We need to do more to develop CLAHRC career structures

CLAHRCs enabled more senior HEI facing clinical academics to attract resources to fund research projects, and thus enable them to further their academic careers. In addition to CLAHRCs being attractive to actors leading different research projects, the collaborative work involved was beneficial to knowledge brokers, secondees from practice, and boundary spanners who were able to learn new skills from the local HEIs and NHS partners. Skills and knowledge gained on implementation, service change, and improvement enhanced the careers of those working in practice or between the two organisations.

Implementation manager, Case I: It’s been good for me but I think the clinical areas here have benefited as well, just by me getting out there and selling their story and telling their story from their side to the senior managers and the theme leads and the deputy leads who sometimes can forget what it’s like out there.

However, for many there was a feeling that the CLAHRC did not progress their career. In particular, junior and mid-career academics found it more challenging to progress with their academic careers and publication rate through CLAHRC.

CLAHRC management two, Case I: So I’m stuck at the top of Grade seven, so from my point of view of my career, it’s not done me any good at all, in terms of moving

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up the university scale. It’s been interesting in terms of moving from a position where I was conducting research, either as a researcher or as a principal investigator, to the position of managing a range of research related activities, including service evaluation projects and doing some teaching and developing you know, online learning resources and those sorts of things. So it’s provided quite a lot of variety and interest. But from a career point of view, as things stand now, I think it’s probably been detrimental to my career.

CLAHRCs were seen as a disadvantage to academic careers, and particularly for those who carried out implementation or management roles. For those from health management or clinical practice, CLAHRC provided them with an opportunity to become more familiar with research projects and academic work. This benefited their careers in health organisations where this form experience and expertise was valued.

Clinical academic five, HEI facing, Case B: Well people who want to go into academic careers, starting in service-based research it [CLAHRC] does not seem to me a good thing. It’s fine for people like me who are clinical science academics, very good in fact, very good, it’s fine for people who are clinicians who want to move into academic work but actually for those people who come from academia, I think it’s a wasteland.

The difficulty facing HEI academics was that the CLAHRC did not enable them to focus on developing a strong publication record. For example, one CLAHRC that was set up with research and implementation themes running in parallel, adopted a problem based approach where knowledge brokers fed into practice and identified gaps in translation. They then worked with practice to improve health services through the translation of research and implementation of new tools and practice. CLAHRC actors working in the implementation theme, but located in the HEIs, generally felt that although there were clear improvements in practice, the processes of implementation to create new institutions were focused more on practice based solutions and less on the generation of new research and publications. This was seen as detrimental to their academic careers.

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Implementation lead, Case C: […] within our CLAHRC here, there wasn’t a great focus on research in the implementation process and that’s really where you would be able to get some sort of academic payback from it, from being able to study it and write it up. I don’t think in terms of the things you’re judged on, it’s not been hugely beneficial to me to being in the CLAHRC. […] Our knowledge [brokers] I actually think that it’s been a great opportunity for them, they’ve developed some really good transferrable skills around how you facilitate change, how you work with stakeholders.

There were concerns junior academics on work based contracts or those who worked across academic disciplines were unable to produce outputs recognised by the performance measures of the HEIs.

Social science academic three, Case E: Is this person, is this new role going to be a bit of business school or a bit of social science or a bit of clinical research, or is it really going to be a hybrid? And if it’s going to be a hybrid, what on earth is it? Because it’s a risk and actually I think if you look at the people who’ve fulfilled those roles it has by and large damaged their careers because they haven’t been able to focus on the academic research that they probably should have done to secure tenure or to develop their career.

Although junior actors in CLAHRCs were seen as central to CLAHRC success they were often left without a clear career structure.

Social science academic three, Case E: And equally, there’s nowhere for them to go because the university career structure doesn’t recognise it. So it’s almost like for the people in the roles, I think actually unless you can get in, use it and get out, it’s dangerous. And I think the people who have gone in, taken something from it and then moved on, have probably done better.

Career progression and incentives for junior academics were poor across the CLAHRCs often because of the nature of the job contracts. Although fellowships, PhDs, and Master courses

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were integrated into the CLAHRCs, these were seen as another stream of funding for postgraduate studies rather than the development of an academic career pathway.

Social science academic three, Case E: What they should have done in this CLAHRC, is devised the career model that would have gone through and said to people ‘Right, you can’t do it for five years, we’re only going to let you do it for two years and then at the end of that you should move on’. I don’t know? But I think that is the single biggest worry and I’m on the record in books for saying I think contract research is really exploitative and I’m really anti-contract research.

In general, CLAHRCs were more beneficial to those working in practice who were able to built research skills that were seen as an asset in clinical practice. For academics however, and especially junior academics, CLAHRCs were generally seen as a temporary contract and organisation that was unable to provide them with a sustainable academic career. Senior academics, however, were able to benefit from CLAHRC funding as it provided them with another funding stream for their research projects and publications.

Social science academic 4, Case C: I don’t think having the name and the identity of the CLAHRC or being part of this wider group has made it for me, as a non- clinical, as a researcher who works in health services research, I still rely on the contacts that I’ve always had and I’ve started to develop through independent research. You work with academic clinicians and they open up doors and it’s a slow, slow process as you develop your career.

9.6. Conclusion

CLAHRCs were an experiment and the intention was from the first round of funding for CLAHRCs to be thought of as ‘learning organisations’. In the beginning CLAHRCs were ‘new’ organisations and although existing relationships and research activity were utilised in many, its infrastructure had to be built, which included new physical workspaces, filling new posts, and building relationships between HEIs and practice.

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Clinical manager, Case I: I think the problem with the first CLAHRCs was it was totally new, people were trying to imagine something that had not been there before and make it exciting, interesting and doable enough to get the money and actually be able to go out and do this work. I think what a second CLAHRC might look like, even if the goalposts change, if we were given different direction from NIHR, I think provided we were given sufficient time, would be a slightly different experience and hopefully a better one. But I think obviously there’s been a lot of learning that we can then use.

With CLAHRCs nearing an end and the potential of CLAHRC refinancing, CLAHRC actors described that although there had been challenges across all of the CLAHRCs, there were important positive outputs, such as service improvements, the creation of new roles, new research, collaborations between research and practice, and an overall increased awareness of the need to translate research into practice more effectively to improve patient care.

CLAHRC management four, Case I: I think one of the successes is the attitude and behaviour change of the research community. I think they are a lot more mindful because of the CLAHRC of the challenges that the NHS has in implementing evidence and engaging with research. They’re much more likely to be running research projects that would have a reasonable chance of continued use in the NHS, whereas before, to be honest, they might not have cared, and what they were really working for is a grant and associated publications.

While there were clear challenges and lessons learnt across all of the CLAHRCs in terms of envisioning, engaging, and embedding, all the CLAHRCs demonstrated efforts to shape and create new institutions to foster knowledge exchange, learning, and build capacity across the different institutions in various ways.

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