title: One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process.
abstract: BACKGROUND
  Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland), which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes.
  
  
  METHODS
  We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia.
  
  
  RESULTS
  Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale.
  
  
  CONCLUSIONS
  If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for gaining research governance approval need improvement. Attention is needed in process implementation and management, particularly in relation to staff training, as well as clarity in guidance and communication within and between organisations.
authors.affiliation: Politics and International Relations, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15A George Square, Edinburgh EH8 9LD, UK.
authors.forename: Andrew G H
authors.initials: AG
authors.lastname: Thompson
authors.forename: Emma F
authors.initials: EF
authors.lastname: France
mesh_terms: D000328:Adult; D001294:Attitude to Health; D054976:Clinical Governance / Q000458:organization & administration*; D017598:Efficiency, Organizational; D004739:England; D005260:Female; D006301:Health Services Needs and Demand; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D011247:Pregnancy; D012108:Research Personnel; D012606:Scotland; D013222:State Medicine / Q000458:organization & administration*; D011795:Surveys and Questionnaires
references.citation: BMJ. 2005 Apr 9;330(7495):847
references.pmid: 15817562
references.citation: J Adv Nurs. 2002 Nov;40(4):379-86
references.pmid: 12421396
references.citation: Health Law J. 2004;12:159-81
references.pmid: 16539080
references.citation: Community Pract. 2007 Feb;80(2):29-32
references.pmid: 17330671
references.citation: BMJ. 2004 Jan 17;328(7432):140-1
references.pmid: 14726341
references.citation: Med J Aust. 2006 Mar 20;184(6):261-3
references.pmid: 16548827
references.citation: J R Soc Med. 2008 Jun;101(6):299-304
references.pmid: 18515777
references.citation: Med Health Care Philos. 2008 Dec;11(4):381-91
references.pmid: 18633729
references.citation: Nurs Ethics. 2002 Jan;9(1):105-9
references.pmid: 16010903
references.citation: J Health Organ Manag. 2007;21(1):59-67
references.pmid: 17455813
references.citation: Soc Sci Med. 2000 Sep;51(6):969-77
references.pmid: 10972439
references.citation: J R Soc Med. 2009 May;102(5):195-8
references.pmid: 19417052
references.citation: J R Soc Med. 2007 May;100(5):234-8
references.pmid: 17470931
references.citation: BMJ. 2009 Oct 16;339:b4013
references.pmid: 19837743
references.citation: BMC Public Health. 2008 Nov 28;8:396
references.pmid: 19040750
references.citation: Hastings Cent Rep. 2001 May-Jun;31(3):9-17
references.pmid: 11478127