Final Proposal for the Establishment of a New Research CfRWCH_ May2013

A Proposal for the Establishment of a New Research Centre in Women’s and Children’s HealthCoordinator: Prof Mark Kilby The University of Birmingham is a pioneer of research into the caus

A Proposal for the Establishment of a New Research Centre in Women’s and Children’s Health

Coordinator: Prof Mark Kilby

The University of Birmingham is a pioneer of research into the causes and best treatments of health problems for women, children and young people today Many researchers across several Schools in the College of Medical and Dental Sciences undertake groundbreaking work focused from “bench to the bedside” across the breadth of obstetric, gynaecological, paediatric, public health and primary health disciplines Increasingly, there are collaborations across Colleges, e.g with colleagues in Psychology (involved in the long-term follow-up and psychometric testing of children) and in Biosciences (metabolomics and gamete science) However, we have no outward facing badge for research of women’s and children’s health in the University of Birmingham and Centre status would achieve this

The primary vision of this Centre is:

1 To develop further understanding of the pathogenesis of disease affecting women, their

pregnancies and children

2 To critically appraise present management strategies and to lead the development of novel strategies for the care of women and children

3 To promote University of Birmingham’s research excellence (with its NHS stakeholders) in the theme of Women’s and Children’s Health to a local, national and international audience

To these ends, the central aim of the centre is:

a) To be identified as a leading world centre of research excellence in women’s, pregnancy and children’s research (defined by winning peer-reviewed national and international research funding and publishing seminal papers of high impact

b) To facilitate increased collaboration between successful researchers within the University of Birmingham in these areas This will lead to a demonstrable improvement in our ability to obtain prestigious peer-reviewed funding in designated successful areas (ie, programme grants)

c) To coordinate the training, mentorship and career development for both clinical and non-clinical researchers within Women’s and Children’s Health

d) To engage our local NHS stakeholders and the wider community in the Centre for Women’s and Children’s Health research activities

e) To align our research strategy within the Centre for Women’s and Children’s Health so that they match those outlined in the recent NIHR clinical network re-organization of early 2013

To date, researchers across Schools and clinical disciplines of obstetrics, gynaecology, genetics and children’s health have little unifying identity In addition, there are no formal regular meetings, seminars or lectures that are truly multidisciplinary across the constituent parts making up the proposed centre

The proposed centre will add opportunities to network with professionals from allied disciplines allowing increased understanding, collaboration and a ‘cross fertilisation’ of ideas A similar ethos of collaboration and understanding would also facilitate educational themes A multidisplinary faculty embedded in a centre would offer increased opportunities for postgraduate taught course at master level and also postgraduate course for CPD

By its very nature, the Centre will include researchers and research activity that focuses on women’s and

‘umbrella’ of Women’s and Children’s Health is diverse (see Appendix 1) Research undertaken basic

laboratory based work into gamete function and fetal development, through child health to maternal and women’s health There is an increasing realisation that prenatal fetal health (influenced by the mother’s health as well as in-utero environment) has influence on neonatal, childhood and adolescent outcomes Such prenatal programming is influenced for the genome as well as epigenetic factors Many diseases of childhood can be congenital (arising during pregnancy) or present de-novo in the neonatal period, childhood or adolescence There are strong platforms of research in paediatric endocrinology, cancer science and immunity Women’s health research is focused on maternity and child birth, fertility and women’s endocrinology and gynaecological morbidity

The major grant giving bodies in the United Kingdom have recognized the importance of research in women’s and children’s health in their mission statements

 The MRC has targeted calls for women’s and children’s health, the most recent of which was focused

on global health research, and allowed the successful attainment of grant funding in an area of early pregnancy loss in developing countries

 The Wellcome Trust outlines areas of ‘research challenge’ as being in: i) the investigation of development, aging and chronic disease and ii) health benefits of genetics and genomics

 A National Institute of Health Research consultation document is being discussed nationally and feedback is anticipated by the middle of February 2013 This presents a proposal for the designation of clinical themes One of the proposed themes is reproduction, child health and genetics NIHR data indicate that the number of open funded portfolio studies in reproductive health and childbirth, paediatrics (medicines for children and non-medicines) and genetics have increased steadily since 2011 Indeed, the total numbers of open studies in these three areas now exceed those focused upon cardiovascular health In addition, the total non-commercial, commercial, multi-centre and single centre studies in this area are second only to cancer sciences in the total number of studies registered

and being performed in the United Kingdom (Figure 2)

The proposed Centre for Women’s and Children’s Health would mirror the thematic approach outlined by the NIHR in a consultative document

Our Centre will:

 Provide a consistent model of leadership which will be transferable locally, nationally and internationally across all areas of women’s and children’s health

 It will promote and encourage “critical mass” of research activity within the University and across the sub-themes of obstetrics, gynaecology, paediatrics, child health, genetics and public health

 The similar designation within NIHR will allow resources to be channelled into this specific area enabling support and will also promote engagement with research funders for studies on portfolio themes

 It will allow championing and promoting clinical research in women’s and children’s health and engagement with both research communities and stakeholders within the National Health Service and

in industry It will encourage engagement with patient groups at a local, national and international level to ensure their support and involvement

Researchers working in women’s and children’s health are in different Schools and Colleges across the University of Birmingham There is close collaboration with the Birmingham Clinical Trials Unit whose infrastructure and experience is pivotal in the successful prosecution of the many clinical research studies already undertaken in maternal and child health All researchers interact with the NHS stakeholders of United Hospitals of Birmingham, The Birmingham Children’s and Birmingham Women’s Foundation Trusts

In the current NIHR Birmingham and Black Country CLAHRC there is a substantial focus upon maternity and children’s health themes The submission of CLAHRC2 will build further upon this applied NHS research and facilitate its implementation at a clinical level

The portfolio of research studies truly span from laboratory-based research [mainly performed within the Institute of Biomedical Research at the University of Birmingham] to bedside translational clinical trials supported by our clinical trials infrastructure at the University of Birmingham These researchers (clinical and non-clinical) cover a broad portfolio of research in the area of Women’s and Children’s Health These

data are detailed in Appendix 1 and the current active grant funding detailed in Appendix 2

The figure below indicates that this diversity of research activity falls into laboratory-based/hypothesis generating research, translational research, randomised trials and evidence synthesis A centre status

would provide an overview of this research, channelling it into these three groupings (Figure 3).

At present we have some major strength that is based on expertise of people and local environment

We have:

1 Broad and successful research bases from the “bench to the bedside”

2 Strong cross-School and College research collaborations

3 A successful portfolio of research across women’s and children’s health

4 Collaboration and highly successful working between Schools, the successful trials units and the local NHS stakeholders (principally by interaction with the research and development department, CRLNs and CLAHRC)

5 Excellent high profile impacts both in terms of publications and media attention

6 Good constructive support from our local research and development and clinical research local networks

We need to co-ordinate the research between the different areas to allow the prosecution of ambitious research themes such as follow-up from fetal life through to the end of childhood

We are competing with successful and established units such as the MRC Centre for Reproductive Health/Tommy’s Campaign Centre in Edinburgh, the Institute for Women’s Health at University College London, the Tommy’s Campaign Women’s Health Centre at Guy’s, King’s and St Thomas’ and the National Perinatal Epidemiological Unit at Oxford Much of our research portfolio is at least as successful as these institutions In addition, we have had an excellent high profile and visible impacts both in terms of research and media success

We have a large local population with a high prevalence of morbidities which makes us an ideal regional portal for studies into pathogenesis and treatment Birmingham has a diverse cultural community This allows, specific advantages (particularly within clinical genetics) when investigating rare diseases with high prevalence within specific families

Finally, we are building a reputation for global maternity health and have a number of successful studies which are being pursued across Africa and the Indo-Pakistan sub-continent

A Centre therefore would allow an executive consortium to improve strategic links with academic institutions within the United Kingdom and abroad and allow further facilitation of trials from the bench to the bedside, working with our highly expert Birmingham Clinical Trials Unit and utilizing the infrastructure

provided within this institution to further obtain trial funding and commercial research support (Figure 4).

The ‘critical outputs’ for the Centre for Women’s and Children’s Health would be:

i) Short term:

1 The development of a ‘taught’ postgraduate course in the area of women’s (including maternal) health and children’s health for academics and NHS trainees, twice annually

2 To establish a regular forum for multidisplinary groups to discuss new research ideas (Blue skies thinking forum)

3 To allow the propagation and submission of two collaborative grant applications (project or programme) to national bodies per annum that includes co-applicants from disciplines within the centre

ii) Medium / long term.

The Centre will also allow us to focus upon strategic funding bids both for:

a) Senior investigator awards (senior fellowships)

b) Programme grant acquisition

c) NIHR bids

d) EU commercial funding

Most of all, it would allow us a national and international badge of identity and excellence

Areas where the Centre will initially start to facilitate collaborative working:

1 Early pregnancy research

2 Global Women’s Health

3 Birth trauma : childbirth and the puerperium

4 Long term morbidity in women after child health

5 Tracking of perinatal morbidity into childhood and adolescence

The Executive team would include:

1 Professor Mark Kilby Professor of Fetal Medicine and Section lead for Reproduction, Genes & Development in the School of Clinical and Experimental Medicine

2 Professor Christine MacArthur Professor of Maternal & Child Epidemiology, School of Health & Population Studies

3 Dr Andrew Ewer Clinical Reader in Neonatal Paediatrics and lead in Research & Development at Birmingham Women’s Foundation Trust

4 Professor Tim Barrett Professor of Paediatric Endocrinology and lead for the Wellcome Trust Clinical Research Facility in Children’s Health

5 Ms Jane Daniels Deputy Director of the Birmingham Clinical Trials Unit, University of Birmingham