Research Strategy 2015-2018 Public Health Wales Research Strategy 2015–2018

01 ForewordText

Public health covers a broad range of activities. These include primary prevention, surveillance and early detection of disease, control and management of communicable diseases and environmental threats, improving healthcare quality, informing policy and implementing interventions and programmes to improve population health and wellbeing.

The public health challenges in Wales are similar Public Health Wales’ Integrated Medium Term Plan Integration between to many post-industrial societies, with an ageing for 2015-2018 clearly identifies a suite of priority population and high prevalence of chronic conditions areas for action. Integration between public health public health research, such as diabetes and cardiovascular disease. Health research, policy and practice will be essential for us policy and practice will be inequalities persist in many areas, and the gap in to drive forward improvements in population health healthy life expectancy between the most and least and wellbeing. We therefore welcome this research essential for us to drive deprived areas is 18 years. For example, 25% of strategy, which aims to develop research capacity forward improvements children aged four to five are overweight or obese, and capability within Public Health Wales. Successful while 22% of adults are obese, with higher prevalence implementation of this strategy over the next three in population health and in more deprived areas. Similar profiles exist for years will create an environment that encourages and smoking and binge drinking. supports research activity within the organisation, wellbeing. stronger collaborations with partners across the The rising healthcare costs, combined with competing wider public health system, including academia, NHS, interests on public finances and an ageing population, industry and third sector partners and a sustainable may result in NHS Wales facing a perfect storm of translational pathway for research evidence into public funding gaps for many health-related services in the health policy and practice. future. Difficult decisions about priorities will have to be made. There is a clear need to renew our efforts on primary prevention of ill health, and reduce pressures on the healthcare system by improving population health and wellbeing. This will necessitate adopting the most effective, best-value interventions and programmes based on evidence, abandoning those that have proven to be ineffective, and developing the evidence base in areas where this is lacking through research, innovation and robust evaluation.

Dr Tracey Cooper Professor Chief Executive Sir Mansel Aylward Public Health Wales Chair Public Health Wales

i Public Health Wales Research Strategy 2015–2018

Contents

1 Foreword ...... i

2 Executive Summary ...... 2

3 Introduction ...... 4 3.1 Context for Developing a Research Strategy within Public Health Wales . 4

4 Our Approach to Developing a Research Strategy ...... 5

5 Framework for Research Conduct and Governance within Public Health Wales ...... 6 5.1 Current Research Activity in Public Health Wales ...... 8

6 Generating New Knowledge to Protect and Improve Population Health and Wellbeing and Promote Sustainable Health Care ...... 11 6.1 Research Priorities 2015 – 2018 ...... 11 6.2 Principles Underpinning Research ...... 11 6.3 Commercial Research Strategy ...... 12

7 Creating an Environment that Supports Research in Public Health Wales 13 7.1 What Our Survey Told Us ...... 13 7.2 Actions to Support Research ...... 13 7.3 Developing and Supporting Public Health Wales’ Research Capacity . . 13 7.4 Facilitating the Generation of New Knowledge ...... 15 7.5 Developing and Strengthening Collaborative Relationships ...... 16 7.6 Effectively Communicating What We Know ...... 18 7.7 What Will Success Look Like? ...... 20

8 Conclusion ...... 20

9 Acknowledgements ...... 21

ii 1 Public Health Wales Research Strategy 2015–2018

2 Executive summary

Public Health Wales has published its strategic objectives for 2015-2018, and the overarching strategic aim is to create ‘a healthier, happier and fairer Wales’. In order to fulfil these objectives, a multi-sectoral and evidence-based approach which places emphasis on evaluation of current public health activities is required.

This research strategy outlines the priorities and commitments for Public Health Wales to foster a culture that will allow for the generation of new research ideas, and the confidence to use research efficiently and effectively in everyday practice.

The extensive ambition of Public Health Wales is The following are a summary of the key actions that to prioritise research activities that align with the Public Health Wales will take to support and promote organisation’s strategic objectives and tackle the public research activity: health challenges we face in Wales. Inequalities in ■■ Developing and supporting Public Health Wales’ healthy life expectancy, high prevalence of childhood research capacity by supporting staff to gain obesity, preparation of services for an increasingly training in a comprehensive range of research ageing population and the need to reduce the methods. overall consumption of healthcare are all examples of challenges that need to be met by evidence-informed ■■ Facilitating the generation of new knowledge This ambitious research strategy will contribute to policies. To achieve this aim, Public Health Wales will through externally funded research and by making improving the health and wellbeing of the Welsh actively engage with external partners to develop available internal funding to pump-prime new and population through evidence-informed public health and evaluate innovative new interventions, policies promising research activities and pilot studies. practice. Critically, this strategy should ensure that and programmes and also work in different settings ■■ Strengthening our public engagement and the research undertaken within Public Health Wales (e.g. workplaces, schools, primary care) to improve collaborations with Higher Education Institutions, will help to deliver on the strategic objectives of the population health and wellbeing. MRC Centres of Excellence for public health (e.g. Integrated Medium Term Plan (also known as the Strategic Plan), have an impact on policy and practice This strategy aims to create an environment within DECIPHer) and e-Health research (e.g. CIPHER), and lead to improved health and reduced health the organisation that is conducive to achieving Welsh Government, Health Boards, the other NHS inequalities. Successful implementation of this strategy these ambitions. A culture needs to be embedded Trusts in Wales, Health and Care Research Wales will be evidenced by: which; (i) develops and supports research capacity infrastructure, third sector organisations and other (ii) facilitates the generation of new knowledge (iii) agencies such as police, education and social ■■ A shared research agenda across the public health develops and strengthens collaborative relationships services that have a wider public health interest in system. and (iv) effectively engages the public in population Wales to co-produce and drive forward our shared ■■ A clear and coherent pathway for external partners health research and communicates research findings. research agenda. to engage with Public Health Wales in research. The Public Health Wales Research and Development ■■ Increasing the profile of Public Health Wales’ (R&D) office will be actively involved in supporting the research by communicating widely with our ■■ An active public health research community. delivery of action in these four key areas, although stakeholders and promoting the translation of ■■ Year on year increase in the number of achieving the ambitions of this strategy will require research into public health policy and practice. commitment from the whole of Public Health Wales. publications by Public Health Wales staff in peer- ■■ Provide a rigorous governance structure for reviewed journals. research across Public Health Wales to ensure ■■ At least a 30% increase in external research quality, ethical integrity and efficiency in its funding received over the next three years from delivery. the baseline levels in 2014.

■■ Review and restructure internal investment in ■■ A clear and coherent pathway for knowledge research so that it aligns with the organisational mobilisation and communication to facilitate and objectives of Public Health Wales and offers value promote evidence-informed policy and practice. for money.

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3 Introduction 4 Our approach to developing a research strategy

Public Health Wales is an NHS organisation providing professional, independent public Research and development are critical, complementary aspects of improving the health advice and services to protect and improve the health and wellbeing of the performance and efficiency of organisations (Box 2). This strategy focuses on research, population of Wales. It was created as a separate NHS Trust in 2009, and is part of an although it does cover aspects of developing research capacity and capability. The integrated public health system in Wales where the local health boards each employ a distinction between research, audit, service evaluation and public health practice can Director of Public Health. often be subtle and are highlighted in Appendix 1.

3.1 Context for developing a research An evidence-based approach is central to achieving This research strategy has been developed in

strategy within Public Health Wales these objectives. It will require a system that is consultation with Public Health Wales’ staff along with sufficiently flexible to identify and make use of the external stakeholders. The content of this strategy was Public Health Wales’ ambition is to achieve a healthier, best available evidence in a timely manner, whilst informed by: happier and fairer Wales by working together with highlighting gaps in knowledge and taking steps various partners. This includes empowering people to ■■ A rapid literature review of strategic research to address these through the generation of new protect and improve their own health and wellbeing documents from the UK and internationally. knowledge. This will require a renewed emphasis on and reduce inequalities by engaging, informing, the evaluation of public health activities, including ■■ A survey within Public Health Wales that advising and speaking up for them. The organisation’s those of Public Health Wales and of our partners, ascertained staff views on the role of research strategic priorities for 2015-20181 are shown in Box 1. focusing on population outcomes. This will be within the organisation, priority areas for research, achieved through participation in primary2 and Box 1. Public Health Wales’ strategic priorities barriers and enablers for staff participation in secondary3 research activity and effective collaboration for 2015 - 2018 research activities and staff developmental needs. with partners in health and care and across the ■■ Four stakeholder consultation workshops, public sector, including education, the criminal justice Shared strategic priorities for an integrated including one with representatives from Higher system, local authorities, Welsh Government, Higher approach to public health across NHS Wales: Education Institutions (HEIs). Discussions included Education Institutions (HEIs), industry and third sector the role of Public Health Wales in research, ■■ Working across sectors to improve the health organisations. Box 2. Definition of research and development of our children in their early years. in the NHS facilitators and barriers for staff participation in This research strategy sets out Public Health Wales’ research, and the potential for developing joint ■■ Developing and supporting primary care commitments to develop and sustain an organisational ■■ Research: Within the NHS, research is research capacity with HEIs. services to improve the public’s health. culture that generates and uses research efficiently defined as the attempt to derive generalisable ■■ Interviews with senior internal and external and effectively. new knowledge against clearly defined ■■ Supporting the NHS to improve healthcare stakeholders to ascertain their views on what research questions, including studies that aim outcomes for patients. role Public Health Wales should play in research, to generate hypotheses as well as studies that research priorities, and enablers and barriers to Strategic priorities specific to Public Health aim to test them. staff participation in research activities. Wales: ■■ Development: Consists of work based on ■■ Adopting and implementing a multi-agency existing knowledge obtained from research or The key messages from the staff survey, stakeholder systems approach to achieving significant practical experience with a view to initiating consultation events and interviews were used to shape improvements in our public’s health. the manufacture of new products or devices, the content of this research strategy. establishing new processes, policies and ■■ In the following sections, we describe the framework Influencing policy to protect and improve services or considerably improving those that for research conduct and governance in Public Health health and reduce inequalities. already exist, including the development of Wales, our research priorities and the key actions that ■■ capacity and capability. Protecting the public and continuously we will take to create an environment that supports improving the quality, safety and effectiveness the generation and use of research in public health of the services we deliver. policy and practice.

1 Public Health Wales’ Integrated Medium Term Plan www.publichealthwales.org/strategy 2 Primary research activity is described as research that involves data collection from study participants, direct observations or experiments. 3 Secondary research activity is described as the summary, collation and/or synthesis of existing research.

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5 Framework for research conduct and governance within Figure 2. Public Health Wales research management structure Public Health Wales Public Health Wales Board Public Health Wales’ Research and Development office receives core funding from Welsh Government’s Division of Social Care and Health Research (DSCHR4) to support the development and delivery of high quality research activity and deliver central research Director of Policy, Research and management and governance functions to ensure Public Health Wales complies with International Development the Research Governance Framework5. This includes offering guidance and approval of NHS research permissions for the organisation, managing the research governance process and overseeing the implementation of national policies (Figures 1 and 2). The R&D office is performance managed by DSCHR against key indicators (Table 1). Research and Research Development Research and and Divisional/Directorate Development Development Groups Strategic Group Office All Public Health Wales’ research projects are required a risk category. The time frame for review will vary to undergo a formal corporate risk review process. depending on the nature of the research project and The R&D office is responsible for assessing the project will be proportionate to the risk associated with the against risk criteria to categorise the research into study. A Research and Development Strategic Group Table 1. Public Health Wales key has been set up to provide strategic direction and performance indicators managed by Health Figure 1. Public Health Wales research governance & management structure showing the leadership for research within the organisation, and Care Research Wales corporate risk review process and oversight of the research governance process. A1. NHS research data tabled at the Public Health Research governance involves balancing efficiency Wales Board meeting: Public Health Wales Board with appropriate assurance and risk management. ■■ Minimum of twice a year The established processes also reflect feedback from Director of Policy, Research and within the organisation on the processes currently in A2. R&D representation at the NHS organisation’s International Development place and have sought to ensure that where possible Board meeting all avoidable delays in approving research have been A3. Up-to-date R&D strategy for NHS organisation removed. The Research and Development Strategic R&D Strategic Group Group is chaired by the consultant leading for research A4. Inclusion of research in Public Health Wales’ annual return report R&D Divisional/Directorate R&D Management and development, and consists of research leads from Groups R&D Office Group each R&D Divisional/Directorate Group6. The Research B2. Appropriate use of NHS R&D allocations in and Development Divisional/Directorate Groups accordance with the DSCHR, Welsh Government’s will put in place operational plans to support the guidance Internal Risk Review implementation of this research strategy and support Projects with Low Corporate Risk B3. Timely and accurate reporting in accordance with by the R&D Office the prioritisation and development of research topics the financial monitoring cycle for NHS R&D allocations within each service area. Virtual Risk Review B4. Implementation of AcoRD [Attributing the costs of by key members of the Corporate Corporate Team health & social care Research & Development] Risk Review Projects with Medium Corporate Risk e.g. Finance, Health & E1. 80 Percent of Health and Care Research Wales Process Safety, Information Governance, Safeguarding Clinical Research Portfolio (CRP) studies receiving NHS research permission within 40 calendar days Full Risk Review E2. 80 Percent of commercially sponsored studies Projects with High Corporate Risk by key members of the Corporate Team and the receiving NHS research permission within 40 calendar R&D Strategic Group days F1. A commercial strategy/policy in place

4 Formerly the National Institute for Social Care and Health Research (NISCHR) 6 These R&D Divisional/Directorate Groups are based within the Health and Wellbeing Directorate, Screening Services, Microbiology and Health 5 http://www.hra.nhs.uk/resources/research-legislation-and-governance/research-governance-frameworks/ Protection Divisions and Policy, Research and International Development Directorate. 6 7 Public Health Wales Research Strategy 2015–2018

5.1 Current research activity in Public Development Directorate. Currently, the Microbiology Health Wales and Screening Divisions have the most recorded Currently, the Research and Development office strives research activity within Public Health Wales (Figure to capture all research activity, particularly where 3). Strengths in Microbiology and Screening Services individuals are engaged in projects based primarily in should be built upon to increase research income other organisations or projects commissioned by Public within these areas and learning should be shared Health Wales from academic and other partners. From across all of Public Health Wales. Public Health Wales’ April 2010 – March 2015, 85 projects within Public ambition is to increase the capture of external funding Health Wales were granted NHS research permissions for research projects, by supporting the development to begin. Public Health Wales funded over half of this of staff to become research active and take on the role research, the majority of which was undertaken within of Principal Investigator in relevant population health the Public Health Services Directorate and lower levels research projects. The key actions Public Health Wales of research activity took place within the Public Health will take to facilitate research are outlined in section 7.

Figure 3. Projects that were granted research permission across Public Health Wales (April 2010 – Public Health Wales works in partnership with HEIs in March 2015) Wales and has developed research partnerships with other organisations. For example, recent collaborations Current Research Activity in Public Health Wales with Public Health Wales staff as Chief Investigator or 20 Co-Investigators include: ■■ A research project on violence and crime in Wales with the South Wales Police and Crime Commissioner’s Office. 15 ■■ A review of the harms that alcohol consumption causes to others (i.e. not the drinker) with Public Health England.

■■ An Economic and Social Research Council 10 funded Electronic Longitudinal Alcohol Study in Communities (ELAStiC) with Cardiff, Swansea and Bristol Universities. http://www.cardiff.ac.uk/violence- research-group/research-projects/alcohol-misuse ■■ A NIHR-HTA funded multi-NHS site novel 5 ■■ A National Awareness and Early Diagnosis Initiative peer-support intervention using Motivational Cancer Research UK funded study to pilot the Interviewing for breastfeeding maintenance (Mam- evaluation of the Tenovus health check: a targeted Kind). http://www.nets.nihr.ac.uk/projects/hta/131805 cancer awareness intervention for people from deprived communities with Cardiff University and ■■ The National Centre for Population Health and 0 Tenovus (ABACus). http://medicine.cf.ac.uk/primary- Health and Policy, Wellbeing Research funded by Health and Care Healthcare Health Health Local Public Research and care-public-health/research/healthcare-communication/ Research Wales. The Centre has the aim of co- Improvement Intelligence Protection Microbiology Screening Health Teams Development development-and-pilot-evaluation-tenovus-health-check/ ordinating multi-institutional, multi-disciplinary, Division Within Public Health Wales Total multi-agency health and social care research, ■■ A commercially funded, multi-centre study 2010-2011 3 1 1 9 5 0 0 19 collaboration with policy and practitioners, and (EXTEND) sponsored by Astellas Pharma Europe 2011-2012 7 2 0 5 6 0 0 20 public involvement across Wales (Box 3). http:// 2012-2013 0 0 2 9 2 1 0 14 Ltd which involves NHS organisations in Wales and www.healthandcareresearch.gov.wales/national-centre-for- 2013-2014 4 0 0 10 0 1 0 15 England, and also involves Switzerland, Norway, population-health-and-wellbeing-research/ 2014-2015 3 0 2 9 2 1 1 18 Russia and Turkey. https://clinicaltrials.gov/ct2/show/NCT02254967

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Box 3. National Centre for Population Health and Wellbeing Research 6 Generating new knowledge to protect and improve The National Centre for Population Health and Wellbeing Research (NCPHWR) brings together public population health and wellbeing and promote sustainable health expertise from: health care ■■ Public Health Wales ■■ Swansea, Cardiff and Bangor Universities 6.1 Research priorities 2015 – 2018 6.2 Principles underpinning research The NCPHWR aims to make a significant impact upon the health and wellbeing of the population of The broader public health challenges for Wales are laid Through working together with experts nationally and Wales through applied research. The Centre will achieve these aims by addressing the multiple challenges out in the Chief Medical Officer for Wales’ report for internationally, Public Health Wales will develop the in generating an evidence base for public health policies, services and interventions, and implementing 2014 and reflected in the 2015-2018 Public Health research capacity and capability required to provide these on a scale that makes a population level impact. NCPHWR will co-ordinate multi-institutional, multi- Wales Strategic Plan. These include the need to tackle professional, scientific and implementation expertise persistent inequalities in healthy life expectancy, disciplinary, multi-agency health and social care research, collaboration with policy and practitioners, and and advice to the public and our partners in the public public involvement across Wales. It is recognised that involving and engaging the population of Wales is childhood obesity, reduce the overall consumption of health system. In so doing, the research that Public crucial for the public to be enthusiastic owners of and participants in research. Accordingly, workshops healthcare and prepare services and communities for Health Wales supports and participates in should will take place with Involving People network members with the intention of proposing and agreeing the challenges of an increasingly ageing population. aspire to follow the principles outlined in Box 4. mechanisms for public involvement in study design and delivery. NCPHWR will have a research focus in New research is needed to find innovative ways to two policy priority areas: (a) children and young people; and (b) the promotion and maintenance of health Box 4. Principles underpinning research achieve effective and efficient change in this complex through an extended working life. environment. We need to understand the attitudes, Public Health Wales will develop and engage in Public Health Wales is leading on knowledge transfer and will facilitate NCPHWR to work with the Public behaviours and factors that drive unhealthy behaviours high quality research that: Health Network Cymru to support engagement and collaboration with practitioners in Public Health Wales, and perpetuate health inequalities. Critically, such ■■ Is expected to make a difference to public local health teams, Health Boards, Local Authorities, third sector organisations and other key stakeholders. understanding must be translated into evidence- health outcomes. based and evaluated action for change. Public Health The Centre presents an excellent opportunity to strengthen Public Health Wales’ links with academia, Wales will actively engage with partners in developing ■■ Is conducted in an ethical manner and in industry and the third sector. It will aid Public Health Wales in making a greater impact on the health and and testing new procedures, interventions, policies accordance with the appropriate research wellbeing of the population of Wales through collaborative research and timely translation of research and programmes, working in different settings permissions. findings to policy and practice. (e.g. in schools, workplaces) to improve health and ■■ Is relevant to current research priorities (see wellbeing outcomes. In doing this, we will support NCPHWR was launched on the 14th May 2015 along with four other centres of research excellence and section 6.1). and encourage the use of the Secure Anonymised three research units in Wales. The NCPHWR programme was awarded through a competitive tendering Information Linkage (SAIL) databank for the evaluation ■■ Uses a range of methods appropriate for process and is funded by DSCHR at £2.25M over three years in the first instance. of public health programmes and policies7. To realise the purpose of the research (including this ambition we will prioritise research activities that quantitative, qualitative and mixed methods). have clear alignment with the organisation’s strategic ■■ priorities while ensuring that we are still capable of Fosters research collaborations internally and responding to emerging issues. externally across different agencies, disciplines and partnership working with government The key actions Public Health Wales will take to departments wherever possible. facilitate research are outlined in section 7. ■■ Is conducted collaboratively with those likely to be affected by the research by linking researchers with policy-makers, practitioners and the public.

■■ Is aligned with the strategic priorities for Public Health Wales as outlined in the Public Health Wales Strategic Plan.

■■ Is appropriately funded to ensure timely delivery and dissemination of research outputs.

7 The SAIL databank brings together the wide range of routinely-collected healthcare data in Wales for longitudinal research, development and evaluation. http://www.saildatabank.com/

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6.3 Commercial research strategy Public Health Wales is engaged in commercial 7 Creating an environment that supports research in Public activities, both as a research site and by seeking Health Wales to increase revenue through the marketing of our services. Through the development of a Commercial While there are currently limited enablers for staff to participate in research8, there is Unit, we will further explore and exploit opportunities a clear recognition from the Public Health Wales Board and throughout Public Health for joint ventures and partnerships, via a greater Wales of the importance of encouraging a research culture. There are already pockets business focus with social enterprises and the wider commercial sector including pharmaceutical of research excellence and projects that involve working across the directorates and companies. divisions, which should be seen as beacons to share and grow such expertise.

Public Health Wales will also continue to work 7.1 What our survey told us 7.3 Developing and supporting Public with Health and Care Research Wales to identify Health Wales’ research capacity opportunities for commercial research. By informing Respondents to the survey circulated within Public Health and Care Research Wales of our research Health Wales perceived a lack of organisational All staff involved with the development and delivery activities, we will be able to work with them to support for participation in research and very of public health services should have the appropriate develop a commercial research portfolio. Ongoing limited opportunities to engage in research in some level of research skills to enable them to access and work will be directed toward improving knowledge specialisms. Securing protected research time was seen use the evidence base and contribute to generating transfer between research and commercial as a key barrier, as well as a perceived lack of mentors evidence that informs their practice. Using the opportunities. Better translation of research into for research who can advise and provide guidance. evidence base and engaging with research activity is commercial outcomes is a key part of building our Staff development through training in research key for the organisation to achieve its commitments. capacity. Public Health Wales will increase research methodologies, data analysis and interpretation, It is recognised that people in the organisation have income by: the use of routinely collected health and social care different levels of research skills, and that all need to datasets, information and research governance be given the opportunity to develop these further to ■■ Working with commercial partners to maximise processes were identified as priority areas to enable contribute to the evidence base within their service external income (grants, support services and participation in high quality research studies. area. commercial income)

■■ Ensuring transparency in financial costings and 7.2 Actions to support research What our staff think: management and resource allocation. This includes In order to achieve better integration of research in “I think we should be enabling staff to engage ensuring all commercial and non-commercial delivering Public Health Wales’ vision for a healthier, with the research as part of their role but in research is costed in line with relevant costing happier and fairer Wales, this research strategy partnership with others... senior staff [should] templates. highlights four key areas for action: encourage a climate in which research is part of their role. ■■ Working with Health and Care Research Wales ■■ Developing and supporting Public Health Wales’ ” in identifying further opportunities to enhance research capacity. “We can guide our appraisers to support and collaboration between publicly funded research ■■ Facilitating the generation of new knowledge. encourage people they are appraising. agencies and industry. ” ■■ Strengthening public engagement and We should think about research that is more This will support our intention to further enhance collaborations with Higher Education Institutions, “ applied and relevant to the priorities of the and develop our international reputation through the MRC Centres of Excellence for public health organisation. We need much greater scrutiny delivery of high impact research. (DECIPHer) and e-Health research (CIPHER), Welsh of the research methods and the application Government, Health Boards, the other NHS to practice it. Trusts in Wales, Health and Care Research Wales ” infrastructure, third sector organisations and other agencies such as police, education and social services that have a wider public health interest in Wales to co-produce and drive forward our shared research agenda. ■■ Increasing the profile of Public Health Wales’ research by communicating widely with our stakeholders and promoting the translation of research into public health policy and practice.

8 A theme identified in the Public Health Wales’ staff research survey.

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Developing the research skills of staff will also benefit In order to develop and support our research The Policy Research and International 7.4 Facilitating the generation of new Public Health Wales in other ways such as raising capacity, Public Health Wales will: Development Directorate will: knowledge the reputation and value of the organisation to a Through the recently launched National Centre for wider audience and encouraging the recruitment and Population Health and Wellbeing Research, Public retention of high-quality staff. Undertaking research 1.1. Support and encourage regular journal clubs 1.6. Strengthen and streamline systems for research Health Wales will take a lead role in ensuring the can also increase the research literacy of the workforce, within and across divisions. management and governance, ensuring the research agenda is linked into and works to support allowing greater interpretation and application of implementation of the R&D Strategic and 1.2. Support staff to gain training in a improvements in public health across Wales. As well as research findings to bring about service improvements. Divisional/Directorate Groups. comprehensive range of quantitative and ensuring that established and emerging areas of Research contributions by Public Health Wales staff can qualitative research methods, data analysis and 1.7. Develop a model that supports research activity research in health protection and screening continue offer a different perspective to academic or industry interpretation, the use of routinely collected within local public health teams. to develop, we will prioritise research that supports the organisations and provide novel approaches, thereby health and social care datasets and research shared priority areas across the public health system9 enhancing the depth and quality of public health governance processes. Where appropriate, 1.8. Develop a standard set of criteria to evaluate the particularly in the areas of childhood obesity, smoking, research and its impact. The benefits for staff who staff will be supported to gain qualifications viability of internally funded research projects improving mental health and wellbeing and reducing undertake research are summarised in Box 5. in a variety of areas such as public health, and a network of academics that can be called- inequalities. Cross-cutting issues include developing mathematical modelling, statistics, health upon to provide scientific peer-review for quality the role of nurses and midwives in primary and Box 5. Benefits to Public Health Wales’ staff informatics, epidemiology and genomics. assurance. secondary prevention activities, the effectiveness and who undertake research cost-effectiveness of services delivered by Public Health 1.9. Raise awareness of the research governance 1.3. Develop research roles for public health Wales and establishing evidence informed and There are considerable benefits for Public Health processes and the support that is available for professionals from non-medical and medical evaluated approaches to multi-agency working. Wales’ staff who undertake research. These backgrounds to promote equity and reflect the research activity within Public Health Wales. include: multi-disciplinary nature of public health. 1.10. Develop a virtual research community for What our stakeholders said: ■■ Opportunities to partake in rewarding and 1.4. Develop the high level capacity required Public Health Wales, linkages with other similar empowering activities. to provide statistical and health economics networks to share examples of good practice, The big health challenges are things like promote networking, avoid duplication and “ ■■ Development of transferable skills. support within Public Health Wales and through childhood obesity, smoking, and healthy collaboration with HEIs. This will include increase understanding of the types of research ageing... we don’t know what the evidence ■■ New career opportunities mapping the capabilities and capacities that and development and public engagement base is around how we keep people healthy activities that individuals may seek to include in ■■ Opportunities for staff to influence policy. already exist and considering how to utilise in older age. I would like Public Health Wales these skills in the most effective way to support their job plans. to be engaged more in making a change to ■■ Networking opportunities. costed evaluation of the impact of public health the population’s health, with an emphasis 1.11. Develop a series of staff development activity. on introducing programmes or activities with ■■ Potential for the formation of new workshops focussed on research methodologies, relationships and partnerships. communities, and working with different 1.5. Provide guidance for appraisers and appraisees public involvement and engagement in research public sector organisations that will actually in the appraisal and revalidation cycles to and practical skills such as writing up research drive improvements. support research objectives as part of their for publication in peer-reviewed journals. ” personal development plans and encourage The research strategy should be multi- 1.12. Liaise across Public Health Wales divisions to “ research to routinely feature in the Public Health professional, where clinical academic roles help identify research needs, prioritising and Wales’ Performance Appraisal Development are developed for nurses and midwives supporting these as appropriate and in line Review. and allied health professionals, linking with with Public Health Wales Operational Plans as the universities, the schools of medicine, they relate to each division, including ensuring nursing and the allied health. I think there research is also linked with academic, Welsh are opportunities to do shared work between Government policy objectives, other public service and education, the higher education sector and third sector partners. side.” There are particular lifestyle issues for “ example, poverty and obesity, which are a particular concern for us to do something about. So the position that we’re in, in terms of policy making, is that we need to reduce the overall consumption of healthcare.”

9 Articulated in Public Health Wales’ Integrated Medium Term Plan.

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In order to facilitate the generation of new 7.5 Developing and strengthening In order to develop and strengthen Box 6. The Research Design and Conduct knowledge, Public Health Wales will: collaborative relationships collaborative relationships, Public Health Service Wales will: Public Health Wales can deliver primary research The Research Design and Conduct Service 2.1. Provide a framework for systematic as a strong, effective and active partner working implementation and robust evaluation of public in collaboration with others, both nationally and 3.1. Widen collaborative partnerships with academia The Research Design and Conduct Service (RDCS) health activity, including measuring cost- internationally, to secure external funding, deliver to include all HEIs in Wales and promote is a free service available to researchers with effectiveness, and understanding the impacts on research outputs, and translate new knowledge into collaborative research opportunities that NHS contracts who are looking to win funding population health and wellbeing. policy and practice. This will be facilitated within a extend beyond the academic-service interface to do research. RDCS provides expert advice context that acknowledges the differences between to include links with Welsh Government, local and guidance on all aspects of compiling high 2.2. Encourage and support collaborative projects academic research and service delivery, identifying joint authorities and local Health Boards. quality funding applications. They have four that use routinely collected health and social working that is mutually beneficial. core consultants and can additionally draw on

care data and record linkage to evaluate public 3.2. Encourage and support national and all of the staff of the South East Wales Trials health programmes and policies. Many funders of research require universities to international collaboration in areas of strategic Unit to act as consultants to provide specific demonstrate the applied impact of their research, importance to ensure access to the most guidance or to help when there are capacity 2.3. Support research that informs implementation which creates an opportunity for multi-disciplinary innovative ideas, technologies and information issues. To date RDCS has consulted on well over and scaling up of programmes that work. research teams that include participation from Public that will have an impact on population health 150 projects and have been involved in winning Health Wales. Through the National Centre for and wellbeing in Wales. 2.4. Adapt and better utilise our systems for over £1.65M in funding. They have a national Population Health and Wellbeing Research and other remit in supporting Public Health Wales and have identifying and tracking diseases and exposures 3.3. Engage with representatives from HEIs strategic research collaborations, Public Health Wales strategic links with them, as well as a regional to infectious and environmental hazards to (including academics specifically involved in the will help to ensure a coherent public health research remit to support researchers based in South East facilitate research. training of allied health professionals) to further agenda that maximises added value and avoids Wales. duplication. develop a sustainable model for student work 2.5. Engage with HealthWise Wales10 and use placements, shared postgraduate supervision opportunities to engage with the public and A sustainable model for student work placements, and staff secondments to provide protected carry out population health research within this shared postgraduate supervision, staff secondments time on a finite piece of work over a clearly framework. and joint appointments with HEIs is needed to enable defined period of time with Public Health Wales’ The Policy Research and International academics to work with Public Health Wales’ staff to Development Directorate will: 2.6. Make available internal funding to pump-prime Professional and Organisational Development develop research portfolios and increase research grant new and promising research activities or pilot team. capture from external sources. This should also provide studies. 3.7. Raise awareness about the Research and 3.4. Strengthen the academic-service interface with academics with an insight into Public Health Wales Development office in Public Health Wales joint appointments between Public Health Wales service areas, demonstrating areas where research with external stakeholders and take on the The Policy Research and International and HEIs where possible, with a planning cycle outputs can potentially be translated into practice. role of a ‘one-stop shop’ to explore research Development Directorate will: of 3-5 years to help create stability with HEIs collaborations within the organisation. This Public Health Wales has a role in training specialty and promote staff retention. includes bringing together relevant Public Health 2.7. Encourage staff to develop research proposal registrars. We will strengthen the provision of Wales staff and external partners with similar ideas based on their public health practice academic supervision and training placements through 3.5. Support Public Health Wales staff to secure interests for grant writing. experience and, where appropriate, support them collaboration with HEIs. We will continue to support Principal Investigator (PI) or co-PI status on projects as appropriate to ensure that Public in developing research bids to external funders the annual training conference as an event that 3.8. Use the International Health Co-ordination Health Wales receives the resource required to e.g. through the organisation of workshops and showcases the research activity that specialty registrars Centre to identify and initiate international participate in and deliver on research and are seminars, and links with the Research Design and have been engaged with at the academic-service research collaborations and partnerships. Conduct Service (see Box 6). interface. involved with agreements about intellectual property and data sharing. 3.9. Ensure staff in Public Health Wales link to and 2.8. Facilitate connections with national and Public Health Wales will expect research publications benefit from external support services such as the 3.6. Strengthen collaboration with local Health international research funders so that Public and research grant submissions to clearly acknowledge Research Design and Conduct Service (Box 6). Health Wales and its partners are informed the support provided by Public Health Wales, including Boards in the generation and delivery of about opportunities to access research income. authorship for Public Health Wales staff commensurate research, utilising Health Boards as test beds 3.10. Continue to support the annual all Wales with input and in accordance with guidelines for for primary research that addresses the wider training conference for public health specialty 2.9. Provide access to tools, advice and information authorship. For research grant applications, the role determinants of health and inequalities. registrars, and encourage the placement of that promotes and supports research and of Public Health Wales staff should be clarified in specialty registrars in HEIs. evaluation for public health practitioners across advance, with appropriate costs included for staff time all sectors in Wales through Public Health and services provided. Network Cymru.

10 HealthWise Wales is a Health and Care Research Wales initiative for a Welsh National Population cohort study, which will engage with the population of Wales and encourage them to become actively involved in research to improve health and wellbeing, and provide a platform for research, policy and service development and evaluation. http://www.healthwisewales.gov.wales/ 16 17 Public Health Wales Research Strategy 2015–2018

7.6 Effectively communicating what Figure 4. The knowledge mobilisation cycle highlighting various stages of the process. we know A population health need or change process is initially identified and assessed together with existing knowledge, Effective communication of the research agenda both where this exists. Implementation may involve changes to practice followed by evaluation to determine within the organisation and with stakeholders and the effectiveness of the outcomes. public is important in order to promote and support research. Public and stakeholder engagement needs to be embedded into the culture of Public Health Define Wales. The new paradigm for prevention is through co-production, therefore innovative methods of Evaluate engaging the public in developing the research agenda and generating data to inform future policies and

programmes is needed. All teams need to understand Knowledge Search

their own public and stakeholder engagement Mobilisation New knowledge priorities. Consideration should be given at the earliest from research, guideline or policy stage to public engagement in the co-production of Cycle Implement research proposals.

Robust, independent research is instrumental in Adapt to helping to shape policy and to ensure that the local context Appraise benefits to population health are maximised. Equally, What our stakeholders said: the empirical assessment of implemented policy is necessary in order to help ensure policy improves Innovate It’s getting more difficult for people to do health and reduces health inequalities. Public “research in conjunction with local public health Health Wales will continue to work with the Welsh Synthesis teams. There are opportunities for us and we Government to empirically assess the impact of policy should be thinking about identifying some of in delivering improved services. those niche areas that people can do research in. Knowledge mobilisation is concerned with ensuring ” that knowledge, generated through research, data In order to effectively communicate what we The Policy Research and International “ It’s important to consider the area of co- analysis, innovation or evaluation, is used in policy know, Public Health Wales will: Development Directorate will: production. We see a considerable number of and practice to inform decision-making. Public community-based programmes facing up to Health Wales is developing a strategy for knowledge 4.1. Encourage and support staff (including specialty 4.6. Produce a monthly Research and Development some of the more serious issues, be they diet, mobilisation which aims to ensure that knowledge registrars) to publish their work in peer-reviewed bulletin and utilise the Public Health Network exercise or community programmes which look is utilised across the public health system to best journals and other peer-reviewed media. Cymru and Public Health Wales internet at economic, social or cultural development; effect (Figure 4). The Knowledge Mobilisation to advertise research news and funding they’re all the wider determinants, which have Strategy focuses on a number of key themes which 4.2. Revisit the format for the Public Health Wales opportunities. health as a by-product.” will be developed into work-streams within an staff conference and explore the potential implementation plan: culture and leadership; systems for a conference programme that includes 4.7. Put in place systems to better capture outputs Public Health Wales has got to bring money and processes; workforce development; partnerships the service-academia interface, linking with from the research that Public Health Wales “in for research and be part of more multi-site with key stakeholders. The strategy will interface academic partners. has been involved with, including plans for activities in the UK and Europe. [Public Health with others, such as this research strategy, enabling implementation and monitoring the uptake of Wales] should be involved in partnering and 4.3. Support staff to present their research findings knowledge ‘outputs’, such as those from research research findings into practice. collaborating in a more organised, proactive and at national and international conferences. activity or evaluation, to be systematically picked up strategically led way. 4.8. Signpost to all relevant new and emerging ” and proactively disseminated and to ensure that we 4.4. Encourage staff to develop plans to improve evidence and research where appropriate learn from them. public engagement and consult with and through existing organisational web sites and involve public and patients throughout their communications platforms and through the research. newly launched Public Health Network Cymru website (www.publichealthnetwork.cymru) (www. 4.5. Facilitate conferences, seminars and workshops rhwydwaithiechydycyhoedd.cymru) promoting evidence-based practice for practitioners and researchers working on public health priorities in all sectors in Wales.

18 19 Public Health Wales Research Strategy 2015–2018

7.7 What will success look like? Successful implementation of this research strategy 8 Conclusion 9 Acknowledgements alongside the Public Health Wales Strategic Plan will enable Public Health Wales to demonstrate the This research strategy will contribute This research strategy is the product of contributions and ideas from the following impact of its activity on promoting equality in health to Public Health Wales’ ambition to stakeholders. Public Health Wales would like to thank all who participated in the and wellbeing outcomes in the population. Public protect health and improve the physical, development of the strategy and hope that such broad-based support continues Health Wales will establish a research track record with emotional and social health of the nation throughout its implementation. partners and position ourselves to be able to increase through evidence-based public health ■■ Aberystwyth University our research income from Europe and blue-chip practice and policy. funders in the future. ■■ Bangor University

■ ■ Cardiff Metropolitan University Specifically, there will be: Over the next three years, Public Health Wales ■ ■ At least 75% of all our research activity aligned will work with other funders of health and social ■■ Cardiff University with the strategic priorities for Public Health Wales care research and HEIs to support and accelerate ■■ National Institute for Health Research as outlined in the Public Health Wales Strategic the translation of research into practice and policy Plan, and be directly applicable to enabling the and large-scale implementation of cost-effective ■■ Division of Social Care and Health Research (formerly NISCHR). organisation to deliver on these priorities11. interventions and programmes. ■■ Public Health England ■■ Research projects carried out in Public Health Public Health Wales will make efficient use of available ■■ Research Design & Conduct Service Wales will employ rigorous methods to ensure that resources and undertake joint working initiatives they are delivered to the highest standards and wherever possible. Collaborations will continue ■■ South East Wales Trials Unit produce high quality outputs. to be sought to ensure complementarities with ■■ Swansea University academia, local authorities, Welsh Government as ■■ A shared research agenda across the public health well as public, private and third sector organisations. ■■ Tenovus system that is synergistic with the National Centre Funding opportunities will be explored for areas of for Population Health and Wellbeing Research. ■■ Welsh Ambulance Services NHS Trust strategic importance from various sources nationally ■■ A clear and coherent pathway for external partners and internationally to strengthen the science and ■■ Welsh Government to engage with Public Health Wales on research. knowledge base. A delivery plan will be developed that includes a framework for evaluation against This research strategy has been developed by the Policy, Research and International Development Directorate. It ■■ An active public health research community. which we will review and refresh this strategy in 2018. has been coordinated by Dr Shantini Paranjothy, Dr Mark Griffiths and Professor Mark Bellis. We would also like ■■ Year on year increase in the number of to thank all the staff in Public Health Wales who have contributed to this document. We are grateful for their publications by Public Health Wales staff in peer- valuable input and feedback. reviewed journals.

■■ At least a 30% increase in external research funding over the next three years from the baseline levels in 2014. Iechyd Cyhoeddus Cymru, Public Health Wales, ■■ A clear and coherent pathway for knowledge 14 Ffordd yr Eglwys Gadeiriol, 14 Cathedral Road, mobilisation and communication to facilitate and Caerdydd, CF11 9LJ Cardiff, CF11 9LJ promote evidence-informed policy and practice. Ffôn: 029 2022 7744 Telephone: 029 2022 7744 Ffacs: 029 2022 6749 Fax: 029 2022 6749 E-bost: [email protected] Email: [email protected] [email protected] [email protected] Twitter: @IechydCyhoeddus Twitter: @PublicHealthW Facebook: Iechyd Cyhoeddus Cymru Facebook: Public Health Wales

Ymholiadau’r Cyfryngau Media Enquiries Dylai newyddiadurwyr sydd am gysylltu ag Iechyd Journalists wishing to contact Public Health Wales Cyhoeddus Cymru ffonio 029 2034 8755 (24 awr). should call 029 2034 8755 (24 hours). There is a Mae swyddog cyfathrebu wrth law bob amser. communications officer on call at all times. 11 As we transition to Public Health Wales wider strategic aims as outlined in the Public Health Wales’ Strategic Plan it is anticipated that there Mae Iechyd Cyhoeddus Cymru yn croesawu Public Health Wales welcomes correspondence in will be a period where ongoing research or activities to which we are committed but which do not fit the Strategic Plan, will need to pro- gress to their natural end. There is also research income generated in Public Health Wales e.g. from testing assays etc which can lead to new gohebiaeth yn Gymraeg neu Saesneg. Welsh or English. diagnostic tests that does not easily map on to the Strategic Plan but are central to the lab’s day to day activities.

20 21 Public Health Wales

Appendix 1

Differentiating research, service delivery, surveillance and monitoring in public health12 Research Service Service Surveillance and delivery evaluation and monitoring audit Aims and Derive generalisable Provide social and Define current care Continuous, systematic objectives new knowledge through health care to to find out if you collection, analysis studies designed to protect, treat or are doing planned and interpretation of generate and test prevent ill health activity. Assess health-related data hypotheses to answer and promote good the impact and with dissemination to clearly defined questions. health. effectiveness of the stimulate action. This can activity to inform be used for the planning, delivery of best implementation, and care. evaluation of public health practice. Surveillance can serve to warn about impending public health emergencies, monitor progress towards specific goals or monitor the epidemiology of health problems to allow priorities to be set and to inform public health policy and strategies. Design and Randomisation i.e. clearly May involve some No randomisation Although surveillance can Allocation defined sampling with group allocation as allocation will be used to document the allocation to groups. but treatment have been decided impact of an intervention, should remain before service or track progress towards unaffected and evaluation begins. specific goals, it does not based upon best involve intervention and evidence. so there is no allocation to groups. Method Test hypotheses following Allied health Measure current Systematic statistical and data established methods. This professional and services and methods including sampling collection may involve collecting practitioner led programmes. Can or analysis of collected data data and can include delivery of services. involve analysis or interview/questionnaire to treatments, samples and Systematic of existing data those exposed. investigations additional statistical methods or evaluation to routine care. may be used. of services by interview or questionnaire.

Ethics Research will often No Research Ethics Committee review is usually required. involve Research Ethics Committee review, unless it solely involves analysis or linkage of previously anonymised data.

12 Definition of health based upon WHO and Health Research Authority research definitions http://www.hra.nhs.uk/documents/2013/09/defining-research.pdf http://www.who.int/topics/public_health_surveillance/en/ Design: Jenney Creative www.jenneycreative.co.uk Design: Jenney Creative 22