Whither Health Research in Ireland?

Graham LoveChief ExecutiveHealth Research Board

West/North West Hospitals Group Conference, 09-09-14From Groups to Trusts – Reforming the Health Service

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Sample R&D Intensities• Healthcare is a KNOWLEDGE industry!• Expectations & costs are rising out of sync with resources. This is not

sustainable.• We need a much smarter use of our resources, people, processes & technology

to meet healthcare needs/expectations.• Our healthcare system needs a much greater self-learning capacity: an ability to

research & develop people/processes/technology both in Ireland and to absorb them from abroad.

• That capacity is not strong in our healthcare system at present.• And should we be surprised? €14,000,000,000

€43,000,0000.31%

£109,000,000,000£2,400,000,0002.20%

$53,000,000,000$2,800,000,0005.28%

Total spendR&D spendR&D as % of total

In order for healthcare to get sm

arter, R

esearch needs to be substa

ntially increased (& mainstre

amed into Care)

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Health Research Board

• State agency under Department of Health.– Budget €43m, funding portfolio €150 - €200m, staff of

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• Providing evidence for policy– Public Health Alcohol Bill, Food Pyramid, Fluoridation

• Information for service planning– Drug use, disability, mental health

• Funding health research– Clinical, Population Health, Health Services Research– Infrastructure, capacity building, specific projects.

external

internal

Providing Evidence for Policy HRB Alcohol Diaries 2013

We drink too muchWe drink in a harmful patternWe don’t know it

Public Health Alcohol Bill

Information systems & evidence for policy

HRB Health Information Systems

• Service planning database for intellectual disabilityNational Intellectual Disability DbEstablished 1995c.27,000 records

• Service planning database for physical and sensory disability

National Physical & Sensory Disability Db Established 2002c.25,000 records

• Epidemiological database recording treated drug and alcohol misuse

National Drug Treatment Reporting SystemEstablished 1990

c.20,000 cases p.a

• Database recording admisssions to and discharges from psychiatric hospitals

National Psychiatric Inpatient Reporting SystemEstablished 1963

c. 18,000 admissions & 18,000 discharges

• Census of drug and alcohol related deaths National Drug Related Deaths IndexEstablished 2005

c. 1,400 p.a

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Cochrane: systematic review infrastructure

HRB provides• Cochrane library access

nationwide• Cochrane fellowships• Cochrane Ireland

Convenor

evidence forClinical Care Programmes

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€50 million from HRB over past decade

ICORG Infrastructure Story:Oncotype DX Public Usage Oct 2011-Sept 2012

Analysis carried out by GHI and presented at St Gallen 2013

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St Vincents Mater UCHG/ West St James's Waterford Beaumont CUH Midwestern0

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Patients TestedPatients Receiving Chemo

Over 4 year clinical trial: €5M saving i.e. €3M in avoided chemotherapy and €2M in free oncotype DX tests for the 690 participating patients.

HRB Centre for Advanced Medical Imaging

• €4m for MRI scanner to be used solely for patient focused research

• Available to researchers nationwide to conduct range of studies

HRB - Perinatal Ireland

• €3.9m for ultrasound equipment and support staff across 7 hospitals

• Created a research collaboration harnessing combined medical expertise and access to large cohorts (75,000) babies for studies that would have otherwise been impossible

• Already led to new national guidelines to protect small babies in womb

• John Foley (Superman), diagnosed with intrauterine growth restriction and born 11 weeks premature weighing just 2 pounds 6 ounces at birth – now 19 months old, with his big brother Martin (4 years).

• Grainne Foley (Superman’s mother) was a participant in Perinatal Ireland research;

• ‘Taking part was a bit of a no-brainer really. Knowing that there was potential for some difficulties was a definite worry, but it was very reassuring to be able to avail of the resources, monitoring and surveillance that the research team brought to the hospital.’

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HRB Clinical Research Facilities

Original Vision infrastructure, physical space facilities expertise • Optimally support patient-

focused research studies and clinical studies

• Translating the knowledge to reimbursed, regulatory-approved advances in patient care as speedily as possible

Benefits for • Researchers and health

professionals• Patients/population• Policy makers

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HRB Clinical Research Facility - Galway

Wellcome Trust-HRB Clinical Research Facility – Dublin

HRB Clinical Research Facility - Cork

Opening of Cork CRF, 2012

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The Groups & the CRFs are aligning...

Dublin North East

Dublin Midlands

Dublin EastSouth/South West

West/North West

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So it’s nice to have CRFs in all the right places….• But the greatest value is probably not the physical

buildings (facilities are a prerequisite…....)

• BUT the processes and people that will wrap around them add the greatest value

• Research Governance• Quality• Safety• Resources, capacity & skill to link and translate

research into practice

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Research & the Groups-to-Trust transition

• The Groups (Trusts) represent a fantastic opportunity to ‘centralise’ research within each region

• Increased– Visibility/Transparency– Quality– Safety– Translation from research to practice

The CRFs represent an excellent opportunity to mainstream Research into Care

?? Make research a criteria for Group to Trust transition??