Research in nursing, midwifery, and the allied health professions

BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7394.833 (Published 19 April 2003) Cite this as: BMJ 2003;326:833

Quantum leap required for quality research

  1. Anne Marie Rafferty, reader (Anne-Marie.Rafferty{at}lshtm.ac.uk),
  2. Michael Traynor, senior lecturer,
  3. David R Thompson, director,
  4. Irene Ilott, group head research and development,
  5. Elizabeth White, research and development officer
  1. Centre for Policy in Nursing Research, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, China
  3. College of Occupational Therapists, London SE1 1LB

    Although the United Kingdom invests almost £3.5bn ($5.5bn; €5.1bn) in medical research from public and private sources,1 73% of published research in nursing and 83% in occupational therapy remain unfunded.2 Underfunding in nursing and allied health professions is relative to that in comparable professions and to the size of their workforce. Recent reports indicate that nursing receives only 20% of that allocated to a national programme in teaching and learning of the Economic and Social Research Council. 2 3 Nurses, midwives, and members of the allied health professions represent two thirds of the staff responsible for direct care for patients, yet little is known of the clinical or cost effectiveness of the largest sector of care. For nurses, only 1482 research publications have appeared in eight years1; this is at a time when NHS research leads to over 13 500 research publications annually. The public, policy makers, and all members of the healthcare team are therefore poorly served by the undernourished research base in nursing, midwifery, and allied health professions. Without targeted investment the service will fail to deliver the benefits of evidence based practice.

    The case for investment needs to address questions of supply as well as the demand for research. Research into the outputs and supply of funding for research in nursing and allied health professions has shown an increase in volume of activity and research income from £3m in 1996-7 to £9.7m in 1999-2000.2 The demand for research is increasing with the policy, service delivery, and design pressures within the NHS, yet nurses, midwives, and allied health professions still lag behind other disciplines.2 Research into “payback” shows that research has several benefits; knowledge generation, occasional cost savingsfor example, in contributing to a more healthy workforce, better decision making because of the improved information base, the development of research skills of individuals, and savings from improved working methods.4

    As “venture capital” investment, decisions in research and development entail risk and rely as much on political will as policy justification and estimates of projected return. One major study from the United States quoted a return on investment 20 times greater than the spending, although such studies tend to be based on heroic assumptions.1 Moreover, the time lag between investment and pay off may be long; patience and persistence as well as serendipity may help to shape outcome as much as science.5 The overall objective of investment should be to upgrade research capacity in nursing and allied health professions to an internationally acceptable level of quality for all health professions that can meet the needs of the service.

    Foundations such as the PPP Foundation have taken the initiative to invest in fellowship schemes. But government action is required to provide a solution that is sustainable in the long term. To its credit the Department of Health has announced the award of a research development scheme of £4.8m for research over the next five years in these areas. But the Department of Health cannot solve the situation alone. The Higher Education Funding Council for England must share the burden by ensuring that its commitment to partnership carries through into its funding policy and practice.

    But where should investment be targeted? Training the next generation of research leaders needs to be done not just at the doctoral or postdoctoral level but at more senior levels. This will provide a clear and career structure of high calibre, sustainable programmes of research, and, in some cases, stabilise the position of nursing, midwifery, and allied health professions in the higher education sector. A flexible portfolio is required to develop the necessary breadth and depth of methodological and substantive expertise. Investment needs to cover individuals and infrastructure as well as institutions. Doctors have benefited from decades of investment in research and development. Nurses and allied health professions are showing that they deserve to do so too.


    • Competing interests None declared.


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