Dr Caroline Wroe is Clinical Director for North East and North Cumbria at NIHR Clinical Research Network (CRN) and a Consultant Kidney Specialist.
Tell us more about your role and your work.
I hold 2 roles, 60% of my time I’m a kidney specialist working at the Freeman Hospital transplant centre in Newcastle, 40% of my time I work for the National Institute of Health Research. In my clinical job I work as part of a team providing kidney transplant services to the whole of Northeast and North Cumbria. I help look after patients with kidney failure, care for them during their transplant and then follow up with them afterwards. In my research role I’m the Clinical Director of the Clinical Research Network (CRN) for North East and North Cumbria. This is the part of the NIHR that supports clinical trial delivery. It’s a bit like Amazon delivery parcel service – it gets the research to the right place at the right time for the right people or patients. It’s the ‘behind the scenes’ part of research. We have a core team of about 70 people, and fund >850 staff across the region to support research delivery. There are about 48,000 people this year that have taken part in 850 different clinical studies in our region.
What do you enjoy most about working in your sector?
It’s the breadth of research that I enjoy. It’s really interesting looking at how we can get that trial out to the people that need it most. Over the last couple of years we’ve started to work with public health and social care, and that’s been really interesting to understand more about that. For example, there’s a big study looking at childhood obesity that we’ve been supporting across all the different schools in our region. We’re also the highest in England for number of people participating in medical technology device trials for our population size. We trial if patients can you use a bit of kit, if it works for them at home and how easy it is to use. When you consider that 80% of items brought into the NHS are technology related, that’s really important.
How important is innovation within your sector?
Particularly because of the delivery research system that I look at, innovation is about how we do what we do. One of the recent things that’s been a huge innovation is moving to a digital trial. So we previously thought if you have to take part in a clinical trial, you have to be recruited on-site and then come into hospital- but that’s not the case now. If patients want to take part in a clinical trial, we look at if we can arrange to have the relevant bit of kit delivered to their house and for them to get all their instructions online and be able to participate remotely rather than in person. Another factor is about how we measure participant feedback. It’s important for us to understand people’s experience of research, and ask if it was good, what were the frustrating parts, would they do it again and what have they learnt from it. Over the last few years, we’ve introduced a digital system to capture people’s feedback and we’re constantly working on and improving that system.
What professional achievement are you most proud of?
During the pandemic, the RECOVERY Trial was set up to identify treatments that may be beneficial for people hospitalised with COVID-19 pneumonia. There was a particular need in the Northeast and North Cumbria as we saw in the first wave that there was a higher mortality in our region because of all the risk factors. I led a team looking at how many people were being recruited into the trial across our region. Some hospitals seemed to really struggle to get patients participating and other hospitals managed despite being under the same massive amount of pressure. So, we did a contemporaneous analysis of what worked in the first and second waves of the pandemic, so that by the third wave, all the learning across one Hospital Trust could be replicated across the others. As a result of that, we had the highest percentage of people with COVID taking part in the Recovery Trial across England. The English average was 9%, in our region this was 11%. So that’s 1 in 10 people admitted to hospital taking part in the RECOVERY trial – which was fantastic! The openness of the system to learn from each other was really good.
Another achievement I’m proud of is my work to support access to kidney transplantation and living kidney donation. I used to work as a kidney specialist in Teesside and my experience of working across these different sectors has been incredibly valuable for me. In Teesside, I set up a service to access kidney transplants for people to become living kidney donors. And when I started, I knew that if patients were in the catchment area of a non-transplanting centre (which the whole of Teesside was) and if you came from a poorer background, you were less likely to get a kidney transplant, and you were less likely to get the best kind of kidney transplant (which is a living donor kidney). The Teesside service we developed work was actually put forward at an All-Party Parliamentary Group for how health services can make things work in an area of deprivation. It was put in the ‘Getting it Right First Time’ report for the UK for Renal services. So that was really powerful to me, because it shows that if we put in consistent work across the team, listen to the system and make every improvement that we can, we can get the best outcomes for our local patients.
What do you think it is about your network that makes it so good at recruiting people into trials?
I think that the great thing about the Clinical Research Network is it’s really looking at what our challenges are across the system, rather than in silo. So we are always asking ourselves: where are the needs in the system, and are we delivering research in the places that really matter? Whilst there’s a little patchiness – for example, there are pockets of County Durham and Darlington where patients can’t access research through their GP practice at all, whereas 80% of practices in particular areas of Northumberland and Stockton are offering trials – we make sure we can still create as an equitable system as possible. We know that research offers patients the most amazing opportunities, it offers new medicine, new technology and if we’re active in research then patients get better outcomes and staff are satisfied, so we are motivated to make research as accessible as possible.
What are the challenges of being a woman working in your sector?
Being taken seriously while working part-time, South Tees NHS Trust offered me a part-time job and were really supportive of me in the Renal department. I then applied to be R&D director and I became a R&D director working a three-day-a-week, which is almost unheard of.
The second was the gender pay gap, although the NHS pays doctors the same basic rate, at senior level there are reward based payments we have to apply for, typically men apply for them and women don’t, part time women are even less likely to apply. So there is nearly 20% difference between what a male and female Consultant get paid.
When I started as R&D director I realised that I was leading a group of mainly men that got paid on average twice what I did. This led to some very interesting self reflection and conversations about how we support women to apply for clinical excellence awards. I still encourage part-time women to go for them because they usually put in loads of extra work.
What advice would you give to other women working in your sector?
Find someone that you trust and respect who understands you. I had two people mentoring me, and both of them knew me as a person. So they understood that I wanted to be there for my kids and wanted to be there at bedtime. They understood my values as well, and that was really helpful and liberating to find someone who sees me and can give me advice and listen.
I also think role models are very important. I have three daughters, I think what’s been interesting is that I’ve bred feminists without realising it. My husband is the most fantastic supporter of me – it’s fascinating viewing that through your kids’ eyes, because my eldest, who is now at University, recognises that her Dad actually does do the shopping, he does put washing on, he does make dinner. I still see lots of people where there’s an unequal amount of work in the home, and that always puts women at a disadvantage. Equality across the system is what liberates us.
What would you say were the key challenges in your sector that currently prevent innovation moving forward?
Communication – I think we don’t listen to each other enough. There’s loads of really good stuff in research but we’re often too busy to look outside of what we do. It’s not that people don’t want to listen, but we need to all be going in the same direction in order to communicate better and faster.
Do you find any particular challenges as a woman working in the North of England?
I think the North has actually been really generous to me. If I was working elsewhere I think I would have struggled to find the confidence to apply for R&D Director as a part time woman.
You can follow the NIHR CRN North East and North Cumbria at @NIHRCRN_NENCumb
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