delicate process. Managing expectations was a major task for the first year. Being realistic with timelines whilst also harnessing the motivation and excitement to get going. "We use the analogy of doing the groundwork on a building site - there is a lot happening that nobody can see at the moment, but soon there will be something that staff, residents and local academics can really see and engage with" (LA) Culture Change Changing the research culture within LAs was seen to be paramount to the success of HDRCs. It is important to understand current approaches in the LAs. Getting some ‘early wins’ in terms of research funding is a good thing for staff to see what success looks like and means. It is important to identify "champions" within the LAs to help champion the work. “It has reinforced my knowledge and the organisational and professional gap between LA officers and researchers, different ways of working and thinking. But I am learning to tackle this” (University) It’s not a competition Some HDRCs are ahead of others in some things and behind in others. Keep to your project plan and enjoy successes whether they are big or small. “Recognise there is a start-up period and manage expectations” (LA) Community involvement is everything Ensure that you work with your community partners and that they are part of the team from as early as possible. “Recruitment of Co-Researchers with lived experience to the project should be the very first thing you do. Think very strongly about how you will make the community members feel valued for their contribution to the project” (LA) Support is imperative Finally, HDRCs found having other HDRCS to get support from was extremely valuable “It is a new and challenging concept and way of working for many of us - the peer support has been invaluable”. NIHR have also been supportive and flexible in a number of ways which has been helpful” (University) This study/project is funded by the NIHR PHR, Health Determinants Research Collaborations. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. References 1. NICE. NICE and health inequalities London [Available from: https://www.nice.org.uk/about/what-we-do/nice-and-health-inequalities. 2. Director of Public Health. Live Well South Tees. Redcar and Cleveland: Public Health South Tees; 2018. 3. Such E. Framing the wider determinants of health and health inequalities: local stakeholder views in England. Evidence & Policy. 2023;19(4):513-35. 4. Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health Equity in England: The Marmot review 10 years on. London: Institute of Health Equity; 2020. 5. Marmot M. Fair Society, Health Lives: Strategic Review of Health Inequalities in England Post-2010. London: The Marmot Review; 2010. 6. Black C. Working for a Healthier Tomorrow: Dame Carol Black's Review of the health of Britain's working age population. London: TSO; 2008. 7. Michie S, Fixsen D, Grimshaw J, Eccles M. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implementation Science. 2009;4(1):40. 8. Glasgow RE, Lichtenstein E, Marcus AC. Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. AJPH. 2003;93(8):1261-7. 9. Ferrer RL. Social Determinants of Health. In: Daaleman TP, Helton MR, editors. Chronic Illness Care: Principles and Practice. Cham: Springer International Publishing; 2023. p. 527-45. 10. Stansfield J, South J, Mapplethorpe T. What are the elements of a whole system approach to community-centred public health? A qualitative study with public health leaders in England’s local authority areas. BMJ Open. 2020;10(8):e036044. 11. National Institute for Health and Care Research. NIHR invests a further £55m to tackle health inequalities through local government research: NIHR; 2023 [Available from: www.nihr.ac.uk/news/nihr-invests-a-further-55m-to-tackle-health-inequalities-through-local-government-research/34972. 12. National Institute for Health and Care Research. £50 million awarded to local government to tackle interventions for health inequalities through research 2022 [Available from: https://www.nihr.ac.uk/news/50-million-awarded-to-local-government-to-tackle-interventions-for-health-inequalities-through-research/31654 13. Azungah T. Qualitative research: deductive and inductive approaches to data analysis. Qualitative Research Journal. 2018;18(4):383-400.
Authors: Dorothy Newbury-Birch, Kathryn Harbin, Ashley Adamson, Sheena Asthana, Claire Batey, Anne L. Buffardi, Jennifer Curley, Carol Dezateux, Andrew Divers, Elaine Fitzsimmons, Lindsay JL Forbes, Sue Frossell, Elizabeth Goyder, Susan Hampshaw, Emily Humphreys, Edward O’Malley, Hannah Maiden, Dalya Marks, Martin Murchie, Shantini Paranjothy, Sheena E Ramsay, Trevor Sheldon, Rob Shore, Amelia Simpson, Andrew Speight, Gary Wallace, Maxine Whelan, David Whiting, Ingrid Wolfe, Brian Ferguson
Institutions: National Health Service, Queen Mary University of London, King's College London, University of Kent, Newcastle City Council, City of Bradford Metropolitan District Council, Coventry City Council, Aberdeen City Council, London School of Hygiene & Tropical Medicine, London Borough of Islington, NHS Grampian, Blackpool Council, Plymouth City Council, London Borough of Tower Hamlets, Gateshead Council, Doncaster Council, University of York, Lancaster University, Coventry University, Newcastle University, Teesside University, University of Plymouth, University of Sheffield
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Awards: G1100761521, G6872490086
OpenAlex ID: W4395015434