Research to improve health practice and policy

Health research has many objectives. It can develop fundamental knowledge about human health and what causes ill health, improve means of diagnosing diseases and treating patients, provide evidence for preventive health strategies and interventions, invent new devices and agents to treat and cure disease, and provide the community with better knowledge on how to safeguard their health and wellbeing.

It is therefore surprising that the health system has historically been the focus of much less research than has been concentrated on the health of individuals. During the past decade, Australia has increased its research effort into public health and preventive health through National Health and Medical Research Council (NHMRC) funding, from a budget of $10.6 million in 1997 — the last year of the Public Health Research and Development Committee (PHRDC) — to $91.5 million in 2009. (The PHRDC was established by the NHMRC in 1987 in response to the Kerr White Report,1 published in the mid 1980s; in 1997, its role was absorbed, along with that of the then Medical Research Committee, into the newly created NHMRC Research Committee.) But health services research has lagged and in 2009 attracted only $32.4 million (out of a total NHMRC research budget of $706.9 million). Of 3111 applications received by the NHMRC for project grants in 2009, only 134 (0.4%) were categorised by applicants as being for health services research. There is further support for health services and systems research from the health system itself, but little by way of a coordinated approach that recruits the most able researchers.

In 2006, the NHMRC made a commitment to increase its support of health services research — in line with the recommendations of the Investment Review of Health and Medical Research review committee chaired by John Grant, which reported in 2004 to the then Minister for Health and Ageing.2 A special advisory group was established by the NHMRC, chaired by Professor Sally Redman of the Sax Institute and the University of Sydney, to set up a framework to influence and support the infusion of evidence from research into improving the health care system and the actions of health professionals, and into public health policy. This committee completed its work in early 2007, and its report was considered by the NHMRC’s Research Committee and Council.3 Both agreed that the NHMRC Partnerships for Better Health initiative be established.

In 2008, the NHMRC committed $250 million over 5 years — commencing in 2009 — to support the Partnerships for Better Health initiative, which comprises two key initiatives.

The first key initiative is the Partnership Projects scheme, which aims to:

• provide support for research that addresses the delivery, organisation and funding of programs and services that affect health; and

• encourage researchers and partner organisations to form alliances to identify research projects, conduct research, interpret their findings, and promote the use of their findings to influence design and evaluation of health and health care policy and practice.

As with all NHMRC funding schemes, a rigorous peer-review process was established for this scheme to ensure that only the best research and researchers would be funded.

Applications for Partnership Projects were called for on 25 July 2008 and closed on 19 December 2008. This longer than normal application period was considered essential, given that a requirement of applications was that a partnership be established between applicants and organisations involved in health care. One hundred and thirteen applications were received, with a wide range of health bodies partnering health researchers. The applications were reviewed by a panel that consisted of experienced health services researchers (including two from New Zealand), as well as experienced, research-trained state and federal health officers.

The 27 successful applications, valued at a total of $21 million, were announced by the Prime Minister on 16 October 2009. They cover a wide range of health services research, including: improving services for people with dual sensory impairment (vision and hearing); improving maternity care services; studies in general practice (including guideline implementation for chronic disease, Indigenous primary care services and diabetic retinopathy monitoring); acute stroke care; sports safety; hepatitis C assessment and treatment in drug users; allied health services in rehabilitation; childhood mental health; system design for the care of pregnant women with diabetes; public health interventions to reduce metabolic syndrome; patient-centred chronic care in Indigenous communities; rural cancer care; and improving hand hygiene in health care settings. A full list of these grants is available at http://www.nhmrc.gov.au/grants/partnerships.htm.

The partner organisations, which have committed to work with the researchers with a view to improving health policy and practice, include state health authorities and non-government organisations, as well as community groups, Indigenous community groups and commercial associations. Other partner organisations include:

• Australian Commission on Safety and Quality in Health Care

• Sydney South West Area Health Service

• Australian Football League

• Hepatitis C Council of NSW

• Cancer Council Australia

• Water Quality Research Australia

• Australian Food and Grocery Council

• Diabetes Australia

• Australian Red Cross Blood Service

• Epilepsy Australia

• National Stroke Foundation.

The second key initiative in the Partnerships for Better Health initiative will be the Partnership Centres for Research Excellence program. This will promote collaboration between researchers and those working in health and the health care system, and will be announced in 2010. A discussion document developed by an international team — Jonathan Lomas (former Director, Canadian Health Services Research Foundation), Sally Davies (Director General, Research and Development, Department of Health, United Kingdom) and Chris Baggoley (Chief Executive Officer, Australian Commission on Safety and Quality in Health Care) — was released for discussion as part of a final consultation process in July 2009.4 The NHMRC Research Committee will consider this feedback in late 2009.

To further promote health services research, the NHMRC introduced the Capacity Building Grants in Population Health and Health Services Research program in 2008, which in 2009 was transformed into the Centres of Research Excellence Scheme. This scheme does not require contributions from partner organisations, and aims to support teams of researchers to pursue collaborative research and develop research capacity in health services.

The cost to Australia of its health system is more than 9% of its gross domestic product, and exceeded $100 billion per year for the first time last year.5 Although many health professionals do not like to regard health care as an industry, it is the second largest employer of Australians and most of us use its services each year. High-quality research and development is therefore essential for developing a health system that operates on the basis of evidence and ensuring that the health system can be, in the words of the National Health and Hospitals Reform Commission, an “agile, self-improving” system into the future.6