Chapter 4 - Investing in the Future
This chapter sets out proposals to ensure Scotland is well placed to realise the benefits of the changing research environment and have an NHS workforce supportive of that ambition.
NHS Research Capacity
The capacity of NHS clinicians to undertake research is an important area if we are to see the planned increase in research activity. The combination of many research active clinicians approaching retirement age, and new appointees finding it difficult to have time allocated for research, is a specific concern. To address the latter, CSO introduced a programme of NRS Career Research Fellowships in 2011, designed to support early stage clinicians participate in research.
The Fellowship scheme has been well received, however its success has had an unforeseen consequence in that, due to a high level of interest and therefore competition, the threshold is higher than anticipated with most appointed fellows being research active doctors. As a consequence staff in other professions with an interest in developing a career in research, but without previous experience, are unsuccessful or being put off applying.
29. CSO intends to develop the NRS Fellowship scheme for candidates with little or no research experience but who demonstrate a clear wish to develop research as part of their career.
" CSO continues to play a vital role in the generation of high-quality research relevant to the work of the NHS in Scotland. The clinical academic constituency has been greatly heartened by the central role of NHS Research Scotland ( NRS) in establishing a new programme of Scottish Senior Clinical fellowships in partnership with the Scottish universities with medical schools. These fellowships will strengthen Scotland's capacity to conduct internationally competitive biomedical research by supporting an emerging generation of talented clinical academics to become the clinical research leaders of the future."
Sir David Carter - Chair of the Board of Academic Medicine
Clinical Academic Capacity Building
Clinical academics are a valuable resource for Scotland, and complement the capacity building activity within the NHS. As University employees who spend at least half of their working week delivering and developing clinical services for the NHS, clinical academics undertake research that not only improves Scotland's health and healthcare but also drives economic growth. There is currently a risk that carefully nurtured early-career clinical academics may be attracted to long-term career posts outside Scotland.
For this reason CSO, the Scottish Government Health Directorates and Scottish Universities have agreed to jointly fund a successor to the Scottish Senior Clinical Fellowship ( SSCF) scheme. At a total cost of £12m over 10 years, the new NRS/University Senior Clinical Academic Fellowships will recruit 15 senior fellows over a five year period. Taken together with the CSO Clinical Academic Fellowships for pre-doctoral medics and dentists, we have effective early and late stage schemes for the key researchers of the future.
However there remains an important mid-career gap for registrars with the risk that they will cease to undertake sufficient research while working towards their Certificate of Completion of Training. NHS Education Scotland currently supports this cadre, allowing 20% of their time for non-training activities such as research. However this threshold of time is less attractive to developing a research career in academia.
30. CSO will work with NES to produce a new jointly funded scheme where a limited number of pre- CCT candidates would receive 50% of their funding to undertake research.
"The Stroke Association is delighted to be working in partnership with the Chief Scientist Office. We share a commitment to maintain and build research excellence and capacity in Scotland. We took that shared value and worked together to create a jointly funded Clinical Senior Lecturer post in stroke and a jointly funded programme of research to help stroke survivors deal with the psychological consequences of stroke. CSO is a fully engaged, committed partner, and one that is passionate about its mission to develop research excellence in Scotland."
Dr Dale Webb - Director of Research and Information, The Stroke Association
Ensuring the development of a strong cohort of researchers who can contribute to the evidence in the areas of health services and public health has been a key focus for CSO. As a consequence CSO has funded fellowships in health services and population health since 2007 to build capacity in this area. The scheme has been successful and many of our Fellows have gone on to secure research posts in Scotland. As such the desired increase in capacity in this specific area has been achieved and there is no strong case for CSO continuing to run a dedicated personal awards scheme to this specific area of research, particularly when CSO already funds units with a capacity building role.
31. CSO will discuss with its health services and public health research units how capacity building in these areas could be sustained by other means.
Emerging Areas of Importance
Scotland has long been a pioneer in the use of linked health service data for research. Data linkage is a highly efficient way to evaluate the capacity of interventions to deliver patient and population health benefit. It allows us to measure long-term outcomes in clinical trials, assess the safety of new and existing medicines and healthcare interventions, and to evaluate the impact of interventions across the whole population.
Much has been done already by way of strategic investments to improve the quality of the NHS datasets and develop the infrastructure for their utilisation. Key developments to date include:
- The Scottish Health Informatics Programme ( SHIP)
- e-Health Informatics Research Centre ( e-HIRC)
- The Farr Institute
- Health Informatics Research Advisory Group ( HIRAG)
However there is an overarching need to ensure that investments are appropriately co-ordinated and focused on providing a coherent and structured informatics policy to direct activity and future investment across Scotland. Scotland cannot rely only on past success, and must consider how to maximise the economic return on this internationally competitive research strength. In doing so we should aim to consolidate and expand the role of the biomedical informatics industry as a dynamic contributor to Scotland's economic growth and social wellbeing.
" CSO's proportionate approach to tissue governance, and its investment in a national network of biorepositories through NHS Research Scotland, makes Scotland an attractive place to undertake research. Combined with Scotland's recognised expertise in informatics and recent investments in genome sequencing, it is well placed to realise its ambition of being a global centre of excellence in precision medicine."
Professor Sir John Saville - University of Edinburgh
The Scottish Government has now published A Health and Biomedical Informatics Research Strategy for Scotland, setting out a number of recommendations for action including:
- establishing a charter of principles for a federated network of safe havens in Scotland that will provide a basis for a safe haven accreditation scheme;
- improving the speed and consistency of health informatics research governance decisions;
- improving the provision of national health datasets for research, and
- developing a programme of public engagement;
- investing in health informatics research training and expertise.
32. CSO will work with key stakeholders so that the recommendations of the Health and Biomedical Informatics Research Strategy for Scotland are taken forward. The charter for safe havens will be published in the course of 2015-16.
Precision Medicine and Digital Health
Many of the investments through the NRS Infrastructure funding are designed to support new areas of research. One such area is Precision Medicine (Stratified Medicine), where using NHS data, tissue and imaging analysis has the capacity to support research that can radically transform the way treatments are provided to patients. If the ambition of providing a patient with the right treatment the first time is to be realised, then there is a need to evidence the economic benefit to the NHS of such an approach in addition to the obvious benefit to the patient.
Investments by the Scottish Funding Council ( SFC) in the Stratified Medicine Scotland Innovation Centre ( SMS- IC) have created a valuable resource that is ready to be used by public sector and industry researchers. The recent £1.2m CSO Stratified Medicine Applied Research Programme was designed to evidence the value to the NHS of adopting a stratified approach. While it was focused on evidencing the value of existing yet unadopted innovations it is anticipated that any subsequent Precision Medicine Applied Research Programme funding might link in more closely to the innovations emerging from the SMS- IC. Similarly for innovations coming from the Digital Health Institute.
" CSO's investments in precision medicine are both timely and relevant. By positioning its funding at the clinical service interface, Scotland is now well placed to combine the wealth of academic expertise in this key area of medicine with an NHS willing and able to benefit from its use."
Anna Dominiczak - Regius Professor of Medicine - University of Glasgow
33. CSO will work with the SFC, Industry and the Innovation Centres - particularly the SMS IC and Digital Health Institute - with a view to ensuring that relevant outputs from these initiatives are suitably evaluated through research to warrant their adoption in the NHS.
Working collaboratively in Scotland is relatively easy because of our culture and scale. However if we are to realise our ambition of being world class in our research we must look outwith our geographical boundaries for independent advice on strategic issues. It is some years now since CSO convened its Chief Scientist Committee, where membership was drawn largely from within Scotland and its remit focused on specific Scottish issues. If Scotland is to deliver on its global ambitions then it must have access to advice on a similar scale.
34. CSO will explore the creation of a new CSO International Advisory Board to provide expert advice on strategic research issues. Meeting once a year, with membership comprising key global leaders in their field, it would provide high level advice on the steps Scotland should be taking to deliver on its aspirations.