Our new normal; still your RDS

I’m not entirely sure how to start this blog post. The global situation – the vast and far-reaching changes to our way of life – are almost inconceivable. Trying to find a way forward in the midst of all this uncertainty and change is difficult. I am very fortunate that, thus far, my family and friends remain safe and well. I am also so very thankful for the wonderful care and support of everyone in the NHS, health and social care, education, social services and a whole host of other vital services that are the very bedrock of our society.

Like many of my colleagues in the NIHR, I am now working from home. There is plenty of valuable advice and support available about how to do this successfully and we are all trying to get into a new routine in which we can all do our jobs. One of first things we implemented here at the Research Design Service in Sussex is a regular virtual coffee morning at 10.30 everyday for whomever is around and free at that time. I am already finding it a much-anticipated part of my morning routine!

We are a few weeks in now and I can say with certainty that the Research Design Service South East is very much still open for business. We have almost seamlessly transitioned from a face-to-face service – visiting researchers in person to discuss their research plans and offer methodological expertise – to an online consultation service. I am becoming adept at various software packages and teleconferencing services and find that these media take very little away from the relationships I am able to form with researchers and nothing from the quality of advice I am able to provide. Our group consultations and review panels are likewise just as effective over telephone, Zoom, Skype or Google Hangout as they are in person. We are even holding our first online webinar shortly – a resource I think will be a valuable addition to the range of support we offer researchers.

If this crisis has taught us anything, it is about the vital and life-saving importance of research. Science and the evidence it provides drives effective care; designing and conducting robust research is what allows for the development and implementation of evidence-based interventions that are crucial assets in any clinician or practitioners tool box.

The NIHR sits at the very forefront of applied health and social care research and now, as always, it reacts swiftly to issue funding calls to support projects that address topics of national priority. NIHR and UK Research and Innovation have already funded a £20 million coronavirus research rapid response initiative into active intervention development and diagnosing & understanding coronavirus which will hopefully deliver much needed evidence to fight this pandemic. We at the Research Design Service remain an important part of this process – offering our free and confidential methodological advice and support to health and social care researchers from across the NHS, social care and public health, academia and industry.

Do please reach out and let us help you, now and in the future. We remain your RDS.


Social care research – a heated debate….?

I, along with my colleagues from the Research Design Service (RDS) South East and RDS South West, recently attended the 5th International Clinical Trials Methodology Conference, which was held this year in Brighton. In addition to attending various talks and sessions, we were involved in one of the conference’s debates – a new item on the programme. The debates were held to encourage discussion around potentially conflicting areas and the conference organisers were keen to play up the potentially antagonistic views held by the speakers on either side of the debate’s motion in a fun and playful way. For our debate, RDS SE Director Jörg Huber decided to focus one of the NIHR’s more recent research priorities – social care research – and to facilitate discussion on whether research in this area is ready to make use of the methodologies employed by clinical trials in health research. The debate was very good-natured and we purposely played up the potentially opposing points of view.

Helen Weatherly, from the Centre for Health Economics at the University of York, took the first position: that the social care evidence base could be enhanced by using the methodologies of clinical trials. She argued that reductions in public expenditure on social care amidst increasing costs meant that the area was ripe for robust research to identify effective and cost-effective interventions. This position is underlined by the work of funders such as NIHR in establishing social care research bodies such as the NIHR School for Social Care Research and funding streams such as the NIHR Research for Social Care call. Given this need for high-quality research, and provided investment is there for researchers and research infrastructure, is social care research really that different to health care research? Indeed there are many similarities – both cover broad-span, complex interventions for which guidance on research methodologies and design already exists – the MRC guidance, for example. Trial design offers technical and ethical advantages in demonstrating the effectiveness of interventions and the methods of trials have been developed in a culture that has been able to embed research in its practice. There are challenges, of course, and we do need to be mindful of the differences of the social care environment, the training and education needs of social care practitioners, and the need to raise awareness of the value of involvement in research. However, there remains value to utlilising the clinical health care research methods in social care research and this is something for which we should strive.

Rosemary Greenwood, from RDS South West and the University of Bristol, and Ann-Marie Towers, from RDS South East and the University of Kent, argued for the second position: that social care research is not yet ready to employ the methodologies of clinical health research. They argued that social care research is still at far too early a stage for such an approach; that even getting a PICO right for a social care research project is fraught with difficulty. How do you get an ‘unbiased’ group? How can you randomize care homes to interventions which *they* are going to have to pay for? This latter is a crucial point – who is going to pay for these novel social care interventions? Social care interventions require co-production, but the resources for this co-production simply hasn’t existed until very recently. We first need to concentrate on using the available research funding to develop such interventions before we even consider evaluating their effectiveness in randomised controlled trials. And, in the meantime, considerable work needs to be done to the social care sector as a whole – from workforce capacity and training to research management infrastructure and incentivisation – for delivering such trials. We also need to figure out the pathways to impact with social care research, especially given the multiple providers of social care and an ever-changing policy backdrop.

We had great engagement from the floor. Issues raised included highlighting that we need to figure out where children’s social care fits into this picture, as current NIHR funding initiatives focus solely on adult social care. And that we really need to be talking about ‘health *and* social care’, as they’re often indivisible from a clinical perspective. Points were also made about the challenges involved with engaging different providers from different sectors with different economic and finance models.

It was a fascinating debate with excellent points from all sides – thank you so much to our excellent speakers! Ultimately, I think we all really do agree that both opportunities and challenges exist as we design and fund social care research and that we must work through these issues together. Social care research is undoubtedly a priority for funding by the NIHR and rightly so. But, as with all NIHR-funded research, it must be of high quality and utilize appropriate research methods. Research questions need to be clearly defined and centred around service users, with outcomes leading to tangible changes to practice which will benefit both the care system itself and the lives and experiences of those who use it. The research methodologies employed to answer these research questions therefore need to be appropriate to producing the right kinds of data. It may very well be the case that these methods will be those already being employed successfully in health care research, but they equally may be entirely different. We need to be aware of, and sensitive to, the different professional and research environments and open to the potential need to adapt or develop new methodologies that may be better suited to the social care arena.

Social care research is here to stay. And your local Research Design Service is here to help you design your research study and apply for funding.

Research – a dizzying climb?

Preparing a research funding application can feel like an uphill struggle and our RDS SE graphic of support events depicts a researcher climbing a staircase towards the goal of funding application submission. It’s a nice metaphor – that planning a study, writing an application, and submitting to a funder takes hard work and dedication. It’s also one that highlights the need for help and support at each step – support which can come from your research team members, your mentors or supervisors, and from other sources such as RDS research advisers and our colleagues in the Clinical Research Networks and Clinical Trials Units.

However, it’s also a little two-dimensional. Research does not progress like a straight staircase and a graphic like this, even one that points out things that we can do to help you climb, can only ever be of limited use as an illustration of what it is really like to plan a study & submit its application for funding. The reality is more like some kind of strange, spiraling staircase, with different flights of steps forking from it a various, and often unexpected, junctions. Not something easy to render in graphical form! However, this is not to say that help is not available for these un-illustrated parts of the climb. Nor is it true that these alternative stairs are always unhelpful diversions. Often there is not a single ‘right’ set of steps to take.

I met with a researcher recently who came prepared with a list of questions. This can be helpful as it can direct a consultation quickly to the issues of greatest import, something especially useful with a submission deadline is fast approaching. However, as we were going through the list, it struck me that rarely was there a simple answer to the questions. Often there were multiple suggestions I could make, each that would send the researcher off to climb a slightly different set of steps. None of these possibilities were any more or less ‘right’ than the other, rather it was simply about the researcher deciding which flight was the one they wanted to climb at this point in time.

The possibility of alternative flights starts early – sometimes at the very first step. Is the NIHR the right funder for your research or should you consider a research council or charity funder? Do you want to apply for a research study from one of the NIHR funding programmes or to the NIHR Academy for a fellowship instead? When thinking about your research questions and outcome measures, is your primary going to be a clinical outcome or something more service-based? What happens when you’re holding a consultation meeting with service users and someone with lived experiences raises a point you hadn’t considered before?

How you deal with these alternatives can help define what your final application will look like and there is plenty of support there to help you make your choice and support you on your way. It can seem daunting, but it is important to remember that there probably isn’t one right choice – there is no guarantee of funding success simply because you picked one flight of steps over another. It is also worth remembering that you can also change your mind and take the other path at any point on your climb toward that goal of application submission.

Contacting your local NIHR Research Design Service can help – with taking that first step and with each one that follows, no matter whether your climb is progressing smoothly upward or spiraling around, down and up again. I have no doubt you’ll make it to the top and get to enjoy the view!

Your RDS adviser – a steadfast travelling companion

When I first started this blog, I wanted to use it to share the research design advice that I give health and social care researchers on a regular basis. Through it, I’ve written about a range of research topics – study design, team formation, fellowship applications, funding feedback and even why researchers should use the RDS in the first place. I’ve also used it to reflect upon my own experiences as an adviser – talking about issues that I’ve encountered and sharing the expertise of my colleagues. But what I haven’t written about is what you, the researcher, can expect from us when you first get in touch with your local NIHR Research Design Service. This is an oversight because we exist purely to support you.

RDS advisers have a wide variety of experiences, areas of expertise and funder insight that we want to share with you. We offer advice in a variety of different ways – in meetings, on teleconferences, during workshops and seminars – but our goal is always the same: we want to improve the quality of your research funding application. This means that we can help you with a wide range of issues because behind your funding application lies pretty much everything related to your research.

The journey to submitting your research application has many stages, some of which may be unexpected. We are here to be your steadfast companion on this journey.

Your application actually starts with the very topic of the research you intend to conduct. From this it flows to the research questions you’re asking and then on to your study design, data collection and analysis plans. And, from here, onward still to the dissemination of your results and your future plans. Your RDS adviser can help with every part of this journey – bringing their own expertise to bear on your plans along with that of other methodologists and service users as needed.

But even once you have this part completed, you still have yet to reach your journey’s end: there is then the matter of the funding application itself. Applications are very different from research plans or protocols despite many of the details being the same. Where the earlier stages of your journey are concerned with putting forward what you are going to do, the process of writing your funding application means that you have to sell these plans, along with yourself and your team, to your research funder. Again, your RDS adviser is there to support you – using our expertise of reviewing for funders and observing panels to offer advice on how to put forward your arguments most effectively and identifying potential pitfalls in your way. We can also offer you detailed peer and lay reviews of your application, allowing you a trial run of this part of your journey.

Yet, even once you have your final stage application submitted, the journey is often not yet over. Panels frequently require detailed responses to comments, even if they decide to provisionally fund your application. You may also be required to attend an interview as a final hurdle. Your RDS adviser can offer their support and advice, seeing you through these last, final stages of your journey.

So although the journey to submitting your research application is long and often unexpectedly meandering, your RDS adviser will be with you every step of the way.

Minding your Ps and Qs

Tactics are important when writing a funding application and knowing what a given funder is looking for can often give one research application the edge over another. Funding panel meetings have packed agendas where many applications are considered by busy people. Knowing how to write for this audience – how to clearly demonstrate why your research application should be funded – is therefore an important skill. One of my main roles as an NIHR Research Design Service adviser is to help researchers pull together their funding applications – to mould their research ideas into a fundable project and to put this across in what are often stark and word-limited application forms.

If you’re applying to the NIHR for funding, there are two important things to keep in mind when starting to write your application: First, is the need to demonstrate the PRIORITY of your research topic and the second, closely related, is to have a clearly defined research QUESTION which your study will directly address and answer through appropriate design and methods.

The first thing that any NIHR funding panel will do is assess the priority of your research topic and question to service users and the NHS. Therefore, it is imperative that you demonstrate this from the outset. The exception to this rule is when you’re applying to a specific commissioned call, where the job of identifying and prioritizing topics has already been done by NIHR panels convened specifically for this purpose. Still, even here, it is worth addressing why your team’s particular take on the requirements of the commissioning brief are a particular priority for service users.

There are many ways to demonstrate the priority of your research topic & associated questions. Your literature review should demonstrate the knowledge gap that your research question is addressing. Your description of the current care pathway can illustrate how and where the problem caused by this gap manifests itself in clinical practice. Your consultation with service users can help demonstrate the burden of this problem on patients and their families. You can look further afield here as well – for example, speak to any relevant charities and check to see whether the James Lind Alliance has set research priorities for your topic. Talk about what will change in clinical practice as a result of answering your research questions. All of these things will help demonstrate that your research is a priority of funding.

In many ways, these are all fairly obvious and are all probably things you are already doing. However, it is worth bearing in mind that the reason you are writing about the literature, your service user consultations, and the problems with current service provision is to prove to the funding panel why they simply must fund your research:

By so doing, there will be direct benefit to service users and the wider NHS once your study completes.

So, when it comes to your NIHR funding application, you really do need to mind your Ps & Qs. And your local RDS can help you do just that.

Research by Design – but which design is right?

One of the tag lines I’ve seen used in the past by the NIHR Research Design Service is ‘research by design’. Appropriate design is obviously central to any research project and describing it vital to the success of any funding application. The involvement of relevant methodologists in your research team is also something on which your funding application will be judged. But, what design is the right one for your study?

One of the things I’ve found it important to remember as an RDS adviser is that there are a myriad of possible designs for researchers to consider when first putting together a study, each with its own advantages over another. Indeed, I often meet researchers who find it hard to decide how best to proceed with designing their study – and this difficulty inevitably leads me to ask to a larger, more basic, underlying question: what is your study really about?

In terms of applied health and social care research, your research study should begin with a problem. This problem could be about anything you encounter in your clinical practice – something to do with the treatments you deliver or the way in which you deliver them, it could be a way they could be delivered differently or to explore an intervention that you’re not delivering but that you could. The list goes on and the NIHR’s wide array of funding programmes offer funding for pretty much any of these kinds of questions. At the heart of it, any of these problems represent something that, once resolved, could benefit patients. It is this last – bringing about benefit to patients – in which many funders, including the NIHR, are interested. They are also problems which research can address, but where different designs are required.

So, when it comes to design, start with the problem you are trying to solve and from here the rest of the research should flow. From the problem, form the questions; from the questions, decide upon the outcomes that will answer them; from these outcomes, decide upon the design that will best produce them.

It is easy to get caught up in the pressure to apply for research funds and there is certainly a desire to immediately begin to fill in application forms. However, in my experience, you are far better served by holding back and considering what the research is really about. This understanding can often help illuminate other issues that will arise later on in the design and planning of the research. All of which will ultimately culminate right back where the research started – by solving the problem in such a way as to benefit patients.
So, yes, design is vital, but it is not where research starts, nor where it ends. It’s the bit in the middle and, although I’ve oversimplified things for the purposes of this blog, it is the bit with which the RDS can help.

If you’re an applied health or social care researcher applying for peer-reviewed funding in England, contact your local RDS and we can help you design your study.

Stop, collaborate and listen

I’ve taken part in a number of RDS and research events recently – speaking at conferences, holding teaching sessions, and participating in advising forums – all of which have given me the opportunity to focus on the benefits of talking through your research in larger groups. There is something unique about having to explain and justify your research topic and design to a group of experienced researchers who are unfamiliar with your specific project.

As I’ve written about before, the strength of your case for the priority of your research topic is one of the very first things any funder of health and social care research will assesses when considering research applications. Nevertheless, in my experience, elucidating the priority of their topic can be something of a struggle for many researchers. It’s easy to become so close to your own area of research that it’s importance becomes self-evident. It is vital to remember that the need for your research may not be so obvious to others.

I’ve spoken before about what I see as one of the strengths of RDS advisers – our outsider’s perspective on the specific topic under investigation alongside our grasp of research design, methodology, and the requirements of various health and social care research funders. Participating in various events in recent weeks has reinforced to me how helpful it can be for researchers to engage with RDS advisers as they design and write their research applications.

But it is not only engagement with RDS advisers that can be helpful. It was with pleasure that I observed, at a recent RDS SE research writing day, how much peer discussion enhances proposals. This is a phenomenon I have observed before – at events such as the National RDS Writing Retreat and RDCS’s Research Retreat. At all of these events, different research teams tended not to view each other as competitors for the same pot of funders money, but rather as fellows researchers all of whom are striving to design and carry out the highest quality research for the benefit of all. Ultimately, we are all part of the same community and are generally delighted to share our experiences, expertise and knowledge with others.

It is considered good practice for research projects to set up a steering group comprising experienced individuals who are external to the research group. The remit of such a group is to oversee the project as it is running and members can be called upon to offer advice when things don’t go according to plan. In some ways, I think such a group could be helpful when designing a study – ensuring that researchers can justify their choices of topic, research question and design, offering advice and expertise to deal with difficult or sensitive issues, and presenting different and external viewpoints that might not otherwise be considered.

This type of informal and ‘pre-award’ steering group is a role that we, as RDS advisers, can, and often do, play. I also think it a valuable role that we should encourage other researchers to adopt and one that we should facilitate whenever possible.

This is one way that I believe we can strengthen our community and the quality of our research design, plans and output.

NIHR Fellowships & ‘One NIHR’

I was lucky enough recently to visit my colleagues at the Research Design Service in the East Midlands (RDS EM), in Leicester to be specific. This was a first for me – to actually meet in person other RDS colleagues in their own patch. As I’ve written about before, we have a so-called ‘National Training Day’ the is held roughly every 2 years, but attending that has been, until now, been my only experience of meeting other RDS colleagues.

Social media can be a great enabler of actual face-to-face contact. My very first ‘follower’ on twitter was Sarah Seaton, an RDS adviser and NIHR doctoral fellow. Through twitter we’ve had numerous conversations on a wide range of health-research and RDS-related topics. As I’ve commented on before, the health research community on twitter is lively and varied. This interaction then led up to a hugely enjoyable Google hangout via the NIHR Hub (where there may or may not have been virtual hats involved at various points in proceedings), and finally to us deciding that it would be a good idea to arrange to meet up in person. Although we are badged as ‘one RDS’ and ‘one NIHR’, the fact still remains that many of us on-the-ground advisers don’t really have all that much contact with the wider, national RDS or, indeed, NIHR.

One of the things that Sarah does in RDS EM is to arrange a 2-hour NIHR Fellowship event every year. As she is herself an NIHR fellow, as well as being a RDS adviser, she is in the perfect position to do so. As we in the RDS SE were due to hold our fellowship event, for the first time, in a couple of weeks, it seemed like the perfect opportunity for me to visit, observe the event, and meet Sarah and her RDS EM colleagues.

Now, I can’t really write this particular post without sharing what I learned from the event. NIHR Fellowships, to quote Dawn Biram from the Trainees Coordinating Centre (TCC) who spoke, fund research and training to develop the research leaders of the future. With a variety of pathways open – for medics, clinically-trained health professionals, and non-clinical health researchers – at a variety of levels – Masters right the way up to Senior Lectureships – they are certainly a something worth considering when planning your research. And, as with all health and social care research applications, they are something on which your local RDS can provide advice, support and guidance.

Sarah had arranged for a range of speakers, all of whom play a different role in the fellowships. There was Dawn from the TCC, the secretariat which manage the fellowship scheme for the NIHR, Matt Bown, a current panel member for the doctoral fellowship pathway, Rhiannon Owen, a current NIHR fellow, Emma Watson, a doctoral fellow with Kidney Research UK, and finally Clare Gilles, an RDS EM adviser.

I was tweeting pretty much continuously during the event as there were so many tips and hints from each of the speakers. I use #NIHRtips, if anyone is interested, as this is a hashtag that I, and others, use for all sorts of NIHR and funding-related advice.

The overwhelming message from all the speakers was just how long it takes to put together a competitive application. These are huge endeavours and require input not just from yourself, but from a range of people both within and outside your NHS Trust or HEI. It is not unexpected for a fellowship application to take 6 months to a year to get right. Make sure you look at the guidance from last year’s competition and use that as a starting place – don’t wait until the new competition opens to put pen to paper (or fingers to keyboard). Try to get your hands on a successful fellow’s application form, so you can see what a really good application looks like (and just how long and complex it is!).

Applications are judged on 3 main things: you as an applicant, your research project & training plan and your institution (both NHS and HEI). Each one of these – person, plans, place – will require careful thought and preparation. So, update your CV, get that publication in, and apply for that small pot of funding to kick-start things. Talk to your local RDS about your plans and carry out a PPI consultation on your research ideas and design. Think about what other organisations you should involve – a clinical trials unit, the clinical research network, a charity or patient stakeholder group. Look at your options for HEIs, supervisors, and mentors. Approach the top people in your field and get advice. Get an idea of what training is out there and plan to attend the best there is available. Get your research networks started now.

There were also lots of tips about filling in the actual form. Panel members are only given a couple of weeks to shortlist 15 or so applications, so do whatever you can to make yours stand out. Be neat and careful with your spelling and grammar. Be consistent in your use of numbering and make sure your references are correct. Use bold, italics and underline to make your application clear and easy to read – don’t just have unbroken lines of dense text.

If you’re invited to interview, this is your chance to really demonstrate that you live up to your application in person – candidates are only interviewed if they are potentially fundable on paper. Make sure your presentation is second-perfect and set up as many mock interviews as you possibly can – your local RDS can help you with this. Google your panel and make sure you’re familiar with them, their research interests and their institutions. You can probably work out fairly easily who will be leading your interview, so anticipate what you might be asked. Be ready to defend your research plan, but don’t ignore input from the panel either. These people are experts in their fields, so give in to their greater experience if they suggest things to you. While you’re speaking, be confident and come out and move around the room. Remember, the panel is looking for future research leaders, so show your passion for your topic. Finally, your last slide will be left up during the Q&A portion of you interview, so use it to leave the panel with the message you want to convey.

Such events are invaluable and getting to talk to people directly can be really helpful if you’re planning to apply for an NIHR fellowship. Contact your local RDS and see if they’re doing something. Even if they’re not, they’ll have the experience of working with many NIHR fellows at various levels. They can help you with your application and may also be able to put you in touch with others who’ve been on the same journey.

From my point of view, it’s this collective experience that is so very valuable. When we share our experiences across the NIHR, we become stronger as a research community. We can help and support each other, offer advice and critical evaluation, and provide a network and a support group for researchers at all levels of the NIHR research pathway. I gained a lot from my visit, both in terms of knowing more about the NIHR fellowships, but also about what it means to be part of the larger NIHR and how, as a research community, we all have our parts to play in ensuring that patients and the public benefit from the very best evidence-based health and social care.

Adaptive Trials

We recently had a speaker come talk about adaptive clinical trials. It was a good seminar with lots of clear, real-life examples and it was well-attended by RDS advisers and researchers based both in universities and in the NHS. I won’t go into detail about the content of the seminar – people far better qualified than me have already done so in abundance – but it did get me thinking about how such designs could be used by the researchers with whom I and my colleagues work.

A large proportion of the health research funded by the NIHR, through such programmes as HTA, EME and RfPB, are clinical trials. And there are many issues to consider when designing an RCT, some of which I’ve discussed before. Most researchers engaged in such projects have input from one of the many Clinical Trials Units (CTUs) and have experienced statisticians, data managers and trial managers on their research teams. And, of course, many RDS advisers who support such studies ourselves have this experience.

What is particularly relevant about adaptive trials, not least in the context of providing advice for health researchers, is the opportunity for flexibility they offer. The goal of an adaptive design is to enable researchers to learn from the accumulating data and make key design changes accordingly as things progress. Usually, while a trial is still in progress, we do not look at any of the data. However, the accumulating material may be more informative than that available before the trial had started. And it is this previously available data – things like effect sizes, recruitment strategies and randomisation, dosages – on which the design of the trial was based. The idea behind adaptive designs is that a trial can be improved by making use of interim data to refine certain aspects of it.

Improvement can mean a number of things, usually to do with making a clinical trial more efficient. It can, for example, lead to doing away with a treatment arm if a particular dosage or intervention is demonstrated to be inappropriate. It can also mean identifying with greater accuracy the number of patients needed or lead to refinements in the recruitment strategy, target population or treatment randomisation. It can even lead to decision-making about, amongst others, key objectives, end-points, test statistics, or subsequent phases of the research.

The trick to it all is in the pre-specification: making it very clear in the trial protocol what purpose will be served by carrying out an interim analysis, when it will be done, on what measures, by whom, and to what end. You need to put procedures in place to ensure that the blind holds and limit the people who see the data at this pre-specified interim stage.

As an RDS adviser, I can see merit in this approach. The ability to carry out a sample size re-estimation, for example, is something that I think could benefit many projects. So too is the ability to drop inferior treatment groups or use preferential randomisation. There are, of course, many other options for adaptive designs, and these are just two examples that I can think of which could be applied to many projects.

The drive for efficiency in health research is nothing new. I’ve written about it before and there are examples of it in the NIHR funding programmes themselves – a recent example being the call the HTA programme issued in the summer of 2014 for ‘efficient study designs’. And, as always, an integral part of any NIHR funding application is the demonstration of the value for money of the research itself. This is, of course, not to say that adaptive trials are the answer or even appropriate. Such designs come with their own risks – errors due to their greater complexity, more time needed in the planning stages, uncertainties around the ethical implications, and the need for greater regulatory review, to name just a few.

As always, the design of a study needs to fit its research question. Adaptive trials offer an intriguing option when uncertainties mean refinements are required during the trial itself in order to optimise its design.


I’ve done a few short talks recently about the NIHR Research Design Service and the services we offer. It has been an interesting exercise – to try to distill in a short space of time the hours of concentrated effort that RDS advisers put into the applications we support and the variety of guises our advice can take. In many ways, this has been a marketing exercise – detailing the ‘unique selling points’ of the RDSs in a way that would appeal to NHS clinicians who are either already involved in research or are interested in so being.

I’ve talked numerous times before about the support RDS advisers can give, but it has been interesting to really focus in on what is unique about the RDSs. I think it comes down to 3 things: (1) collective experience, (2) peer review, and (3) lay review.

First of all, collectively, we have experience with literally hundreds of funding applications from a wide range of applied health and social care research funders. We’ve seen what works as well as what doesn’t. We’ve worked on bids that have been funded first time around and ones that have been funded fifth time around. We’ve worked on a huge variety of research topics, we know our remit as advisers and our strengths as researchers and methodologists in our own right. And, perhaps most importantly of all, we occupy a unique position of being committed to an applications success and yet not being part of the research team and, as such, not too close to the research idea. Of course, this is not to say that we can therefore guarantee a particular application’s success – but making use of our expertise certainly can’t hurt.

Peer review is, in my opinion, another big USP. As far as I am aware, all of the 10 RDSs in England offer some form of formal peer review. Like many, the RDS SE holds a regular meeting, which we call a ‘pre-submission panel’. Advisers from across our region get together and review funding applications in detail in a way that mirrors as closely as possible the assessment process of the NIHR research programmes. This trial run gives researchers an invaluable opportunity to address any potential weaknesses identified in their application prior to submission. It also allows them to make the, sometimes vital, decision not to submit just yet.

Thirdly, lay review is something that many RDSs offer. At the RDS SE, we offer researchers the opportunity to have their applications reviewed by 2 lay reviewers. This is also linked to the peer review process – where 2 lay reviewers sit on our pre-submission panel. Again, this reflects to some extent the NIHR’s assessment procedure and also allows researchers to hear directly from lay representatives their views on the research question and the research team’s plans to address it.

Now, I don’t in any way believe that consultation with an NIHR RDS will necessarily mean a successful application for funding. Certainly this would be impossible given that, in the South East at any rate, our aim is to provide advice and methodological support for as many projects as possible.

However, this does bring us to a fourth USP: we provide our service to researchers free of charge.

So, my take home message is this: if you are preparing an application for health or social care research funding, come and talk to us.