I think you get someone who is used to dealing with women in pregnancy, at all different stages of pregnancy, and has the knowledge to do that. And I think you get someone with a whole raft of skills that they’ve honed whilst working clinically, so I guess it’s good value for money [laughs] compared to someone who hasn’t got any idea about the pregnancy continuum. And also I think you know a lot of the time the studies that we do, we have to flag up if somethings abnormal and refer women on, whereas how you would do that without a midwifery or an obstetric background, I don’t know.

I mean space, it’s always been a hot topic in, in our region and I guess it will still remain. But everyone needs to have a feeling of I belong here’ and I can do something, you know, even if it’s a hot desk probably-, other people being more aware of you needing that space, would have helped the situation. But if I was asked again to go into a job where I hot desk, I will never do it again, I will never recommend anyone to do it. And always when you have people coming up, Oh I have this funding for a new nurse, Where are you gonna place that nurse? What are you gonna do with her? and all those questions. So I feel entitled that I have to ask those questions because I have to say to them, Well, if you don’t find a place where that nurse will stay, it’s not going to last three or six months.

But I, you know, at the end of the day you know everything is very, very tight at the moment. I mean an example of this is [knock to mic] during the winter, I think a lot of researchers will tell you that they got called back for, to support clinical care, and that’s, that’s absolutely fine. But we’re through the [gestures quote marks] winter pressures’ now, we’ve got a new pressure which is that we’re being asked to cover breaks still on an ongoing basis and in a more formal way, to actually agree at the beginning of a day when you’re going to cover a break. And I-, it sort of fills me with a bit of ergh’ because I think it’s not that I don’t want to support our clinical colleagues, and absolutely if, if they go down to the unit and things are terrible down there and they need help and no-one’s had a break and there are awful situations going on, of course they need to help. But to start structuring in which breaks you’re going to cover on a day-day basis, I just think it’s very hard to claw that time back. And I’ve been in this position before, a few year ago, and, where we were expected to give up to two hours a day for helping the unit. And actually, when you broke it down, it almost worked out, with your own break taken into account, it was, you know, sort of like a quarter to a third of your work-, of your day. So actually, when you added it up over the week we were losing huge amounts of research time to support the unit. And I don’t feel, feel very torn. I think we all feel that clinical responsibility, responsibility for patient safety, patient care, for our colleagues to make sure they’re getting a break, but at the same time we’ve got to make sure that research works. If we don’t answer those research questions, if we don’t recruit to target, if we don’t collect the data, if we don’t make sure everything is done to the book what happens is that study will close, the answer won’t be reached and that study will never get funded again. And I-, it’s a real dilemma and it’s hard to-, and I, you know, hard to make everyone appreciate that picture.

And I think that’s the key to this. I think individual professions will struggle to get this mandated. It needs to come through as research being a legitimate part of professional activity that is weighted in somebodies work plan correctly. It’s not an add on extra. It’s part of the work. And that really needs to come out from quite high up across all the disciplines I think for it to be successful. I do think some disciplines have mastered this better than others. I think physiotherapy for example have mastered this better. I suspect that’s because they’ve always worked much more autonomously and I think possibly their leadership skills of their individuals, so therefore stronger.

What we’ve had in radiography is we’ve worked under another profession, which is, that’s always been quite difficult. So a diagnostic radiographer works under, you know has worked under a radiologist, a therapeutic radiographer like myself has worked under an oncologist. So that has caused an element of stifling. Whereas I think in a profession such as physiotherapy where they can work independently autonomously, they’ve not had to break through that ceiling. So it’s slightly different for radiography, I think. So I think for us we would benefit greatly from a more overarching, statement or condition even, that comes out from say Health Education England, that this has to be done. Cos at the moment it’s not mandatory. And it, if something is not mandatory it will always drop off the radar. It will be always one of the first things that will drop.

I think the, you know you’ve got so much money to pay for all of the activity, I think that the, the level of paperwork is not always proportionate to the element of risk within any one trial, so you will have to go through almost the same amount of paperwork and forms, if you are doing a trial that is about surgery that could potentially harm you, and lead to a really serious adverse event, or to some of the other interventionist trials, than you do for an intervention that is really about one method of giving exercise to another method of giving exercise. So, whatever happens the level of any clinical risk is really low, you know with the worst you’re going to do is waste somebody’s time really. And yet the paperwork you go through is as, you know you’ve got to fill in every form, even if it’s to say that it’s not applicable, you know, I don’t, I think that time was better spent on doing more towards the research, and I think that you know research governance needs to be more, more nuanced and more proportionate to the level of risk of what the trial is, rather than having this blanket very heavy handed approach for everything.

Obviously there’s there are some Trusts that have permanent contracts for their research midwives and I think it makes a massive difference, I think some midwives may decide to leave because it doesn’t provide financial stability to them. I think it’s, it’s worrying especially if you have children you know, if you have mortgage it’s something that you can’t afford so I think long term that’s something that we will need to look at because we do have research so we should trust the fact that you need a permanent post and it’s not something that may or may not happen next year, you know, you still have your patients you have to follow them up you have to make sure they’re healthy, you can’t just say from one day actually there is no funding for research midwives so you’re on your own. So I think it should be, it’s something that it should be embraced within the NHS and we should provide some more security for our midwives and I think sadly that’s why many midwives don’t get into research because they think how am I going to, you know, afford a mortgage or the rent and what if my contract doesn’t get renewed because there aren’t any funding’s for me how will that affect, you know, my ability to find a new job?

So I am with, so I’m paid by the NHS but our posts are funded by the CRN [Clinical Research Network].

Okay.

So that means that it depends on the amount of accruals that we have if we get, if our contracts get renewed or not which puts a lot of pressure on, on, on efficiency of maybe quality of the work that you provide because sometimes there’s a bit of it’s, it’s difficult to define what efficient means. Having lots of patients recruited is probably efficient but also not being able to then follow them up and looking after them properly, is that efficient, I think it is efficient to be able to, you know, to have to, you know, to recruit patients in a smart way so that you’d be able to actually look after them properly and ensure they’re safe and, and that you are actually provided, you’re providing the trial with meaningful findings because if you’re unable to collect the data because you have too much, too many patients or if you’re unable to, you know, follow them up properly, you can see recruited too many patients you then, you will have lots of accruals the next year, you will have lots of midwives, lots of, you know, funding for midwives, the actual quality of the job you’ve done isn’t probably great. So that’s something that I think we probably should all reflect on and I can get there’s room for improvement.

Because I think it’s, some studies are also more time consuming so for, for a patient you have to spend, if you want to do your job properly, if you care you want to spend some time with them and that time is just recognised as one accrual, one patient. Whereas for other studies where the ethical implications are there but they’re still, they’re, you know, minor you can spend less time with patients and that time isn’t recognised in any way and it, it’s, we’re, you know, it’s not encouraged there’s no encouragement for us to spend more time in actual quality of the job that we provide, of the care that we provide so I think yeah that’s probably something that we could look into.

Also all the questionnaire’s I think questionnaires and qualitative research doesn’t count as accruals which is such a shame because it’s so important and there is no, sometimes there’s very little point in having these big numbers if you can’t actually give meaning to the numbers that you have.

If you don’t follow the, this pathway that I’ve followed then I don’t know how people do it. You know, cos either you leave your job and you take a stipend and then you go and almost start from scratch, which if you want people at a reasonable level of experience-, so if you want experienced clinicians, most people can’t afford to do that. So the clinical academic pathway I think is brilliant. They’ve made it a bit inaccessible at points, cos they’ve changed the time scales and it doesn’t quite butterfly to-, it doesn’t quite sort of, I don’t know, it doesn’t quite flow in the way that it could, cos they moved the, the, the sort of time in the year that they advertise things. But it does give you the ability to follow a pathway and receive back-, backfill. So your organisation isn’t penalised. It’s hard if you do an unusual job, because you might not just have someone that can step into your role so I think, you know, that’s, that is an issue. But it does, so my sort of working arrangements for the last three years have been that I’ve taken-, I’ve got like a temporary reduction in my hours, and then, so I work these few hours that I’m allowed to work, and that keeps my pension going, and that sort of thing, although it’s reduced what I’m contributing. And then they, the organisations have got the backfill to employ someone to do the rest of my job. So that’s real-, that’s relied on them being very flexible, you know, and very accommodating of, of my sort of desire to do this piece of research. Many people wouldn’t be, you know, they wouldn’t, they wouldn’t have that flexibility. So the working environment I think is not always that supportive of people doing this kind of thing.

I think for a while I felt like I’d sort of stepped outside of my professional identity and gone into a new one. And so I felt very much like a fledgling health researcher, and that wasn’t my intention, it was because I’d, you know, I’d set off with my research question which was about what an art psychotherapist might offer this particular patient group. And then in my first literature review found such a lack of research that it was like okay, well either I don’t do this, or I go, step, take some of the steps back and do some of that research that hasn’t been done. Which is what I chose to do, and I’m glad because it’s made me much more sort of, you know, it’s put me in contact with a much broader range of colleagues and professions and people and, than if I’d stayed very much as an art psychotherapy researcher, that would have been quite narrow, for me. But as the study has progressed and I’ve thought more about how I’ve collected data, how I’m analysing data, how I might bring the study together, how I might disseminate it, and bring, even write up the thesis, you know, the art psychotherapy part of me has engaged more and more and more. From ethics onwards really. So from sort of going to that panel and having to sort of think-, sort of reassure about the patient group but also then defend the methodology choices, it feels like the art psychotherapy bit of me has kind of re-engaged. And my intention would be, you know, if I could have my wish, [laugh] if you like, would be that I could go back into a clinical-academic art psychotherapy post. And be part of helping the, the kind the health and social care research world understand what art therapists can offer, beyond-.

We are quite a misunderstood profession and we spend quite a lot of our careers, all of us, explaining what art therapy is and isn’t. And I think what I’d like to do is to kind of be able to explain, not only what art psychotherapy is and isn’t as a clinical intervention, but what the, what art therapists have as skills that are useful in their own research world. So how we could be helpful for research teams in facilitating workshops in a safe, ethical way, with vulnerable groups particularly. So I’ve been asked to, you know, get involved and support other people’s studies because they’ve wanted a bit of that. So, you know, where I’ve got a colleague who’s a nurse, and she said, Will you co-facilitate, because then I’m kind of almost covering that bit if you like, I’m covering that, that side of things that so that’s quite interesting cos, you know, it’s not traditionally what we’ve done, but absolutely what we could do.

A part of what we could do.

I’ve always seen it a little bit like that because it is so nursing biased, that you do feel like you’re blazing a trail for another profession because you are, you have to fight a little bit for recognition and, and it’s very subtle, it’s not always in your face. It could be a subtle sort of discrimination almost, I would say. It can be subtle, and you have to be very, are you sure of yourself and what you’re doing and why you’re doing it to be able to make a stand. But I like the term blaze a trail, and if they’ve used it, brilliant. Because I think that’s how it feels and I think you’re either the sort of person that wants to do that, and will, will get fired up at the idea of doing that, or you won’t. And I would say give it a go, definitely give it a go, but I wouldn’t say, I don’t think it’s for the faint hearted. Research is not for the faint hearted. But it’s incredibly rewarding and I absolutely love it. I can’t imagine doing anything else now. I just, I can’t. I think it’s brilliant.

I think it’s quite an exciting time, because of what NIHR [National Institute for Health Research] are doing in terms of opportunities for clinicians to be funded to be trained and then have sort of joint roles, posts that, you know, so I, it’s, it’s a good time. So, I would say to health visitors now, pursue that route, you know, look at what NIHR offer. The way I did it was just by luck and chance, and an interest in research. I sort of just somehow fell into, you know, but, stumbled along building a bit of a career by chance really than by any, you know, there weren’t particular support mechanisms out there, institutional support mechanisms. So, I just sort of, and I probably, looking back, could have been a lot more ambitious about it, but it’s, I think, I feel I’ve like I’ve had a great career. But yeah, anybody doing it now, I would say the, the structures are increasingly there. And I would say get into those structures, so you’ve got support, you’ve got mentoring, you’ve got, you know, yeah, all the things I didn’t have but, you know, found my way really through luck, ending up here I guess anyway. So that’s what I would, and I would say, you know, because I really believe in health visiting as a service, there’s a, you know, there’s a huge job to be done in terms of the evidence base and the profile and yeah. I would say to health visitors, you know, go for it, do it.

One of the conversations which keeps on happening, or coming up again and again when we think about this idea of clinical academics is sort of aligning sort of the, the national strategy with the motivations and, and of an operational management I suppose of NHS organisations. And what I’ve found is that within the NIHR, within government policy, within, you know, the research projects, there’s an awareness of the impact that having clinical academics can have and that research active organisations have on the ultimate and the benefit’s it has on patients, you know, the impact it has on outcomes for patients, is well recognised. And yet we still don’t have a culture within NHS organisations that really sort of supports the idea of clinical academic roles. And particularly thinking about the kind of I guess recognition and banding that maybe clinical academics should have.

And I suppose what would be really nice would be to know that at some point conversations were happening between leaders and health organisations and leaders and higher educational institutes, and leaders with health strategy organisations such as NHS England, and the NIHR where really, we’re thinking about sort of how to fund and evaluate clinical academic roles, in order that they can become practical reality. And not just for teaching hospital Trusts, which I know is where lots of money goes, because they get the research funding. But also, for community Trusts who are really looking to develop their research capacity.

Cos they talk about it as a career pathway, but if, if there are sort of significant barriers along that pathway-. So, for me the clinical lectureship would be the next sort of stage, so you need a year post-doc experience-, you know, you need to have a year of that. Now, if I go back to work, I’m not at the university, so how do I maintain that? There’s not really a sort of a way of being at the university a day a week, that’s what it needs. It needs something like that, so you go back to your practice but perhaps you have a day a week at the university to develop as a post-doctoral researcher, work on that application, maybe work on another study. But there’s not really a funding mechanism for that, so the danger is you go back and then you’re back in clinical practice and you’ve not got the space to develop that application. So, I mean I’ll do it and I’ll find a way, but, but the pathway, it doesn’t, it doesn’t, it’s got some gaps.

I think that could just, just need looking at.