CLAHRC Yorkshire and Humber Delivering innovative research through effective partnerships
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (CLAHRC YH) www.clahrc-yh.nihr.ac.uk
Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber
Delivering innovative research through effective partnerships
Welcome This collaboration is building on the success of CLAHRC for South Yorkshire (CLAHRC SY) and CLAHRC for Leeds, York and Bradford (CLAHRC LYB). Our success is evidenced not only by our external evaluations, but also by ongoing feedback from the NIHR which year on year has commended us on our PPI and our partnership working with industry. More importantly however, our success and impact over the last five years has contributed to our ability to generate commitments of over ÂŁ14 million of match funding for CLAHRC YH. This is a significant amount, especially at a time of financial restraint in public services. Most of this commitment comes from NHS providers /commissioners, universities, charities and local authorities. Our region has some of the highest levels of social deprivation and health inequalities in the country, coupled with an ageing and rapidly diversifying population, so we have significant health and social care challenges to address. These challenges are compounded by the current turbulence within the NHS and social care environment in England, and by the recommendations of the Francis report 1 which encourages the NHS to improve the quality of patient care whilst enduring year on year financial restraints.
We believe we have designed and built a new collaboration that can have a major impact on these regional inequalities at the same time as supporting the NHS and local authorities in developing new knowledge and exploring new ways of working to improve the health and wellbeing of our population. We feel the research knowledge generated by our CLAHRC will have a much wider reach than the Yorkshire and Humber AHSN. We intend to utilise innovative models of knowledge mobilisation for all our stakeholders at a macro-, meso- and micro- level. We believe that our CLAHRCs have been at the forefront of a new way of working to ensure co-production and partnership engagement in research and evidence implementation. We intend to make this knowledge visible on both the national and international stage through the national CLAHRC forum and through our international collaborations and publications. I look forward to the next five years with excitement and pride knowing that we have succeeded in achieving so much, not only in CLAHRC SY and LYB, but also in bringing this extraordinarily innovative and dynamic collaboration together for Yorkshire and Humber. Professor Sue Mawson Director
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NIHR CLAHRCs
National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are collaborative partnerships between universities and surrounding NHS organisations, focused on improving patient outcomes through the conduct and application of applied health research. Our purpose
Our challenge
• To address the ‘second gap in translation’ of research into practice as identified by Sir David Cooksey’s Review of Health Research. • To address a key recommendation of the Chief Medical Officer’s High Level Group on Clinical Effectiveness - the need for the NHS to harness better the capacity of higher education to support initiatives to enhance the effectiveness and efficiency of clinical care.
‘If we are to face the enormous challenges of heath economics and health outcomes for the people of Yorkshire and Humber then access to and use of near to patient research will be crucial.
Our aims Each CLAHRC aims to improve patient outcomes across the geographic area covered by this collaboration through three key interlinked functions: • Conducting high quality applied health research • Implementing the findings from research in clinical practice • Increasing the capacity of NHS organisations to engage with and apply research.
We have come a long way since the publication of David Cooksey’s ground breaking report on applied health research in 2006 but the advent of the regional CLAHRC’s accelerates that process bringing the research power of our universities directly to the bedside with patients being the direct beneficiaries. It is this emphasis on patient centred research that makes the ongoing challenge for the Yorkshire and Humber CLAHRC so rewarding.’ Lord Willis of Knaresborough NIHR CLAHRC YH Strategic Partnership Board Chair
Our vision and principles TO COME FROM JANE
Nine CLAHRC pilots ran between 2008-2013. Since 2014 there are have been thirteen CLAHRCs around the UK.
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Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber
Delivering innovative research through effective partnerships
CLAHRC YH People The CLAHRC Yorkshire and Humber core management team works across the collaboration ensuring that the CLAHRC is more than the sum of its parts. The Core Programme Team will help to ensure the ongoing development, progress and success of the whole initiative. We hope that every individual project within CLAHRC will have a positive impact. However, the success and sustainability of CLAHRC will be largely measured by the success of the initiative rather than the individual projects taking place within it.
Sue Mawson: Director As Director of CLAHRC YH Sue is responsible for the strategic direction and leadership of the collaboration. Sue originally trained as a Physiotherapist before working in South Africa. On returning to the UK Sue entered University completing her PhD in 1997. She was appointed Professor of Health Services Research in the School for Health and Related Research at the University of Sheffield where her role is to develop stronger links between researchers at ScHARR, the NHS, industry and the voluntary sector with a specific focus on research into new interventions and technologies for people with disabilities, older people and people with long-term conditions and public health.
Jo Cooke: Director of Programme and Research Capacity Lead As Capacity lead for CLAHRC YH Jo is responsible for supporting individuals, teams and organisations to develop the skills required to deliver world class research. Alongside the Director, Jo is involved in promoting and planning for the long-term sustainability of collaboration´s activities through horizon scanning for opportunities, and supporting and developing further research and innovation funds. Jo initially trained as a nurse at the University of Manchester, and held a variety of clinical nursing posts. She was the Director of Trent Research & Development Support Unit, and the Research Design Service based in ScHARR. This was an NIHR initiative aimed to support research capacity development in health, and health related social care.
Christine Smith: Programme Manager As programme manager Christine is responsible for the programme’s finance management and engagement with key partners. Christine has a background in nutrition. After obtaining a MMedSci in Human Nutrition she joined the University of Sheffield, where she worked as a scientist, researching the effects of preterm birth on bone development. She is the Director of Research and Development in Barnsley Hospital NFT. Her research interests are obesity, the process of translating research into practice and the evaluation of complex programmes.
Dan Wolstenholme: Communication Lead As communication lead Dan is responsible for the internal and external communication of the CLAHRC. Dan undertook a first degree in Neuroscience before training as a nurse During this time Dan completed an MMedSci in nursing and healthcare studies and lectured on pre- and post-registration nursing courses within the School of Nursing at the University of Sheffield. Following this Dan worked in Research management and governance in Chesterfield and Sheffield hospitals before taking up his role as project manager and clinical researcher on the User-centred Healthcare Design project Dan’s own research interests lie in exploring the potential of the theory and practice of design in healthcare.
Chung Fu: Programme Administrator Chung joined CLAHRC YH as Programme Coordinator, part of the Core team working across themes in CLAHRC YH. He is actively involved in supporting the reporting of CLAHRC YH activity and developing effective relationships with Theme Leads and Project Managers to support the vision of the programme. Based in Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Chung is also a Business Manager with responsibilities in a range of business functions including contract and budget management of research grants in the department.
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Theme summaries
Avoidable Attendance and Admissions
Evidence-Based Transformation Within the NHS
The NHS emergency and urgent care healthcare system is under a great deal of pressure, with too many people being admitted to hospital when they could be treated more effectively in other parts of the NHS. About two-thirds of emergency admissions are people with long-term conditions. Reducing these admissions is a major priority to ease the pressure on the system, and to direct resources more effectively. The Avoidable Attendance and Admissions theme aims to: • identify people in the Yorkshire and Humber region who are attending the Emergency department or being admitted to hospital, and who might benefit from a different kind of response when they need help • find new, innovative ways (known as ‘interventions’) to deliver patient-centred care for people with long-term conditions, so they don’t need to be admitted to hospital as often • evaluate how well these interventions work - for patients, for NHS staff and for the healthcare system as a whole.
The overall aim of this theme is to make sure that, when people receive care in hospital or in the community, that care is safe and focussed on their needs. We will bring together healthcare professionals, patients and researchers to make sure that: • what we do reflects the real problems that people face • the solutions we develop will work for patients and staff alike.
We will also support our partner organisations such as the ambulance service and other NHS trusts - in developing their own capacity to progress with these aims.
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Most research on patient safety has looked at what happens when things go wrong. Our approach, however, is to identify those teams and units that are doing better than average - providing exceptionally high-quality, safe care for patients. Having identified these high performers, we will study them more closely, to understand what they are doing to get such good results. Once we understand how they are doing so well, we aim to: • spread this learning across the region • provide services to support improvements in patient safety • evaluate the cost-effectiveness of these improvements. It is very important for us to receive feedback from patients on the safety of their care. So we will look at how patients’ feedback might be collected by hospital volunteers, and by medical students as part of their education. As an example of our work in the Yorkshire and Humber region, we are studying how to support staff in responding to people at risk of acute kidney injury.
Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber
Delivering innovative research through effective partnerships
Health Economics and Outcomes Measurement (HEOM) Because healthcare budgets are limited, every new treatment or service must be evaluated so that decisions can be made about whether to fund it, and whether this will be at the expense of other treatments or services. The HEOM theme aims to provide the best possible information to healthcare decision makers, so they can make the spending choices that will be best for their patients. We will do this by: • increasing the understanding of health economics and outcomes management • exploring the methodology used, to ensure that it is as robust and reliable as possible • advising how best to collect the data needed to provide evidence for decision making. It is important that information is presented to decision makers in a uniform way, so that the cost-effectiveness of different treatments can be meaningfully compared -for example, to allow a comparison between a treatment for cancer and a service for maternity care. Health economists do this by presenting their results as costs per qualityadjusted life year —taking into account both the effectiveness of the treatment, and how it affects patients’ quality of life. The HEOM theme will also work with other themes in CLAHRC to analyse the cost-effectiveness of innovative treatments, as a basis for budgetary decision making.
Healthy Children, Healthy Families As a whole, the Yorkshire and Humber CLAHRC has a goal of improving the health of children. The Healthy Children, Healthy Families theme addresses six areas:
Dental disease This is the most widespread yet preventable health problem in children; for example: • in Bradford, 52% of children under 5 have some level of dental disease, compared with 39% regionally and 31% nationally • among children of South Asian origin, dental disease is twice as common as in white British children. We are therefore looking at ways to encourage parents of children under 12 to supervise them in brushing their teeth.
Early developing literacy skills The development of these skills is key to how well children are likely to do at school and beyond. To promote early literacy, we are: • looking at how poor eyesight might affect children’s learning to read and write • exploring with parents and carers how they access children’s eye care, and their thoughts about their children wearing glasses.
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Theme summaries
Parenting programmes Effective programmes can promote emotional health and well-being, relationship skills and behaviour management. We are therefore: • investigating which of the available programmes are most acceptable and effective, measured by how many people attend and carry on attending • looking at what adaptations have been made to meet differing cultural needs, and whether these have made a positive difference • assessing the cost of delivering effective programmes.
Healthy lifestyle When children develop healthy lifestyles, this behaviour tends to carry through as they grow older. To support children in doing so, we are: • testing whether height-adjustable desks can be used in classrooms to reduce time spent sitting down • promoting and testing a European healthy-eating campaign called We Love Eating • developing ways to improve air quality and encourage active travel -for example, to school and to work
Asthma One in eight children in the UK are currently being treated for asthma. To help address this, we are: • using data collected in the Born in Bradford study, to look at levels of wheezing and asthma in children there • investigating how wheezing and asthma are treated, and how we can improve care.
Mental Health and Co-morbidities People with severe mental illness are more likely to suffer from other long-term health conditions; those with illnesses such as schizophrenia, bipolar disorder and chronic depression have some of the lowest lifeexpectancy of any section of the population. This link is known as co-morbidity. The Mental Health and Co-Morbidities theme looks at the relationship between mental and physical ill-health, and aims to identify and develop ways to address this major health inequality. We will: • target unhealthy behaviours and lifestyle, such as poor diet, smoking and alcohol • investigate the problems people may have in getting access to good healthcare • look at how physical health problems - such as diabetes, respiratory illness and heart disease - are managed in people with mental health problems • encourage physical health and well-being, for example by promoting good sexual health. We can draw upon a range of specialist knowledge to assist us in our aims -for example, our work on smoking builds upon an international reputation for expertise in tobacco addiction.
Co-ordination and control To address the problem of poor movement control, we are: • investigating whether routine assessments can predict children who will have problems • testing ways to help children improve their control, such as by using a robotic arm.
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Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber
Delivering innovative research through effective partnerships
Primary Care-Based Management of Frailty in Older People Frailty is a condition that becomes more common as people get older and their bodily systems (including the brain, the immune system, muscles and bones) decline. There are currently around 85,000 frail older people living in the Yorkshire and Humber region, and people with frailty tend to become more frail over time. Frail older people are more likely to be admitted to hospital or long-term care, and have a lower life expectancy. Even a small event - such as a change in medication or a minor operation - can have a major effect on a frail person, causing them to go from independent to dependent, or from mobile to immobile. Up to now, healthcare systems have typically responded to frailty only when something goes wrong -for example, when an older person arrives in hospital. This theme aims to take a more proactive approach, identifying people at different stages of frailty, and finding possible treatments that may prevent them getting worse. We have developed an electronic frailty index, so that GPs can identify frail older people from their health records. This is available to approximately 2200 GP practices. To study frailty in more detail, we plan to: • recruit up to 1000 older people with mild, moderate and severe frailty • follow them for up to 4 years, collecting information about their health and their social and economic circumstances • invite some to take part in studies looking at treatments, such as a home-based exercise programme • invite some, with their carers, to take part in a study to help us understand how people develop resourcefulness in this situation, and how support services could help. We will also take blood samples, so that future researchers can investigate biological and genetic factors that may contribute to frailty. This is important, as little is currently known about why some people become frail.
Public Health and Inequalities Yorkshire and Humber is a region with wide health inequalities and some major public health challenges. The Public Health and Inequalities theme aims to carry out and support research into what underlies these inequalities and what can be done to tackle them (in the form of ‘interventions’). We are looking at: • socioeconomic factors, such as housing and fuel poverty • behavioural factors, such as diet, physical activity, alcohol and tobacco • cultural factors, such as those applying to different ethnic groups. Our five main areas of work are: • Expanding the Yorkshire Health Study. Through this study, we have collected information from over 27,000 people on a wide range of chronic conditions, as well as on their health, lifestyle and socioeconomic status. We aim to extend this to at least 50,000 participants. The collected information provides an important resource for targeting interventions to the needs of individuals and communities. • Extending and targeting ‘Making Every Contact Count’ interventions in the community. • Engaging with colleagues in local authorities, public health and community groups, to identify priorities for research. We also plan a series of consultation events and workshops, to develop a shared understanding and commitment to tackling health inequalities. • Tailoring interventions to address inequalities between ethnic groups. • Healthy Weight projects, to encourage healthy eating and exercise. We are well placed to undertake this challenging programme, as we have a history of partnership, working on regional health inequalities within the two pilot CLAHRCs (in South and West Yorkshire, 2008– 2011). We can now tap into this expertise across the whole Yorkshire and Humber area.
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Telehealth and Care Technologies (TACT)
Translating Knowledge into Action (TK2A)
Telehealth and telecare use technology to help people live independently and stay in control of their own health and well-being. • With telehealth, people exchange information with their healthcare professional over a remote link (such as a phone line). Telehealth can include home-based units to monitor such things as blood pressure, temperature and other symptoms, or how much the person has been active that day. • Similarly, Telecare is remote monitoring, with the aim of enabling people to live independently for longer. It can include sensors to detect falls, a reminder to take medications, or an alarm to call for help.
The TK2A theme aims to improve the quality of patient care through developing new ways to get research findings into everyday practice. All too often, research is done ‘on subjects’, and the findings are published only in dusty academic journals, to be read by the researchers themselves; our approach is different. By involving from the outset the people who may change the way they work in response to the findings, we make it more likely that the research will have a real impact where it counts for patients. We will be working with other teams in CLAHRC, and with other organisations in Yorkshire and Humber, to identify and develop new forms of research that can be shared by everybody, learning from each other and from studies around the world, and spreading the knowledge as widely as possible. By sharing understanding, we will also help build the capacity to do more of this work. We are creating a website, to make available to everyone what we have learnt and developed, such as toolkits. This will be tested with staff and patients over the next few months before being launched. As an example of our work, one of our first projects involves a new way of working with teenagers with diabetes, to improve their understanding of how to look after their health. This was developed in Sheffield, and we are extending it to Leeds and Harrogate. Working with patients and the public is really important to us. We will continue to develop new ways to involve their experience and expertise -influencing not only how we work, but also the way we share that work with others.
The TaCT theme aims to improve knowledge and practice in the design and use of telehealth and telecare, in response to the health needs and priorities in the Yorkshire and Humber region. We work closely with the local clinical commissioning groups, and with users of the technologies, to identify these priorities. We take a user-centred approach to all aspects of our work, closely involving patients, their carers and their healthcare workers. Our theme includes an active patient and public involvement group. We also involve people from industry and other teams within the CLAHRC in identifying, testing and using these technologies to improve people’s health and quality of life. Examples of our current work include: • investigating whether a new mobile phone app can help overweight people with diabetes to reduce their weight and blood sugar • developing technology to help people with chronic obstructive pulmonary disease (COPD) to selfmanage their condition.
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Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber
Delivering innovative research through effective partnerships
Areas in which CLAHRC YH already has formal partners and planned project activities.
SKIPTON
HARROGATE YORK
BRADFORD
LEEDS
HALIFAX
HULL
Areas in which we will engage through partnership working with the Yorkshire and Humber Academic Health Science Network. New formal matched funding partnerships may be developed.
WAKEFIELD
HUDDERSFIELD BARNSLEY SHEFFIELD
DONCASTER ROTHERHAM
RETFORD
National Health Service • Barnsley NHS Foundation Trust • Bradford District Care Trust • Bradford Teaching Hospitals NHS Foundation Trust • Doncaster and Bassetlaw NHS Foundation Trust • Hull and East Yorkshire Hospitals NHS Trust • Leeds and York Partnerships NHS Foundation Trust • Leeds Teaching Hospitals NHS Trust • NHS Sheffield Clinical Commissioning Group • NHS Yorkshire and Humber Commissioning Support • Rotherham, Doncaster and South Humber NHS Foundation Trust • Sheffield Children’s NHS Foundation Trust • Sheffield Health and Social Care NHS Foundation Trust • Sheffield Teaching Hospitals NHS Foundation Trust • Yorkshire Ambulance Service NHS Trust
Higher Education Institutions • • • • • •
Sheffield Hallam University University of Bradford University of Hull University of Leeds University of Sheffield University of York
Local Authorities • Barnsley Metropolitan Borough Council • Doncaster Metropolitan Borough Council • Rotherham Metropolitan Borough Council • Sheffield City Council
Charities • Barnsley Hospital Charity Industry • Sheffield Hospitals Charity • Yorkshire Cancer Research
Other • Medipex • National Centre for Sports and Exercise Medicine • Patient Opinion • White Rose Consortium • Yorkshire and Humber Academic Health Science Network
CLAHRC Yorkshire and Humber Associates • Barnsley Hospital Medical Physics Department • HealthWatch Sheffield • Lab4Living at the Art & Design Research Centre, Sheffield Hallam University • Longhand Data Ltd • NIHR Clinical Research Network • NIHR Healthcare Technology Co-operative for Devices for Dignity • NIHR Research Design Service Yorkshire and the Humber • Optical Jukebox • Qbtech
Contact us clahrc-yh@sth.nhs.uk
This brochure presents independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH). www.clahrc-yh.nir.ac.uk. The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.