Ten years of CRN Greater Manchester: Strategic Impact Report, 2014 - 2024

Foreword

For the last 10 years, Clinical Research Network (CRN) Greater Manchester has been extremely honoured to be part of the research community working with delivery partners and stakeholders throughout Greater Manchester, East Lancashire and East Cheshire to deliver high quality health and care research. Over this time, over 632,938 participants have been recruited from across 4,900 NIHR portfolio studies with all health and care specialties and settings represented. This report showcases highlights which span the last decade, providing a snapshot of the region's research impact, as well as how we have collaborated to overcome challenges to provide our communities with an array of research opportunities.

As a region, we have consistently excelled in commercial research which is a vital part in providing local people with access to the latest treatments, preventions and technologies. We are proud to share that CRN Greater Manchester delivery sites averaged 84% in reaching their study targets, on time, over the last 10 years. This is attributed to the hard work and dedication of all those involved in the delivery of the local commercial portfolio, and the time and commitment of our local communities.

Our exceptional specialty leads, with the support from the CRN Greater Manchester core team, have provided leadership across all 31 health and care areas. Within this report we are delighted to share examples of how studies, spanning these areas, have had a positive impact on the lives of people within our local communities.

The COVID-19 pandemic brought unavoidable disruption across all aspects of our lives in 2020 and research delivery was no exception. However we are immensely proud of our fantastic research teams across the region who excelled in the delivery of urgent public health studies that focused on vaccines, diagnostics, treatments and monitoring disease progression. We ensured studies were set up with efficiency and speed so that they were delivered at pace.

In 2021, we agreed our CRN Greater Manchester values: Relevant Research, Inclusive Involvement and Exceptional Experience. They quickly became embedded in all that we do and became the natural framework which we used to structure our regional research delivery development and growth. CRN Greater Manchester has invested £1.67m across 62 strategic projects, which were underpinned by collaborative working and the need for transferable outcomes.

Over the last decade, the growing need for research to meet the needs of communities outside the hospital setting has intensified. Improving research access for communities, not historically given the opportunity to participate, is paramount to our work. CRN Greater Manchester responded through a number of strategies which include the state-of-the-art research van, health research festivals and the formation of the direct delivery team working within local communities

As we look forward to the next 10 years we want to give our heartfelt thanks to all the people who have given their time to be part of a research study. We also want to thank all those involved in the delivery of portfolio studies, whatever their role. As we approach the end of the local Clinical Research Network we have lots of reasons to be excited about the future NIHR North Research Delivery Network as we build together on a decade of successful research delivery.

Thank you for your support and thank you to everyone who has contributed to the successes outlined in this report.

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

A decade by numbers

Funding invested in local research delivery - £203m
Total participants in research - 632,938 (over 20% of Greater Manchester population)
Total recruiting studies - 4,900
Total recruiting sites in CRN Greater Manchester - 1,285
Total participants in commercial research - 44, 256 (highest in England)
Total commercial recruiting studies - 1,775
Average percentage of commercial recruitment to time and target - 84% (highest in England)
Global, European, UK first recruits - 30 global/European, 33 UK
Participants in Primary Care - 42,541
Participants in COVID-19 Urgent Public Health studies - 76,045
Number of research staff (WTEs) funded - 40,000
Number of Clinical Programmed Activities (PAs) funded - 900
Staff to complete Good Clinical Practice training - 23,154
Responses to Participants in Research Experience Survey (since 2018/19) - 10,097
Percentage of surveyed participants who would take part again - 91%
Strategic research delivery projects funded - 62 (£1.67m invested)

2014: The Clinical Research Network is born

CRN Greater Manchester was launched by NIHR in April 2014 as one of the 15 Local CRNs (LCRNs) across England. The LCRNs were established to work together with the CRN Coordinating Centre, based in London and Leeds, to support the set-up and delivery of research.

Before this, England’s research system had been made up of 102 overlapping and separately funded regional networks. Each supported research in different therapy areas. The introduction of the CRN brought together all the expertise of those topic-specific networks into a centralised organisation with on-the-ground infrastructure in the 15 LCRNs to assist with the delivery of studies.

Our CRN Greater Manchester patch covered Greater Manchester, East Cheshire and East Lancashire. With an average budget of £20.3m per year we supported research delivery by working with NHS trusts, local care organisations, primary care, social care, public health and non-NHS partners. We were hosted by Manchester University NHS Foundation Trust (MFT) for the duration of the 10 years.

Who we worked with

We worked with all of the NHS trusts, local care organisations, primary care, social care, public health and non-NHS partners across Greater Manchester, East Cheshire and East Lancashire.

Our local partner trusts were:

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 worked with local care organisations in all of our communities across our region. This included:

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

Our CRN Greater Manchester funding and core team

The core funding allocated by CRN Greater Manchester represented a significant income stream for our partner organisations. Over 10 years, our funding helped provide stability in the system and enabled organisations to build teams and plan and deliver research effectively. We funded various roles essential to the set up, delivery, and management of research. These roles spanned clinical, administrative, and leadership functions, ensuring a comprehensive support network which enabled our region to deliver research across all specialty areas and settings. Many of the highlights in this report would not have been possible without the CRN Greater Manchester funding which ensured capacity and capability were in place.

Our core team

The in-house departments which formed our CRN Greater Manchester core team played a crucial part in the success of our network. Directly or indirectly, one or more of the departments listed below, at some stage in the research cycle, contributed to all the achievements outlined in these pages.

Our joint Study Support Service and Industry team were often the first point of contact to help researchers and the life sciences Industry plan, set-up and deliver research to planned timescales.
Our Research Delivery Managers and Assistant Research Delivery Managers oversaw our portfolio of studies by supporting the different specialty areas and collaborating with our local health and care organisations.
Our Workforce Learning and Development team ensured we had the right people, in the right number, in the right place, at the right time, with the right skills, to enable high quality research delivery to take place.
Our Delivery Team worked with local health and care organisations, study teams and communities to provide research opportunities to people in a wide variety of settings.
Our Communications team managed all of our internal and external communications directed at the public, staff or other partners, and led the management of our events.
Our Information Management and Technology team analysed data and provided insights to inform strategic decisions and improve research outcomes.
Our Finance team managed budgets, funding allocations, and financial reporting to ensure efficient use of resources.

CRN Greater Manchester: A timeline 2014 to 2024

2014

CRN Greater Manchester launches

The Department of Health (as it was then called) launched a strategy called ‘Best Research for Best Health’ to enhance health research. A key action was to establish the NIHR Clinical Research Network (CRN) in 2014, which involved the restructuring of topic specific networks into 15 regional networks. CRN Greater Manchester’s launch event was held on 29 April 2014. We began supporting the delivery of all health and care specialties which we managed across six divisions. Social Care research was later added to the CRN portfolio.

Digital system for rapid recruitment and set-up

FARSITE is a digital system developed with our colleagues at NWEH. Since before we launched in 2014, FARSITE provided faster patient recruitment and trial set up, enabling searches of over 3.3 million anonymised patient records for potential participants based on specific criteria. It has been a particularly priceless resource for carrying out feasibility checks to assess the suitability of studies for our patient population.

Our regional research registry

Research for the Future was founded in 2011 to help Greater Manchester’s residents get involved in research. Following our formation in 2014, it became a key part of our CRN infrastructure and expanded to cover all health and care areas and the entire North West. Over 17,000 people registered and over 300 research teams were supported.

Anaesthesia trial results show less pain for bowel cancer patients

Research led and delivered in our network showed an alternative approach provides greater pain relief and fewer side-effects after major abdominal surgery. The TERSC trial was delivered with 130 bowel cancer patients in East Lancashire and focused on laparotomy, routine for emergencies such as peritonitis. In the UK, this is a common procedure with around 30,000 performed each year. Results showed the benefits of instead using Rectus Sheath Catheters, a fine tube that is inserted into the abdomen allowing pain-relieving medications to be injected.

Analysing the effectiveness of local service changes

The Salford Integrated Care Programme aimed to change the way health and social care is provided to older people and make care more ‘joined up’. Research led by our Health Services Research Specialty Lead spoke to professionals involved and watched new services being delivered to understand how they worked. Almost 5,000 older people, recruited through Primary Care, were spoken to, answered a survey and tested services to see if they were better. Results gave an insight into whether the major service changes have improved patient care.

Recognising our region’s excellence

CRN Greater Manchester hosted the Greater Manchester Clinical Research Awards every year from 2014, except for the COVID-affected period 2020-21. Later known as the Greater Manchester Health and Care Research Awards, the event became a major date in the research calendar, attracting over 200 nominations a year.

2015

Delivering groundbreaking ‘real world’ research in Salford

We supported the world’s first real-world respiratory trial to be carried out with a patient population within a single geographical setting. Closing to recruitment in 2015, the groundbreaking Salford Lung Study evaluated a new treatment for Chronic Obstructive Pulmonary Disease (COPD) and asthma with over 2,800 patients from primary care. The trial model represented a major advance in the way clinical trials were conducted. Results showed the treatment, taken once a day, significantly improved asthma control in patients compared with their usual care.

Join Dementia Research (JDR) launched

JDR launched as a national NIHR initiative in 2015. Since this time over 2,900 people have registered to be part of the service in the CRN Greater Manchester region, with 1,500 people participating in studies. So far 127 studies have been available for people to consider taking part in.

Greater Manchester Devolution

Following an agreement with the government in 2014, the health and social care devolution deal was confirmed in February 2015. This enabled the formation of a regional plan with additional powers for the health and care needs of the population of Greater Manchester. NIHR research published in 2024 showed devolution enabled significant improvements in many parts of the health system in Greater Manchester.

2016

First region to introduce video game shoulder rehab

Our network transformed the way shoulder surgery patients receive physiotherapy by using video games to help patients rehab. Trafford Hospital was thought to be the first in the world to adopt this technology into day-to-day physio following a successful Greater Manchester-led study delivered between 2016 and 2018.

Studying how best to support people living with dementia at home

Over half of people with dementia live at home. Greater Manchester-led social care research identified what home support is available and what helps people with dementia and their carers. The findings were shared to guide organisations. A trial carried out as part of the programme tested whether or not guided use of memory aids helped people in the early stages of dementia. Results showed daily living activities were no better for those using memory aids than for those in usual care.

The woman who can smell Parkinson’s

A neurology study enabled scientists in Manchester to develop a test which could help diagnose Parkinson’s in three minutes using a simple skin swab. This research was inspired by Joy Milne, who discovered she had the ability to ‘smell Parkinson’s’ following her husband’s diagnosis. We helped recruit to the study by taking swab samples from volunteers’ necks.

Addressing Manchester’s child tooth decay statistics

Tooth decay in children in Manchester is worse than the England average, causing pain, poor sleep and school absences. It can mean children have several or all their teeth extracted. A Greater Manchester-led oral and dental study, called Tiger Teeth, tested the benefits of supplying free toothpaste, brushes and guidance information to families with a child who had teeth removed under anaesthetic. It found that any families with a child with at least one dental extraction under general anaesthetic should be targeted with future oral health interventions.

2017

Biggest ever children’s study supports decision-making on Emergency Department admissions

A new guidance tool to support decision-making on admissions to hospital emergency departments was introduced following the CRN’s highest-ever recruiting children’s study. This was possible thanks to the Greater Manchester-led PAT-POPS study which recruited more than 36,000 children and young people.

Ground-breaking glaucoma study

Michele Steventon from Saddleworth described how taking part in glaucoma research “freed her” from the condition. Michelle was among the first two patients in Europe to be part of the Summit study, trialling the use of a tiny stent inserted to reduce the eye pressure caused by advanced glaucoma.

Injections give new hope to psoriasis patients

Greater Manchester-led research published in 2017 showed weekly injections of a treatment for psoriasis can help more people with this inflammatory skin condition. People with severe psoriasis, or those for whom creams and ointments haven’t worked, can be prescribed what are known as systemic treatments or medicines, often a drug called methotrexate given in tablet form. However, a study we supported showed nearly half of patients who had methotrexate, but as an injection, for a full year saw a 75% improvement in their skin condition.

NHS rolls out ‘life-changing’ sickle cell treatment following trial

In 2017 our network recruited the first patient in Europe to research looking at a drug to help patients living with sickle cell disorder. The haematology trial found that more than half of people given the trial medication had an increase in haemoglobin (a protein inside red blood cells that carries oxygen around the body) which could improve symptoms and quality of life for people with the condition. Thousands of patients with sickle cell disorder are now to be offered the “life-changing” treatment on the NHS.

60-minute iron infusion can prevent heart failure admissions

Heart failure accounts for 4,300 hospital admissions in Greater Manchester per year. Our region played a key role in research which showed that an hour-long iron infusion into the vein every one to two years could help people with heart failure avoid being admitted to hospital and improve quality of life. Almost 140 participants across four hospitals from our region took part in the IRONMAN study, which recruited participants throughout 2017 and beyond, and two of our senior investigators were co-organisers of the research.

2018

Research provides couple with the gift of life

Research quite literally changed the lives of an East Lancashire couple who had been unable to conceive for three years. In 2018 Jessica Corbally and husband Chris experienced the joy of their second child, baby Joshua, after Jessica took part in a study evaluating whether a new procedure results in higher pregnancy rates in couples with unexplained infertility.

Trial shows drug can ease chronic cough symptoms

Chronic coughing is thought to affect between four and 10% of the population. The condition can cause abdominal pain, urinary incontinence in women, as well as anxiety, depression and difficulty sleeping. The results of the world’s first Phase 3 trials of a new drug called Gefapixant showed it can ease the often distressing symptoms, with minimal side effects. Our network supported the delivery of the study, which held the potential to have a significant impact on the lives of thousands of sufferers.

On the move

In May 2018 our core team moved headquarters into Citylabs 1.0, a precision medicine and health innovation hub on Manchester University NHS Foundation Trust’s Oxford Road Campus. We were previously based nearby at the rear of Manchester Royal Infirmary.

Sequencing 100,000 genomes

Greater Manchester played a key part in the 100,000 Genomes Project set up to sequence 100,000 genomes from 85,000 NHS patients affected by a rare disease or cancer. As a result, patients have been offered a diagnosis where there wasn’t one before. The project also enabled the delivery of new research. Combining genomic sequence data with medical records in the NHS developed a resource for researchers with ethical approval to study how best to use genomics in healthcare and how best to interpret the data to help patients.

Safely reducing antibiotic use in patients with sepsis

Annually in the UK, about 200,000 people develop sepsis and up to a quarter will die. A Manchester-led Critical Care study, ADEPT SEPSIS, carried out with almost 2,800 participants, looked at whether the duration of antibiotic treatment given to patients with sepsis can be safely reduced following the close daily monitoring of bloods. Shorter courses of antibiotics for a patient with sepsis may result in less antibiotic use, resulting in fewer side effects, less risk of antibiotic resistance and a reduction in NHS costs.

NHS 70th birthday celebrations

As the nation marked the NHS’ landmark 70th birthday in July 2018, we hosted a packed event which brought together partner organisations from across the network. The day celebrated our region’s research contribution over the seven decades and promoted current participation opportunities.

Meningitis vaccine in teens helps protect all age groups

‘Be on the Team’, also known as MENCAR, was conducted at schools across the country with recruitment starting in 2018 within our region's schools. Greater Manchester was the highest recruiting region, with 5,200 teens involved. The CRN Delivery Team was involved in taking throat swabs from participants aged 16 to 18 to assess the prevalence of meningitis causing bacteria before and after the introduction of the MenACWY vaccine programme for teenagers in 2015.

First reliable test for dementia in people with hearing loss

Researchers developed the first reliable test for dementia in people with hearing loss, following a Manchester-led study we helped to deliver. Hearing loss commonly occurs alongside dementia. However, tests for dementia often include spoken questions that rely on hearing. People with hearing loss therefore score worse in these tests, which can lead to a false diagnosis of dementia. The new test from the SENSE-Cog study could accurately diagnose dementia in people with hearing problems.

2019

Celebrating women in research on International Women’s Day

There was standing room only as an audience of 60 people attended our first event to mark International Women’s Day, titled ‘Celebrating Women in Clinical Research’, in March 2019. The event toasted the wealth of outstanding women leading and contributing to research at all levels in our region.

Virtual reality therapy helps people with agoraphobia

Our network helped deliver the largest ever clinical trial of virtual reality technology in mental health. The gameChange VR therapy is for people living with psychosis whose fears have caused them to become largely housebound. Study results showed gameChange led to reductions in anxiety and distress in everyday situations compared with usual care alone.

Reducing strain on A&E and ambulance crews

Chest pain is the second most common reason people call 999. However, most of such hospital visits turn out to be unnecessary, as symptoms of a heart attack and other non-cardiac conditions are often similar. CRN GM led a study, called PRESTO, which started recruiting in 2019, showing patients who call 999 with chest pain can be safely assessed and managed by paramedics using a decision aid. This can provide early reassurance for patients and has the potential to ease pressure on A&E and ambulances services.

Be Part of Research launches

NIHR launched its Be Part of Research website in May 2019, creating a new and easier way for people to find and take part in studies relevant to them. We celebrated the launch with a special event for partners and the public on International Clinical Trials Day.

2020

All non-COVID research pauses

The Prime Minister announced the first lockdown in the UK in March 2020 following the coronavirus outbreak, ordering people to “stay at home”. All attention in the CRN turned to expediting the set up and delivery of Urgent Public Health studies.

Participant receives landmark plasma donor from recovered COVID patient

Our network recorded its first adult patient to receive a transfusion of blood plasma from a donor who had recovered from COVID-19. This was part of their involvement in the REMAP-CAP trial looking at potential treatments for the condition. Jo Henry from our Delivery Team administered the transfusion.

First Public Health study traces spread of COVID

The Virus Watch study was set up in June 2020 to identify how COVID-19 spread and how to stop it. Our network contributed to the research, our first involvement in a Public Health study, which recruited almost 60,000 participants from over 28,000 households. Researchers were able to estimate the incidence rates using study data and comparing it with estimates from the Office for National Statistics. The results were vital in informing government planning, public health and NHS responses to the virus.

Debbie takes well-deserved retirement

Our network had a change in leadership following the retirement of Chief Operating Officer (COO) Debbie Vinsun in September 2020. She was succeeded by Deputy COO Sarah Fallon who provided leadership through to the completion of the CRN in 2024.

2021

New values embedded in everything we do

Following the pandemic, in 2021/22 we consulted with our research community and took on board a variety of perspectives to form our renewed values for the region. They were Relevant Research, Inclusive Involvement and Exceptional Experience.

Greater Manchester showcases social care research ambitions

CRN Greater Manchester was delighted to welcome the newly-appointed NIHR Chief Executive, Professor Lucy Chappell, to our headquarters in October 2021. She heard presentations on the Social Care research programmes and delivery models being carried out in the region and had the opportunity to meet representatives from various parts of the Greater Manchester NIHR infrastructure.

Report shows CRN Greater Manchester’s pandemic impact

Our network’s crucial contribution to the groundbreaking research which helped turn the tide on COVID-19 was outlined in a strategic impact report. The brochure demonstrated how our region played a significant part in the development of vaccines, treatments, and diagnostics which allowed millions of people to be safely tested, treated, and protected from the virus.

Public urged to Help BEAT Coronavirus

We launched a new campaign in our region in June 2021 to encourage people to take part in research to help the NHS in the fight against COVID-19. ‘Help BEAT Coronavirus’ was added to the specific disease area campaigns run as part of our Research for the Future initiative.

Working through pandemic inspires research career journey

When COVID-19 first took hold, Sarah Yousif was a nurse at Wythenshawe Hospital and had never been involved in research before. After being redeployed to COVID wards, she decided she wanted to make a difference by following a career in research.

Online ceremony celebrates outstanding pandemic effort

In November 2021 we celebrated our colleagues behind the research that took place during the pandemic with a special online awards ceremony. Over 90 individual and team contributions featured in our Greater Manchester Evening of Excellence which was viewed over 1,600 times.

Vaccine trial campaign recognised at Northern marketing awards

Our awareness campaign which resulted in over 24,000 people in our region registering an interest in taking part in a COVID-19 vaccine trial was recognised at the Prolific North Marketing Awards held in November 2021. We were shortlisted for Best Health Campaign and Best Not For Profit Campaign.

Using digital to trial new treatment in Primary Care

We collaborated with the Greater Manchester system on a study of 900 patients 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. This research allowed staff to identify and recruit at-risk groups digitally, track the patient journey and provide real-time monitoring. The study proved the capability to identify an at-risk population in Greater Manchester who may benefit from a cholesterol-lowering medication.

Manchester-led research could diagnose diabetes in A&E

It is expected over 25% of people living in Greater Manchester will develop type 2 diabetes in their lifetime. The FIND-IT study, which was Tameside-led research, could be transformative system-wide by helping identify type 2 diabetes earlier in people via a simple blood test during visits to A&E. This can set patients on treatment plans to improve health outcomes and reduce long-term strain on the NHS.

2022

Inspirational students excel on research placement

Ten ambitious A-Level students excelled during a jam-packed Nuffield Research Placement with our team in August 2022. We then signed up to host placements each year until the end of our CRN contract.

Our first Health Research Festival

We held our very first Health Research Festival in Levenshulme, Manchester, in November 2022. Over 100 people attended what would become a series of popular events taking place in community locations across Greater Manchester over the next two years.

First UK patient treated with pioneering gene therapy

The first patient in the UK was treated in Greater Manchester with a pioneering new investigational gene therapy designed to treat the debilitating genetic disorder Gaucher disease. They had access to the one-off treatment on a study for the inherited condition, which causes harmful substances to build up in cells that then accumulate in various organs. The treatment has potential to stop disease progression, improve outcomes, and free people from lifelong treatments, none of which currently work for everyone.

Providing a further treatment option for ulcerative colitis

The UK has a prevalence of one-in-200 for inflammatory bowel disease which greatly impacts people’s daily lives. Novel therapies have helped patients whose conditions haven’t responded to treatment. Our network recruited the first patient in the UK to a study assessing the real-world effectiveness of filgotinib, a small molecule licensed for treatment of ulcerative colitis. Findings, drawn from a diverse patient population, showed that filgotinib is an effective and low-risk treatment option.

2023

New clinical system for early identification of liver disease

Greater Manchester has one of the UK’s highest rates of liver disease. Our network led pioneering research which invited hundreds of patients in primary care potentially at-risk of liver disease to be part of the ID LIVER study. Participants received a liver assessment and provided information which allowed researchers to develop new, improved tests for detecting liver disease earlier and predicting disease progression. The study was the first to utilise our Research Van in the community in January 2023.

An insight into our core team’s day-to-day

Our CRN Greater Manchester core team created a series of blogs which formed a successful part of the NIHR’s ‘Shape the Future’ campaign. The blogs gave an insight into how each department works and lives our team values each day.

Book encourages children to think about research

In May 2023 we launched a story book in collaboration with a local author and designed to give children a greater understanding of research from a young age. We shared hundreds of free copies of Ready for Research with schools and NHS partners.

Workforce recognition scheme rewards excellence across network

Long-serving research midwife Linda Peacock became the first person to receive the CRN Greater Manchester Certificate of Achievement in May 2023. We introduced this initiative to formally recognise excellence throughout the year.

First-of-its-kind Commercial conference promotes the North

In November 2023, over 450 delegates attended our first ever Great North Research Conference for the Life Sciences and Med Tech industries, held in the Concorde Conference Centre, Manchester.

Findings shared from first Research Ready Communities (RRC) project

Older people in Salford shared their perceptions of research as part of our first NIHR Research Ready Communities (RRC) initiative. The community organisation Inspiring Communities Together presented an action plan for future activities during their wrap-up event in November 2023.

2024

Record recruitment in Primary Care

As the 2023/24 financial year ended, we celebrated our best year for primary care research recruitment (over 12,000 participants), providing more patients with opportunities in general practice than ever before thanks to more research-active sites. Our revised engagement strategy saw the number of practices applying for Research Site Initiative funding more than double compared to 2022/23. A total of 184 practices recruited to studies, with 103 of these new to research.

Award success for Inclusive Innovation

We won an award at the Northern Power Women Awards, held in Manchester in March 2024, in recognition of our work in making research more inclusive. We took home the award for Inclusive Innovation which recognised nominations pursuing game changing innovation which led to accelerating equality.

Special event celebrates 10 years of CRN Greater Manchester

The region’s research community came together in July 2024 to celebrate the decade of impact made by our network. The afternoon culminated with an inspiring presentation from bowel cancer patient Lyndsey Ainscough from Leigh. Lyndsey spoke movingly about her research journey, explaining how she is now cancer-free after taking part in a trial.

CRN becomes the RDN

CRN Greater Manchester reached the end of its contract on 30 September 2024, in line with all LCRNs. From October 2024, our organisation formally begins its transition into the Regional Research Delivery Network (RDN) North West. The RDN will be hosted by Manchester University NHS Foundation Trust and led by Director, Professor Andy Ustianowski. The transition is an opportunity to evolve the network and meet the demands of the health and care needs of the future.

Digital

Our development and use of digital solutions over the decade confirmed that digital is one of the best ways to continually improve our services. From linking health records for trial recruitment, to implementing ground breaking site identification software, we made huge progress in improving efficiency and effectiveness in the research system.

Introducing a Local Portfolio Management System

Before 2016, national research activity was recorded and uploaded manually to the Central Portfolio Management System (CPMS) - a cloud-based system which holds the CRN portfolio. Later, all LCRNs were required to procure and implement a Local Portfolio Management System (LPMS) to capture local research activity. In partnership with our host trust, Manchester University NHS Foundation Trust, in April 2016 we went live with a system called R-PEAK which went above and beyond LPMS requirements. It provided a complete solution to efficiently manage studies, including performance and finances, and enabled the electronic transfer of research activity into the CPMS. R-PEAK gave us a database, document repository and enabled NHS staff to efficiently create reports and track the progress of study.

Developing a local app to support our research staff

The NIHR’s Open Data Platform (ODP) allows researchers to access CPMS data and understand the research landscape across England and the UK, including national and local recruitment trends over time, recruitment hotspots and possible new research locations. In 2019, we led the way as one of the first LCRNs to create our own ODP app for local bespoke reporting. Our app drove efficiency and aided decision making, allowing our research community to gain up-to-date, meaningful insights into research activity. This innovation allowed our network to analyse activity by dashboards specifically for partners and specialties and access data on set up times and performance against targets. This

Showcasing capability and saving thousands of pounds

In order to bring research studies to our region, stakeholders need to know we have the facilities to deliver their study to the highest standards. Face-to-face visits can sometimes be time-consuming and expensive, so in 2022 we created a series of virtual tours to demonstrate the capability of key delivery sites in our region. These walkaround tours enabled virtual site selection and increased efficiency and cost effectiveness for the life science industry. Our colleagues at The Christie NHS Foundation Trust calculated the tours of their sites saved around £97,000 a year in staff time.

Automation site identification saves month of staff time

The identification of suitable delivery sites for commercial trials can be time-consuming and delays studies getting up-and-running. We transformed the local site identification process with the use of the Site Identification Support App (SISTA). This enabled sites to receive a pre-populated site identification form which saves around 25 business days per year across Greater Manchester as well as increased data quality and consistency of expressions of interest submitted to companies. Subsequently, research opportunities were made available to our population in a timely manner and studies were placed and delivered in the best way.

App boosts commercial trial efficiency

The National Contract Value Review (NCVR) is the new UK-wide standardised approach to costing and contracting for commercial contract research. The Lord O'Shaughnessy UK independent review of commercial studies recommended in 2023 that it should be ‘radically expanded’. We developed an app to enable proactive study resource monitoring for NVCR. This innovation helped set up times, sponsor experience and reduce business development risk at a regional and national level. In Primary Care, our engagement resulted in our network having the highest number of committed practices choosing to proactively join NVCR in the UK.

Commercial research excellence

Commercial research – studies or trials that are sponsored and funded by independent pharmaceutical or medical technology companies – plays a crucial part in keeping the NHS at the forefront of modern treatments and research, while also giving patients and participants early access to the latest developments for diagnosing and treating illness. Our network excelled in this area with a portfolio that was 36% commercial, above the national average of 30%.

England’s best record for recruitment efficiency

Our recruitment to time and target record for commercial studies was among our network’s badges of honour throughout the decade. We averaged 84% across our 1,775 commercial studies, significantly higher than the next best network average of 75% and the national average of 60%. We reached a high of 91% in 2015/16 and were the only network to average a 10-year ‘green’ rating on the NIHR’s ‘red, amber, green (RAG)’ performance scale. In fact, we stayed in the green zone for nine out of 10 years. This consistent excellence meant we offered the reliability which trial sponsors crave because it allowed data to be analysed sooner and made it possible for findings to be implemented faster. This helped us generate ‘repeat custom’ and offer more life-enhancing commercial research participation opportunities to our population.

National review highlights CRN Greater Manchester excellence

In 2023 the rest of the country was encouraged to take a closer look at how Greater Manchester operates after our region was singled out for praise in the Lord O’Shaughnessy Review. The major report was commissioned by the government in response to a challenging period for UK participation in commercial trials between 2017 and 2022. Lord O’Shaughnessy set out the actions needed to address key challenges within the national system, and included a case study looking specifically at the success of our network, saying Greater Manchester had “bucked the trend”.

While national participation in commercially sponsored trials had fallen by 36%, in our region it rose by 19%. The review also described how we beat national average times for study set-up (an average of 51 days, in comparison to the national median of 117) and praised our integration with the wider Greater Manchester health and care system. This achievement earned us a place in The Independent’s Best of British campaign.

Global collaborations bring research opportunities to CRN Greater Manchester residents

We successfully collaborated with a number of the global top-10 Clinical Research Organisations (CROs) and pharmaceutical companies which supported our values. For example, in 2017 we strengthened our partnership with Medpace by becoming one of the first organisations to join their prestigious ‘Flagship programme’ and were named a certified centre of excellence when the programme first launched. We built a network of key partner organisations in a number of rare disease conditions which strengthened our portfolio of opportunities for participants. As a result, we saw a rapid increase in the number of studies, which grew by 171% from 2017/18 to the end of 2023/24. One key performance indicator of a Flagship site is rapid recruitment and we were the highest UK recruiting site to four studies in 2023/24.

Supporting Small and Medium Enterprises (SMEs)

We supported local SMEs in their ambition to deliver clinical research in our region. To achieve this, we refined our process to form an ‘SME forum’ in collaboration with regional stakeholders, including Health Innovation Manchester, three universities and other Manchester-hosted NIHR infrastructure. The forum was established to reduce the duplication of discussions in the region and give industry access to the relevant partner for their product. Many of the SMEs we engaged with highlighted that they were “very satisfied” with the experience they had received and that the “direct support with all stakeholders involved” had been most valuable. As a result, we were able to support 137 MedTech studies in the region, with 11,052 participants recruited on to these studies.

Our commercial research impact report for 2014 - 2024 provides a comprehensive review of our achievements in this area. Contact researchsupport.crngm@nihr.ac.uk to request a printed copy.

Our COVID-19 response

COVID-19 presented one of the biggest global medical challenges of modern times. Our response was significant as colleagues pivoted to focus entirely on coronavirus research for more than 12 months, working incredibly hard in some of the most testing conditions the NHS has known, and for over two years in total. Together we enabled 76,000 participants to be part of COVID research across more than 50 Urgent Public Health studies.

Supporting the global effort for COVID vaccines

Establishing safe vaccines to combat COVID-19 was arguably the most urgent challenge of the past decade. To play our part, we devised a ‘One Greater Manchester’ vaccine strategy to maximise access for our population to these trials and steered a weekly meeting to plan and deliver vaccine trials. Notably, we were the UK’s highest recruiting region to the Novavax-sponsored trial, with over 1,655 volunteers thanks to a multi-Trust effort across two community sites in 2020/21. In 2022, the vaccine became the fifth to be approved for use in the UK and added another option globally.

Meanwhile, our network demonstrated its efficiency by consenting the first person in the world to the Janssen-sponsored ENSEMBLE 2 two-dose vaccine trial. Later, we delivered studies which informed the UK’s nationwide booster programme and looked at the most effective use of vaccines during pregnancy and the fight against COVID variants.

National praise for lateral flow study delivery

We were recognised for the crucial role we played in 2020 in evaluating the use of 30-minute lateral flow tests which became part and parcel of people’s everyday lives during the pandemic. Our Delivery Team was a finalist in the Team of the Year category at the prestigious Royal College of Nursing Awards 2021, and the only research finalist represented in any category. This recognition came after we led the way on the nationally-prioritised FALCON diagnostics study, to which we recruited over 200 participants, making us the highest recruiting region in the country. The study was completed within just 32 days which enabled the tests to be used across the UK 40 days after our team’s initial input.

Finding treatments to save lives

When COVID-19 first emerged, there were no known treatments available to save the lives of those critically ill with the disease. We supported the flagship RECOVERY trial, recruiting over 2,500 patients across 11 hospitals from 2020. The study quickly led to two life-saving treatments which were rapidly adopted as part of standard hospital treatment around the world. Dexamethasone, a low-cost steroid, was the first to be discovered and reduced deaths by up to one third. The results became a major news story and started a recurring theme of research featuring regularly in the headlines during the pandemic and significantly raised public awareness of the research process and its importance.

Leading the very first COVID study

In the early days of the pandemic in January 2020, we were made the lead network for ISARIC CCP-UK, the very first Urgent Public Health study for coronavirus. Plans were activated to enable this large-scale observational study to be opened rapidly at sites across the UK. This coordinated effort ultimately enabled over 300,000 participants nationally to take part, including more than 29,500 from our region. Analysis of the data from patients guided UK policy and allowed crucial discoveries to be made. For example, during the initial pandemic phase, the study found patients admitted to hospital with COVID could be divided into four distinct risk groups using a mortality score and offered treatment accordingly.

Recovering after unprecedented disruption

The coronavirus outbreak caused unavoidable disruption to all non-COVID research. However by April 2021, a little over a year since the pandemic began, we were by far the leading regional network in terms of portfolio recovery. By this time, 36% of our studies and sites were open and had recruited participants, while the national average was only 20% and the second highest region 27%. Later, this process would be managed as part of the national Reset programme which continued until 2023. Our network’s recovery continued strongly locally, providing more opportunities sooner for participants, and nationally we provided leadership through our Chief Operating Officer, Sarah Fallon, who chaired the working group.

Taking research into our communities

During the course of the decade, we changed how we worked to make research more accessible for our population and gradually delivered more studies in our communities, as well as in our hospitals. This involved the development of agile teams and community delivery models to carry out research in settings we had previously been unable to reach. Several of our approaches led the way nationally.

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

We invested £500,000 in a state-of-the-art Research Van to enhance our ability to reach diverse populations and conduct research in various locations, helping to increase accessibility and participation in research. This bespoke facility launched in 2022 and was the first of its kind in the UK. It now allows staff in our network to conduct complex trials in community settings via a 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 centres and supermarket car parks.

Providing research opportunities in Primary Care

In Primary Care Research, we delivered the NIHR’s Research Site Initiative (RSI) which provided local sites with funding that significantly enhanced our regional research capability and infrastructure in general practice. With expert support from our core team, this enabled practices to become more research-active and open research opportunities to their patients. In total, 42,541 participants were involved in research in Primary Care over the decade, peaking in our final year as 184 practices recruited to studies.

Holding Health Research Festivals across Greater Manchester

In 2022, we established a Health Research Festival model which became a regular fixture in our strategy to make research more inclusive. Working in partnership with the NHS trust local to the area, we held six festivals in six different boroughs. Each took place in a community setting with high public footfall and provided a bustling marketplace with family fun to help start conversations. We attracted up to 400 people per festival and the events provided an excellent platform for research teams to recruit to studies, with dozens of people taking the opportunity to be part of research each time. The model earned regional award success and national praise, reaching a point where partners approached us to get involved.

Forming an agile team to work across community settings

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, in 2021 we established a Direct Delivery Team to deliver research in locations away from secondary care. This multidisciplinary team recruited participants across therapy areas and primary care. Delivery took place in settings including schools, and universities, community centres and festivals, and places of worship. They developed 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.

Increasing flexibility with ‘high throughput’ weekend clinics

We introduced a pioneering ‘high throughput’ model based on our experience of carrying out several large scale COVID-19 vaccine trials. This innovation enabled us to invite large numbers of participants to bespoke research clinics, often outside of traditional hours, and recruit dozens of participants in a day. This approach immediately had an impact as our Delivery Team applied the model to the Immune Mediated Inflammatory Diseases (IMID) BioResource study. After we invited 800 eligible people, more than 100 took part at clinics held over three weekends. The majority of sites typically do not recruit this many participants in an entire year via the traditional method of opportunistic recruiting from outpatient clinics. Our process from screening to completion of the clinics took only eight weeks, allowing us to quickly meet targets and move on to other studies.

Global recognition for adapting our pandemic strategies

During the pandemic we had to work differently to adapt to the unique circumstances we were presented with. This brought out the best in our core team at the time, but on a longer-term basis we learned a vast amount which shaped our future strategy and ensured a lasting legacy of how we delivered research, often in ways which were more efficient and more convenient for participants. The way we converted these learnings into business as usual earned us recognition at the PharmaTimes International Clinical Researcher of the Year Awards 2023. We were shortlisted in the category for Clinical Site Team of the Year and won the bronze award. Judges were impressed by how we used pandemic-inspired initiatives - such as recruitment sessions in the community, at weekends, and aboard our Research Van - to deliver non-COVID research.

Our research registries: Matching participants with research

Research for the Future

Research for the Future was founded in 2011 as Greater Manchester’s very own platform to help residents get involved in research, initially to advance NHS care and treatments for diabetes. Following our formation three years later, the initiative became a key part of CRN Greater Manchester’s infrastructure as it expanded to also cover respiratory, cardiovascular and kidney disease, and later coronavirus.

Since its launch, over 17,000 people registered and consented to be approached, and the service supported over 300 research teams to recruit to a wide range of opportunities. Feedback from researchers was overwhelmingly positive with numerous peer-reviewed journals acknowledging the contribution Research for the Future made. The service later expanded to become open to all people across the North West and cover research in all health and care areas.

A particular highlight was an award-winning collaboration with artist Christine Wilcox-Baker on ‘Seven Thousand Feet’, an art installation of 7,000 individual socks which highlighted the devastating effect of diabetes-related amputation. The exhibition was utilised at science and research events and featured in the 2018 Manchester Science Festival, attended by almost 2,000 members of the public and healthcare professionals.

Join Dementia Research

NIHR launched Join Dementia Research (JDR) in 2015 as a national service which enabled people to register interest and be matched with suitable research studies. Since JDR formed, in Greater Manchester over 2,900 people registered with the service and more than 1,500 subsequently participated in studies. Over 50% of those registered with a dementia diagnosis took part in studies. A total of 127 studies have been available for participation via JDR.

In 2022 Manchester researchers described how working with our JDR team was transformative for their recruitment. 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 living at home. Professor Debora Price, Principal Investigator on the study, said: “Without adoption by the CRN and the very considerable hands-on support for recruitment provided, we would not have recruited sufficient respondents.”

Enabling Research in Care Homes

Over 100 of our region’s care homes were registered with NIHR’s Enabling Research in Care Homes (ENRICH) network over the 10 years, forming a regional community led by our core team. In doing so, they supported research delivery in numerous ways, from distributing information, to helping conduct studies on site with residents.

Notably, we supported Beenstock Home in Salford to become the UK's first care home to deliver the NIHR-funded AFRI-C study. This research looked 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.

ENRICH also helped researchers wanting to work with care homes to make connections with sites and plan studies involving care home residents. Dr Mark Hayes was a Research Fellow in Communication Disability at Manchester Metropolitan University and the Chief Investigator for the Mental Capacity Assessment in Care Homes study. He said: “It was thanks to the support from the ENRICH team in Greater Manchester that we recruited to my care homes study. We managed to recruit enough for completed data collection and analysis."

Strategic Funding

In April 2021 we introduced an annual Strategic Funding call which gave partners the opportunity to apply for additional funds to deliver projects to support the delivery of research. Funding was aligned to our core values of Relevant Research, Inclusive Involvement and Exceptional Experience, as well as portfolio recovery post-COVID and projects addressing Multiple Long Term Conditions. Overall we invested £1.67m across 62 projects. Outcomes were shared in our annual spring showcase so everyone in our research community could learn from the successes and challenges. Below are just a few examples:

Enhancing research opportunities for patients with cervical cancer

The incidence of cervical cancer is 7% higher in Greater Manchester than the rest of England. However, research in our region had traditionally focused on other gynaecological cancers. We supported our flagship cancer trust with Strategic Funding for a dedicated cervical cancer research nurse to promote and expand the portfolio of studies in this field, to meet the needs of local patients.

Drawing from outpatients clinics attended by women from across Greater Manchester, this improved patient referrals and identified more suitable participants for treatment trials. Recruitment targets more than doubled and women had opportunities to access therapies not available as standard of care. This was a prime example of our infrastructure targeting regional health needs of the population.

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 showed 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 resulted in a toolkit our entire research community could apply.

Developing a centralised pharmacy approach

Greater Manchester colleagues carried out pioneering work to develop a centralised pharmacy approach to setting up and delivering clinical trials in NHS trusts across the region. After receiving our Strategic Funding, they led on a number of projects to bring together different elements of research delivery in NHS trust pharmacy departments and thereby address a national challenge. From a regional perspective, this work harnessed true integration across all health and care organisations, which is creating more capacity for delivering research at a local level that will save and improve lives. From a national perspective, the principles of this work are scalable across England and the devolved administrations, developing opportunities for pharmacy careers in research delivery which is a new spotlight being generated by this work.

Improving 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 funded projects focused on improving the accessibility of all health and care research in prisons. Consultation with academics and HMP staff showed 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. Our continued work in this field saw us set-up a national prison research community of practice, uniting CRN staff and prison researchers from across England to address barriers and enable more research in prison and probation settings.

CRN Greater Manchester Celebration Event: Ten years of research excellence

The region’s research community came together to celebrate the decade of impact made by CRN Greater Manchester between 2014 and 2024.

The special event, held in the Hyatt Regency Manchester on 26 July 2024, began with a presentation which reflected on notable achievements made across the decade. This was followed by a lively panel discussion featuring regional and national research leaders.

Next, there was an inspiring presentation from bowel cancer patient Lyndsey Ainscough from Leigh. Lyndsey spoke movingly about her research journey, explaining how she is now cancer-free after taking part in a trial at The Christie NHS Foundation Trust.

Lyndsey presented Sarah Fallon with a commemorative plaque which will be displayed at the organisation’s headquarters to mark the legacy of CRN Greater Manchester. A video montage summarising the network’s contribution to health and care research was played to conclude the afternoon.

Conclusion

A word from our host

Hosting CRN Greater Manchester has always been something of which MFT is proud, for both the success which the CRN team have achieved and the benefit this brings to our Greater Manchester partners across NHS, social care and education sectors. Being able to do that on a North West footprint with the future RRDN will take that, and what can be achieved for the region, to another level.

CRN Greater Manchester’s core funding of research staff within delivery partner organisations has provided increased capacity and reliability which has enabled longer term planning and building up in areas where there was less research activity. On top of that, the Strategic Funding, which has evolved particularly in the last handful of years to become another form of reliable funding targeted at removing barriers or trying new initiatives, has been especially helpful.

The knowledgeable and proactive support from CRN Greater Manchester for supporting commercial trials and relationships with industry has always been exemplary, as seen across all Greater Manchester performance in this area compared nationally. Helping bring trials in, feasibilities, site selection visits and onward problem solving have all been helped by the work of CRN Greater Manchester colleagues.

We look forward to hosting the North West RRDN, welcoming our new colleagues from CRN North West Coast who bring their expertise and experience across a range of areas, including a particularly excellent track record in Primary Care delivery. The RDN transition has already been in motion for several months and the complementary nature of each network's strengths, coupled with the strong partnerships already in place, mean we are well placed to deliver future work which advances health and care for our communities.

Mark Cubbon

Group Chief Executive at Manchester University NHS Foundation Trust (MFT)