The publication of Making knowledge work for health: A strategy for health research, by Minister Micheál Martin in September 2001 marked a turning pointy for the health services. For the first time, the importance of research to the quality of our health services was recognised. So too was the contribution health researchers in Ireland could make to the creation of world knowledge for health and to prevent disability and disease. The Strategy for health research committed the government to much greater support for the creation of knowledge for health. It also committed the government for the first time to building a strong research and development function in the health services to underpin quality of care, professional development and effective services. The commitments of the research strategy were endorsed in Quality and fairness: A health system for you—the health strategy that was published a few months later.
Creating knowledge for health
For many years those wishing to undertake research into health-related issues had great difficulty securing funding in Ireland. As recently as 1998, the European Union was still the main source of funding for health research here, unlike the other member states where national funding far exceeds what is available from Europe. Since 1999 there has been a dramatic rise in the funding available for health research nationally, both through the Health research Board and through new organisations such as the Science Foundation Ireland, the Irish Research Council for Science, Engineering and Technology, and the Irish Council for the Humanities and Social Science. All these organisations have at least one thing in common—funding for research is made available by open competition and decisions are reached following review by indendent experts. The increase in funding has also been accompanied by a much stronger focus on disability in our universities—the recent creation by University College Dublin and the St John of God Brothers of a Chair of Mental Health Research, and the newly established Chair of Disability Studies, are very welcome developments.
While the funding issue is being addressed, Making knowledge work for health identifies structural issues that are holding back the potential of researchers in Ireland to maximise their contribution to global understanding of health, disability and disease. Unlike other countries, we have few health professionals who can undertake research on a fulltime, or nearly fulltime, basis. Most of those engaged in health research in this country carry a heavy teaching or service commitment. Their research often has to be fitted in at the end of a busy day. We need to have more flexible employment arrangements between our universities and health services that would enable those health professionals who wish to do so to give most of their time to research, but still have close contacts with clients, patients and students.
The research strategy also draws attention to the need for protected space and resources for research to encourage scientists and clinicians to work together to generate ideas for research and to encourage the translation of research ideas into practical ways of helping people. In other countries the development of clinical research centres attached to general hospitals has encouraged that kind of dialogue and the earlier development of interventions that make a difference of people’s health. The concept of research centres linked with appropriate services could also be of great assistance in promoting research on disability and primary care.
Research and development for health
The most radical proposals of the research strategy are those to build a strong research and development culture in the health services. Research has, to some extent, been seen as a luxury in the health services—something to be tolerated rather than supported and encouraged. The research strategy points out that this country cannot have a world-class health service if it is not underpinned by an active culture of research and development. This is partly because of the pace at which global knowledge is growing—just to stay abreast of the knowledge needed to do one’s job well is becoming ever more challenging. It is partly to do with the greater accountability expected of all health professionals these days—health staff must demonstrate that they are adhering to best practice and standards are changing all the time. It is also about ensuring greater job satisfaction for health staff. Intellectual stimulation should not end with graduation. Life-long learning should be both welcomed and encouraged among healthcare staff. One of the ways of promoting an active approach to learning and knowledge is to support research and development.
Making knowledge work for health commits the Department of Health and Children to appointing a Director of Research and Development and to establishing a Forum for Health Research. The purpose of the forum is to agree the research issues underpinning the key objectives of the health services as identified in Quality and fairness. The main health agencies are being encouraged to appoint research and development officers to prepare research strategies for their organisations and programmes of research for funding. These programmes will build on the research strengths of the agencies, strengthen their research capacity and link with the research agenda to be agreed by the Health Research Forum. Health agencies will be able to compete for funding from the Health Research Board for the programmes they put forward. Funding will be made available for five years, at which time their research activities will be reviewed by independent experts. An important part of each research programme will be proposals to build research capacity, by providing staff with research skills and supporting development activities to translate the evidence from research into interventions that benefit clients and patients.
A start has been made on this radical agenda, with the allocation of funding to the health boards to employ research and development officers and to begin the process of drafting research strategies for their agencies. These research strategies will have to be drafted in close consultation with the universities and institute of technology, and with voluntary organisations—not all of which may wish to develop their own research strategies. It is hoped that the Department of Health and Children will appoint a Director of Research and Development—someone with a strong track record in health research—and that it will establish the Forum for Health Research before the end of this year.
How will Making knowledge work for health affect the staff and clients of individual services? That question can only be answered by the services themselves. Some already have a strong commitment to research and development and are well positioned to take advantage of the steps promised in the research strategy. It is hoped that the support of services for the early implementation of the commitments of the research strategy could help to ensure that the benefits of a strong research and development culture are felt by clients and staff without delay.