What will the NIHR look like at 70?





by Dr Matthew Ridd
Reader in Primary Health Care
Centre for Academic Primary Care

As the NHS celebrates its 70th birthday, I hope that in another 58 years there will be similar celebrations and appreciation when its research arm, the National Institute for Health Research (NIHR), turns 70.

In a recent BMJ poll marking the 70th anniversary of the NHS, ‘research’ came last out of a top 10 NHS achievements. However, competition was stiff, ‘being free at point of use’ coming top. As a GP and NIHR post-doctoral fellow, I felt conflicted: should I vote for general practice or research? I admit to voting for the former – primary care needs every plaudit it can get currently – 90% of contacts in the NHS, for less than 9% of the NHS budget, and all that.

So, if the adolescent NIHR, as progeny of the NHS, is to survive and attract the same level of public esteem, what needs to happen? It’s easy as a junior researcher, whether funded by the NIHR or not, to identify faults, but if you were in charge, what would you change? Despite its youth, the NIHR like the NHS itself, is a complex structure: do you know your CCF from your NETSCC, your TCC from your EME and your CLAHRC from your CRN for example? Understanding how the different parts interface and work together is a challenge, let alone where you fit into it.

Together with colleagues on the Ashridge leadership scheme for NIHR trainees, we decided to turn the tables. We invited members from different parts of the NIHR to attend a one-day conference on how the next generation of NIHR leaders (#NIHRnextgen) can begin to shape and sustain it. Over 43 attended, spanning many of the arms of NIHR, and together we worked on five themes: digital strategy; training and career development; grants and funding panels; equality, diversity and inclusion; and “Push the pace”.

This was an ambitious agenda in the time available and, as always, it is easier to identify the problems than work on the solutions. But the interest and enthusiasm on all sides was genuine, and the day ended with a commitment to translate ideas into actions. For example, NIHR trainees are a more diverse group of people than those who serve at senior or strategy board level. ‘Reverse mentoring’, where trainees are invited to have honest conversations with those in charge, was floated as one way of ensuring the cultural and diversity ‘health’ of NIHR.

I look forward to following-up on the discussions that we started on that hot, July summer’s day. Meanwhile, the (simple but challenging) message I came away was to ’be the change you want to see’. Many of the issues identified across the different topics are embedded in organisational culture. Culture is not an object, but something we all contribute to through our actions (or lack of them). Therefore, NIHR-funded or not, if we work in health services research and want to change things for the better, that changes starts with us.