The research, known as the HERON study, was led by the Nuffield Department of Primary Care Health Sciences at the University of Oxford together with the NIHR HealthTech Research Centre in Community Healthcare. Over five months, from June to November 2025, the team surveyed 314 people across all four nations of the United Kingdom, asking them to describe the biggest problems in respiratory care and the places where technology might help. The responses amounted to nearly 1,300 distinct challenges and ideas, which the researchers then sorted and refined into 73 separate areas where a device, app, test or data system could plausibly make a difference to care.

What happened next is what gives the study its force. Rather than simply publishing a wish list, the team checked each of the 73 areas against what already exists, ranging from early laboratory prototypes to products currently on sale. The results were stark. In 52 of the 73 areas, they found nothing adequate on the market or in development. A further 21 areas were only partly covered by existing technology. And not a single area met the demanding bar the study set itself: a suitable solution already in routine use at scale across the UK. The authors note that the picture may have shifted in the time since they completed their review, but the overall message is difficult to escape. The technology that patients and clinicians want most is, for the most part, not the technology being built.

This mismatch matters because the scale of respiratory disease in the UK is enormous. Around one in five people lives with a lung condition, making respiratory illness the third leading cause of death in the country and responsible for more than 700,000 hospital admissions each year. The burden falls disproportionately on poorer communities, where air quality, housing conditions and access to care combine to worsen outcomes, yet research funding has not kept pace with the scale of the problem. Meanwhile, the market for respiratory technology has grown quickly, but the products emerging from it have tended to follow what is technically possible rather than what users have asked for. Cutting-edge features, the study’s authors observe, do not always match what the people using those products actually want or need.

To break that pattern, the Oxford team adapted a method with a strong track record in a different field. The James Lind Alliance has long brought patients and clinicians together to agree which research questions matter most, a process known as priority setting. HERON turned that same participatory logic onto technology itself, defining the term broadly to include anything from a home lung-function test to a smartphone app to the data infrastructure behind a virtual ward. As far as the authors are aware, no one had previously described a systematic method of this kind for setting HealthTech priorities in chronic respiratory disease, making the study a methodological first as well as a practical roadmap.

The researchers were also deliberate about who they reached. Online surveys, however convenient, systematically miss many of the people most affected by lung disease, including those without reliable internet access, those with low literacy and those whose lives are consumed by managing illness. So alongside the survey, the team went into the community, attending pulmonary rehabilitation classes, a singing group for people living with breathlessness and a respiratory service for people who are homeless. These sessions took place in Greater Manchester, Norwich, Bristol, Nottingham and Weston-super-Mare, and were kept deliberately informal to lower the barriers to participation. The researchers did not collect demographic details at these sessions, so they cannot measure precisely how far they succeeded in broadening the sample, an honest limitation they acknowledge openly.

In March 2026, the longlist was put to the test. Twenty-three patients, carers and clinicians spent a day together working through the 73 areas and narrowing them down to a final top 20. The priorities span the whole journey of living with lung disease, from screening people who are at risk before symptoms become serious, through day-to-day management, to helping people maintain their gains after a course of pulmonary rehabilitation ends, a point at which support often abruptly stops. Some of the most striking items are strikingly modest in conception: an inhaler that shows when it is running out, oxygen equipment that can leave the house, a tool that helps separate anxiety from the onset of an exacerbation. Each addresses a failure point that patients describe constantly and that current devices simply ignore.

One demand cut across all twenty priorities, and the authors present it as the study’s central design principle. Whatever gets built has to work for someone with poor eyesight, unsteady hands or no confidence with a smartphone, and it has to be affordable to run, both for the National Health Service and for the patient. Accessibility, usability and equity, they argue, cannot be retrofitted late in development or bolted on as an afterthought; they need to be built in from the very start. Dr Helen Ashdown, an academic general practitioner at the University of Oxford who led the study, said that there is enormous potential for technology to improve respiratory care, but that simply developing more technology is not enough. HERON, she explained, identifies not only where the eventual users of technology think innovation could make the greatest difference, but also what they need from those technologies if they are going to work in real life.

The roadmap is already being put to work. The National Institute for Health and Care Research has opened its latest Invention for Innovation, or i4i FAST, funding opportunity for chronic respiratory health technology, and it explicitly encourages applicants to address the HERON priorities in their applications. That means the list is not merely an academic exercise but a live filter through which public research money will flow. The Respiratory Transformation Partnership, a national collaboration between the NHS, government and industry established to improve asthma and COPD care, is also supporting the findings, which will inform its considerations and help connect promising technologies with the needs of patients and respiratory services. Dr Jonathan Fuld, National Clinical Director for Respiratory Disease at NHS England and Chair of the partnership, said that patients should be at the heart of how new respiratory technologies are developed, and that by aligning innovation support with these priorities there is an opportunity to help promising technologies progress from development and evaluation through to adoption in the NHS.

The study was funded by LifeArc, a medical research charity, and its ambitions extend beyond the chest clinic. The method itself, the authors point out, is not tied to lungs. The same structured process of gathering challenges from patients, carers and clinicians, mapping them against the existing technology landscape and distilling a ranked set of priorities could be applied wherever HealthTech priorities need setting, from diabetes to dementia. If it catches on, the HERON study may be remembered less for its list of twenty technologies than for the question it forces the industry to answer before writing a single line of code or moulding a single prototype: who asked for this, and what did they actually say they needed? For the one in five people in the UK living with lung disease, and the clinicians trying to keep them out of hospital, the answer has never been spelled out so clearly.

Subject of Research: Patient and clinician priorities for respiratory health technology development in the UK

Article Title: Respiratory patients and clinicians name the 20 technologies they want most – and could transform NHS lung care

Article References: Respiratory patients and clinicians name the 20 technologies they want most – and could transform NHS lung care. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: respiratory disease, health technology, HERON study, University of Oxford, Thorax, patient priorities, NHS, inhalers, COPD, asthma, medical devices, NIHR

The scale and ambition of the collaboration are considerable. ARC London will be hosted by Guy’s and St Thomas’ NHS Foundation Trust, with its leadership team drawn from three of the capital’s most research-intensive institutions: King’s College London, University College London and Imperial College London. The wider partnership spans 20 organisations, including members of King’s Health Partners, the academic health sciences centre that brings together King’s College London with Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts. This breadth is deliberate. The challenges facing modern health and social care, from an ageing population living with multiple long-term conditions to the pressures of rising demand and constrained budgets, are too complex for any single institution or discipline to solve alone.

ARC London does not operate in isolation. It joins a national network of 11 Applied Research Collaborations spread across England, each funded by the National Institute for Health and Care Research as part of a £170 million investment over five years. The ARCs work together, sharing expertise and learning to support research and implementation at scale, so that innovations proven in one region can be adapted and adopted elsewhere. Within this network, ARC London’s role is distinctive: it serves a city of extraordinary diversity, where profound health inequalities sit alongside world-leading biomedical science, and where the lessons learned can be relevant to urban populations across the country and beyond.

The collaboration has organised its work around four research themes, each addressing a major challenge facing the health and social care sectors. The first, neighbourhood health and social care, focuses on supporting independent living, reducing emergency hospital visits and better helping people with multiple health and care needs throughout their lives. This theme reflects a growing recognition, both in the United Kingdom and internationally, that the health of populations is shaped less in hospitals than in the neighbourhoods where people live, work and age, and that strengthening community-based care can prevent crises before they require emergency intervention.

The second theme concentrates on prevention and early intervention in people with major conditions, including cardiovascular, renal and metabolic disease and mental ill health. These groups of conditions account for a substantial share of the burden of disease in London and across the United Kingdom, and their origins often lie years or decades before diagnosis. By identifying risk earlier and intervening sooner, researchers aim to shift the balance of the health system from reactive treatment towards proactive prevention, a direction that aligns closely with the current strategic focus of the NHS.

The third theme addresses productivity and economic growth, with the goal of supporting the highest quality health and care services at an affordable cost. In a health system facing sustained financial pressure, productivity is not simply a matter of doing more with less; it is about finding smarter models of care, better use of the workforce and more efficient pathways that maintain or improve quality while releasing resources. The fourth theme, data sciences for healthcare, underpins much of this ambition. Advanced analysis of health and care data can help understand people’s needs earlier, prevent illness and improve care, and London’s concentration of data science expertise makes it well placed to lead in this field.

King’s College London brings a distinctive set of strengths to the partnership. The university contributes expertise in population health, data science and social science, alongside long-standing experience in major health challenges including mental health, maternal and child health, cardiometabolic disease and respiratory disease. This combination matters because the questions ARC London will tackle are not purely biomedical. They involve how services are organised, how people behave, how policies are designed and how evidence moves into practice. Social science and population health perspectives are essential for understanding why effective interventions sometimes fail to reach the people who need them most, and for designing research that reflects the realities of diverse urban communities.

The leadership team reflects the three-way institutional partnership. Professor Laura Shallcross of University College London serves as Director of ARC London, with Dr Ana Luisa Neves of Imperial College London as Deputy Director. King’s College London’s role is embodied by Ingrid Wolfe, Professor of Paediatrics and Child Population Health at King’s College London and Guy’s and St Thomas’, who serves as Co-Director. Wolfe has described the moment as a golden opportunity to deliver research that will genuinely improve outcomes for patients and the public, and has emphasised that at a time when the NHS is focused on prevention, neighbourhood care and innovation, ARC London provides a unique opportunity to generate the evidence needed to support lasting transformation across health and social care.

One of the most scientifically demanding areas of the collaboration concerns people living with multiple long-term conditions, sometimes called multimorbidity. Mieke Van Hemelrijck, Professor in Cancer Epidemiology at King’s College London, is leading work focused on adults in this group. Her argument is a compelling one for the future of health research: multiple long-term conditions are inherently complex, so no single discipline or disease area can address them alone. Combining expertise from across London, spanning a wide range of diseases, populations and research approaches, will allow researchers to ask more ambitious questions and translate research into greater impact for patients and the NHS. King’s researchers are also leading collaboration across the ARC’s themes to benefit children and young people, a population whose health trajectories are shaped by early experiences and whose needs often fall between adult and paediatric services.

Research alone, however rigorous, does not change systems. ARC London has therefore built translation into its structure from the outset. The King’s Policy Institute is supporting the collaboration’s efforts to connect research findings to improvements in policy and practice, helping ensure that evidence reaches the decision-makers who shape services. The partnership will also respond to the issues that matter most to people living with the greatest burden of disease in London and beyond, and it will address health inequalities by embedding inclusive approaches across all projects and programmes. The aim is that findings are relevant for a broad and diverse population, and that any resulting interventions can be successfully delivered to the people who need them most, rather than benefiting only those easiest to reach.

The collaboration’s reach extends further still. ARC London will partner with the other NIHR Applied Research Collaborations, with NIHR infrastructure across London and with partners in the life sciences sector, creating collaborations intended to bring innovative new medicines, technologies and models of care into practice sooner. Professor Marian Knight, Scientific Director for NIHR Infrastructure, has described the new London ARC as playing a vital role in turning research into real-world improvements in health and care, generating evidence across the capital that benefits communities nationwide, and framing the bringing together of partners from every corner of London as a unique opportunity to collaborate, innovate, drive economic growth and deliver meaningful impact for patients. For a city whose health and care services serve millions of people from every background, the promise of research that is designed from the beginning to be inclusive, practical and translatable represents a significant step forward, and the coming five years will show how far that promise can be realised.

Subject of Research: A £22 million London-wide applied research partnership translating health and social care research into practice

Article Title: King’s College London joins London-wide partnership awarded £22 million to transform health and social care through research

Article References: King’s College London joins London-wide partnership awarded £22 million to transform health and social care through research. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: NIHR, Applied Research Collaboration, King's College London, health and social care, NHS, health inequalities, multimorbidity, data science, prevention, neighbourhood health, London, research funding

The authors draw on their experience delivering multiple studies funded by the National Institute for Health and Care Research and government bodies, in which they have served as chief investigators, co-investigators and delivery researchers across qualitative and mixed-methods projects on NHS workforce behaviour, organizational culture and collaboration between healthcare providers. They are careful to frame the piece as a reflective commentary rather than a systematic audit: the patterns they describe have not been quantified nationally, but they emerge repeatedly from the lived experience of running organizationally sensitive research inside the health service. The focus is on England’s NHS, although the underlying architecture, including the Integrated Research Application System known as IRAS and approval by the Health Research Authority, operates UK-wide, meaning many of the same risks apply in Scotland, Wales and Northern Ireland.

The core problem, the authors argue, is a mismatch of design. Existing governance treats the participant as a patient, the site as a treatment facility, and transparency as a safety mechanism. That logic makes sense for a drug trial, where a local principal investigator needs to know which patients are enrolled so they can respond to adverse events. It makes far less sense for a survey of staff experiences of unprofessional behaviour, where the organization itself is the subject of scrutiny rather than merely a gateway to patients. Yet many NHS research and development departments still apply the most stringent clinical interpretation of the rules to workforce studies, requiring named local principal investigators, senior leadership sign-off and detailed site documentation that can reveal exactly who is being studied, where, and why.

The mechanisms of exposure are varied and often invisible to ethics committees. Distributing a full local information pack to every participating site exposes all included sites to each other. Research passports issued to external researchers list every organization involved. The NIHR Research Delivery Network portfolio, which exists to track study progress and is often a prerequisite for sites to access infrastructure and funding, can make participating sites identifiable through the Open Data Platform and other publicly visible systems. Even where a research team has scrupulously protected confidentiality in its own communications, the act of portfolio registration itself can broadcast an organization’s involvement to any interested party, including potentially its own leadership and staff.

The consequences for data quality are direct. Participant information sheets routinely assure staff that their organization will not be identifiable in publications, and research ethics committees approve those assurances in good faith. But where sites require senior leadership sign-off before a study can be set up locally, people within the host organization may learn that the study is happening, what it is investigating, who the local principal investigator is, and which categories of staff are being recruited. If staff suspect their employer is aware of a study on bullying or patient safety, the rational response is to self-censor in interviews or surveys. Research demanding a high degree of psychological safety, or posing reputational risk to organizations, is particularly vulnerable, because these are precisely the topics on which employees moderate their answers when they feel under institutional surveillance. The result can be under-reporting and guarded accounts that obscure the very behaviours researchers are trying to understand.

The burden of the system is also measurable. A recent survey of 252 health services researchers found governance processes widely perceived as disproportionate, inflexible and ill-suited to non-interventional and qualitative work. In a striking audit, Petrova and Barclay found that a single low-risk NHS study required 89 individuals to approve it and generated 491 exchanges outside formal systems such as IRAS. Some NHS trusts decline workforce studies altogether, citing capacity problems in their research and development units. For an under-pressure R&D department, a low-risk interview study about sensitive organizational issues may demand many of the same local processes as clinical research while offering little treatment innovation, minimal recruitment numbers, no local funding and potential reputational discomfort, creating a structural disincentive to take part.

Change, however, is underway. From March 2026, the Health Research Authority introduced a new governance pathway for studies involving NHS and social care staff as participants. It streamlines site set-up, limits the visibility of participating sites within IRAS, reduces the need for local site authorization in many cases, allows chief investigators to act across sites without local principal investigators, and clarifies that research passports are not required for studies conducted remotely. The reforms were not designed explicitly around confidentiality, but the authors argue they may partially mitigate the risks while cutting administrative burden. A replacement for IRAS, called the Plan and Manage Health and Care Research system and hosted on gov.uk, is also being piloted, though early experience suggests site R&D departments will need training to process study modifications under the new platform.

The commentary goes further, setting out six prioritized recommendations. These include a dedicated Health Research Authority pathway for sensitive organizational research; removing or reducing local principal investigator requirements in low-risk staff studies in favour of a minimal site contact with no access to participant identities; binding national guidance limiting local re-review of matters already assessed centrally, with an escalation route where it is ignored; pseudonymized, restricted-access or delayed-disclosure options for portfolio and Open Data Platform listings so sites can access funding without public exposure; waiving local sign-off entirely for low-risk, staff-only studies already approved nationally; and co-designing future reforms with researchers and R&D departments, with confidentiality protection treated as an explicit evaluation criterion alongside administrative burden.

The authors are careful not to swing the pendulum too far. Site visibility serves legitimate functions, from evidencing that a study has an authorized host to allowing funders to monitor public resources and providing a route for urgent safety escalation. Their proposals would preserve these functions through secure central records, role-based access, audit trails and named site contacts, while limiting disclosure to what is genuinely necessary. Waiving local sign-off would apply only to clearly defined low-risk studies with no patient intervention or clinical contact, and portfolio pseudonymization would retain auditable mapping for authorized oversight bodies. Accountability, they stress, need not depend on revealing participant identities.

The stakes extend well beyond research logistics. Sensitive workforce studies underpin efforts to tackle bullying, unprofessional behaviour and patient safety failures across the NHS, and they depend on honest accounts from staff who fear reprisal. If governance processes designed for clinical trials continue to undermine the confidentiality those studies promise, the result will be delayed research, declining participation and self-censored data, all at a cost to publicly funded science and ultimately to patients. The authors conclude that meaningful progress has begun, but that fundamental tensions between transparency, oversight and confidentiality will only be resolved through governance explicitly designed for organizational research, co-designed with the people and departments who must deliver it, rather than adapted once again from the world of clinical trials.

Subject of Research: Confidentiality risks in NHS research governance for healthcare workforce studies

Article Title: Research governance in England needs improvements to ensure participant and site confidentiality in healthcare workforce research

Article References: Aunger, J., Ferguson, J., Karaagac, E. A., Spence, T., Maben, J., Patnaik, A., Mannion, R., Zhao, Y., Proudlove, N., Bodenham-Chilton, H., & Walshe, K. (2026). Research governance in England needs improvements to ensure participant and site confidentiality in healthcare workforce research. Health Research Policy and Systems, 24(1), Article 81. https://doi.org/10.1186/s12961-026-01538-6

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01538-6

Keywords: NHS, research governance, confidentiality, Health Research Authority, IRAS, workforce research, research ethics, health policy, qualitative research, bureaucracy, patient safety, NIHR