There has been good progress in the Critical Care site, with the main research projects progressing well, and getting to a position where it could start to have a greater influence on practice:
“clearly the sort of public patient, you know, family involvement in the development of an online resource for people recovering in the community from intensive care. I think that’s super and it wasn’t anticipated even by the people in that area at that time. So that’s very much kind of an engagement and a kind of progressive developmental process that has happened with a number of studies that have sort of fitted together. So that’s starting to literally change how things are done in that particular care pathway." (Management Group)
“I think there are elements of that that are being translated into practice in terms of patient, setting up, there’s a patient experience group in Critical Care.” (Management Group)
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"I think that for the CARC, for the first one, for the Critical Care one, I think there are lots of benefits. You know, they’ve actually demonstrated that they’ve been able to build a programme of research even more robustly … they’ve really been able to add to that and make it much bigger, which I think is a huge benefit." (Steering Group)
Influencing factors within this site included having a strong clinical lead; academic support from staff who also had an interest in clinical practice; an existing research culture with suitably qualified and interested people already involved in research, albeit in a clinical capacity rather than academic, who were in a position to apply for the CARC roles; having some degree of overlap between the clinical and research roles:
"I think the clinical lead people in the sites are the really key role. Because I think that service pressures are such that there’s always a tendency for sort of research issues to take lower priority and stuff, and so people have to make quite active conscious efforts to help with that integration process. And I think the academics need to and have learnt that how you really have to be flexible with that and appreciative of what’s going on in service in order to fully kind of integrate that.” (Management Group)
“I think for Critical Care, you could argue well that infrastructure to some degree existed because there was already quite a strong interdisciplinary research community. And I think that’s one of the reasons why they were the only ones that were successful because they were in a position where they had nurses who were doing doctorates, or were completing doctorates, and therefore they could apply” (Management Group)
"other aspects that were important in terms of assuring success was the support of both the postdoc and the doctoral level post, and so with the doctoral level post there’s doctoral supervision in place within nursing studies, and the two supervisors also have a role in clinical practice" (Management Group)
“I think that for Edinburgh the area they have selected there was quite a lot of work that was going on already there in this particular area. An individual just slotted in and they carried their work forward, and I think their site is very very successful and grows arms and legs.”
(Management Group)
“And some of the work she’s doing in both jobs there’s overlap between some of the work.
So that is quite easy and that makes it so much easier from my perspective to manage it, because it’s very much in-house if that makes sense." (Demonstration Site)
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Substance Misuse
The CARC scheme has enabled a new area of research to be introduced within the Substance Misuse directorate, which would not otherwise have been developed:
"I think for Substance Misuse it’s created a new entity that didn’t exist before, and therefore I think it’s given a focus on research that didn’t exist before" (Management Group)
"I don’t think anything would have happened in Substance Misuse [without CARC].”
(Management Group)
Staff members within the Substance Misuse Directorate are becoming more receptive to ideas about how the research underway can be used to achieve the biggest impact in practice:
“I think that directorate is very open to the impact of the work the CARC scheme people do”
(Demonstration Site)
Other factors having a more negative influence on the progress made within this site include changes in management in the Substance Misuse Directorate, introduction of challenging targets within service delivery; and the current research interests of the academic lead.
"Because of everything else that was going on and hitting targets and significant kind of management changes in, in circumstances that were extremely difficult and not well understood I think.” (Demonstration Site)
“I don’t think that at the time that the CARC was awarded [the academic lead] was doing anything on Substance Misuse… So that’s why I think it will take longer here to become compared to Edinburgh Uni, which picked up like that, because there were so many things in that area going on at that time.” (Management Group)
Weight Management
The Weight Management demonstration site was created essentially for the purpose of getting the CARC funding, and did not exist with the current partnership before the scheme was developed:
“With the Weight Management thing, I mean I know it hasn’t started yet, but that wouldn’t have happened [without CARC]” (Management Group)
Finding the right clinical area to submit as a demonstration site was seen to be a challenge, with problems in matching up academic and clinical expertise:
“So that was more challenging in terms of that alignment process between what NHS Lothian AHP-land might want to be engaged in and the expertise or interest from the university side of the fence. I think that’s the main thing. They’ve always been willing, always wanted to make this thing work, make it a success. It was just a matter of finding a way, you know, 75
some proposal or programme or content which was sufficiently of interest on all sides."
(Management Group)
“on the basis of what I’ve heard they found it really difficult to recruit individuals. And again we’re going back to the area issue, there might be someone in Queen Margaret who is interested in this area to take this forward, but it was not matched with appropriate expertise in the service to make that happen, so I’m not quite sure whether their background before they go for something like that whether they had any people in mind.” (Management Group)
It has been very difficult to recruit, as there is no suitably qualified pool of AHPs who want to apply for the postdoctoral posts in the scheme. To address this, the CARC model has been adapted within the Weight Management site to have two Senior Practitioner (PhD student) posts, rather than one senior and one a
Advanced Practitioner post:
“I think the particular challenge if you like around selection has been about the pool of people at grade 7 to then do postdoctoral, take a postdoctoral fellowship, ... there wasn’t the pool particularly the allied health professionals” (Management Group)
"But in a way having two PhDs we’re back to sort of training up people. I think there was a particular set of circumstances around that, that decision as well, but it certainly was a challenge and I suppose it’s not the perfect solution but it was the solution that we eventually agreed on." (Steering Group)