Speaking of Science: International Research Translation Practice

For the July Speaking of Science webinar, we were encouraged to ask ourselves ‘what is the change I am seeking to make?’, ‘so what… why should anyone care?’ and ‘what happened as a result?’ when it comes to research.

NHMRC was joined by experts in the field, Professor Tom Walley (UK), Professor Martha MacLeod (Canada) and Professor John Prins (Australia) to discuss international research translation practice and the impact it has on the health and medical research sector globally.

Listen to our conversation with Professor Walley, Professor MacLeod and Professor Prins as they unpack the lessons learnt on research translation in the UK, Canada and Australia, and how it is fundamentally bridging the gap between knowledge and its application into practice.

Recorded on Wednesday 24 July 2024 from 12:00 – 13:15 AEST.

Video transcript

Professor Steve Wesselingh 0:17
OK. I think we might start. I think there's a few people still coming online, but it is a couple of minutes past. And so, I think it's important to start. And so, I'd like to welcome everyone and, and just mention that I think we've got a record number of registrations for this webinar, and I think that goes to the guests that we've got to talk to today. And so, I want to thank our guests and I'll obviously introduce them in a minute. But before we start, I really want to acknowledge that I'm in Adelaide today and I'm on Kaurna land and I'd like to acknowledge the Kaurna people as the Traditional Custodians of the lands and waters of the Adelaide region of where I am today. And I'd like to pay my respects to First Nations elders past and present and their ongoing culture that connects and enriches our country. I'd also like to pay my respects to the Traditional Custodians of all the different lands that everyone is on today and extend that respect to First Nations people that are joining us today. So really important. For a bit of housekeeping, I'd like to remind everyone there will be an opportunity to ask the panel members questions towards the end and the people in the room can obviously do that with the roving microphone. People online, if they want to put their questions into chat, we'll try and address those questions that are put into chat. And importantly, we're recording all of our webinars and they're available on the NHMRC website and today's discussion will be recorded and uploaded so people can watch it in the future.

Welcome to this very special edition of Speaking of Science. And I'm sorry I'm not there, but most of the people are actually online so I think that works quite well. But I'm sure that the people in the office and in action must see in Canberra have been really looking after our guests and showing them around.

Today's topic is international practice in the translation of health and medical research, unpacking lessons learnt in the UK, Canada and Australia. Since 2014, NHMRC has recognised leading centres of collaboration in Australia that excel in providing research-based healthcare and training through research translation centres. And I think that's been a really important initiative of the NHMRC. Prior to being the CEO of the NHMRC, obviously I participated in one of those centres in Adelaide and it was just a great experience. So, to date, there are 11 NHMRC-accredited research translation centres in Australia and through this accreditation, NHMRC recognises the value of excellence in research, translation and collaboration and the training of health professionals and other end users within the evidence-based environment. This is an initiative that's happened all over the world, but particularly in the UK and Canada, and certainly we looked at the UK when this initiative was started.

Today, I think it's really important to reflect on the different global practices in the translation of health and medical research and delve into the lessons learned from our experts in the UK, Canada and Australia. So, which brings us to our guests, and I'm really delighted to be joined by Professor Tom Walley, Pro-Vice-Chancellor for Clinical Research and Professor of Clinical Directorate Professional Services at the Institute of Population Health at University of Liverpool. Tom also had some previous experience of research translation in Australia as the former Director of the Hunter Medical Research Institute. In addition, Tom has been working with the NHMRC for quite a while with our assessment of research translation centres since it began in 2014, so he's been on this journey for quite a while.

Also, I'd like to induce Professor Martha MacLeod, Professor of Nursing and Health Sciences at the University of Northern British Columbia in Canada, and she was the Northern Health University of Northern British Columbia Knowledge Mobilisation Chair and Co-Leader of the Health Research Institute. As Knowledge Mobilisation Chair, she explored how knowledge can be developed and taken up into practise in complex rural and remote health systems.

Our final panel member is Professor John Prins and John is the Chair of the Australian Health Research Alliance and Executive Director of Health Translation Queensland. John is an active clinician, scientist and thought leader in diabetes and endocrinology in Australia. His leadership spans academia, health, pharmacy and the pharmaceutical sector and this includes prior roles as head of Melbourne Medical School, University of Melbourne, Director of Metro South Hospital and Health Services Board, CEO of the Marter Group and Director of the Marter Research Institute, UQ. In July 2023, he was appointed Chair of AHRA, the national voice of the 14 Research Translation Centres that are either fully accredited or recognised as emerging by the NHMRC. So welcome, Tom, Martha and John, and thanks so much for being here with us and so much for all the help that you've given NHMRC in this initiative.

At this point, I'm going to hand over to Doctor Nick Johnson, the Executive Director of our Research Partnerships Branch at NHMRC, who's going to assist me with facilitating the discussion with the panel. As sort of my “man in the room” as so to speak. Nick's going to introduce himself and then invite our panellists to make the introductory presentations. And then after that, we'll go come back to me and we'll start a sort of discussion, get the panel answering questions and hopefully we'll get lots of questions in the chat and in the room. So, thanks Nick.

Dr Nick Johnson 6:47
Thanks Steve. I just want to acknowledge that here in Canberra we're on Ngunnawal and Ngambri Country and pay my respects to elders past, present and emerging as well.
As Steve said, I'm the Executive Director of Research Partnerships here at NHMRC and our part of NHMRC deals with the research translation policy and it runs the Research Translation Centre Accreditation Program. I'm delighted to be joined by our distinguished panel today. We have short presentations of about 10 minutes from each of them and should be followed by the Q&A session. So first, if I'd like to introduce Professor Tom Walley to write his presentation. Thanks, Tom.

Professor Tom Walley 7:31
Thank you, Steve, kind introduction. Thank you, Nick. So delighted to be here this afternoon. Delighted to be able to work with NHMRC over many years on research translation. So, I'll talk a little bit perhaps what I've learned through that process in my own time in the NHS. So, can I have my first slide, please? I'm not nervous really. Right.

This is my opening and I'm talking about research translation in England, and I put it as an England because one of the things I learnt when I worked in Australia was how independent all the states were of one another. And what happened in NSW wasn't going to happen in Western Australia and the same is true in the UK. England does things differently to Scotland, does things differently to Wales and all that so I'm talking about England, and I've got this rather long title here, but the most relevant part of my title is the very last line. I used to be the director of the NIHR, and I'll explain what NIHR is in a moment, HTA programme, which is a very large clinical trials programme. So, we learned a lot about how we influence the outcomes of how we actually have our trials implemented. That's what I'm going to talk about. I'm going to talk about this at 2 levels, the first being a national level and then afterwards a local level. DHRTCs perhaps operate more at the local level of ensuring implementation on the ground in their own area. I'm going to start off at a national level first of all, if I may.

I'm going to use a slightly different term to research translation. I'm going to talk about impact. When academics here impact, they think impact factor of the journal, “I'm submitting my article 2 or my H-Index” or something like that. And this has nothing to do with that whatsoever. Impact is defined in the UK health research system as the ‘effect on change of benefit to the economy, society, culture, public policy or services, health, environmental or quality of life’ and the key message here is beyond academia. So, if the world hasn't changed as a result of your research, you have not had impact and the number of pieces of work you have you do which will actually have impact is probably very limited because it takes time to build up to a project that really has impact.

You can't do a pilot study. A pilot study has no impact in the real world. You may want to do all kinds of other analysis, biochemical stuff studies, whatever. They are not going to impact in the real world. What's actually going to change clinical practice is the issue here, and the kind of things that you have to ask yourself when you think about impact is what exactly am I trying to change here? Why are you doing this research? Are you doing it to boost up your CV, bring more money into your university, squeeze more money out of the NHMRC? All those things. But actually, what we hope we're doing is that we're going to make something happen as a result. We're going to change something that's out there and unsatisfactory at the moment. You're trying to fill an evidence gap and hopefully filling that evidence gap is going to change clinical practice in some way. So next slide.

The NHMRC is a great organisation. It takes 3 organisations in the UK to cover the same remit. The first one is the Medical Research Council, which has been around for a long, long time, and the division of Labour in the UK now is that the Medical Research Council covers discovery science, basic biosciences and would take human sciences through to early phase one, early phase two, clinical trials, no further than that. At that point it switches to remit and there's overlap between the second organisation that I'll talk about in a moment, and the budget from the MRC comes from a parliamentary vote for education, universities and innovation.

The second organisation is NIHR, the National Institute for Health and Care Research. That's the organisation I was involved in for a long time and that operates in the clinical space. It undertakes clinical trials, systematic reviews, social research, health services research, all those other–that's the more applied end of the spectrum. And that receives its money from a parliamentary vote for health and that's really significant. So, in other words, there are two very separate votes, the education vote, you can do science for science's sake. Health vote, you better be impacting on hot science, on healthcare and changing something in the end of the day, not every time, but that's your drive and you will be evaluated on that basis. So, when you as a researcher apply to NIHR, as well as having top quality science in the applied health sciences area, you've got to demonstrate that your question is actually relevant to the end users. Does anyone actually care about the question you're asking? And how have you picked out that question? How have you engaged with the end users? And the end users will be clinicians, it'll be people who work in the health service, it'll be patients, and it'll be the public. If you can't demonstrate that you've engaged with those people and that engagement has confirmed, this is an important question, it's dead. It's not going to get anywhere past the funding panel within NIHR. You may want to you'll be expected to have undertaken a systematic review to demonstrate that you're not duplicating research unnecessarily.

You may want to combine the systematic review and the patient involvement process to what's called the James Lind Alliance who undertake studies on behalf of us to identify priority topics. And when you put your bid in, you're going to be expected to have an impact plan of some kind. You're going to say in your grant application, this is how we expect this to actually modify things, and this is how we will make it happen. So, it's really important. As some who lead a funder, we fund other parts of NIHI, we run a dissemination centre whose job it is to disseminate our results very carefully and we get called to account. This little picture over here on the right-hand side is a report that I had to commission around the economic value of the studies we had funded, and this was for the Treasury, and the Treasury don't care whether you publish in the New England Journal or not. The Treasury care about what have you actually made better at the end of the day. So hardnosed accountants, and you better be prepared, to justify that back to me is as a funder because I have got to justify to Parliament at the end of the day. The impression that you need impact comes right in at the very start at the very top. Next slide please.

Now I am guessing most people watching are academics and oh, one more organisation. The third organisation that takes on some of the roles of NHMRC is NICE, the National Institute for Health and Care Excellence. This is a guide, it's the body that draws up guidelines around care, evaluates new procedures, new devices, new drugs and then recommends them for application in the NHS. If you don't get a NICE approval, then it's highly unlikely your technique or your device will ever actually feature in NHS practice. Conversely, once NICE writes a guideline, it becomes a standard of care and when hospitals or primary care practices are inspected by the Care Quality Commission, and the equivalent in Australia will be the Commission on Safety and Quality in Healthcare, when they come to inspect, they will inspect your care against what's NICE Guidelines say. You don't have to stick rigidly with NICE Guidelines. You can justify why you happen to follow the guidelines, but that's a big start. Therefore, if you as a researcher can influence a NICE guideline, can influence a recommendation, your job in terms of security impact is done because now it's going to happen and will become a standard of care within the NHS.

The third aspect of this is, next slide please, I'd say most people watching are probably academics and as an academic you are increasingly required to demonstrate impact. We have a Research Evaluation Framework or the REF, which is the equivalent of Excellence in Research Australia, which is conducted every seven years, where you make a submission as a university to the REF process, identifying your key outputs, what work you've done, your income and all those things and you are given gradings and lots of areas. Your outcome from the REF process is measured in all kinds of fields. But overall, about 60% of your REF outcome depends on the outputs of the papers you've published. About 15% depends on the environment, which usually means what you're doing about bringing the next generation researchers through, how you're training the next generation and about 25% comes in impact. What has actually changed? The number, we measure this by producing what are called impact case studies. Basically, you tell a story about how your research has had an impact, and you're not going to do that for every single paper. The number of impact case studies you as a university can put in is proportional to the number of staff you're submitting in the return process. But a university like mine, Liverpool, which is a medium sized university, would produce maybe 20 or 30 impact case studies across all fields, including health, engineering, all those areas. You've really got to pick out your best impact case studies and you can’t put many of them in, so they better really count. This has been the case in our research evaluation process since 2014 and in the most recent one in 2021, and it looks for the next one, which is going to be 2029, as if they're going to actually boost the proportion of the return on impact. If you were sitting in a university as a vice chancellor or whatever, you make sure you have an impact on translation team and you make sure you hound all your academics to communicate with that impact on translation team to produce good stories at the end of the day. You're not going to use a good story unless you actually think about impact at every step along the research training.

Things that would count would be, for instance, a demonstration that healthcare has improved in some way, that the outcomes for patients have improved, fewer people die of disease X or maybe that NICE have adopted therapy Y and therefore it's now being widely used in NHS. That would count as an impact, a very strong impact case study as well. And the impact case study has come back about 14 years from the time of the REF, so we recognise that impact doesn't happen overnight and usually outside the term at which most academics operate and think about the research processes. Examples of impact studies next, please.

The first one I'll tell you is, is the recovery studies conducted during COVID where we managed to put together a huge clinical trials process at very short notice. We did it by cannibalising every other research trial process we actually had under way, most of which are falling apart during the lockdown pandemic anyway so all the staff will be directed into COVID studies. We produced studies with huge numbers of patients, 48,000 patients very rapidly, huge influence on clinical practice. Here's an area where for instance, the outputs in many ways were relatively weak because the publishing process couldn't keep pace with the change in science. These were all published on the web first of all and spread by word of mouth and disseminated. But influence practice in the real world came almost in real time. So hugely influential. That would be a really strong impact case study for various universities who are involved in mainly the University of Oxford in the next REF process. But we also look for research impact and other studies into the next slide.

So does it change practise? Here’s an example of a study that I funded, it's use of tranexamic acid in trauma. Up to this, tranexamic acid had been used for very, very few indications. It's a drug which is an anti-fibrolytic, reduces bleeding. It was applied, for instance, treatment of menorrhagia.

But one of our researchers concluded that why wouldn't it be valuable all kinds of other areas, particularly in life threatening trauma? And why wasn't it used in life threatening trauma? Because there was a concern that although it might stop bleeding in life threatening trauma, it would provoke strokes, it would prove thrombotic strokes. We did a trial of 20,000 patients. It was an international study, and it demonstrated a very effective 10% reduction in mortality from major bleeding trauma. That influenced practice very quickly in ER departments all over the country and internationally. It influenced practise, for instance, in the British Army in Afghanistan, and it worked so well that the American Army took it, so this is now standard practice in many parts of the world as a result of this trial. So, there's a good story. Next one, please.

Though not all stories of taking things up. This is the story about the use of manual profession, mechanical profession devices for out of hospital cardiac arrest, which were starting to catch on in ambulance services. They're quite dear to run. We did a trial in ambulance services of these, and the conclusion was that it didn't actually make any difference and ambulance services disinvested in this area. Sometimes we save money here by doing these things and that study demonstrated that didn't work in the UK, which is a highly urbanised society where there's no ER more than 20 minutes away from you. It might be quite different in another environment, more dispersed population like Australia, but in the UK, this didn't work, so it didn't proceed. So those are evidence of national impact and the national processes.

Steve mentioned the applied research translation centres in Australia where the equivalent in the UK would be these, the ARCS, the Applied Research Collaborations. And these are collaborations of health and social care providers for hospitals, GPs, social care, very important, local councils and universities, public advisors, voluntary organisations, all working together to try to bring about change for their population by undertaking research. But then I've seen that research applied in some form in locality. So, there are fifteen of these across the UK, across England. You can see from the map, where maybe you can't, that it does actually achieve national coverage. There's an ARC covering every part of the country and unlike the RTCs in Australia, these do actually get funding and they're funded the two about two and a half, £1,000,000 a year, about $5,000,000 a year from central government, from the NIHR budget and they're funded for periods of usually six to seven years. In fact, we've just coming to the end of the funding period now. There'll be a new competition starting within the next few months. And whether you're successful in that competition will then require you being able to demonstrate what has changed in your area as a result. So, we've gone from the low from the national level impact down to local level impact. What can you change locally? Because everywhere is different. The kind of problems faced in my part of the country, which is the North-West is not the same as you'll find in inner city London. So how we adjusted our behaviour in ERs, in GP practices, in social care to actually meet the local population needs.

So, one of the questions we were asked in preparation for the seminar was around how we actually achieved things like equity. For instance, I work with the North-West of England Applied Research Centre, the one in purple or the long stringy one down the West Coast and it's stringy like that because that's the way the roads and the transport lines run. It's not just weird. But the map beside it shows one of our big issues, which is health inequalities. So, the colour change goes from red, which is the worst life expectancy in the UK, down to the green which is the best. And you can see that that whole corridor and up into the North-West have this enormous disparity in life expectancy.

So healthy life, life expectancy is about 10 years shorter in many of these parts than it is in the more wealthy areas. And it's down to poverty, poor education, all the things that you can think, but serious health inequalities arising from those. And this particular ARC, is dedicated to trying to improve health inequalities across the patch.

And we're expected to, oh, I should have said the funding. Very importantly, the funding does not go to a university. Universities try to run these things. But the funding by the rules, must sit in the health organisation. So, universities can't go up and do their own thing. They must place the agendas of the health organisations. Next slide.

And there's heavy expectation of involvement of the public at every level in the. So, in the UK, we don't talk about CCI, we talk about patient and public involvement PPI, but it's basically the same thing. And so, the ARCs in particular are expected to have very heavy PPI at every level. For instance, here's a patient who would acknowledge that he's been suicidal at times and discusses what the ARC is doing around trying to reduce the risk of suicide. Other examples of PPI are degeneration topics so the topic on the other side is around quality of air. And so that for instance, has had an impact on first of all, doing the study to identify the quality there, then working out why it's so poor in certain areas, which is often down to traffic and that's influenced local councils and to alter blinds of traffic, close roads, reopen other roads, consider other means of transport. Season can be highly influential. Next slide.

Here's an example around public health research done in an ARC, looking, for instance, at what were the real hotspots of COVID mortality, and entirely bleak debate, they were in areas where the health inequalities were greatest, where the poor people lived for the most part. They were the areas where people suffered most from COVID in the UK. And the last one.

My last slide is around what do we actually learn from all of this? So first of all, I would say that we have created a very clear expectation that research will be conducted in the health service, both in part of the health service and in the part of researchers that the health service expect to participate in research, expect to be influenced by the results of research, particularly ones they've been involved in.
We've created an expectation and a needed requirement that researchers will think about impact and how they're going to change things. We've created an expectation on the part of patients that research is going to make things better and things are going to change. So, it's not just a process of the academics pushing the research all the time. There's pull from the health service and a pull from patients and the public as well to ensure implementation. Very key that we should share priority questions. You must get the question right, and it must be a question driven by the needs of the population, by the health service. We must engage the public and the health service in design of the research. So, all kinds of issues there. How often do you drag the patient into be clinically seen again? How necessary is it? Where can you see the patient? Is it easier for the patient to actually participate in research? All those issues we're expecting to see in the projects we fund. We need to have implementation champions to help us bring things about actually on the ground. The study I showed you earlier on about the tranexamic acid, the research champion for that came from a surprising source. It was the Surgeon General of the British Military. He thought this was a really good idea and it started to be used by the British Army in Afghanistan at the time and once it was being used by the British Army paramedics. We sometimes like to be sort of quasi-paramilitary. If it's good enough for the army in Afghanistan, it's good enough for me. So, this is now routine practice and ambulances at the roadside, road traffic accidents in the UK so a champion is really important. We must tell people about our research. We must tell people about it before we do it, why we're doing it, while we're doing it and afterwards what's the outcome. And we must do it in plain language, and we're absolutely appalling as academics and translating things into plain language that the people can really understand. And if you do all that, if we ask the right question, you involve the end users every step along the way, if you disseminate quite quickly, then the research translation should be easy. Shouldn't it? Maybe. Thank you.

Dr Nick Johnson 27:56
Thanks very much, Tom. Now, Professor Martha MacLeod, next presentation.

Professor Martha MacLeod 28:14
Wait for the first slide to come up. You can hear me? OK, good. And I want to thank you for that kind introduction. You'll hear that there will be certainly overlap, but the structure, the organisational structure of the country makes a big difference, I think in in how these issues are borne off. I'm speaking as a qualitative researcher. I'm also speaking, as you heard, from the Knowledge Mobilisation Research Chair and others, but I've been involved in the Canadian Institutes of Health Research for many, many years, including in their strategic planning in Michael Smith Health Research BC, which is the health funder in British Columbia, and as part of the Integrated Knowledge Research Network. And I want to thank Graham, who many of you may know for that. Next side.

I am fortunate to live and work in Northern British Columbia on the traditional lands of the Lheidli T’enneh, which is now known as Prince George in northern British Columbia. It's a 10-hour drive from Vancouver that many of you may know about to Prince George and I work in a university that has accountability along with the health delivery service for the northern 2/3 of the province in which there are about 300,000 people living. And we're very thankful right now to the Australian firefighters who have come to help fight the fires that are burning all that not far from my area. Next slide please.

I've got over map here of Australia and Canada, so you can see that the distances are large, and the land mass is fairly much similar. There's some, next slide please. 
There are some affinities between the two countries that impact how research is both developed and translated. In Australia, the vast majority of the people live along the coast in Australia, but in Canada 90% of the population live within 160 kilometres of the US border and with the vast majority in Ontario and then in Quebec.

So accordingly, for me, the theme of context, geographical context in which makes possible the undertaking of research and it's translation is very key. Also, in Canada the organisation is that the provinces, which is the equivalent of the states and territories have legislative authority for education and health. So, there is not a national initiative in quite the same way as there is in Australia. Next slide please.

But I want to talk about the national and institutional support to encourage research translation. And you may find that the CIHRs Institute of Health Services and Policy Research, which is easily searchable, has got a very good definition of knowledge mobilisation, which is what is now used as the term in Canada, and it's moved from knowledge translation and the definition of knowledge users. So, it's researchers and knowledge users are generally what's talked about, and the introduction integrated knowledge translation and co-production. So, the strategy of patient-oriented research is another national project and national initiative on the part of the CIHR, but it is played out differently in every province. And so, the national and provincial programmes are challenged to develop an approach that really gives the attention to rural and remote practice and research development that there is. And so, one of the things that the Michael Smith Health Research BC has done, who organises the strategy for patient-oriented research, is to develop regional hubs within the province that are for research generation and translation and a huge amount of capacity development. So, the provincial and national program delivery don't develop that regional capacity and so particular attention needs to be paid. The next one, please.

One of the things I wanted to talk about because I knew that much of the audience would be the NHMRC, is the believers that funding organisations can play for knowledge mobilisation, knowledge translation. And I'm thankful to Bev Holmes, who is the executive director of British Columbia Michael Smith Health Research BC. And that includes both the funding, but influencing the systems in which the health research system exists, advancing the science of knowledge translation. For instance, some of the research that I've been doing on a hermeneutic approach to implementation has been funded through specific attention to what methodologies really work in knowledge translation. And the other key here is recognising the power relationships and unintended consequences of granting formulation and then how researchers and knowledge users can be separated as opposed to thinking of them as people with very different kinds of perspectives, but equal experience and resources on particular teams that are research and knowledge translation integrated teams. Can I talk about the next one about impacts of research translation?

The impacts of research translation, I know Tom has really gone into that. The metrics and use of it are a little bit different in Canada, not as coordinated as in the UK for sure. One of the things that we're finding is increasing evidence that clinical trial trials that are initiated in rural areas on issues of concern to rural people have new approaches to treatment. And an example of that is kind of the Sabre 5 trial organised by Rob Olson, who is the Research and Clinical Trials Lead and the Radiation Oncology Oncologist for the British Columbia Cancer Agency Centre for the North in Prince George. And what he identified from people in the in the North was and also incorporated patient-reported outcome measures was that travelling for radiation was too much. So, what they've done is that they then have looked and done higher doses with less treatments have been just as effective as ongoing. And those are kinds of things that are not identified and then applied. It was generated from rural in remote areas and I think that's something that we need to really look at differently. I want to go to the next slide.

I was involved on a CIHR knowledge translation evaluation. Now this was a decade ago, but what was important were that the traditional measures of success were compared, and you can see the integrated knowledge translation group of funding opportunities with knowledge synthesis, knowledge to action, knowledge translation, research and planning and dissemination grants compared to the OOGP which was the Open Grants Competition. And next one, please. You can see that the number of students and post-docs was higher in the Integrated Knowledge Translation one, the next one, academic outputs were about the same, but knowledge translation outputs were remarkably different in the two. Now over time, what has happened is CIHR has no longer has separate integrated knowledge translation projects. Instead, every single application within CIHR, including increasingly in the biomedical area, is expected to have a knowledge translation component. But what's happened is, is that the funding has without that directed funding, there are some kinds of KT developments that have changed. What the IKT funding focus meant that more women and younger researchers and researchers from smaller, more rurally situated universities aren't there. Next one, please.

So how can equitable research translation occur? Now we know that researchers and those who actually use research findings have different cultures, different languages, different priorities, different incentives and different timelines. But without the bridges provided by integrated knowledge translation and co-production initiatives that you've identified here for sure in the research translation centres, the communities have few opportunities to learn from each other. And I think that we need to look at integrated knowledge translation and co-creation approaches, provide opportunities for those who dwell, who live all the time in rural and remote context, to work interactively with researchers to create topics for implementation and work together to both create and implement knowledge in workable ways. And we're finding that, for instance, on some of the guidelines that are created for stroke guidelines where you need to have ACT scan within a certain amount of time, if you're living five hours from a community, let alone another fifteen hours drive from a CT scan, it's not useful. So, what happens is the clinicians just ignore these kinds of things and develop other kinds of methods of assessment. And what we don't have is knowledge of those other kinds generated from the rural areas. So next and next slide, please.

Lessons that I've learned, we've learned over time. So, co-production and integrated knowledge translation can advance research, education and practice, which in order for all to advance, they all need to be interconnected. I think it's a folly that big complex research projects have the greatest potential to make most changes and most impact. And that's because I really think that we have to take a page from adult learning and all those involved to be responsible for change, particularly in the health services area. And to do that, it is actively create new knowledge, not just implementing and adapting knowledge that's been identified and created from somewhere else with a set of assumptions that cannot be held in those rural and remote areas. The other thing that I've seen is I've sat on Knowledge Creation Committees. Knowledge Translation Committees is an expanding over reliance on theories, models and frameworks that I think are stifling innovative approaches. And that is a requirement because you run by funders to say OK and committees that you need to have these, these things and I see it as being stifling. Now too often and people that were on the committees with me yesterday, we hear about integrated knowledge translation research as focusing on knowledge that can be implemented in the health system. In partner research, both partners change. So, I think we need to attend more the impacts in the academic researcher environment. So, what happens when there is that partnership and what impacts on that of that partnership happen in the universities. So, to me, that's I think I'd like to end on that, and thank you very much for this and my welcome questions.

Dr Nick Johnson 41:13
Thanks, Martha. And our final speaker, Professor John Prins. Welcome John.

Professor John Prins 41:20
Thanks very much Nick, and thanks Steve for the introduction. As Martha said, there is a lot of overlap with our presentations, which I think is a is a very good thing, so we can go to the next one. Thanks.

So, I thought I'd start with a bit of a background on how I see the state of play in Australia, as Martha and Tom have both done for their countries as it happened. Firstly, a reminder that we have a small but wonderfully diverse population spread across a large geographical area. At the hospital I work, there's over 150 languages spoken by the patient population and that's got to be a fantastically good thing. However, just as Tom has described in the UK and we've heard from Canada, there is significant health disparity across the country despite an overall very healthy population. So, one has to drill down a little bit beyond average life expectancy to see that there's still a lot of work to be done. And to be fair to all the agencies that are involved, there is a lot of work being done to address that. We have a very strong traditional style academic sector, but our sector is weaker in innovation and commercialisation type outcomes, although it is improving. And that's of great relevance to health translation because at the end of the day, a lot of the translational efforts at the very end of the line do require the input of industry and other players and it cannot be confined to government and academic sectors. We have a bit of a problem in the way health is funded here as it's effectively a “fee for service” type funding arrangement, which makes it actually difficult to build in an R&D spend into that because it becomes a competitive environment in terms of numbers of patients seen or numbers of occasions of service. And whereas if it's a block funded type system, then one can build in mandate and R&D spend. Now I won't get into the argument about what percentage of that R&D spend should be. But as you would have seen from the papers in the last week, this is an active debate and I think one that's an important one that we get involved in. And then like my picture of a bunch of liquorice all sorts, our difficulty we have is that there are multiple funders and players across the life course. So, from cradle to grave, one's health is looked after, if you like, from any combination of variation of federal government, state government, local authorities, private health systems, other government agencies. And there's not a lot of continuity of service, if one could say that between those and that is a major issue that we all know about and we all face and again needs to be addressed. Thanks.

But on the upside, as an optimist, just as I think Tom and Martha have said, it is getting easier to do good quality health translation and there are a number of reasons for that. Firstly, we are beautifully equipped with data and with systems for capturing that data and increasingly our capability for analysing that data and as close to real time as possible is getting much, much more sophisticated and much better. And that's a major solution to that sort of discontinuous sort of cradle to grave care system, we've got good quality data and one can overcome some of those divisions. There is much increased collaboration and coordination, both coming from within the sector where we can see that that's valuable. But also, it's being in a sense driven by funders as we'll come to. CCI as we call it, as Tom said, Consumer Community Involvement is increasing again being driven by a lot of directions and that is a really good thing and it certainly impacted the types of questions that are being asked and the types of questions that are being funded, which is important. We also have an increase in what I call problem-orientated funding as opposed to an investigator-initiated funding. And both Tom and Marta alluded to the same things where what are the problems that are to be solved, and the best place to start is asking patients or the community. And then are we in the most efficient way possible actually collaborating and coordinating our efforts to solve those problems. There is an improved recognition of health services research across both federal and state and also within our academic institutions, which is a good thing. It's that closer to the clinical end of the research spectrum that is so important in terms of impact, and it needs to be recognised as an extremely important discipline. And I use that in the broadest possible sense in terms of that terminology. And I think probably one of the most exciting things for me is some really interesting and important upcoming legislative change, both particularly the federal level, but also at some of the state levels, which will put patients much more in control of their health data. And then the ultimate skin in the game comes from patients, they have the ultimate skin in the game, and they will not tolerate poor use of data or poor communication between different agencies are looking after their care. And if they hold the data, they will be driving, I think, a very rapid move to a much more integrated collaborative approach to the problems that they face. Thanks.

We also have a significant workforce challenge and I've called it workforces challenge here, if you'll bear with me with my very clumsy diagram here. On the X axis, we've got the workers that are addressing health in our community, and they range from the clinicians at the left-hand end to the more academic end at the right-hand end. And then the Y axis is the number of workers involved in those varying sectors. And at the left-hand end, the vast majority of our clinical workforce and support workforce, which is very important, literally day to day, 24 hours a day working to look after patients or preventative health or acute care etcetera. And they are predominantly clinicians. At the other end of the spectrum, there are those that are more on the research side or the teaching side that are involved in the academic pursuits and are less integrated or have less time on the clinical tools or clinical understanding and there are gradations in between them. We have a shortage of workers in all of those categories. We have a, you know, a shortage of just pure clinicians of every persuasion, but we also have a shortage in every discipline of those the more academic into the spectrum. And it's well known from the literature that the more the greater proportion of your overall health workforce and I include support workers, administrators, etcetera in that, that have an academic bend that have a tinge of a tinge of red there then the outcome for the patients is improved. But we need to define which population of workforce we're talking about, what type of workforce when we're discussing how we might address that workforce strategy. Because the strategy you might induce, you might implement to improve or increase the number of pure clinicians will be a very different strategy perhaps from what you might want to do to improve the number of clinicians that are actively involved in quality assurance or quality improvement and the number of clinicians or support staff that are driving academic research questions. Thanks.

We also have some facilitators as has been mentioned by the previous speakers here. We have NHMRC Research Translation Centres, which Steve spoke about in the introduction. You can see from the map, we're not quite up where Tom was describing, but we cover collectively the Research Translation Centres cover about 90% of the health workforce and about 90% of the geography of the country, which is a terrific achievement. They are becoming much better coordinated and integrated from within. It was the Australian Health Research Alliance, and we are trying to practise what we preach in the alliance by not duplicating stuff, by learning from the things that each of us are doing well, plagiarising each other's good ideas, making sure we don't repeat each other's things that didn't work quite as well, and that's going very well. We also have two other federal agencies which I think are very important in this area and one is the Australian Clinical Trials Alliance and third is the Australian Academy of Health and Medical Sciences, which is one of Australia's learned academies. Those three organisations represent the whole of the country, and their only interest is in the welfare of the patients from a health perspective. So, they don't have individual axes to grind and they're working more closely than ever before. And again, I think this is a way in which we can, through those agencies, ensure as best as we can that the funders are looking after the health of the community and comes with a focus on impact. But also, that we can ensure that we are not duplicating things. We are learning from other countries; we are learning from each other. The other facilitator is an increased proportion of the funds that are available for health-related research that are problem-orientated, and there are also driving collaborations. There are now increasing chunks of money available that are only available to collaborative entities. So, the days of a single researcher beavering away and expecting to be funded for his or her bright ideas, I think diminishing to some extent and more importantly, there's money now available to address specific health problems identified at the coalface rather than identified by the researcher. And significant approaches to reduce waste and Tom gave some terrific examples of it's important to stop doing stuff sometimes as well as start doing stuff. And reviews of our MBS and PBS in recent years led by the federal government have made a great, I think a really important step to ensuring that the drugs that we are using are the top of class. The procedures that we are implementing really do have a benefit to patients etcetera. Thanks.

So, I just want to talk about varying roles, and I think universities and medical research institutes, and medical research institutes are a relatively Australian sort of unique animal for want of a better word, they have, I think the exquisite advantage of being able to work across sectors. They can approach a problem irrespective of who might be involved in the management of that problem. And so, they're not bound by funders of healthcare and that puts them in a beautiful position, I think, to work collaboratively with the people within those sectors to address the problems. They also have an opportunity and I believe a responsibility to train the workforces of the future rather than the workforces of the past. The training I had as a medical student or liberal relationship to the training that I currently are involved in providing medical and that's a good reason for that because the environment in which our graduates are going to operate now is very, very different. But there's some sectors of the health workforce that we do not yet have really good quality training programmes for. And I'll choose a couple including health data experts. We are desperately short of people that understand how to use health data, how to apply health data, how to manipulate it, how to interrogate it, how to code those sorts of things. And health administrators, you know, good quality health administrators that understand academic reader, understand quality assurance. We do not have bespoke, really good quality programmes across the board where they are seen as an identified workforce that we need to train really, really well. Next thanks.

So, the role of governments and providers is of course, to give us some cash. They are the payers and as Tom's indicated some of the things that he's, you know, his organisations have paid for. And I would argue that if you look at the impact or return on investment, there are a couple of areas where governments could really spend money. Next slide thanks.

And this graph here, will be familiar to many of you came out of the McKeon review of NHMRC. And on the X axis, it's the number of dollars that you're spending on your health service and on the Y axis is the quality of the outcome, in this case measured by quality adjusted life use. But you could measure it in in many other ways. And the first and last sections of that curve is where the money is, a high value intervention such as vaccination, public health information screening, that's where we've got to do really good quality research because the programmes that work in regional areas may not work in metropolitan areas. The programmes that work for one language population may not work for others, etcetera. And then at the other end of the spectrum is about 30% of our health spend does not provide any benefit to patients and can provide harm to patients. So how much of that can we rescue with good quality research and then have that money available for interventions that are beneficial? So that's sort of reducing waste from an economic sort of perspective. Thanks.

And so, the final sort of considerations or philosophical musings before we go to questions is that I think we have a wonderful opportunity now there's the federal government has initiated a Health and Medical Research Strategy which is under development. And that's an opportunity for us to really think seriously about how we might provide within the funding system mandated R&D spend and how that spent might be undertaken. I believe Australia is very well positioned to take a global leadership role in the use of data and in clinical trials, particularly early phase clinical trials and happy to expand where I think that we can’t, and we shouldn't try and compete with the types of trials that can be done in a high population area that Tom spoke about. But trials in regional remote areas, trials that require teledata, telehealth, etcetera are ones where we should be leading the way. And we have a regulatory system that's very advantageous in terms of early first in human studies, for example. And then just a reminder that successful research translation doesn't actually save the community money. What it does is provides better health outcomes for the same money and it's a very important distinction. And every politician knows that your intervention will not necessarily save the system money because we have waiting lists, we have unmet demand. So, you're not going to save cash, but you will improve health outcome, you will reduce waste, you will reduce harm, and as Tom alerted, you’ll reduce the time to implementation of new knowledge. And that might be how long it takes you to stop doing stuff that we now realise is not in the patient's best interest and how long it takes to start doing stuff that we now know is in the patient's best interest. Thanks very much.

Professor Steve Wesselingh 55:26
OK, what fantastic presentations and we could almost stop there because there was just so much there. And I think we've all learned a lot just from those presentations, but we do have an opportunity to ask questions and to interrogate this a little further. And so, I'm going to start with a few questions and then I might try and incorporate some of the ones on chat and Nick's going to look out for any questions in the audience in Canberra. But I'm going to start with Tom.

And Tom, you talked about these groups, these Translation Centres for one of a better word in the UK I think one of them had sixty members. So how, how does such a complex group decide on the questions they're going to answer? How do those questions come up and who decides what's the most important question to answer?

Professor Tom Walley 56:20
So an organisation with sixty members is very complex. Pressing button is always a good move. So yeah, sixty members is very difficult to organise, and those sixty members will need sometimes to be helped to develop their priorities by bodies and firm views. So, people like universities and health services will have firm views. They may not take a view of the patient responsive element, what patients actually want to hear, that they may not take a view of, for instance, what the local councils wanted to hear. So, the help may be improved not by spending more money in the health service, but actually in other areas. So, it's a very, very complex environment and it's never totally satisfactory and there are frequently arguments about this. At the end of the day, it does have to be pushed through by the executive group who have to lead it, and it does require leadership to convince people this is the right thing to spend money on. But they've got to do that by listening to their audience first of all and taking advice on the audience. But is everybody happy at the end of today? No.

Professor Steve Wesselingh 57:37
Thanks, Tom. I might move on to Martha. One of one of the issues that we've had in Australia is the research and funding of research conducted by nurses and by allied health professionals and I actually recently had a conversation with the chief nurse in Australia about this issue and how we could possibly grow that area. And one of the strengths I think that nursing and allied health have is that they are at the coalface, and you know, right there in terms of translation and impact and knowledge implementation. I wonder if you can comment on any of the thoughts you might have about what's happened in Canada and about how you could increase that really important component of our workforce and how we could encourage and get more involved in research?

Professor Martha MacLeod 58:25
And thanks for that. That is one of the major things that I've been doing over the course of my career is working in partnership with practising nurses to work on topics that they want to be attended to. And that's the biggest thing I think is for, to create an environment where researchers are able to respond to the, the nurses and funding then helps to free nurses and others up to or to contribute to meetings and to then be supported to go to conferences. A very small example of that is that in British Columbia there is a nursing research fund through Michael Smith Foundation for Health Research. And in Northern British Columbia, the clinical practitioner said that we've got this clinic in Port Saint John that the doctors have said it's all theirs. But the people who are really making this work are the nurses. And so, can you come and identify what it is the nurses are really doing to contribute to the healthy pregnancy and birth of the women in this particular community? And so, what happened was, is, is the two of us came up, we worked with the nurse leaders there. We created a research project and then started it. But then there was a turnover and then there was, and then there was COVID. And so, we came back with the, we got permission from the funders to pause. And because in that environment there wasn't the depth of the personnel to be able to continue to work on it. So thankfully the agency paused it. And then we went back, and we started to work again on the same topic with a different angle with the nurses that were in that were there and they were then supported by their managers. Within this last year, did some shadowing of the nurses, did interviewing and then came up with a report that has gone back to them and publications that have come out. And we are getting support from the health agency, the health delivery service to support the nurses to go to the national conference to do the presentation with us as the researchers. And so, the nurses then are going to be learning about presenting, they're going to go to a conference where there's clinicians and others, but they need to get that support on the ground for their involvement and the presence away from their employers. And it's that kind of small but really critical important work that isn't there for nursing. And the that's the kind of thing that I think those very small but very important on the ground aspects coupled with researchers that are willing to work with people on different topics. I have nothing to do with perinatal, but somebody else did and so we worked together on this, and we could then make something happen with terms of capacity development.

Professor Steve Wesselingh 1:01:59
Thanks for that. That was terrific. Thank you, John. Having heard the other two presentations and spent some time chatting to our international guests, what immediate learnings have you gathered about the Australian system and how we could improve the Australian system in terms of translation or impact?

Professor John Prins 1:02:24
Thanks, Steve. I'm trying to avoid saying dollars, but Tom did that for me. So that was very gracious of him. So, I think particularly in the UK, you know, we're looking easily at the central coordination, the response that Tom described with the clinical trial and code. We saw quite a lot of that in Australia and code. But sadly, I think we've slipped back a little in terms of a really national collaborative approach to issues large and small. And it sounds from talking to Martha that Canada's probably around about the same sort of level of what the word is maybe maturity in, in that I'm thinking there's always a balance between local requirements and centralisation and the efficiencies that centralisation has. But you know, that's a balance that I think we could probably spend a little bit more time on in Australia thinking about that at a very practical level. The growing integration between our two major funders, the NHMRC and MRFF is a really good step toward that where we're taking a much more coordinated approach to things. So that's good. The other, I think important thing that especially came from Martha's comments that were the required times, the requirement for the questions to be asked to be sourced locally. And you know an anecdotal, an example from Queensland actually is about 6-7 years ago. The cancer researchers and clinicians did some work to address the hypothesis, to explore the hypothesis that if you're living in a regional remote rural area, your outcome from a particular type of cancer is likely to be poorer than if you lived in the city. And in fact, that hypothesis was in a sense disproved because what was discovered was that irrespective of where you lived, if you were being looked after by a model of disciplinary team, your outcome was good. And so, you could live around the corner from a major teaching hospital. But if you weren't looked after by a multidisciplinary team your outcomes [were poor].  So that was a question driven from the coalface, done with true scientific rigour and the answer was a bit unexpected for many of us. And yet that's now been rolled out and implemented with an almost insistence from the patients and from the clinicians that they should be part of multidisciplinary teams no matter where they live. Now that's the sort of research that is impactful and makes a difference. And to come maybe a little bit to the question you put to Martha, I take a very liberal sort of view of what translation research is. And I think it includes audit and quality assurance and quality improvement, which can be done in every ward It can be done in every primary care practice and that's how you involve the workforce in things. And as long as they have the skills to do those sorts of in, to undertake those endeavours with academic rigour, then that's going to make a big difference in real time to our patient outcomes.

Professor Steve Wesselingh 1:05:28
Thanks for that. I might just paraphrase one of the questions I've got on chat and looks like Nick might have a question in the room as well, but it's around health technologies. And you know, health technologies do drive improvement in healthcare, but they also drive increasing costs and sometimes health technologies don't actually improve the quality of health. And so, I was just wondering about the role of what we're, what we call in Australia, health translation centres in doing health translate health technology assessments and working with government in terms of what health technology should be moving forward. And, and maybe I'll go to Tom first to see what happens in regard to that in the UK.

Professor Tom Walley 1:06:13
So having been the Director of the Health Technology Assessment Program once upon a time, I better know the answer to this one. The broad outline is that health technologies are approved for NHS use by NICE as I mentioned. But as the HTA programme, we would pick up areas that industry would not fund and indeed sometimes might be seen as opposed to the interests of industry. So, for instance, I talked about the tranexamic acid example. Tranexamic acid has been off paid since 1955. No company is going to invest in that. But an example perhaps where we challenged industry was around the use of Ranibizumab and Denosumab in the treatment of age-related bacterial degeneration. Refunded direct comparative trial, both drugs made by the same company, one costing vastly more than the other, both drugs having similar efficacy. And we went through, we conducted the trial in the face of opposition and then the implementation required extensive legal cases with the companies attempting to block uptake of the cheaper drug by the NHS. And so, we drove forward at the data as far as we could. Beyond that, it starts to become a bit of a political battle. And where did that idea of doing the study come from? It came from a group of local ophthalmologists who had started using Denosumab before that more expensive drug was available. They like the results they felt on in their observations that was really no difference between the two and therefore they justified a trial. But it's not for the like of an ARC in the UK to take that forward. I think the Australian systems are rather broader, the HRTCs are using an old term and Australia are rather broader and sometimes more biomedically-focused than perhaps the ARC would be in the UK. And they've got a broader remit than the ARC in the UK. So, I think there are possibilities for the Australian Research Translation Centres to drive forward that kind of practical, on the ground study of real-world issues and sometimes challenging the kind of authority and power of companies and regulators.

Professor Steve Wesselingh 1:08:30
Thanks for that Tom. Does anyone else want to comment on that at all? Or we can go to Nick and see if there's a question in the room.

Dr Nick Johnson1:08:38
So they've got to see first. Anyone, Phil, has got a question. Jump up here. Speak in the microphone.

Dr Phillip Gould 1:08:45
Thanks everyone. So, I'm Philip Gould, I'm from the Commonwealth Department of Health and Aged Care, so I look after the Health Economics and Research Division. I'm here with some colleagues including Natasha Ploenges, who’s the CEO of the Health Medical Research Office and I believe Tom, your previous counterpart in Australia with her role leading the Health Technology Assessment Office here. I'm really interested in any observations that the panel has on the commercialisation side of translation. So, we did Tom, you mentioned an economic benefit being something that we are looking to achieve. Are there any observations around how Australia might gear up its, you know, really well-regarded research sector to translate some of that work into successful businesses which then impact, of course, models of care?

Professor John Prins 1:09:44
Thanks very much for that question. It's a very hot topic obviously, and I alluded to my slides that, you know, if you look at one of a better way of evaluation rankings, at universities rank very, very highly on an international space. But if you look at outputs, different commercial outputs, we, we do not. So, there's a gap there. There are a few reasons. I think we don't have a lot of major industry here. It's so obvious. So, you know, when I worked in the UK, it was literally fifty kilometres down the road to a major pharmaceutical organisation that you could, and it was all good that we were sharing. This was pure research, so there's less opportunities for that type of interaction but also, we have perhaps a slightly unusual way of managing intellectual property here, particularly in the university institute sector, which does make things a little bit more difficult. We are less pragmatic about how to take things forward. Deals take a long time to be done and so there's room for improvement there. To be fair, there's lots of good work going on in that area, but it's driven by governments and by the industry itself and the interaction between interesting academics is the best it’s ever been, and things are improving. There is a significant amount of venture capital cash in this country now, which is never been seen before. There are wonderful opportunities for research to be taken forward and growing recognition that we need industry. There's very little drug or devices on the planet that have been entirely developed by government agencies anywhere in the world. So, we've got to get over a little bit of an historical sort of idea that they're bad folk because I mean no company in the world wants to produce a drug that's not in the best interest of a patient or producer. Devices that are not going to last, you know, a significant period of time etcetera. So, the issues, the issues however, are still a little in terms of support and issues and funding issues they’re coming from different agencies in federal government, they're coming in different agencies, state government. It's not a coordinated picture at the moment so it's actually quite hard. And I see it from the researchers that might have an idea that could be spun out and it might be, but it's a complicated sort of web and there's still some lag time in a lot of those processes. So, but it's improving quickly.

Profess Tom Walley 1:12:09
If I can add to that, there's recently been a major government report in the UK on exactly this topic because it's recognised, we're really quite poor at it, particularly in relation to pharmaceutical industry. And one of the problems here is actually the NHS in many ways, because although I thought about the NHS, if it's some kind of united body, it's not. It's a lot of independent victims in all kinds of ways. So, if you want to trial or get approval almost in every hospital and the bureaucracy just slows things down so much, makes it far more worthwhile for a company to go to some other country to get his work done. So, we really have to get our act together and think commercially. As John said, there isn't sort of a feeling that commercial money is second best in some way rather than thinking others what actually fuels the economy and gives us the money to do everything else we want to do. So, I think we've got to change a cultural attitude of both part of healthcare and universities.

Professor Martha MacLeod 1:13:01
I'd just like to add from the Health Research British Columbia situation is that organisation has got commercialisation as a major issue just as the CIHR has. But it's interesting in NBC, the researchers have taken some very important developments just to a certain point and then they find that taking the next step going to the US for production collaboratively is better. So, I think that and there's some issues being raised about that. So that notion about the development of the commercialisation within the country vis a vis, but at what point do people go out because it's easier is something that really needs to be done.

Professor Steve Wesselingh 1:14:00
Thanks for that. And I think that's a really important topic and really a priority for NHMRC to see how we can improve that in collaboration with the MRFF who's been doing, doing a lot of good work in that area. Is there anyone else in the room, Nick, who has a question?

Dr Nick Johnson 1:14:18
I think we're pushing up against time. I would see, Steve, if anyone wanted to ask one if there's time, I could squeeze you one quick question.

Professor Steve Wesselingh 1:14:27
We're one minute over, but I think, yeah, I'm very happy to go 5 minutes over.

Dr Nick Johnson 1:14:32
Yeah, OK, thanks. So, I guess there was some really wonderful examples of research translation that were presented by the panel and some of them are clearly context specific, but others are broadly applicable. So, I'm wondering, can you speak about where you see the lessons, those translation outcomes being shared between our countries and more broadly and where those things aren't happening? What are the barriers, what might we do to help encourage those lessons that were in each of our countries being taken up, you know, the health services?

Professor Martha MacLeod 1:15:09
And I'd just like to speak that one of the similarities between the two countries is the development of the Aboriginal and Torres [Strait] Island people's work in research and research translation and the Canadian Indigenous people's development in that area. And I do know that there are some really exciting initiatives between the two. And I think raising the profile of those and looking at commonalities might be something that would be very helpful to do. And lessons learned in the two countries may be very, very helpful to move some of that forward.

Professor Tom Walley 1:15:52
And I would say that when we were looking at a research topic, one of the first things we would do would be to see what happened in Australia because for cultural reasons, the quality of research has been done with enormous respect to what goes on in Australia. And we would try not to duplicate things that we were doing unless we thought that you were doing it in a particular context, and it wasn't applicable in the UK. So, a lot of American research, for instance, we can't apply in the context. It's just too different. Australian research usually just flows straight through the very minor modification into translation. So, I think we learn a lot from you in all of that, but I think we can work together and learn more in other all kinds of ways.

Professor Martha MacLeod 1:16:32
That ability of Canadian rural and remote researchers to work and draw on Australian research is absolutely there. We cannot draw on US research in the same room because the context is so different. So, we learn an awful lot from rural and remote research in Australia.

Professor Steve Wesselingh 1:16:56
All right, well, thank you so much for that. And actually, on that note, you know, I think it's time to close. I think we've always had a terrific collaboration between the UK, Canada and Australia. And Nick and I were only talking this morning about how we can enhance that and work more closely together on all sorts of areas. So, I think that's a terrific topic to close on. I'd like to really thank our panel. I mean, your presentations were brilliant, and I think from the chat, it was clear that, you know, it was the topics were really important to the people on the chat and on and people logged in and really, it's an area that we're all trying to develop. So, thank you so much. And in fact, I think we had a record number of people log into the webinar, not quite as many as Kamala Harris had yesterday in her announcement, but still quite a lot. So, I think that just shows how important this area is.

And I do want to thank everyone who did take the time and effort to log on and listen and ask questions and also the people in the room. I also want to emphasise that this has been recorded. And so, anyone who couldn't get on and if you're talking to anyone about it, let them know that they can find it on the website and, and, and watch it later. So, on that note, I again just like to thank the panel both for their presentations and this webinar, but also the work that they've done over the last few days with NHMRC and particularly over the last few years with NHMRC in this area and in relation to the translation centres. So, thank you so much. Brilliant webinar. Thank you everyone. Thanks everyone who was involved in producing it and looking forward to the next webinar next month. Thank you very much.

End of transcript.