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Government funding for clinical research in the National Health Service (NHS) is channelled through the various parts of the National Institute for Health Research (NIHR).1 This is the one area of the NHS which is still receiving a real terms annual increase in funding despite the economic crisis. In exchange for this abnormal largess, the government is keen to ensure that the best possible value is derived from their money. The charity funders of medical research are also very keen to ensure that the donations that they receive are used as efficiently as possible, and industry wants to keep commercial research costs down. All of the sources of research funding therefore have a common objective: increasing efficiency in the delivery of clinical research.
The current main measure of efficiency is whether or not the study delivers to ‘time and target’; in other words, whether or not the researchers recruit the sample number of patients in the time that they said they would. Other performance ‘metrics’ are whether or not the study starts on the planned date (called ‘time to initiation’), and whether or not the researcher is entering data each month into the NHS Portfolio2 (called ‘upload engagement’: a process that has to happen every month, even if the number of patients recruited is zero). In order to calculate the targets for each research project the sample size, start date and planned recruitment time are taken from the information that the researcher submitted in the Integrated Research Application System (IRAS)3 form, so the performance targets are in fact set by the researcher themselves: being held to account against a target that you set …
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