Monday, 3 December 2018

Health Care Data - Improving Lives through Research

Health Care Data - Improving Lives through Research Follow #healthdataconf18 on Twitter

This article follows on from a post I wrote a few months ago: The word DATA makes it sound a lot like numbers! It can be found on the National Institute for Health Research (NIHR) website here. I find it helpful to record my thoughts as I get more involved in this part of research,

I have been a member of numerous 'Patient Panels' at Conferences over many years. These Panels are most often at the end of the day or just before lunch. Attendees sometimes seem more intent to get home or are very hungry.

Today, at the Health and Care Data: Improving Lives Through Research conference, we are on FIRST. It is a positive reminder that this is about improving people's lives. It is about setting a tone of partnership. It is about imagining how data can be used to make a difference. It is a lesson for other conferences.

The event in Leeds on 3rd Dec was organised by Health Data Research UK, the National Institute for Health Research and NHS Digital

The Panel consists of Molly Watt, Usability and Accessibility ConsultantRichard Stephens, Chair of the Cancer Consumer Forum and myself. It is chaired by Simon Denegri, OBE, National Director for Patients.

Here are some of issues I think about when considering data...


I want my health information to be used to help me live well. I would like to think that data on me could help others. I hope that I will be informed about research studies I might wish to join. I want to know the results of any studies I join. 

I hope that all of those working with health data remember it is not just information on a spreadsheet - there is a person, their close family and friends as well as those who might just point at them in the street. It could easily be a relative of yours.

It is why involving patients, for example in this Panel, is so important. Getting the perspective of patients and members of the public helps affirm our actions or even challenge our accepted thinking. It can provide an assurance to our work and help unpick some of the moral dilemmas.


Many years ago when I was handling information about a young person excluded from schools, I composed it a manner that that protected the individual and them usually hand delivered the letter. It was a highly considered act because of the numerous stages - nowadays it is too easy to just press send without consideration of the consequences.

We need to remind all staff working with data of the importance of being respectful. The speed with which information can be shared has positive or negative repercussions.

My two rules of thumb are: ‘Would I post private information on my front door?’ and ‘How might a tabloid newspaper view and report this information?’

This all comes down to a matter of trust and why we need Patient and Public Involvement for our decision making. It helps to think through the possible responses and reactions for research and possibly to avoid breaches.  


I often feel that there is a risk that data gets collected because it is possible rather than needed. It seems more important to think about what aspects of people's lives need/want improvement and ask what we might gain from the data. Equally, asking data experts how we might gather and use it effectively is a key feature of modern working in research. 

We can apply the following comment by Professor Stephen Evans, the medical statistician, to health data research "It is better to measure imprecisely that which is relevant that measure precisely that which is irrelevant" (BMJ Reference below)

Again, it is by engaging the public and offering further opportunities to get actively involved in meaningful dialogue that helps identify the most valuable information.


By engaging the public you show how you have been working together, how you have sought to be inclusive and you can demonstrate the impact that these discussions have upon the research. 

Involvement can illustrate how patient experience, insight and knowledge have helped shape your thinking, behaviours and actions. It ensures what you are doing is relevant, suitable and appropriate.

Some further notes...

Health Data Research UK has a Public Advisory Board

The Population Health Research Network in Australia has a policy to actively involve pateit=nts and public includes learning and development opportunities

BMJ 20th May 1995 Vol 310 Pages 1315-1318 What do I want from health research and researchers when I am a patient?

Wednesday, 28 November 2018

Developing a Research Culture

Many thanks to Worcestershire Acute Hospitals, Wye Valley and Worcestershire Health & Care NHS Trusts for inviting me to give a talk at their Developing a Research Culture conference. 

What does being Research Active mean? (You can read my other blog post on this on the BMJ website which can be accessed here?)

I believe that a Research Culture can be identified by a common desire to provide and receive the best treatments and care. It is about us being open with each other about what is known and what is not known. It is about creating a partnership with our communities that helps us ask the relevant, suitable and most appropriate questions. It is about clinical practice and the services we provide being an agreement with patients and their families - a mutual learning environment. See the Kings Fund report – Shared Responsibility for Health.

It is about research being integrated into the normal and everyday part of the patient pathway but how will we know?

How might we all see, hear and touch a Research Active Culture? 

This is my Top Ten (Well, actually just 9 as I am keen to know what you think should be added at number 10)

Signage in Liverpool
1. RESEARCH GETS A MENTION…in letters, outpatient appointments, consultations, on noticeboards and through different media and language.                                                       

2. WHY WE DO RESEARCH…explains the ambition and value of providing the best evidenced based care and treatment for patients. e.g. that high quality research is a means of making sure our patients receive the best care; that research drives the work we do; that we retain and attract the best staff. Join #WhyWEDoResearch on Twitter for a conversation.

A Business Card from Nottingham
3. ASK ABOUT RESEARCH…becomes a norm People are prompted to ask if there are any research studies that would suit - link to a list of active studies. Staff are encouraged to apply for NIHR Fellowships. And providing staff including reception and the Board with the appropriate responses including the important use of Patient Data.

4. EVIDENCE IS APPARENT…on display boards about the types of research that has taken place over the years (Selected by a patient panel).

A Research Day in Birmingham
5. STORIES ARE TOLD…in Monthly bulletins about patients taking part, the research nurse, researchers work, lab and tissue work, leader board.  

6. LOCAL PEOPLE INVOLVED...and encouraged to help inform, shape and influence the research by identifying priorities. Patient Involvement is inclusive and reaches out into the community including support groups. 

7. THINK DIGITAL the way technology is used to improve the research experience. Research on Trust Home Page -  One click to a page celebrating practice, the stories, the policies, performance and media coverage. 

I Am Research Campaign
8. PARTNERS ARE ENGAGED Examples of local and national work with local council, charities are included in annual reporting.

9. HOW WE CAN ALL made clear on signs and display as to how people can get involved, take part and donate, money, blood, tissue and data. Use small business cards, postcards, leaflets and completing the Patient Research Experience Survey (PRES)

10. What would YOU add to the list?????

Community Involvement

To ensure we get these right it is vital to actively involve our local population. It ensures that the research and the culture is…

·      Relevant- directly related to the individual - why it is needed and wanted

·      Suitable - for a particular purpose and part of the patient pathway or service

·      Appropriate - whether this is something we should be doing.

This involvement provides the opportunities to tap into PATIENT EXPERIENCE and INSIGHT, KNOWLEDGE and SKILLS. Equally we, as patients, get to understand more about our health and the challenges faced by the NHS.

YOU can, of course, also suggest...

A TOPIC for Scientific Enquiry (Closes 29th Nov 2018) by the All Party Science & Technology Committee

Wednesday, 17 October 2018

Patient Advisory Groups (Part 4) DEVELOPING PEOPLE

Developing People (Patient/Public Involvement Standard: Support and Learning)

- Being a member of a Patient Advisory Group may help research yet it is also an opportunity for learning and developing as a person - patients and researchers.

This is Part 4 in a series of articles about Patient Advisory Groups. You can read the other posts in the series by clicking on these links: Patient Advisory Groups (PAG) Part 1; From Story to Reflection - Part 2 ; Purpose and Plans - Part 3. The final article will look at how we record and report on the activity of a Patient Advisory Group: A Tale to Tell.


I have been a member of many Patient Advisory Groups. I am always amazed by people's willingness to give of their time to help improve research. I learn so much from listening to other's experiences, knowledge and skills whether as patients or researchers. I am even more pleased to see people grow and develop as individuals. This article, Empowered Patients, by Marie Ennis-O'Connor may be particularly helpful.

So far, in this series, I have spoken about making a difference to the research yet through our involvement experiences we invariably develop as people.  We obtain new knowledge, gain different understanding and even develop new skills.

We have the opportunity to obtain information relating to our own health, the current thinking about treatments, the latest research. For starters, we discover more about the way researchers work, the methods they use and the challenges they face. We find out more about science, medicines and the human body. We discover more about health reasons that brought us to the table.

Making Sense 

Members of Patient Advisory Groups might like to think about how we make sense of all the information we are being asked to consider. I have found it helpful to reflect by grouping the issues into different categories: 

  1. Our Condition or illness  - e.g. the causes, diagnosis, treatments, etc. 
  2. Current Research - e.g. the type, methods, approach, regulation, etc.
  3. The Science - e.g. the pathology, laboratory, genetics, medicines, etc.

This makes me think about the question or observation I might like to make in the meeting. You can choose your own categories to meet your needs.

There is NO necessity to formally learn these subjects. We pick up what we need in the same way we learn a few phrases on a visit to another country. Our presence in research land is to bring the patient voice to the table whilst reflecting on our experiences. It is, however, good a have a grasp about some of the issues, to raise our awareness and to gain knowledge. These help make our contributions more appropriate.

I have a much better understanding now of the complexity of getting research done and the complications around applying the findings in practice. I know of the developments of more targeted treatments and the greater precision these are intending to provide.

Personal Development

There is a further area that is about how all of this affects us on a personal level:

     4. Our Self - e.g. wellbeing, developing and coping 

I understand much more about my own wellbeing. I take much greater care about what I eat and keeping myself healthy. A health tracker has become a useful wearable addition to my life. As a consequence I have made fewer visits to my GP and take little or no medicine. 

All of this learning does not take place in the normal places of education. It takes place in the classroom of our experience and affects our feelings and emotions. I never imagined that I would become actively involved with clinicians and researchers - science was one of my weakest subjects at school. I therefore surprise myself at being so interested.

Just as we have the emotional ups and downs in reaction to our illness, so these responses are revisited when we attend meetings. These are elements of ‘fight’ or ‘flight’ where we want to take on the world or run screaming from the area.

It is worth thinking about how you might cope when something is said or done that might upset you. Members of a Nottingham Breast Cancer Research Patient Advisory Group suggested:
  • Distraction activity - thinking of something else, doodling on the papers
  • Counting to 10 and/or breathing slowly and deeply
  • Thinking of worse/ best scenarios and usually finding yourself in middle
  • Think through possible scenarios beforehand - what happens if and thinking of decision
  • Getting up and leaving the room for a few minutes
In reality, these moments are extremely rare in Advisory Group setting but they do occur. They are perfectly normal

The important fact is these moments reconnect us to our patient experience and remind us to think of those who might be asked to take part in a research study in question.

Learning by Experience

The learning itself takes place in a haphazard fashion depending on the people we meet.  It is not a linear course of instruction. It is referred to as experiential learning and David Kolb, the educationalist describes this as the difference between visiting a place rather than merely reading about it.

As an example, having attended a meeting of the Nottingham group yesterday, I realised that some of the activity involves basic science and pre-clinical work including animal testing. Some of the examples from last week's blog might be of interest and use.

I learned more about breast cancer and the treatments (condition), about the planned diagnostic tests (research) as well as how this is being targeted at specific cells (science). I found out about health economics (research). I also felt supported by hearing from the members about their experiences (self).

These, in turn, invite us to consider the purpose of our involvement with research and how we record and report this activity. It is the subject of the next blog post - A Tale to Tell (PPI Standard: (Communication)

Note: If you are new to Patient/Public Involvement in Research then this post provides a lot of background sources of information

Friday, 12 October 2018


Involving Patient, Families and Public in Pre-clinical or Non-clinical Research - Useful Sources of Information 

The idea of Patient and Public Involvement (PPI) in research is fairly clear when you consult with patients. It can be perceived as more challenging when the research is done at a distance yet it is far from impossible.

Here are some articles, papers and websites that Bec Hanley and I found helpful in thinking about the issues around involving people in the laboratory, decontamination, animal and data research studies - ie pre-clinical or non-clinical research.

These were initially prepared for a Workshop with those working and affected by Creutzfeldt-Jacob Disease (CJD) hosted by the National Institute for Health Research - Central Commissioning Facility, Policy Research Programme,  (NIHR CCF PRP) in Twickenham. We are grateful for their support and to all those we interviewed and met on the day.

A number of the references were sourced through a Twitter request using 

The SOURCES are grouped into categories for ease of searching:

Patient and Public Involvement – Pre-clinical

Involving Patients in Pre-clinical Research This is a helpful article in the BMJ Open Science Blog by Katherine Cowan, an independent consultant and a Senior Adviser to the James Lind Alliance. 

Bridging The Gap Between Research And Impact: Public And Patient Involvement In Health Research Dr Emma Dorris makes the case for involving patients and the public as being about... Quality & Clarity, Needs and Value. 

Involving People in Laboratory Based Research This is a useful discussion paper from the Shared Learning Group on Involvement (Research) which brings together many of those working in engagement and involvement in the charity sector. It includes a list of papers about PPI in lab-based research. 

Facilitating Patient and Public Involvement in basic and preclinical health research. Paper by James Maccarthy, Suzanne Guerin, Anthony G Wilson, Emma Dorris

Involving Patients in Parkinson’s UK research UPDATED GUIDANCE along with other excellent resources and information from lab based researchers. Good You Tube video as well.

Involvement in Dementia Research - Excellent series of articles and a paper by James Pickett and Matt Murray

Diversifying audiences and producers of public involvement in scientific research: the AudioLab - Great example from Bella Starling and Jemma Tanswell about how we might reach out and merge engagement with involvement

Involving Children and Young People - Harvey's Gang is a great example of helping young people to understand what happens elsewhere in a hospital eg with blood tests 

Autistica UK has developed a research strategy with the whole community 

PPI Strategy for NIHR Health Protection Research Units - The Health Care Associated Infections (HCAI) and Antimicrobial Resistance (AMR) at Imperial have produced a Strategy for Involvement & Engagement

Involving People in Research - This Australian website has some good examples of involvement in health data - patient/family involvement is described here as 'consumer'

For more general information, please go to NIHR Involve Briefing Notes for Researchers

Animal Research

Transparency and Public Involvement in Animal Research Paper on how patient involvement might increase openness 

The Animal Research Nexus This network provides information about understanding about animal research. They have recently produced an excellent set of resources including You Tube clips

Patients in Research (in general)

Clarifying the roles of patients in research A BMJ Editorial on meaningful patient partnerships in research

Innovative Medicines Initiative - A guide to Involvement in EU funded research

Public Engagement 

Meet the Researchers - A simple yet effective means of making 'engagement' work for researchers and public Thanks @jonathanboote

The Research Councils UK worked with Involve who specialise in public engagement 

Patient Advocates

Sense About Science 
A Public Engagement Guide that includes information on actively involving people

The 2 major supports in Public Engagement are 

The Wellcome Trust– produced a new strategy for engagement


Patient Engagement and Involvement in Research and Development
An article by Pfizer on the new opportunities for patient engagement

Improving Patient Involvement in the Drug Development Process 
Article on value of social media to engage patients 

Article in Pharma Phorum

Engaging Patients In Clinical Trials with Alan Thomas & Juliet Moritz
Excellent podcast about why the patient voice is important in trial development


Research Impact- Interesting and valuable resources from Dr Julie Bayley(

Why Impact matters in User Involvement - Excellent resource from NPC

The National PPI Standards

Information about the PPI Standards 

….AND MORE  (I will continue to add and then categorise later)

From Canada @CAR_PSP via twitter on Involvement in Anesthesia Research

Count Me In - A great example of how patients can help with encouraging PARTICIPATION in a Study using a Vimeo clipThanks @MBCNbuzz

Involvement in Evidence Synthesis - Wonderful example of how involving patients, families and public can make a difference in complex and complicated areas of research. Thanks @CochraneUK

Arthritis Research Conference in Ireland which included science, treatments and care with patients attending

Saturday, 15 September 2018

Blog Posts in other places

I have been relatively quiet on my own blog recently but that doesn't mean I have been silent. I have just been posting stuff elsewhere...

What does the phrase 'Research Active' mean to you?

This post is on the BMJ website and can be accessed here

Join us on Sept 18th 2018 for a Tweetchat at 2000hrs (BST) on this topic.

The word DATA makes it sound a lot like numbers!

This post can be found on the NIHR website here

Patients and Research - Together

This article was for the Clinical & Contract Research Association Yearbook which was launched at the House of Lords in July 2018. My article is here

Tuesday, 10 July 2018

Why do we, as patients, have to prove our worth?

Evidence of IMPACT is increasingly being mentioned when we talk about patient and public involvement.

But, why do we have to prove our worth? Why should we have to gather evidence to show the difference we have made? We don't expect the clinician, the statistician, the methodologist, the data manager to prove their worth in the research process. We don’t say - why are you here?

One of the first things most researchers do…is a literature review. They naturally want to find out what is known already. They often start with what is published in Peer Reviewed Journals. 

If there is NO mention of how patients and the public have been involved then in the reality of research there is NO Patient & Public Involvement. 

I exaggerate, but there is an element of truth that if there is no evidence then how do we know. The others, I mentioned have over years shown their value. We must do the same.

We make a real and tangible difference...

To Individual research studies
  • Enriching the reality of the research - the priorities, relevance, and value
  • Informing the design of the study - outcome measures, inclusion measures, Patient Information Leaflets
  • Improving the doing of the study - advice on where to promote and recruit, membership of trial management and even co-applicants
By talking about Research
  • Raising awareness about research in general through the Research Ambassadors initiative
  • Increasing access and provosinh more information about research 

For Patients, Public and Healthcare Organisations
  • By being Active in these changes
It is more than just making improvements to the research and doing studies.

It is about research under-pining and being a part of the normal patient pathway. My own story bears witness that the knowledge of research, experience of treatments and the patient discussing the options are the important elements.

It is about making a difference to the individual study and the researcher, the broader aspects of access and recruitment as well as the general direction of intertwining high quality research as part of good clinical practice.

We are seeing the movement of research from academia, though clinical care to being a serious patient asset.

We, as patients, should expect, seek and maybe sometimes demand more. 

Our questions should be about the research, the evidence as well as being able to participate. Some of the KEY Questions are highlighted in the box. 

Are we making a difference?

The following notes are based on a Workshop in Coventry - Impact is not just about counting things. We need the evidence in story form, photographs and videos about...

  • Before and after Patient Informational Leaflets - examples of the how language changes from medical to plain English, how the layout of a leaflet alters, the visual diagrams that have been added, maybe even the use of other media
  • Simple personal diaries asking people's expectations of being involved at the beginning of a project then at some intervals
  • Reporting of the why, what, how of the Involvement with illustrative instances of improvements
  • Preparing a simple evaluation sheet with grades to note information, knowledge, experience, confidence
  • Making a case study of a person or group's involvement
  • Booklets on the Involvement - CRUK
  • Social media summary around a particular discussion 

We must also ensure that the story of the involvement is mentioned in dissemination, on posters and in publications. 

Many of these changes are about the day to day PRACTICE yet we should also be looking at the shift in CULTURE (people's attitudes) and the CLIMATE (people's behaviours) 

We must see the Patients Included accreditation for every event.