The NHS “Five Year Review”. View from the West Midlands CLAHRC

We were delighted to note the emphasis on controlled studies and operational research in the NHS’s “Five Year Forward View”. CLAHRCs have taken the lead in supporting the development of new interventions and in evaluating them, and have been at the forefront of evaluations of whole-scale service change and ‘combinatorial innovation’ heralded by the report. For example, our particular CLAHRC has:

  • Documented improved access to mental health following an intervention designed in collaboration with service users.[1]
  • Developed and then evaluated an intervention to support women with social risk factors over the peri-natal period.[2]
  • Evaluated a £400m intervention to bring social housing up to minimum standards.[3]

CLAHRCs often take the lead in pilot studies that are then rolled out into national evaluations funded by competitive grants; local examples include evaluations of new IT platforms as they are introduced into NHS hospitals,[4] methods to increase access to mental health services,[5] and of increased consultant provision over weekends.[6]

CLAHRCs played a large role in applications for the AHSNs and continue to work in close alignment with these bodies, for example in developing, adapting and evaluating projects to enhance patient safety. CLAHRCs have combined intellectual rigour with the need to respond rapidly to the service timetable and have become international leaders in imaginative designs such as step wedge trials.[7]

We also applaud the emphasis on prevention and reducing disparities in the review; here again CLAHRCs are making a substantial contribution at many levels, providing state of the science evidence through systematic reviews, option appraisal (through economic models),[4] [8] [9] intervention development incorporating expertise in subjects as diverse as behavioural economics and organisational theory, alpha testing in off-line simulations and large scale intervention through randomised trials. CLAHRCs are all working with local authorities in this work and are therefore well positioned to lead evaluations where local evaluations are rolled out more widely. Our CLAHRC has contributed to the development of economic models to evaluate service change, as well as individual technologies such as regenerative medicine,[10] [11] thereby strengthening both the supply and demand sides of the health economy.

— Richard Lilford, CLAHRC WM Director


  1. Birchwood M, Connor C, Lester H, Patterson P, Freemantle N, Marshall M, Fowler D, Lewis S, Jones P, Amos T, Everard L, Singh SP. Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. Br J Psychiatry. 2013; 203(1): 58-64.
  2. Kenyon S, Jolly K, Hemming K, Ingram L, Blissett J, Dann S-A, Chambers J, MacArthur C. Evaluation of Lay Support in Pregnant women with Social risk (ELSIPS): a randomised controlled trial. BMC Pregnancy Childbirth. 2012. 12: 11.
  3. Sandwell Homes. Sandwell Homes Business and Delivery Action Plan 2010/2011. 2009.
  4. Lilford RJ, Girling AJ, Sheikh A, Coleman JJ, Chilton PJ, Burn SL, Jenkinson DJ, Blake L, Hemming K. Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototypes for other related health information technologies. BMC Health Serv Res. 2014. 14: 314.
  5. Marshall M, Husain N, Bork N, Chaudhry IB, Lester H, Everard L, Singh SP, Freemantle N, Sharma V, Jones PB, Fowler D, Amos T, Tomenson B, Birchwood M. Impact of early intervention services on duration of untreated psychosis: Data from the National EDEN prospective cohort study. Schizophr Res. 2014; 159(1): 1-6.
  6. Bion J, Dixon J, Evans T, et al. Stepping Up: A Phased Evaluation of the Impact of High-Intensity Specialist-Led Acute Care (HiSLAC) of Emergency Medical Admissions to NSH Hospitals. HS&DR 12/128/17.
  7. Hemming K, Lilford RJ, Girling AJ. Stepped-wedge cluster randomised controlled trials: a generic framework including parallel and multiple-level designs. Stat Med. 2014;[ePub].
  8. Lilford RJ, Chilton PJ, Hemming K, Girling AJ, Taylor CA, Barach P. Evaluating policy and service interventions: framework to guide selection and interpretation of study end points. BMJ. 2010: c4413.
  9. Yao GL, Novielli N, Manaseki-Holland S, Chen YF, van der Klink M, Barach P, Chilton PJ, Lilford RJ; European HANDOVER Research Collaborative. Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers. BMJ Qual Saf. 2012;21 (s1): i29-38.
  10. Girling AJ, Young TP, Brown CA, Lilford RJ. Early-stage valuation of medical devices: the role of developmental uncertainty. Value Health. 2010; 13(5): 585-91.
  11. Girling AJ, Lilford RJ, Young TP. Pricing of medical devices under coverage uncertainty – a modelling approach. Health Econ. 2012; 21(12): 1502-1507.

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