CRN Greater Manchester - Strategic Impact Report 2021/22

Foreword

CRN Greater Manchester is proud to be part of a health and care community that contributed so much to research over the past year. Delivery teams and leaders in our region showed a great deal of resilience to ensure a broad research offering which gave 81,700 local participants the opportunity to be part of research in 2021/22.

Our network has continued to deliver healthcare research superbly well and we have made good progress in public health and social care research delivery. Activity in the latter two areas has grown significantly, in line with NIHR’s Best Research for Best Health: The Next Chapter, and will become even bigger areas of focus to ensure our research meets the needs of all our communities.

All of this has been achieved against the backdrop of COVID-19 which continued to cause unavoidable disruption. However, our portfolio made a strong recovery thanks to a managed approach, consistent with the UK Clinical Research Recovery, Resilience and Growth Programme, and three-quarters of all studies in our region were open and recruited participants in 2021/22.

As a network, we needed to ensure any positive lessons the pandemic taught us were not forgotten. By the end of the year, we feel that has been achieved and in many ways our network has changed how it delivers research, for the benefit of participants and stakeholders.

After conducting vaccine trials successfully in sports halls, it is now the norm for us to deliver research, of all different kinds, in lots of community settings like this. We have seen how community delivery is efficient and convenient for participants, and we are aiming to do lots more of it, alongside the equally vital delivery models which must continue in traditional hospital settings.

Regardless of the challenge, we now start by referring to our new CRN Greater Manchester core values. These three key themes were developed in consultation with our local communities, teams and stakeholders to ensure we continue to hold a shared purpose, just like we did when the pandemic gave us no option but to find solutions to COVID-19. This report is structured according to these values, which are now embedded in everything we do. They are: Relevant Research, Inclusive Involvement and Exceptional Experience.

We believe there are lots of exciting opportunities ahead for us to improve our region’s health and wellbeing through research, some of which you can find in our forward planning brochure for 2022/23 and beyond. The new regional Integrated Care Systems present us with lots of opportunities to come together to plan and deliver joined up health and care services for the benefit of local citizens, and we are in a good position to build given that our devolved Greater Manchester Health and Social Care Partnership has now been operating for five years. Thank you to everyone who has contributed to the successes outlined in this report and many more besides in 2021/22.

CRN Greater Manchester Senior Leadership team

Sarah Fallon – Chief Operating Officer
Susan Neeson – Deputy Chief Operating Officer
Professor Martin Gibson – Co-Clinical Director
Professor Andy Ustianowski – Co-Clinical Director

10 key highlights from 2021/22

So much was achieved by CRN Greater Mancherster in the past year. Here are just 10 highlights, as chosen by our core team.

Our Delivery Team were a Team of the Year finalist at the Royal College of Nursing Awards 2021. We were recognised for our role in evaluating 30-minute lateral flow tests for COVID-19 which became part of people’s everyday lives.
We were the highest recruiting region in the country to life sciences research, with almost 4,000 participants across 220 studies. And we were comfortably the best performing network for recruitment to time and target (82%) on commercially sponsored studies.
Six world-first participants were recruited on to studies delivered in our region, showing our world-class ability to set-up studies efficiently for the benefit of patients and the global progress of health and care.
We became the only region in England to have a mobile research delivery unit complete with on-board pharmacy capability.
Newly-appointed NIHR Chief Executive, Professor Lucy Chappell, praised Greater Manchester’s commitment to social care research during a visit. She thanked the “vibrant and multidisciplinary group committed to social care research in this region”.
Almost 6,000 citizens were involved in research through their GP practice in Greater Manchester and East Cheshire, the highest number in six years for our region. Almost 40% of practices recruited participants on to CRN portfolio research studies.
We established a Direct Delivery Team to provide participation opportunities in locations away from secondary care. They recruited across eight studies in settings including care homes, community centres and places of worship.
We celebrated the workforce behind the health and care research which took place during the pandemic with a special online celebration, the Greater Manchester Evening of Excellence. Over 90 individual and team contributions featured.
Our Strategic Funding programme became the first of its kind in Greater Manchester. It funded partner organisations to co-create and deliver projects which served community needs and boost regional growth in research delivery.
Our CRN Greater Manchester Workforce, Learning and Development Team entered into a successful collaboration with our colleagues at CRN North West Coast to provide a single workforce function for the region and match Deanery and Health Education England provision across the North West.

National NIHR programmes

At CRN Greater Manchester, we are part of the wider NIHR family which reports to the Department of Health and Social Care to deliver on UK priorities. Below are some of the national programmes which shape our work locally.

NIHR’s Best Research for Best Health: The Next Chapter: This programme underpins the work and aspirations of all organisations in the NIHR, including CRN Greater Manchester. The document sets out how the NIHR aims to address the nation’s health and social care challenges and gives strategic focus on where significant changes are needed in how we will work in the future.

The Future of UK Clinical Research Delivery: This vision sets out the ambition to create a patient-centred, pro-innovation and data-enabled clinical research environment. The aim is to create a system which empowers everyone across the health service to participate in delivering research and enables people across the country to take part in research that is of relevance to them.

UK Clinical Research Recovery, Resilience and Growth Programme: This programme helps shape large-scale visions, such as the Future of Clinical Research Delivery. Triggered by the success of the COVID-19 response, it outlines a pathway for research services to not only recover from pandemic disruption, but to also become more robust and prosper.

NHS COVID-19 Vaccine Research Registry: This registry was established following the outbreak of COVID-19 and played a pivotal role in matching volunteers with trials which led to the UK’s successful vaccine programme. The registry, which had over 20,000 sign-ups in our region, continues to support vaccine studies looking at new booster options and helping to understand how we can keep the spread of the virus under control. The Be Part of Research service is building on the success of the Vaccine Research Registry, creating a new service that allows people to sign-up to be contacted about all other types of research, in specific health areas and locations.

Chapter 1: Establishing our research vision and values

When the COVID-19 pandemic happened in early 2020, our research community instantly came together with the common goal of finding treatments, diagnostics and vaccines for coronavirus. There was no other option and, more than ever, we became a city united in the fight against the virus. There was strength in this approach, as shown by our region’s fantastic research response to COVID, and we soon identified the need to harness everything that was good about this way of working. The pandemic showed us that we needed a shared purpose and vision for the future.

To do this, in 2021/22 we consulted with our extended research community and took on board a variety of perspectives to form our research ambitions for the region. We spoke with stakeholders including our local health and care organisations, members of the public, our research Specialty Leads, Industry and sponsor colleagues, our Research Champions and other parts of our local NIHR family. As a result, we heard what mattered to our region and the things to which we could commit collectively. This resulted in our vision and values, created by the region for the region.

Our vision

To change lives through research, by enabling the best care for our entire population through world-class collaboration, experiences and performance.

Our values

Relevant Research, our commitment to fully understanding the health and care needs of our local population and finding the best ways to make a difference to citizens and communities through research. Led by Professor Phil Kalra.
Inclusive Involvement, our focus on identifying underserved communities and recognising research involvement beyond participation. Led by Professor Kathryn Abel.
Exceptional Experience, our investment to service improvements which advance the practice of research delivery for participants, staff, investigators, communities, partners and sponsors. Led by Dr Abdul Ashish.

Our values are now firmly embedded in everything that we do. This includes:

Leadership: For each value, we have appointed a senior researcher as Theme Lead to oversee, bring people together and drive forward work in these areas to meet the needs of our population and care services.

Infrastructure: We introduced an annual Strategic Funding initiative which supports co-created projects developed with local partners to transform regional research delivery models. Each successful project aligns to one of our values. Outcomes from the projects are shared in our annual spring showcase so that everyone in our research community can learn together from the successes and challenges.

Culture: CRN Greater Manchester core team staff are supported to become catalysts for change through a monthly innovation scheme. This provides colleagues with protected time to channel their unique, local perspectives and develop ideas, aligned to our three values, to address unmet needs across our local research system.

Chapter 2: Accessing our cohorts of local volunteers

In addition to the research participation opportunities available at our partner organisations, we have a range of ‘consent to approach’ campaigns that people can sign-up for. Lots of ‘research ready’ volunteers are registered with these initiatives, which means they are interested and waiting to hear about different types of research they can get involved in. We can help your research reach these people. By speaking with the teams behind these initiatives, researchers and delivery teams can make sure their studies and other participation opportunities are shared directly with these volunteers.

Interested in how it works? You can get in touch via the contacts below and why not register yourself and even encourage your colleagues and family to sign-up? It couldn't be simpler and by doing so you will unlock the same opportunities that are open to our local volunteers. By having this participant experience, you should hopefully see how you, as a research professional, can benefit from these services.

Research for the Future

Research for the Future is a North West service which can help you to involve, engage and recruit the right people to participate in your research. It helps find participants for a wide range of research involvement and engagement opportunities including grant applications, clinical trials and other patient and public involvement and engagement opportunities. Since its formation in 2011, over 12,500 people have registered and consented to be approached about research opportunities, and it has supported over 250 studies to recruit to a range of research opportunities.

Research for the Future has also developed a research-ready community of people to take part in research into long COVID. The consent-for-approach database is collecting information about people’s COVID status, recovery, and whether they have received a coronavirus vaccine. Over 3,000 people have already opted into this cohort.

Call 0161 206 3636 or email research.future@nca.nhs.uk to speak with a member of the team, or go to www.researchforthefuture.org

Anyone aged 18-plus, regardless of their health background, can sign-up to Research for the Future. Registering means you will be informed about local research opportunities you may wish to take part in.

Be Part of Research

Be Part of Research is a website run by the NIHR. It is designed to help people of all ages find and contact the teams working on research studies taking place near them. This includes studies happening across our region. Users can search for participation opportunities by typing in a condition, or a place or postcode. There is also an A-Z of conditions to search by. Go to www.bepartofresearch.nihr.ac.uk.

This site is designed to make it easier for researchers and delivery teams to attract participants to their study. For your trial or study to be included on this website, you must create a listing on one of these two registry sites; ISRCTN or clinicaltrials.gov.

There is now also new Be Part of Research functionality, which allows people to sign-up to be contacted directly about research of their choosing in specific health and care areas and locations. For this, go to volunteer.bepartofresearch.nihr.ac.uk/participants/register

Contact bepartofresearch@nihr.ac.uk with any queries.

Join Dementia Research

Join Dementia Research is an NIHR service that enables people to register their interest and be matched with suitable dementia research studies taking place nearby. People do not need to have dementia to get involved, and it’s also okay to sign-up and manage an account on behalf of someone else. On the flipside, researchers can use Join Dementia Research to find volunteers for their study. Services include an option to request a call back for patients who want to know more.

Go to www.joindementiaresearch.nihr.ac.uk or contact our local support officer lindsay.ray@nihr.ac.uk.

Utilising the support of our Research Champions

We coordinate a group of Research Champions, who are patients and carers with a passion for research. Our current focus is to identify activities to target under-served communities to be part of research. We are keen to work closer with our partner organisations and researchers so please contact us if you would like to work with our champions to promote research in your area. Some examples include:

Visiting health services, patient groups or community groups to talk about relevant research studies
Involvement in discussions around recruitment methods
Co-designing materials, such as posters and leaflets, to raise public awareness of health and care research
Taking part in activities to mark health awareness days.

Contact learning.lcrnsnorthwest@nihr.ac.uk

Care home research

Care homes interested in getting involved in research can join our Enabling Research in Care Homes (ENRICH) network and access support from our team. There are many ways people working in care homes can be involved with research. Supporting research can range from distributing information to helping conduct studies on site with residents.

ENRICH also helps researchers who are wanting to work with care homes, or planning a study involving care home residents, to understand and overcome challenges with conducting research outside NHS healthcare settings.

Contact enrich-gm@nihr.ac.uk to speak with our team, or go to www.enrich.nihr.ac.uk

Who we work with

We work with all of the NHS trusts, local care organisations, social care and non-NHS partners across Greater Manchester, East Cheshire and East Lancashire. A full list is below. Email us at researchsupport.crngm@nihr.ac.uk if you are keen to be introduced to a research contact at any of our partner organisations.

Our local partner trusts are:

Bolton NHS Foundation Trust

Bridgewater Community Healthcare NHS Foundation Trust

East Cheshire NHS Trust

East Lancashire Hospitals NHS Trust

Greater Manchester Mental Health NHS Foundation Trust

Manchester University NHS Foundation Trust

Northern Care Alliance NHS Foundation Trust

North West Ambulance Service NHS Trust

Pennine Care NHS Foundation Trust

Stockport NHS Foundation Trust

Tameside and Glossop Integrated Care NHS Foundation Trust

The Christie NHS Foundation Trust

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

Local Care Organisations

We work with local care organisations in all of our communities across our region. This includes:

Community mental health / Child and Adolescent Mental Health Service

Prisons

Voluntary sector

Community Hospitals

Residential care, social care and domiciliary care

Health visitors / schools

GP practices / federations / networks

Urgent treatment centres

Community nurses

NHS hospice care

Urgent care at home teams

Community based clinics

Other independent contractors e.g. pharmacy

Specialist community based clinics e.g. sexual health / drug / alcohol

Local authorities

Charities

Chapter 3: Relevant Research

The Right Place

Making research more relevant means seeking answers to the health and care questions and challenges which matter most to the people, and to the health and care organisations, in our local communities. When delivering any research, it should address the health and care needs of our population. By doing this, our network can help improve outcomes for citizens in our ethnically diverse region where, unfortunately, the life expectancy for men and women is below the national average.

People living in our region have the second highest rates of illness in the country, behind only the North East. On average, a 60-year-old woman living in the most deprived parts of Greater Manchester will have the same level of 'diagnosed illness' as a 76-year-old woman living in the richest part of the country. This is not a new trend. For years our health has been poorer than the UK average, with more people suffering from illnesses, such as cancer, diabetes and mental health problems, than other parts of the country. If the research carried out locally is relevant to our communities, we can help change this by working across the integrated care systems to deliver studies in the right places.

What have we achieved together?

“Increased health and care opportunities in areas and populations that have the most need.”

Enabling access to latest depression research opportunities

Greater Manchester has a much higher number of people in contact with mental health services than many other parts of the country. A new transcranial magnetic stimulation (TMS) service for depression, the first of its kind in the North West, opened in our network. TMS is designed to support the brain’s natural electrical activity. This introduction has enabled local participation in the largest trial of TMS outside of North America. This research is investigating TMS treatments to help people living with depression. For eligible participants, this research opportunity has life-changing potential because other solutions, such as medication or talking therapies, have not worked for them.

Leading the way with cutting-edge cancer research

One-in-two people in Greater Manchester will develop some form of cancer during their lifetime. Following pandemic disruption, it has been imperative for us to offer a large range of cancer studies for patient participation and over 7,800 individuals took part, across more than 300 studies, last year. This made us the highest enrolling region for cancer research in the country when accounting for population size, and the third highest recruiter overall.

The rate of lung, trachea and bronchus cancers in Greater Manchester is almost 25% higher than the national average. Grandfather-of-three Barry Stainforth became the UK’s first lung cancer patient to benefit from a state-of-art radiotherapy treatment, as part of his involvement in a trial in Greater Manchester. Barry, 81, was treated using technology which performs real-time MRI scans while X-ray beams target the tumour. For patients undergoing radiotherapy to kill cancer cells, this approach means the tumour can be targeted with greater precision than has previously been the case, avoiding surrounding healthy tissue and side-effects. This global radiotherapy trial offers hope for many patients, as it aims to target a variety of different cancers to hopefully discover which react best to the treatment. Barry said: “It really lifts your spirits when you have such confidence in the people looking after you, and to be able to help science along the way is an even better feeling.”

‘A thriving community of social care researchers’

The importance of social care research for the NIHR has been recognised in the new name of our organisation nationally. We are building our local capacity and capability in this area and appointed a Specialty Lead for social care, with a wealth of experience in this field.

This is enabling us to drive forward our support for research which improves people’s lives and helps them live well, as noted by NIHR Chief Executive, Professor Lucy Chappell, who praised Greater Manchester’s contribution to social care research during a visit in October 2021. She said: “It has shown me that there is a thriving community of researchers in Greater Manchester, with Patient and Public Involvement and Engagement woven in, and that we should continue to ensure funding opportunities and support for this area; both ensuring that it is ‘special’ and integrated more fully into all of the NIHR work.”

Our successful Enabling Research in Care Homes (ENRICH) initiative, which makes care homes ‘research ready’, is a key part of our social care research. Through ENRICH we supported Beenstock Home in Salford to become the UK's first care home to deliver the NIHR-funded AFRI-C study. This research is looking at the use of air filters to reduce respiratory infections, such as coughs, colds and flu, and COVID-19 in care homes. The number of people aged over 65 and living in care homes is predicted to double by 2040, and, as highlighted by the devastating effects of COVID in care homes, reducing the spread of infections in care homes is a research priority.

“Collaborated with sponsors and researchers to achieve accessible and decentralised study designs to enable the best local delivery plans.”

Dedicated team established to deliver research in communities

Participation in research today often does not need to happen in hospitals with specialist facilities. In many cases, people can take part without being an inpatient and can often be a healthy volunteer. For these reasons, we established a Direct Delivery Team specifically to deliver research in locations away from secondary care.

This multidisciplinary team have already recruited participants across eight studies. Delivery took place in settings including schools and universities, community centres and festivals, and places of worship. They have made trusted relationships with community leaders to understand local needs and reached out to underserved populations to raise awareness and broaden participation. This has all been done in locations which are more convenient for people to access in their everyday lives.

Finding COVID-19 vaccines for all

We continued to deliver trials supporting the global effort to find safe and effective COVID-19 vaccines for everyone. Almost 650 local participants took part across seven trials in the past year. This provided crucial data for research which is informing the UK’s nationwide booster programme and investigating smaller booster doses which could avoid unnecessary side-effects for younger people and bolster global vaccine supplies. Other trials delivered with our support are looking at the most effective use of vaccines during pregnancy and the fight against COVID variants.

In an exciting development, the first results of an early trial of a multivariant COVID-19 vaccine booster, launched and led in Manchester with 20 participants, showed it is driving a comprehensive immune response. Plus, we welcomed a landmark moment when Novavax’s COVID-19 vaccine became the fifth to be authorised for use in the UK. Over 1,655 volunteers took part in Greater Manchester, the UK’s highest recruiting region to the trial.

In addition, our campaign which raised awareness of the first COVID-19 vaccine trials was recognised at a ceremony celebrating the best marketing campaigns in the North of England. We were shortlisted for Best Health Campaign and Best Not For Profit Campaign at the Prolific North Marketing Awards. Thanks to our campaign, over 24,000 people in our region registered an interest in taking part in a vaccine trial, with thousands subsequently taking part in vaccine trials locally.

Setting up bespoke research clinics with ‘high throughput’

We introduced a pioneering ‘high throughput’ model based on our experience of carrying out several large-scale COVID-19 vaccine trials. This Greater Manchester innovation has enabled us to invite large numbers of participants to bespoke research clinics, often outside of traditional hours, which is more convenient for many who told us they had work commitments on weekdays. High throughput means dozens of participants can be recruited in a day, far more than is possible via traditional recruitment approaches.

This model reduces study recruitment periods, which helps ensure research outcomes can be reported quicker, for the benefit of participants, researchers and society. A successful pilot session delivering the NIHR Immune Mediated Inflammatory Disease BioResource, which recruits volunteers with conditions such as rheumatoid arthritis, psoriasis, and lupus, gave us the evidence-base to roll out this model which has become one of our flagship Greater Manchester delivery strategies.

“Connected specialty leaders and teams to improve research opportunities for people living with multiple long term conditions.”

Examining cardiovascular illnesses among patients with kidney disease

By bringing research in different specialty areas together, we can provide further participation options for patients living with more than two long-term conditions and contribute to an improved system where people do not have to move between health and care specialists as frequently.

Almost 400 participants were involved in the Salford Kidney Study in 2021 and 2022, contributing to a growing biobank of data and samples to support research collaborations across different specialty areas. Following targeted recruitment, the study was able to show that participants with chronic kidney disease also had a high level of cardiovascular illness, with 29% having diabetes, 19% having experienced heart failure, and 9% with coronary heart disease. The study team is also offering this population the opportunity to be part of a mental health questionnaire.

Building a Common Mental Health Data Set

In health research, a significant amount of information is collected about a person’s physical wellbeing. However, much less is known about their mental health and how the two are related. Our network therefore conducted workshops to understand people’s views about sharing their mental health and wellbeing data for research purposes. Following on from this, we are aiming to build an app to collect mental health data from which researchers can improve our understanding of the links between physical and mental illness. A series of stakeholder workshops were undertaken with physical health study stakeholders, data organisations, technical experts, and members of the public to co-define the content, structure and collection methods of a Common Mental Health Data Set for collection in all physical health portfolio studies.

Better research into the health and care of our prison population

The physical health of the prison population is much poorer than that of the general population. Mental ill health and personality disorders are also higher than in the rest of society. Recognising these issues, and the fact that prisoners are an underserved group in research, we supported Greater Manchester-led research focused on improving the accessibility of all health and care research in prisons. Consultation with academics and HMP staff has shown an appetite to explore opportunities, including testing the effectiveness of digital health solutions used extensively in the community, such as apps and wearables, in the prison environment. This work is pursuing next steps including Patient and Public Involvement and Engagement and cyber security considerations.

“Expanded the diversity of delivery to include more digitally led trials.”

Using digital to test new treatment in the community

The Greater Manchester system collaborated on a groundbreaking study in primary care to test the implementation of a new drug to reduce bad cholesterol, high levels of which make people more likely to suffer a heart attack or stroke. Sustained lowering can help stop cardiovascular disease. This research allowed us to identify and recruit at-risk groups digitally, track the patient journey and provide real-time monitoring. The study randomised 900 patients from 17 practices across eight boroughs. Through this, our region is hoping to deliver better outcomes for those at risk of cardiovascular disease and deliver care closer to people’s homes. This research addresses a key system challenge, with around 50,000 people living with heart and circulatory diseases in Manchester.

Delivering groundbreaking antiviral COVID-19 research with digital sign-up

The ability to prescribe treatments that help clinically vulnerable people with COVID-19 recover sooner, at home, without the need for hospital care, will transform how we live with coronavirus. We have contributed to this critical effort by delivering the PANORAMIC trial, which has been producing the evidence needed to make game-changing antiviral drugs widely available to those who need them most. Over 21,000 people were part of the trial’s first arm, which investigated a potentially-revolutionary antiviral pill. Participants have been encouraged to register online or via their GP as part of a national centralised model designed to make it easier for people to connect to research. Bindhu Xavier, CRN Greater Manchester Senior Research Nurse, said it’s been a “privilege” to work on this trial. She added: “The uptake in registrations in the community, supported by GPs, has been phenomenal and there is huge appreciation for the participants taking part.”

Using virtual reality to treat mental health problems

In Greater Manchester, we have a much higher number of people in contact with mental health services than many other parts of the country. Over a 12-month period, our region’s NHS mental health trust sees around 65,000 service users, and we have a high prevalence of psychosis.

Our network played an important part in an NIHR-funded study which showed automated virtual reality technology can help people recover from mental health problems, particularly those who found it hardest to leave the house, and those with symptoms such as severe anxiety, depression, delusions, and hallucinations. It was the biggest ever trial of VR for mental health and was designed to treat agoraphobia and help patients re-engage with day-to-day activities, taking them from a housebound existence to life back in the world outside. More than 50 local participants were part of the trial, which saw the user guided by a virtual coach, meaning the treatment can reach many more patients than if staff were seeing patients face-to-face.

Manchester service user Leo co-produced the gameChange trial, bringing his lived experience to help shape the research. He said: “When I took off the headset, I felt more confident speaking to people and using eye contact in social situations. I felt as if it had conquered a fear.”

“Building a thriving research community”

Our region has a flourishing research community which we are always looking to support, recognise and invest in. Below are two key examples:

National accolades for senior and trainee investigators

Each year the Royal College of Physicians and NIHR Award recognises outstanding contributions from a select few research-active NHS consultants and trainees. In September 2021, of the six consultants honoured, two were from Greater Manchester: Professor Andy Ustianowski, our Co-Clinical Director; and Dr Abdul Ashish, our Theme Lead for Exceptional Experience. Dr Sam Hey, an Internal Medical Trainee in Manchester, was among the four prize winners in the trainee category following his involvement in the NIHR Associate Principal Investigator Scheme. All three were honoured for the ways in which they targeted pandemic health needs by leading and delivering coronavirus research.

Realising potential with growth funding

Greater Manchester is leading the way in developing research growth for Carcinoma Unknown Primary (CUP), the sixth highest cause of cancer death in the UK. This refers to cancer spread that has been found in the body, but it is unclear where the cancer started. When additional support for our local CUP service was needed following pandemic disruption, our Strategic Funding enabled the appointment of the UK’s first CUP research nurse. This quadrupled the rate of patient recruitment and increased the number of participation opportunities within the hospital and across Greater Manchester thanks to collaboration with nearby hospitals to reach a wider patient group and liaise with rapid diagnostic centres.

Chapter 4: Inclusive Involvement

The right People

Our Inclusive Involvement value is about making sure the right people are involved in the studies delivered in our region. We engage with communities to raise awareness and provide opportunities to get involved in research, while also seeking to understand the needs of the people who are not taking part. It is also our responsibility to inclusively involve different staff groups in the delivery of research, so that we can provide opportunities for professional development in research and build our workforce of the future.

What have we learnt together?

“Improved access for communities who are not historically given the opportunity to participate in research.”

App removing barriers to patient and public engagement

We funded a project to develop an app designed to overcome barriers to people getting involved in Patient and Public Involvement and Engagement. The app allows researchers to add project details and questions; then allows participants to filter according to their interests, read project details, and respond to questions to help shape the research. Having initially focused on mental health research, the app has expanded to support all health and care specialty areas. It can collect anonymous demographic data and has a jargon detector to remove academic terms. Funding has been secured to expand the project until 2024 and the long-term vision is to build a national platform integrated with NIHR and NHS digital infrastructure.

Culturally adapted research to help improve patients’ mental health outcomes

A Manchester-led trial is looking at a new form of talking therapy for people from African and Caribbean backgrounds. The Culturally Adapted Family Intervention study, known as CaFI, has been developed at the University of Manchester to support people who are diagnosed with schizophrenia or psychosis. Black people are four times more likely to be sectioned and given medication over talking therapy than those who are white, statistics have shown. However, the team behind CaFI believe just 10 one-hour sessions of the therapy, which has a specific focus on race and people’s lived experiences of being racialised, can change lives. Nadia, 38, who was diagnosed with Paranoid Schizophrenia as a teenager, took part in the pilot study. Since having the therapy she has gone back to college and moved into supported accommodation. She said: “The therapy sessions made me more confident. They made me believe I can be somebody and I can do something.”

State-of-the-art van takes research into neighbourhoods

As part of our priority to make research more accessible, we secured funding for a state-of-the-art Research Van. This bespoke facility launched in January 2022 and now allows staff to conduct complex trials in community settings thanks to the built-in pharmacy and clinical area. Study teams across the region can utilise this unique resource which was inspired by pandemic pressures but now has a lasting legacy by allowing staff to deliver research in places convenient for the participant, such as community centre and supermarket car parks.

In a similar fashion, our Secondary Care Delivery Team helped diagnose lung cancer sooner by supporting community research on board ‘lung health trucks’ which visit community locations. A total of 1,200 people took part in the Manchester Lung Health Study, which is assessing the uptake of a lung cancer screening service and its impact across north and east Manchester, and the IDx Lung study which is looking at using blood samples and a nose swab to detect lung cancer. Lung cancer is the leading cause of premature death in the UK and Manchester has the highest number of cases anywhere in England.

“Using data to understand local communities most underserved.”

Using deprivation markers to understand gaps in participation

Our leading cancer research partner organisation utilised information in the Greater Manchester cancer care record to identify the characteristics of participants who have consented to be part of clinical trials, and those who have not, since 2018. The exercise was designed to increase recruitment and, more crucially, reduce inequality in the research offer. Looking at postcodes, this methodology took into account deprivation markers such as employment, health, income and crime. Analysis of the data showed a lack of diversity among participants in research and set in motion a review to identify potential strategies that can be used across Greater Manchester to improve access to clinical trials to those in underserved groups.

A literature review synthesised with a survey completed by over 100 local NHS colleagues showed there are common groups underserved by research. Tellingly, the majority of survey respondents disagreed with the statement that research at the NHS organisation they work for is inclusive. Other key findings showed that research is not always designed in an inclusive way and much can be done to allow for equitable access, and that inclusion and diversity should be embedded in research design from the very beginning. We should look at scoping future work and investing to proactively monitor the local research offering. The outcomes of this work are helping shape work across our Inclusive Involvement theme to help improve diversity in research throughout the region.

Understanding the demographics of our participants

The only way to know which communities and citizens are being well served by research is to understand more about the demographics of our previous participants. This will allow us to identify gaps in participation to help research funders, industry and study designers develop research suited to our communities. With this in mind, we have worked with partner organisations to overcome barriers to collecting demographic data of participants. Following collaboration with our flagship cancer trust, we are now able to record the age profile of their participants and are exploring with care providers across our region how we can capture further data such as a person’s NHS number.

“Explored ways to increase staff diversity and expand involvement in research delivery”

Supporting our practitioners towards accredited status

Clinical Research Practitioners form a crucial part of our local workforce. Working in research delivery roles that involve direct contact with patients or other study participants, they have been officially classified as an occupational group in health and care since 2020. However, we have also supported practitioners to elevate their professional status by qualifying for the Clinical Research Practitioner Accredited Register. By helping staff attain this standard, we have helped them become recognised as a skilled professional with a status which offers assurance and accountability to participants and research teams. Promotion of the register is also helping raise the profile of the practitioner role.

Supporting young people into work in research

The career prospects of young people were disproportionately hampered by the pandemic and the disruption it caused to employment opportunities. We signed-up to the government’s Kickstart Scheme to support 16 to 25-year-olds in receipt of Universal Credit into work and were delighted to celebrate a real success story. Megan Balmer joined us on an initial six-month contract and after excelling in an administrative role earned a permanent position by grasping her opportunity and becoming an integral part of the team. Megan has since been promoted to Network Wide Senior Clinical Trials Administrator and is supporting the delivery of research with teams across the region.

Greater Manchester’s first cohort joins investigator development programme

We funded four health professionals to be part of a developmental programme designed to equip them with the skills, knowledge and experience to become Principal and Chief investigators. Dr Hiren Divecha, a Consultant Trauma and Orthopaedic Surgeon, is part of the first Greater Manchester cohort on the Research Scholars programme, which has given him a clear vision for his research career. He said: "Ultimately, I hope to be a clinical academic leader in the North West, helping to support the development of future aspiring clinical academics and guiding the research landscape in orthopaedics to ultimately benefit the patients we treat and the healthcare systems that provide this life-changing care.”

“Building on the partnerships we have established with patients and the public, health and social care professionals and the research community”

We are excited about the opportunities which lie ahead to realise the full potential of our Inclusive Involvement theme. Two great examples of existing partnerships helping us to achieve this are:

Improving under-representation of ethnic minority communities in research

People from minority ethnic backgrounds experience greater health and social care inequalities and are under-represented in research in our region and nationwide. We funded a project to help address this under-representation by improving the cultural awareness and confidence of research staff when engaging with and recruiting different ethnic groups. The project also focused on recruiting, training, and deploying community ‘research champions’. The findings have shown the importance of building trust and that minoritised community members are supportive of research engagement where information is clear and detailed, and are more likely to ‘open up’ with ‘ethnically concordant’ research staff. The project has resulted in a toolkit our entire research community can apply.

Hearing about maternity care experiences of all women

There is a large body of evidence showing that women from ethnic minorities and their babies have much worse maternity outcomes than their white counterparts. There is a need to fully understand their experiences of care to drive forward change. With this in mind, a Manchester study, which was recognised at our annual awards ceremony, investigated the maternity care experiences of women in the city, with a focus on those living in deprived communities and from ethnic minority backgrounds. Almost 400 women were part of the survey study. This included 260 women from black, Asian or other ethnic minority backgrounds thanks to a fully inclusive approach which involved visiting community postnatal clinics and having conversations to encourage participation. Numerous women were also interviewed in their own homes, with interpretation services arranged where English was not a participant’s first language.

Chapter 5: Exceptional Experience

The right Practice

Our third core value is about how we make people feel when they are involved in research across all of our regional services and sites. This could be a participant who takes part in a trial, a staff member who helps set up or deliver a study, or any stakeholder we deal with during the research cycle. We need to ensure they think and feel positively about their experience afterwards. By providing Exceptional Experiences, we can help ensure participants take part again, that we retain and recognise staff, and that we attract high-quality and relevant studies to our region for the benefit of our population. One Exceptional Experience should lead to another and make our region an amazing place to be involved in research.

Participant experiences:

These are important because people who have had a positive experience can be confident and comfortable repeat participants and encourage friends and family to be part of research. By listening to people’s perspectives and lived experiences, we can make improvements to the relevance of our research and its impact.

Over 90% of research participants would take part again

Nine-out-of-10 people who took part in health and care research in our region last year would get involved again. This was according to our Participant in Research Experience Survey completed by over 2,000 local adults. In the survey conducted in collaboration with our partner health and care organisations, over 92% said they would take part in a study again. To ensure they had that opportunity, everyone who completed the survey was given the option to register with our local consent-to-approach initiative Research for the Future. Recurring themes in participant comments were that they had an exceptional experience courtesy of local research staff, and that they were proud to be contributing to research that could make a difference to future patients or help tackle a specific health or care need.

Mohammad proud to be part of earliest COVID-19 Delta variant research

Patients in Greater Manchester played a key early role in furthering global understanding of emerging COVID-19 variants. As local Delta cases surged in summer 2021, researchers sought to understand more about the new strain and requested further patient samples from our region. Mohammad Attique was among the local patients to take part in a study gathering this data. Ordinarily a fit and healthy man, he fell critically ill with COVID-19 and spent 22 days in hospital including nine in ICU. The father-of-three said: “We lost a family member to COVID-19 and I was very happy to be part of this study and contribute to this important research. All of the research staff were very helpful.”

Staff experiences:

These are important because a motivated and skilled research delivery workforce is a key component in attracting studies to our region and delivering them to high standards. Positive staff interactions will support our region’s future workforce and help us build the capacity and capability needed to deliver our ambitions.

Investing in our future research leaders

We funded eight health professionals to be part of our latest Early Career Researcher Development Pathway Programme. Open to nurses, midwives and allied health professionals, the nine-month programme equipped each with the tools to pursue their own personal five-year career plan to achieve leadership potential. The Greater Manchester cohort wholeheartedly recommended others to consider the programme. Charlotte Williams, a Physiotherapy Practitioner, said “If you want to open doors into an amazing world of warmth, encouragement, knowledge and be equipped with the skills required to build research questions and activity into your clinical role, then this programme is perfect for you.”

Starting health professionals on their research career journey

Over 80 doctors, nurses and other health professionals from our region got involved with research for the first time as part of NIHR's Associate Principal Investigator Scheme. The in-work training programme provided them with practical experience and building blocks towards becoming investigators. Heidi Prior, an Advanced Nurse Practitioner in Respiratory Medicine, is “so thankful” for the opportunity. She said: “It has been a great asset in developing my role within research, but has also provided a better formatted support system when it comes to structuring engagement between the research team and other multidisciplinary team members.”

A lasting reminder of how our research community rose to the challenge

We celebrated the staff behind the incredible health and care research that took place during the pandemic with a special digital showcase. Over 90 individual and team contributions featured in our Greater Manchester Evening of Excellence, an uplifting film which provided a lasting reminder of the invaluable research delivery contributions made by our network. Our ceremony was viewed over 1,300 times, generating plenty of local pride, as our workforce watched remotely while enjoying hampers provided in collaboration with our sponsors. Juliette Novasio, a Research and Innovation Manager at our host trust, said: “I really enjoyed seeing the amazing Greater Manchester response to COVID and all the other great work our colleagues have done. We couldn’t do it without our wonderfully supportive CRN.”

Wave of thanks reaches over 200 people in research community

Over 200 people working in all types of organisations across our research community received a message of gratitude, thanks to our innovative Note of Thanks initiative. Our digital form allowed people to send a deserving staff member a short complimentary note, keeping themselves anonymous if they wished, direct to their inbox. The recipient also received a link to the form and was encouraged to congratulate someone else for their efforts. This resulted in a chain of gratitude which swept across organisations during the International Clinical Trials Day campaign period. It generated a feelgood factor which ensured hundreds of individuals were recognised for their contribution to research.

Industry and partner experiences:

If we cannot provide partners with great experiences, then we are giving them no incentive to work with our region again. This results in missed opportunities for our communities. A harmonious relationship with industry and other stakeholders helps us create an integrated research system that meets the needs of our population, is at the forefront of research, and attracts inward investment.

98% satisfaction from local partners

Every year our local partner organisations are asked by the NIHR to complete a survey on how we are delivering on the core activities expected of a Clinical Research Network. The latest survey showed our overall median partner satisfaction level was 98%. The 2021 survey also contained a question, introduced for the first time, to help inform progress against the NIHR’s focus to bring research to under-served regions and communities with major health needs. A total of 75% of respondents agreed, and 25% somewhat agreed, they were satisfied with our progress in this area.

Helping biotech deliver research

The biotech sector has the ability to improve people’s health outcomes through groundbreaking technology. However, high quality research support is needed to trial products and gather the required data. Jonathan Abraham, Chief Executive Officer and founder of healum, a digital health platform for managing patients with long-term conditions, says his firm could not have managed this without our Study Support Service. With our support, over 180 local participants took part in a trial evaluating how effective a mobile app is at helping people with type 2 diabetes learn about and manage their condition. Mr Abraham said: "For anyone thinking of partnering with primary care sites, firstly: use the NIHR. I can't stress enough, we would not have been able to do what we've done without them.”

Researchers praise transformative impact of Join Dementia Research

Manchester researchers described how working with our team has been transformative. The Care Act Easement Study aimed to understand the impact of pandemic-enforced changes in service provision on the experiences of older carers supporting a family member with dementia to live at home. Working in partnership with our Join Dementia Research service was particularly fruitful. Professor Debora Price, Principal Investigator on the study, said: “We were really struggling with recruitment of older people in the community providing care at home to a family member during the pandemic, as many of our usual routes to recruitment were closed. We needed to recruit substantial numbers to an online survey. Without adoption by the CRN and the very considerable hands-on support for recruitment provided, we would not have recruited sufficient respondents.”

Helping life-changing cancer research get up and running

Our Study Support Service provides a range of services throughout the cycle of a study. The team behind the OnCoRe project said their research could not have happened without this help. This research recruited patients whose rectal cancer regressed after chemotherapy to look at the safety of a ‘watch and wait’ policy, as opposed to proceeding directly to radical surgery. The findings mean some patients will avoid the need to have a permanent colostomy bag. Professor Andrew Renehan, the Chief Investigator, based at The Christie NHS Foundation Trust, said: “Without CRN Greater Manchester’s support, OnCoRe would never have managed to recruit the numbers it has managed [over 80 in Greater Manchester alone], despite the unavoidable setback of the pandemic. This has resulted in practice-changing publications in the Lancet group of papers and NICE adding to its guidance that patients who go on to the complete response pathway should be entered into the OnCoRe national registry.”

“Building world-class research delivery services”

We are working to support the development of our current and future services to make our region the best place to be part of research. Standout examples from the past year include:

National recognition for our delivery

We were recognised on a national level for the crucial role we played in evaluating the use of 30-minute lateral flow tests which became part and parcel of people’s everyday lives. Our Delivery Team was a finalist in the Team of the Year category at the prestigious Royal College of Nursing Awards 2021, and was the only dedicated research finalist represented in any category. This recognition came after we led the way on the nationally-prioritised COVID-19 diagnostics study, to which we recruited over 200 participants, making us the highest recruiting region. The study was completed within just 32 days which enabled the tests to be used across the UK 40 days after the team’s initial input.

Providing high-quality training and development across the whole North West

Our Workforce Learning and Development team ensures we have the right people, in the right number, in the right place, at the right time, with the right skills to deliver research. We became the first CRN to establish a combined team which now covers the CRNs for Greater Manchester and North West Coast. This means we now have a ‘One North West’ research workforce team working flexibly to help staff at all levels from our local health and care organisations develop and refine their delivery skills.

Excellence across our Local Clinical Research Networks

The Clinical Research Network does not just exist in Greater Manchester, East Cheshire and East Lancashire. We are part of a thriving national NIHR system with local networks embedded in 15 regions across England, all collaborating and sharing knowledge and experience to provide the best services for our regional populations. Almost 1,300,000 participants took part in over 4,600 portfolio studies across our networks in 2021/22. Here’s some highlights from our CRN partners.

Taking research to the Commonwealth Games

From Coventry to Wolverhampton, Sandwell to Walsall, the #BePartOfResearch message was handed to the people of the West Midlands across Queen's Baton Relay events as CRN West Midlands made the most of the Commonwealth Games to engage with communities. By attending Baton Relay and Games Festival events before and during the spectacle, network staff were involved in this global celebration of sport. It was a great opportunity to debunk some myths about research and give people more information about how they could get involved.

Landmark funding award for care home

CRN North East and North Cumbria supported Clare Leonard of Appleby Care Home in Whitley Bay to become the first ever care home manager to secure an NIHR Greenshoots award. The Greenshoots Principal Investigator Scheme provides funding and development opportunities for applicants to pursue a career in research. Clare plans to use the funding to increase training for care home staff and to put Appleby on the map for being a research-active care home.

New investigator funding yields UK firsts

CRN East of England achieved eight UK commercial firsts (a fifth of all network firsts), three of which were from Greenshoots awardees. Of the Greenshoots commercial firsts, one was in Primary Care, where the awardee took on the role of Principal Investigator for the first time and surpassed the site’s recruitment target. The others were for two separate cancer studies, reflecting the calibre of the scheme’s applicants and their tremendous potential to further develop the region’s portfolio of studies.

Creating Research Ready Communities

Three of our local networks were chosen to take part in a pilot scheme designed to engage under-served communities, and improve inclusion and representation in health and care research. At CRN North West Coast, staff worked with young people aged 16 to 21 in Blackpool on a series of work streams which a group of 16 young professionals could get involved in, with the aim to upskill them in different areas of research. The pilot has been so successful that it is now being rolled out across England.

Tackling health inequalities

Alongside being chosen to pilot the Research Ready Communities pilot, CRN South London hosted an Equality, Diversity and Inclusion Symposium in February 2022: a ‘call to action’ to make a critical difference in building positive relationships with under-served communities. This led to the creation of the Inclusivity Panel, a diverse group of individuals representative of the community who now lead on projects and ensure core business is consistently inclusive.

Establishing virtual ward for groundbreaking antiviral study

In late 2021, the University of Oxford announced the PANORAMIC study into whether antiviral treatments for COVID-19 can be provided in the community to reduce the need for hospital admission and help people get better sooner. To support centralised recruitment, CRN Thames Valley and South Midlands collaborated with other LCRNs to provide 33 whole time equivalent staff members to consent by telephone those volunteers who signed up online. These staff were added to a ‘virtual ward’ rota, supporting the recruitment of more than 25,000 people.

Recognising workforces across the country

Recognition of our workforce is important across the NIHR and several of our networks held award ceremonies to celebrate the excellence and hard work of staff in their regions. In brand new additions to the calendar, CRN Kent, Surrey and Sussex and CRN West of England held their inaugural ceremonies. Both received a large number of entries and brought together the local research communities to celebrate success. And for the first time, CRN East Midlands hosted its awards ceremony as a hybrid event, enabling people to attend in-person in Nottingham, or to participate virtually online.

London alliance using pandemic lessons to improve research

The North West London Clinical Trials Alliance was born out of necessity during the pandemic. Partners from across the region came together to collaborate in new ways to deliver urgent public health studies in record times. Achievements in the first year included the delivery of eight COVID-19 vaccine trials with 1,600 participants recruited at 100% time-to-target. The alliance is now working to replicate its success in other disease areas. It aims to increase its regional capacity for delivering commercial clinical research and improve the ease and speed of research delivery.

Booster study informs national COVID-19 vaccine policy

The latest results from the COV-BOOST trial, led by CRN Wessex, showed that a fourth dose mRNA vaccine is safe and boosts antibody levels - even higher than that of a third dose. The NIHR-funded study provided the world’s first data on the safety, immune responses and side-effects of a third COVID-19 vaccine dose in mix and match schedules. The study was key to shaping the UK’s 2021 autumn booster programme and gives vital evidence for global vaccination efforts.

Regional partnerships

As well as being part of a national system with the 14 other Local Clinical Research Networks, we collaborate particularly closely with our fellow northern networks as we seek to overcome similar challenges facing our populations.

Collaborating to bring more life sciences research to the north

Along with our colleagues at CRN Yorkshire and Humber, we are part of the Northern Prime Site. This is a partnership between NIHR and IQVIA, the global health technology and human data science company focused on the delivery of life-changing clinical research. This relationship brings together NHS research-ready hospitals across the two regions and is facilitating a significant increase in clinical trials and real world evidence studies in the north. Since its inception, the number of studies delivered across both regions has risen from 50 in 2017/8 to 85 in 2021/22, and the number of participants has increased from 287 to 416.

Taking a broader view of our northern populations

We are part of the Northern Diamond, which sees us work closely with our colleagues at CRN North West Coast, CRN Yorkshire and Humber, and CRN North East and North Cumbria. This alliance is about ensuring we see the North as a collective research destination, as opposed to working in silos and competing with one another for study placement. This collaboration helps us to support and improve the health of the northern population and transfer knowledge.

Meeting shared regional challenges together

Together with our fellow northern CRNs, we collaborate on projects where we share the same challenges. For example in February 2022, we came together to host a successful diabetes webinar designed to raise awareness and generate interest in different areas of diabetes treatment and research in the north of England. Over 300 delegates enjoyed a varied schedule which took a Multiple Long Term Conditions approach covering type 1 and type 2 diabetes, mental health, heart failure, and chronic kidney disease, to name but a few.

Conclusion

2021/22 was a year which saw the continuation of vital COVID-19 research alongside the recovery of our capacity to deliver life-changing research in other areas. Everyone in our network should be extremely proud of the way in which we have successfully managed to balance these two challenges. To put things in context, 60% of our research volunteers were part of non-COVID studies in the last year, compared to 36% in 2020/21. This would have been unthinkable at the height of the pandemic and helps to show our resilience in getting a broad portfolio up and running once more.

In line with our three values, staff across our network have worked tirelessly to deliver health and care research that is relevant to our region, inclusive to our communities and provides exceptional experiences. An enormous thank you to everyone who has played a part in this effort. Equally, research would not be possible without the many people who give their time and effort to take part in studies, raise public awareness, and contribute in countless other ways. Thank you to everyone.

Looking forward, good progress is being made in our plans for 2022/23 and beyond and we are looking forward to becoming part of the new North West Regional Research Delivery Network from April 2024, a transition which presents us with even more opportunities to change lives through research as we prepare to serve a population of over seven million people.

Roger Spencer
Chairman of the CRN Greater Manchester Partnership Board,
and Chief Executive of The Christie NHS Foundation Trust.

Contact us

For all enquiries about how we can support you to set up and deliver research in NHS, Public Health and Social Care settings in Greater Manchester, East Cheshire and East Lancashire, email our single point of contact address: researchsupport.crngm@nihr.ac.uk

You can also find out more by:

Visiting our website - https://local.nihr.ac.uk/lcrn/greater-manchester/
Following us on social media: Twitter: twitter.com/NIHRCRN_gman and LinkedIn: linkedin.com/company/nihr-clinical-research-network-greater-manchester