Research Impact Report 2021 - 22 by UEA Health and Social Care Partners

CONTENTS Introduction UEA Vice Chancellor & President Professor David Richardson.

Foreword UEA Pro-Vice Chancellor Professor Charles ffrench-Constant and UEA Dean of Health Sciences Professor Sally Hardy.

The year in numbers Our Impact Our Board Members on the value of UEAHSCP. Successful Partnership Funded Research Projects Progress of the four projects from last year's funding round. Plans for New 3D Medical Printing Facility A case study on the progress towards setting up an exciting new regional innovation. Study Reveals Impact of Pandemic on non-COVID-19 Serious Illness The impact on patients' access to healthcare during the emergency phase of COIVID-19. Collaborative Workforce Transformation Academy in the East of England Setting up a supportive workforce transformation infrastructure. Project Seeks to Better Support Menopausal Ambulance Staff A case study on an important partner-led initiative.

Project to Improve Flu Jab Uptake in Care Home Staff Medicines Optimisation researchers are among those leading this project. Concussion Research Referenced in Digital, Culture, Media & Sport Committee’s Report Expert evidence was quoted throughout the report. New Group Aims to Boost Rehabilitation Innovation Introducing the newly formed research group, AbiliTec. New Learning Disabilities Group Introducing a new research group, aiming to address gaps in research, share best practice and support service development. Partnership Projects Sweep 2021 UEA Innovation and Impact Awards Read about our Partnership success. Impact of Research by the LANTERN Network Read about the real world impact towards facilitating positive mental health support for children and young people with care experience. International Nurses Day 2021 We celebrate the achievments of some of our nurses across UEAHSCP. The Future of UEAHSCP Research Director Carrie Jackson outlines the exciting trajectory of UEA Health and Social Care Partners.

INTRODUCTION VICE-CHANCELLOR & PRESIDENT DAVID RICHARDSON REFLECTS ON A YEAR OF RESILIENCE

This Annual Report for UEA Health and Social Care Partners (UEAHSCP) provides an opportunity to celebrate and reflect on the impact of pioneering collaborative research and innovation to improve health and care services in our region during 2021-2022. Since its launch in April 2019, the partnership has established itself as a regional catalyst rapidly increasing the level of collaboration in health and social care research despite the challenges of a global pandemic. It is testament to the hard work, passion, and ingenuity of the talented practitioners, academics, researchers and citizens that we work with, and I am delighted to introduce their achievements this year. During this uniquely challenging time and beyond, I know that UEA Health and Social Care Partners will continue to enable significant transformative work at an accelerated pace and its successful principles of partnership working will support the provision of world leading health and social care.

PROFESSOR DAVID RICHARDSON

I congratulate all those who have collaborated in the past year and encourage all our colleagues to make the most of the many opportunities working with the Partnership provides.

catalyst rapidly increasing the

VICE-CHANCELLOR & PRESIDENT, UNIVERSITY OF EAST ANGLIA.

"The partnership has established itself as a regional level of collaboration in health and social care research despite the challenges of a global pandemic”.

FOREWORD CHARLES FFRENCH-CONSTANT AND SALLY HARDY ON THE IMPORTANCE OF JOINT RESEARCH UEA Health and Social Care Partners is a key part of the University of East Anglia and its Faculty of Medicine and Health Sciences’ strategy, from which to address the health and care needs of the population of East Anglia. As this Annual Impact report describes, the partnership provides an enabling platform for our partners to connect and work with our research centres developing practice led research and innovation projects that make a difference to people’s lives and the population health needs of our region. A partnership approach is central to the success of future research strategy of the Faculty of Medicine and Health Sciences, playing a key role in helping to identify, accelerate and support our strategic priorities. We are delighted to present a revitalised and strengthened partnership approach through providing seed funding across a range of capacity building initiatives for the coming year. The partnership has demonstrated an outstanding degree of leverage over the past year, acting as a catalyst for generating £2.3 million in research income across the region. Building on this success, and working closely with the newly launched Citizens Academy, we will now leverage new opportunities to support our inclusive approach to addressing important research outcomes and evidencing how they reflect what matters to our citizens.

Professor Charles ffrench-Constant Pro-Vice-Chancellor Faculty of Medicine and Health Sciences

Professor Sally Hardy Dean, School of Health Sciences Faculty of Medicine and Health Sciences We look forward to welcoming further members to the partnership, so that the strategic priorities of our newly formed Integrated Care Systems in the East of England are being well supported by UEA as a recognised anchor institution. We hope you enjoy reading this annual summary of our impact, and we look forward to working with you and with our partners as a community from which to develop even stronger evidence and outcomes of our, as a collective impact.

THE YEAR IN NUMBERS

£2,220,854 Funding Secured

135

Projects supported altogether

322

Group Members

Research Groups

£159,581 Partnership Investment

Partner Organisations

Associate Partner Organisations

£390,000 Partnership Investment for 2022/23

OUR REGIONAL IMPACT Our Governance Boards are made up of some of the most prominent and effective industry leaders from across the health and social care sphere in the East of England. Their strategic expertise and long-standing support is intrinsic to our Partnership model. Hear from some of our Board members on the positive impact of our collaborative research:

“Access to research trials via UEA Health and Social Care Partners is a vital part of the cutting edge treatment and care we provide to our patients.” Caroline Shaw CBE CEO The Queen Elizabeth Hospital King’s Lynn

“Research which is co-designed with those working in and using services means we are generating and answering questions which are important to people as well as systems. This contributes to embedding a positive research culture and working with the partnership enhances this work through collaboration with other Trusts and groups, pooling resources for the benefit of our patients.” Jo Segasby Chief Executive James Paget University Hospitals NHS Foundation Trust

“Being a part of the collaborative research relationships that have been developed by UEAHSCP has opened up many opportunities for research and grown our patient focussed research capability.” Professor Erika Denton Medical Director Norfolk and Norwich University Hospitals NHS Foundation Trust

“Citizens that have the opportunity to take part in clinical research have better health outcomes. The collaborative research model coordinated by UEAHSCP aligns well with our Integrated Care System. By working more closely with a wide range of research partners we can further the principle of integrated working to improve patient outcomes.” Andrew Kelso Medical Director Designate Suffolk and North East Essex ICS

“UEAHSCP is important to bring together like-minded individuals irrespective of the nature of their host organisations to focus on what is important to their patients/clients and to encourage research projects with their priorities in mind.” Professor John Chapman Clinical Lead for Transformation James Paget University Hospital

SUCCESSFUL PARTNERSHIP-FUNDED RESEARCH PROJECTS 2021-2022 We announced our first-ever ‘Power of Collaborative Research’ Strategic Fund in July 2021 to support practitioner researchers to develop ideas that can help tackle the most pressing challenges facing local health and social care services. The focus of the call was young people’s mental health, healthy ageing and living with longterm conditions, while also driving local recovery from the economic impact of the COVID-19 pandemic. Four projects received a share of the £75k funding. Read on to learn more about these four projects.

Watch our researchers introducing their projects

We also partnered with Young Academics UEA to provide partnership seed funding of £4,000 to fund two full-time, paid summer research project positions to UEA Medical students. This was a fantastic opportunity for the summer students to immerse themselves in research, grow their portfolio and build relationships with two of our leading UEAHSCP research groups. Read more about the two projects on pages 12 and 28.

Assessing the Social Needs and Wellbeing of Young People with Pre-Existing Mental Health Needs post-COVID-19 Pandemic (ANSWERS), is led by Dr Jon Wilson from Norfolk and Suffolk NHS Foundation Trust. This project involves a collaborative team of researchers from Norfolk and Suffolk NHS Foundation Trust, UEA, Norfolk and Waveney CCG and Norfolk County Council working closely with young people across Norfolk and Suffolk to better understand the unique issues that impact their mental health and wellbeing, including the impact of COVID-19. By working directly with young people, this project will build a more nuanced understanding of experiences around mental health and wellbeing, and the relationship between physical health, social and environmental factors. Conversations with young people will encompass specific social needs and neighbourhood perspectives, and how this relates to health service use. Results will be fed back to local mental healthcare systems to inform positive change in policy and strategy.

“We aim to fill a critical intelligence gap for cross-system mental health organisations, educational providers and policy makers regarding collaborative service planning and delivery during the COVID-19 recovery period to meet the holistic needs of young people.” Dr Jon Wilson

Co-production of promising interventions to support multiple behaviour change in socially deprived communities (CHarMlNg) is led by Professor Wendy Hardeman from the School of Health Sciences at UEA. Unhealthy behaviours place a heavy burden on regional health and social care services. Physical inactivity, unhealthy diets, tobacco smoking, and excessive alcohol consumption are called the ‘big four’ behaviours. People living in underrepresented communities are much more likely to engage in all four behaviours. We have known for more than ten years that these behaviours cluster, but still don’t know how best to support change in multiple behaviours.

The essence of this project is partnership working. The project brings together members of the public, practitioners, voluntary and community organisations, policy makers, and researchers from across the UEA, the Norwich Institute of Healthy Ageing, Norfolk and Suffolk NHS Foundation Trust, Norfolk and Waveney CCG, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk Community Health and Care NHS Trust, West Suffolk NHS Foundation Trust, Norwich City Council, Norfolk County Council, Suffolk County Council and Active Norfolk.

CHarMINg aims to identify promising ways to support multiple behaviour change in underrepresented communities. Findings will inform innovation in practice and research.

“For the first time, we’re bringing together a wide range of stakeholders including members of the public to find out how best to support multiple behaviour change. Our project aims to reach people who can benefit the most and to equip those who support others with evidence-based approaches for multiple behaviour change.” Professor Wendy Hardeman

The Social Care in Rheumatoid Arthritis project (SOCRA), is led by Dr Max Yates of UEA’s Norwich Medical School. The project seeks to improve care for patients with rheumatoid arthritis and will bring local data together to provide new insights into the provision of social care and improve support services. For the last 30 years, the Norfolk Arthritis Register (NOAR) has been clinically reviewing patients with early onset inflammatory arthritis. Data from the register has been instrumental in forming policy on delivering care. The SOCRA project will bring local data together to provide new insights into the provision of social care and improve support services for patients with rheumatoid arthritis. By harnessing data, SOCRA will deliver a uniquely important resource for understanding the care needs of patients now and in the future.

Another separate project linked to Dr Yates' research portfolio was supported by Ahmar Iftikhar Talib, one of two recipients of the Young Academics (YA) summer studentship award. Young Academics UEA is an affiliated society that offers medical students the opportunity to get involved in research. This looked at the co-localisation of both the Norfolk Arthritis Register (NOAR), and European Prospective Investigation into Cancer and Nutrition (EPIC) and provided a unique opportunity to investigate environmental and dietary exposures and their associated risk to new onset inflammatory arthritis. As part of this project, Ahmar carried out work to ensure those with inflammatory arthritis can be identified within EPIC, taking account of the link between the two registers. Analysis of the data will be used to generate risk association estimates and findings from this study will be presented at an international conference and ultimately submitted for peer-review publication.

“Whilst we've seen big advances in the treatment of rheumatoid arthritis since NOAR's inception, medications don't result in cure, and as a result patients may develop complications over time which require social care and support. Partnership funding will allow for better provision of complex data to better inform social care policy.” Dr Max Yates

Regional NHS Point-Of-Care 3D Printing Service: Better and Faster Medical Treatment Tailored to Patient’s Needs is led by Professor Sheng Qi, from UEA’s School of Pharmacy. This project aims to produce surgical equipment tailored to individual needs, in one of the region’s hospitals, and an offsite research and development 3D Printing suite could help patients receive treatment more quickly and help reduce costs within the NHS. Professor Sheng Qi on the value of being awarded partnership seed funding: “Partnership funding will enable us to take a significant step towards building our own Regional Medical 3D printing capability. “Such Regional Medical 3D printing services already exist in some other parts of UK, but not yet within our region. We also would like to go a step further to build new mechanisms to make the most efficient use of the synergy between the research capability at UEA and our regional NHS clinical innovation to accelerate the Med tech industry within our region.” More about this exciting project and its progress so far on page 13.

“Partnership funding has enabled us to take a significant step towards building our own Regional Medical 3D printing capability that can deliver cheaper, faster and better treatment to our patients.” Professor Sheng Qi

COLLABORATION PROPELS PLANS FOR 3D MEDICAL PRINTING FACILITY A hybrid event funded by UEAHSCP linked together like-minded local NHS clinical specialists and UEA researchers looking to coordinate the implementation of a regional 3D medical printing service. The event launched a cutting-edge research innovation project aiming to set up a 3Dprinting service to produce surgical equipment tailored to individual needs, to be housed in one of our region’s hospitals, as well as setting up an offsite research and development 3D Printing suite. It is hoped that this project could help patients receive treatment more quickly and help reduce costs within the NHS. Discussion was led by Professor Sheng Qi, Professor of Pharmaceutical Material Science and Technology at UEA’s School of Pharmacy, who heads up the Partnership’s Point-of-Care 3D printing research group. The group’s primary ambition is to drive forward joint discussions to develop and run a regional 3D Printing (3DP) capability which would include a 3DP service within one of our hospitals for clinical use, and an off-site R&D service at UEA to facilitate medical innovation and technology transfer. Speakers included UEA’s Head of Engineering Professor Chris Atkin, Professor Richard Bibb from Loughborough University, Matt Pilley from University Hospitals of Leicester, Erik Erickson from Stratasys and Joanne Staples from Materialise. The workshop finished with in person attendees touring UEA’s own Productivity East Additive Manufacturing facility.

3D printing has revolutionised many sectors, and has many benefits for clinical use, including the production of surgical models to help plan and support surgeries and implants. Housing a 3D facility regionally will support the delivery of patient centred services, allowing more effective treatment to be delivered to patients faster, and offering significant cost-saving for the NHS.

3DP responds directly to the growing need to build flexibility and resilience into the manufacturing and supply capabilities of the NHS and to contribute to the Greener NHS agenda. On top of current applications, Professor Qi’s vision for 3DP includes enabling a tool of personalised medicines at point of care to print medications based on a patient’s personal needs in terms of dose and drug combinations. “Personalised medicine uses new manufacturing technology to produce pills that have the accurate dose and drug combinations tailored to individual patients. This would allow the patients to get maximal drug benefits with minimal side effects. Such treatment approaches can particularly benefit elderly patients who often have to take many different types of medicines per day and patients with complicated conditions.” The group’s work, Professor Qi said, will build upon the foundation of this research to design the technology needed in future to produce personalised medicine at the pointof-care: “For health and social care, particularly acute hospital environments, 3D printing is emerging as integral to designing personalized and effective treatment with rapid service delivery and at a lower cost for certain patient populations.” “We’re exploring the feasibility of setting up a two-tier 3DP service. We firstly want to see how we can offer our expertise to help our local NHS Trusts to set up an in-house print service; and secondly how UEA’s own state of the art 3D printing facilities and capabilities could potentially support the local medical tech industry to move current ideas to future implementation." - Research Group Lead Professor Sheng Qi.

UEAHSCP Research Director Carrie Jackson is delighted with the progress of this research and anticipates this work will make a real difference to service user experience: “I’m excited by the opportunities that 3D printing offers in providing highly personalised care, particularly the group’s innovative research into printing medicines to an individual’s prescription.” At present, the research group are conducting a survey with consultants across our partner organisations to better understand the current state of 3D printing in hospitals. Researchers will be visiting other NHS 3D Printing services in Cambridge University Hospitals and Nottingham University Hospitals to conduct similar discussions. Researchers will also soon begin consultation with the Medicines and Healthcare Regulatory Agency (MHRA) on the regulatory requirements for on-site surgical 3DP and personalised medicine. This work will generate a feasibility and cost-saving estimation report, identifying a path towards setting up and subsequent growth and development of the regional service in late 2022. The group is composed of leading academics and clinicians from UEA, East Suffolk and North Essex NHS Foundation Trust, Loughborough University, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, and West Suffolk NHS Foundation Trust, and has the vision and ambition to make our region the leader of transforming 3D printing technologies into cost-effective tools to serve the NHS and service users.

STUDY REVEALS IMPACT OF PANDEMIC ON NON-COVID-19 SERIOUS ILLNESS During the national COVID-19 lockdowns in England, people were asked to stay at home. A&E departments and GP surgeries saw significantly fewer people, leading to concerns that people were not actively seeking help when they needed it and the onset of serious medical conditions that needed urgent attention were not being reported. Evidence from previous epidemics shows significant morbidity and mortality from nonoutbreak related problems and Office for National Statistics’ data showed 27.8% (12.9k) of the excess deaths between March and May 2020 didn't involve COVID-19. Healthcare service delivery changed significantly after lockdown and direct patient access reduced due to triage and remote consultation systems. Given the ongoing restrictions and changes to healthcare access and capacity, seeking help for non-COVID-19 problems has the potential to become a longer-term issue; indeed, deaths involving diabetes, hypertension and cardiac arrhythmias remained above the five-year average after the first lockdown. The choices people make about seeking help for new, urgent health problems during COVID-19 are not easy. We supported the ‘Help in COVID’ study to better understand this decision process and to provide support structures for future emergencies.

This qualitative study interviewed people who had sought help for a new, serious symptom or were diagnosed with a serious condition during COVID-19. The team also spoke to people who did not seek help at all or delayed seeking help. The study’s results will contribute to improving healthcare during pandemics and a summary of the results will be publicly available as well as presented in academic papers and meetings. The study was led by UEA researchers Helen Parretti (Consultant Clinical Senior Lecturer) & Pippa Belderson (Senior Research Associate) from our Changing Behaviour and Implementing Best Practice group and is supported by staff from NHS Norfolk and Waveney Clinical Commissioning Group, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, NHS Ipswich and East Suffolk Clinical Commissioning Group, East England Ambulance Service NHS Trust, Norfolk and Suffolk NHS Foundation Trust, Norfolk Community Health and Care NHS Trust, and the University of Edinburgh.

COLLABORATIVE WORKFORCE TRANSFORMATION ACADEMY IN THE EAST OF ENGLAND A project from the ImpACT research group. Project timeline: November 2021 - ongoing Project summary: As the Integrated Care Systems come to fruition (expected from 1 July 2022), attention has been focused on working with external stakeholders to build confidence, excitement and potential new roles and services across our Norfolk and Waveney System, and beyond. The workforce transformation agenda is central to achieving sustainable service models, and the workforce scope, practice and skills that can enhance health and care futures for all that builds upon new and existing partners. The Collaborative Workforce Transformation Academy (WTxA), co-created with stakeholders, offers a supportive infrastructure and academic architecture to stimulate workforce transformation, through co-ordinating a variety of activities focused on system, regional and national priorities, bringing people together to maximise regional expertise that further promotes initiatives for tackling health and care service priorities. Impact Summary: Knowledge exchange and transferable skill enhancements were achieved through a series of bespoke, organisation based programmes, supplemented by three series of international webinars each month, and 5 Communities of Practice established for culture change, system level leadership, skilled facilitation, innovation and improvement, and embedded research.

Major benefits seen through several programmes of work are being recommissioned, focused on the Guiding Lights of Effective Workplace Culture, and the VITAL project for Band 7s. Reach in terms of engagement with external partners has rapidly moved beyond the East of England, with active projects taking place in Gloucester, Liverpool, Torbay & Devon, with enquiry/exploratory contacts made with Avon and Wiltshire, Scotland and Teeside, as people receive reports of the WTxA activities. Key initiatives that have arisen as a result of this work in the past year are: 1. The national Multiprofessional Advanced and Consultant Level Practice career capability framework in collaboration with Health Education England. 2. The development of a new integrated Eye Care Workforce for multiprofessionals in the East of England is influencing national work by NHS England and Improvement and Health Education England in this specialist field.

An inductive Impact framework has been devised and mapped against all ImpACT Research Group activity, to demonstrate how the capacity and capability of the multi-professional workforce across the region can grow and develop, to enable integrated care that is people and communities centred with continuity. This important work dovetails well with the Norfolk and Waveney Integrated Care System (N&W ICS) workforce and service transformation agendas as well as those of the other 5 ICS’s in East of England. For more information please contact the ImpACT Research Group via our administrator Danielle.O’Hara@uea.ac.uk. All the ImpACT Webinars are recorded and made freely available on the ImpACT YouTube channel.

Pictured: the ImpACT research team 21

PROJECT SEEKS TO BETTER SUPPORT MENOPAUSAL AMBULANCE STAFF Female Ambulance Staff Experiences of Menopause Transition (CESSATION) Preliminary Findings. Menopausal symptoms can have a significant impact on female health and wellbeing and are known to affect workplace attendance and performance. All women will experience the menopause, yet there is currently limited menopause support in the ambulance setting. Adopting a three-phase study methodology, the main aims of CESSATION were to identify the current menopause guidance offered by UK ambulance services; understand the impacts of the menopause on female ambulance staff; and identify service interventions that may best support staff during the menopause transition. Preliminary CESSATION findings: UK ambulance services vary in their provision of either a Menopause Policy or Guidance, as well as their offering of organisation, manager and staff menopause-related education, wellbeing, practical support (including signposting to expert resources) and absence management guidance. All 12 eligible ambulance services participated in the UK-wide CESSATION survey and more than 1900 responses were received. The majority of survey participants were female, aged 45 – 54 years, either in the peri-menopause or menopause phase of the menopause transition, and worked in emergency operational service delivery with a shiftbased work pattern.

Participants’ menopause symptoms were numerous and varied, and often individuals were not prepared for their symptoms and/or their severity. Tiredness or low energy levels, difficulty sleeping, night sweats, mood changes (including anxiety and depression), hot flushes and memory/concentration problems were the six most severely experienced. Various self-care strategies and professional menopause support services, in particular General Practitioners, were sought by participants to support their menopause transition experience. The impacts of menopause symptoms were wide-reaching: detrimental effects on working lives and personal wellbeing were noted. Despite this, only a minority of participants reported feeling supported in the workplace. Further insight of participant experiences was provided by numerous additional free-text comments, the themes of which were: impact of work role; awareness of preparedness for menopause transition; personal impact of symptoms; desired support; appropriate sickness and menopause policy; managerial development; compassion and dignity; impact of working environment; personal and patient safety; and lack of choice. Further exploration of these findings is underway utilising semi-structured research interviews involving twenty-one study participants.

Exploring the experiences and menopause transition knowledge of managers from one ambulance service (CESSATION-EEAST survey) revealed limited menopause training completion and menopause policy awareness. In addition, these survey participants reported varying comfort levels for managing menopausal female staff and variable knowledge regarding menopausal female work and health concerns. Their main managerial concerns were staff personal health and wellbeing, sickness management and lack of Trust guidance. Managerial participants also provided additional free-text comments with the following themes: access to guidance to inform management and staff; training and awareness of symptoms; suggested workplace adjustments; negative perception of menopausal women; provision of specialist information to female staff; and male manager focus. Preliminary CESSATION recommendations: 1. The CESSATION findings to be made available throughout all UK ambulance services. 2. Dissemination of study findings via suitable conferences and publications. 3. Menopause transition awareness to be raised in all UK ambulance services, with signposting to evidenced advice. 4. Service developments, including uniform redesign, to take into consideration study findings. 5. Convene a stakeholder panel to determine the development of menopause-support interventions. CESSATION has received funding from UEA Health and Social Care Partners and the College of Paramedics.

This exploratory study was led by associate member East of England Ambulance Service NHS Trust (EEAST) which sits within UEAHSCP’s Workforce Sustainability research group. Led by Professor Kristy Sanderson, membership represents leading health & social care organisations across our region including partner members James Paget University Hospitals NHS Foundation Trust, NHS Norfolk and Waveney Clinical Commissioning Group, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk and Suffolk NHS Foundation Trust and Norfolk Community Health and Care NHS Trust with associate member East of England Ambulance Service NHS Trust.

MEDICINES OPTIMISATION MEMBERS LEAD £1.4M PROJECT TO IMPROVE FLU JAB UPTAKE IN CARE HOME STAFF Medicines Optimisation East Anglia (MOG_EA) research group members are among those leading a project aiming to encourage more care home staff to get the flu vaccine. The three-year FluCare project, funded by the National Institute for Health Research (NIHR), aims to find out which approaches work best to increase the number of staff being vaccinated, and researchers hope that their learnings can also be used to improve COVID-19 vaccine future uptake. The study will trial different ways of encouraging staff to take up the vaccine, such as vaccinating staff within the care home setting, and offering incentives to managers. The methods will initially be tested in 10 care homes and pharmacies across East Anglia, London, and the East Midlands during flu season. Researchers will then go on to work with another 70 care homes with low vaccination levels to see whether the new methods have increased the uptake of the vaccine and, in turn, improve the health of residents. Currently, less than half of care home staff in the UK are vaccinated. Researchers have found several reasons for why staff do or do not get vaccinated, including how easily they can access vaccines, how important their manager sees staff vaccination, and their own personal attitudes and beliefs about vaccination.

The research team hope the project will help to reduce the number of flu cases in care homes and ultimately save lives. The project is hosted by NHS Norfolk and Waveney Clinical Commissioning Group and involves collaboration with the universities of Leicester and Liverpool, Norwich Clinical Trials Unit and organisations including NHS England and NHS Improvement, the National Care Forum, Care England, Boots UK, and Day Lewis Pharmacy. MOG_EA researcher Dr Amrish Patel, from UEA’s School of Economics, explains why it is critical to vaccinate those closest to care home residents as well as the residents themselves: “Every year flu, caught from staff and visitors, causes serious illness and death in care home residents. While vaccines work in most people, there are always some for whom they do not work. That means that if we give vaccines to care home residents, some will still not be protected. “The best way to protect residents is therefore to vaccinate care home staff as well. But while the World Health Organisation recommends that over three quarters of care home staff should be vaccinated, in the UK less than half of staff take up the jab. And this puts residents at higher risk.” Learning from this, the project team will refine the service and decide which mixture of approaches to study on a larger scale.

“We will also look at the economic impact of the interventions we propose to see if they will help save money for the NHS. We will listen to people involved to find out what did and did not work to learn how to improve the service. Finally, we will use our findings to develop a toolkit. This will tell people about our new service and encourage them to use it. While we do this research, we will work closely with residents and relatives. They will help us design and manage the studies, collect information, look at the results and present them to the outside world.” MOG_EA group member Dr Martyn Patel, Norfolk and Norwich University Hospitals NHS Foundation Trust.

CONCUSSION RESEARCH REFERENCED IN DIGITAL, CULTURE, MEDIA & SPORT COMMITTEE’S REPORT The Concussion Action Programme is a collaborative research team that aim to raise awareness of the impact of concussion injury, and reduce the risks for athletes and school children through research and education programmes with health professionals. CAP Group Lead Dr Michael Grey, Reader in Rehabilitation Neuroscience at UEA, gave evidence during the Digital, Culture Media and Sport (DCMS) Select Committee inquiry into acquired brain injury in sport. A Trustee of the UK Acquired Brain Injury Forum, Dr Grey is playing a leading role nationally to highlight the need for government to drive change and the importance of independent research to help tackle the issue. His address to the Parliamentary inquiry into the links between sport and long-term injury referred to evidence from a recent survey conducted by CAP which looked at the inconsistent advice provided across health and social care services to those who had suffered brain injuries. The Committee considered the scientific evidence linking sport and long-term brain injury and the role national governing bodies should be taking, including their responsibility to understand risks involved for players and actions that could be taken to mitigate them.

The report found failings including a lack of government action on previous safety recommendations. Parts of Dr Grey’s expert evidence was quoted throughout the report: “In the East of England we have the Concussion Action Programme and we have recently looked at this issue and produced a report. With respect to the NHS, we found that there is a large variation in the content and quality of discharge information that people are given if they attend A&E with a mild traumatic brain injury. That information is typically these red flag issues but there is nothing given typically on return to play, return to learn or return to work issues.” The collaborative and community-driven basis of CAP’s research culture will enable the group to develop a competency-based behavioural curriculum for a school-based concussion management programme to combat post-concussion syndrome in children slipping through the gaps. CAP is also tackling one of the most debated topics in football. Concussion in contact sports are one of the most common injuries and repetitive sub-concussive impacts are believed to lead to early neurodegeneration. You can read the report here. Related media coverage: Former Norwich players demand action after report on concussion in sport UKABIF contribute to government report on sport.

NEW RESEARCH GROUP AIMS TO BOOST REHABILITATION INNOVATION The Partnership's newly formed research group AbiliTec, led by UEA Lecturer & Researcher in Physiotherapy and Neurorehabilitation Dr Nicola Hancock, is a collaborative initiative of clinicians and researchers looking to support co-production of innovative rehabilitation technologies and address the current challenges of uptake and use of new innovations by service users, commissioners, providers, and clinical teams. Work to date has centred on stroke and acquired brain injury, and as AbiliTec continue to innovate in this area, the group will also support innovation across the rehabilitation community. On the group’s future impact, Dr Hancock said: “Well-designed technologies have enormous potential to meet needs across local services. The inclusive development and use of new rehabilitation technologies aligns with national policy on person-centred care for those with long-term conditions.” Researchers will adopt principles of inclusive, user-centred design of devices and testing programmes. Well designed technologies have great potential to meet service need and the development of new rehabilitation technologies aligns with national policy on person-centred care for those with longterm conditions. One such project is our work in developing a prototype walking device for people with stroke, alongside clinicians, service users, engineers, academics, and the Design Council UK.

NEW LEARNING DISABILITIES GROUP AIMS TO ADDRESS GAPS IN RESEARCH The Learning Disabilities research group launched in 2021, and is co-led by UEA’s Neil James, Associate Professor in Nursing Sciences (Learning Disabilities), and Lynne Fanning, Head of Clinical Education and Research at Norfolk Community Health and Care NHS Trust. With almost 1.5 million people with a learning disability in the UK, collaborative research and sharing of best practice is vital to the improvement of service delivery, therapies, and support that place the person with a learning disability in the driving seat. The group are keen to identify and address the most pressing practice and research gaps in the field of Learning Disability and in June 2022 held a collaborative workshop to identify its key priorities and to connect up with other practitioners and researchers working in other regions of the UK. According to the ONS, people with learning disabilities were much more likely to get infected with COVID-19 than other people during the first phase of the pandemic, a function of people's social and economic circumstances, insecure working conditions in social care, and a lack of provision of basic infection control equipment. In its first phase, the group’s activities will focus primarily on sharing best practice, evidence dissemination and initiating project collaboration and service development. Researchers will aim to ensure the challenges of health inequalities and the need for effective inclusivity remain at the forefront of thinking of any projects and programmes.

Exploring the real-world impact the pandemic has had on the lives of people with a learning disability and their carers will therefore be a priority for the group. The group also aim to explore the rapid response made by regional health and social care services to continue with delivery and person-centred approaches to provide support during the challenges presented by the pandemic. Research co-lead Neil James is pleased to be taking this research and practice agenda forward: “This group has an exciting membership that will look to make a positive and meaningful impact on service delivery and the experiences of people with a learning disability. “Looking at ways to further enhance services so that they are able to meet the complex needs of individuals will be at the forefront of our thinking and planning. What we aim to support is equitable and inclusive access to all services and activities.” The group is made up of representatives from our partner organisations Norfolk County Council, Norfolk Community Health and Care NHS Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, University of East Anglia, West Suffolk NHS Foundation Trust, Norfolk and Suffolk NHS Foundation Trust, James Paget University Hospitals NHS Foundation Trust, NHS Norfolk and Waveney Clinical Commissioning Group, associate partner East of England Ambulance Service NHS Trust and Hertfordshire NHS Foundation Trust.

PARTNERSHIP PROJECTS SWEEP 2021 UEA INNOVATION AND IMPACT AWARDS UEA Research & Innovation Services have held the Annual Innovation and Impact Awards since 2018, to recognise and reward research and innovation that makes a significant impact. The awards are always fiercely competitive, highlighting some of the best and most ground-breaking UEA projects. UEAHSCP were proud to be nominated in the Partnership of the Year category - a sincere thank you to all our colleagues and supporters, without whom this achievement would not have been possible. We were delighted that eight UEAHSCPsupported projects were nominated for awards, and that two projects went on to win in the Partnership of the Year and Outstanding Contribution/Response to COVID-19 categories. To find out more about all of last year’s finalists, read the 2021 brochure, or watch this year’s 2022 awards here.

Congratulations to the partnership projects recognised in 2021: 1. The SCORES Project, won for Partnership of the Year (Dr Michael Grey and Dr Sarah Hanson from the Concussion Action Programme with Ellen Boucher, and Prof Michael Hornberger). 2. The C-19 Health Behaviour and Wellbeing Daily Tracker Study, won for Outstanding Contribution/Response to COVID-19 (Dr Felix Naughton and Professor Caitlin Notley from the Changing Behaviour research group). 3. A Centenary of Caring, nominated for Outstanding Impact in Health, Wellbeing and Welfare (Professor Sally Hardy, Associate Professor Carrie Jackson, and Professor Jonathan Webster from the ImpACT research group). 4. Compassionate Communities across East Anglia: a public health approach to palliative and end of life care, nominated for Partnership of the Year (Dr Guy Peryer, former lead of the Palliative Care research group).

In addition, the Norwich Testing Initiative (NTI) won the Chancellor’s Award for Outstanding Achievement. This ground-breaking initiative was established at a time during the COVID-19 pandemic where mass asymptomatic testing was not widely available and produced an effective template for establishing community testing by taking advantage of our outstanding regional knowledge and infrastructure, readying our community for another surge in cases during winter 2020/21. The project was delivered by leveraging expertise across Norwich Research Park through collaborative working with the Earlham Institute, the University of East Anglia the Norfolk and Norwich University Hospitals NHS Trust, the John Innes Centre, the Quadram Institute, and The Sainsbury Laboratory, with project management and support from UEA Health and Social Care Partners. The initiative reported into Public Health England and involved close liaison with officers in the Norfolk Public Health team. Funding for the pilot came from the organisations involved, with support from local charities and philanthropists.

IMPACT OF RESEARCH BY THE LANTERN NETWORK Dr Simon P Hammond is an applied psychologist, Lecturer in Education in UEA's School of Education and Lifelong Learning and Honorary Associate Professor at Norfolk and Suffolk NHS Foundation Trust. He leads the Looked After Children’s Mental Health Research Network (LANTERN) within UEAHSCP. He has forged strong national links with leading organisations, including The Fostering Network and Internet Matters. LANTERN has three priority areas of work: 1. Better evidencing of practice innovations. 2. Promoting positive mental health. 3. Supporting better online lives. These interrelated priority areas converge to provide real world impact that facilitates positive mental health, and the availability of positive mental health support, for children and young people with care experience.

“Evidence shows that online risks are not evenly spread – young people with offline vulnerabilities are more at risk online and, very often, are less supported. We need to do more work in addressing this.” - Dr Simon P. Hammond

Pictured: Dr Simon P. Hammond at 2019's Young People's Mental Health and Wellbeing conference.

Changing conversations: Empowering vulnerable children in a digital world Research shows that vulnerable children experience significant benefits from being online. However, they are also more likely to experience online risks. As such, they require very specific support to develop digital resilience to benefit safely. LANTERN group lead Dr Hammond was commissioned via Internet Matters and Huawei to explore the current approach to online risks faced by vulnerable children and how regulators, professionals and parents/carers can change these practises to better support these children. This research aimed to establish whether, and how, a wide variety of professionals within or connected to education currently support a specific group of vulnerable children to grow, play and thrive in their connected lives. We also wanted to understand how vulnerable children and their parents/carers felt about the support they received. The project was supported by Freya Boswell, one of two recipients of the Young Academics (YA) summer studentship award. Young Academics UEA is an affiliated society that offers medical students the opportunity to get involved in research. As part of this project, Freya helped produce the public facing report for Internet Matters to lobby political figures to promote better support in vulnerable children and young people, mental health, and their online lives. Freya supported data collection through online interviews with 30 professionals working with vulnerable children and carried out online focus groups with 14 vulnerable children aged 8-15 years, holding separate focus groups attended by a parent/carer of each of these children. She also contributed to the analysis of literature for a rapid evidence synthesis and end of project report.

The Changing Conversations report had four key messages: 1. Professionals frequently struggle to support vulnerable children in their connected lives 2. This is because professionals often focus solely on the risks associated with connected technologies 3. As a result, vulnerable children’s connected experiences become marginalised, meaning professionals are in danger of providing less support to those who need it the most 4. However, where digital resilience is embraced, vulnerable children receive more child-centred support and empowerment opportunities These key messages have been distilled into “Key tips and insights” for professionals working with vulnerable children these key points are available on the Internet Matters website here.

UEAHSCP Research Informs New Digital Skills Course for Foster Carers LANTERN group lead Dr Simon Hammond's research has informed an online training course that aims to empower foster carers to support the development of digital resilience of children and young people with care experience to enjoy the opportunities connectivity presents whilst being able to manage and navigate the risks of these spaces. Funded via a £150,000 grant from Nominet Social Impact’s REACH programme, the course is freely available and is the first CPD accredited course of its kind. It has four modules which build on the skills and knowledge foster carers already have and show how they can support their child’s safety, confidence, and competence online. The course was launched by Internet Matters and The Fostering Network and co-created with help of care experienced young people and foster carers from across the UK. Dr Hammond and Dr Kimberly Bartholomew will lead the process evaluation of the course. The course is available here.

New Tool Launched to Keep Children Safe Online Research by LANTERN has helped to inform the development of an important new digital passport designed to help children with care experience make the most of technology through relationship building and communication. The Digital Passport was the idea of Adrienne Katz and was created by her with expert input from Adam Gordon, Dr Simon Hammond, Steve Bailey, and other members of the UK Council for Internet Safety (UKCIS) Vulnerable Users Working Group. The Digital Passport enables careexperienced children to enjoy the benefits of online connectivity safely. It will provide details of the child’s knowledge and use of digital technology so that their wellbeing can be supported as well as helping carers to safeguard their online safety by being aware of their online capabilities. Dr Hammond said the resource is a critical tool to facilitate communication about digital communication: “One of the most important and effective ways of keeping children and young people safe online is for them to have regular and meaningful conversations with a trusted adult about what they do online, why they love it, and if they have any concerns.” According to the Vulnerable Users Working Group, foster carers can be tech-hesitant and may default to removing devices and restricting digital access when, for many young people in care, it is the only way of connecting to friends and, where appropriate, family.

Chair of the UKCIS Vulnerable Users Working Group Claire Levens says the passport will serve as an important resource to support foster carers in managing the crucial conversations that will help them understand, support, and safeguard their child’s online life: “This digital passport will help initiate those conversations and to write down information. It is vital that caregivers are equipped with bespoke understandings of these issues within the context of children and young people with care experiences in ways that enable them to flourish in this increasingly vital area.” The tool: Helps enable the child’s digital life in a positive and supportive way Enables carers to clarify and support a discussion and understanding about online life Supports agreements about internet access and device use between carer and child Creates consistency for a child or young person if they move to another placement or home environment Is a record to improve safeguarding Helps make the most of what technology offers and opens opportunities for children and young people, especially those in or leaving care “Our work aims to provide professionals and young people with strategies, skills and knowledge to better navigate, recover and grow following online risk experiences.” concluded Chair of the UKCIS Vulnerable Users Working Group Claire Levens. You can find the passport here.

To date, there have been 420 downloads of the Adult digital passport, 350 downloads of the children’s passport and 315 downloads of the introductory document.

INTERNATIONAL NURSES DAY 2021 In May 2021, we marked International Nurses Day by celebrating nurses across our community and thanking them for their dedication. During an especially difficult period due to the pressure of the COVID-19 pandemic on our health and social care system, we featured some of our partnership’s leading nurses and highlighted their innovation, service delivery and leadership, including ground-breaking initiatives like designing an accessible COVID-19 vaccine clinic for those with learning disabilities and autism, setting up the reservist nurse scheme to attract nurses back to the NHS in its time of need, and much more.

Anna Morgan, Director of Workforce at Norfolk and Waveney Health & Care Partnership “We were successful in attracting over 70 nurses back to the NHS to deliver over 10K hours of COVID-19 vaccinations from December onwards. Nurses from all backgrounds, including those that have retired or left nursing, came forward to become a ‘Reservist Nurse’ to provide screening and vaccinations in primary care settings, hospitals and vaccination centres. The Reservist role enabled nurses to enlist and support the NHS by undertaking 2 days of training and a shadow session before mobilising quickly into action. We will take the learning from this programme to expand the scope of the Reservist role for Nurses and other professions to deliver more exceptional and complementary roles to the wider workforce.” Follow Anna on Twitter: @mmorgan_anna

Claire Whitehouse, MSc, Bsc RN, Senior Nurse for Nursing, Midwifery and AHP Research for The James Paget University Hospitals NHS Foundation Trust “We have developed new opportunities for Nurses, Midwives and Allied Health Professionals (NMAHPs) which span clinical care, research and academic progress. Building capacity, capability and, perhaps most importantly, confidence in NMAHP staff in research activity is central to high quality, patientcentred care. Nurses are familiar with using an evidence base to provide the best care for their patients from preregistration to throughout their careers, however, NMAHP-led research has been less visible, until now. Central to this development, there has been a commitment from Board, senior leaders, middle management and everyone on the front line. We have spent time developing collaborative working relationships regionally, nationally and internationally and are excited to bring new options in the next 6 or so months, watch this space.” Follow Claire on Twitter: @ClaireW_UK

Dr Jonathan Webster, Professor of Practice Development and Co-Director of ImpACT Research Group at University of East Anglia “Transformation of a profession always starts from personal transformation. For me, this last year has been a rollercoaster, not only in taking up a new post as part of the ImpACT Research Group at UEA but living through the COVID-19 pandemic. Over the last 12 months, I have been continuously impressed by the inspiring people I have met. Many colleagues, friends and family members have been on the front line, walking alongside them from a mentorship, professional support and clinical supervision perspective, I have constantly been humbled by their professional commitment to care, no matter how challenging the situation. Our profession has a real opportunity to reflect on the past 12 months and what we have been able to achieve, what we have discovered and what genuinely adds value to those people we serve and care for. Whatever our role, we have a part to play in ensuring that the future rests firmly in the difference we want to see.” Follow Jonathan on Twitter: @IPDJwebster.

Rebecca Crossley, Learning Disability and Autism Liaison Nurse at James Paget University Hospitals NHS Foundation Trust “Along my journey to get my vaccination, I sat waiting and my mind drifted and I started thinking about the people I work with. I asked myself how they would feel in this environment. I started noticing everything around me, every sound, movement and touch and quickly realised an accessible clinic was needed. Starting an accessible vaccine clinic for people with learning disabilities and Autism along with those with severe and enduring mental health conditions was an essential thing to do. The most vulnerable in our communities and those most likely to die if they developed COVID-19 are these cohorts of people not because of comorbidities but because of sensory needs or anxiety associated with hospitals, masks, and uniforms. To date, we have vaccinated 242 people some with severe needle phobias who previously have never received vaccines. I am humbled by the gratitude of the families and carers of these inspiring people whose resilience and bravery astound me. How, we, as a nation deliver vaccinations to these cohorts of people we hope will have changed forever.” Follow Rebecca on Twitter: @RebeccaCrossle2

Rebecca was presented with an RCN (Royal College of Nursing) Award for her incredible efforts setting up an accessible Covid-19 vaccination clinics - congratulations Rebecca! Read more about Rebecca's award winning project.

LOOKING TO THE FUTURE UEAHSCP RESEARCH DIRECTOR CARRIE JACKSON ON THE FUTURE DIRECTION OF OUR PARTNERSHIP I am delighted to share our future plan with you for the next two years. With partnership seed funding provided up front in an annual pot of investment we are launching two partnership research capacity funding rounds a year from July 2022 so that we can support more cutting edge research. This will be complemented by a new co-badged UEAHSCP fellowship with the East of England NIHR Applied Research Collaborative. The fellowship is open to clinicians and practitioners who do not wish to focus on a traditional PhD career route but instead focus on a project that will help to improve services locally. The fellowship provides an opportunity to learn in a community alongside other fellows and be supported through action learning as well as having a designated supervisor from UEA. Adverts will open in October and the programme will commence in April 2023 running until March 2024. The Fellowship provides backfill for one day a week of support to the successful project applicant. Launching in September we will be offering smaller awards for research scholarships to enable practitioners to undertake small projects like literature reviews, writing up work for publication, developing posters for conferences, developing research proposals. We hope to run this alongside The Citizens Academy so that there are scholarships available for both practitioners and citizens interested in doing research.

CARRIE JACKSON RESEARCH DIRECTOR, UEA HEALTH AND SOCIAL CARE PARTNERS Another initiative we are involved in is ensuring we look after each other’s wellbeing to support recovery from the pandemic. To this end, we are setting up two new Research Sandpit events a year which partners can bring research challenges, questions & ideas along to. With the aim of reducing the number of meetings people have to attend for the partnership, these sandpits will coalesce talent and creativity of the partnership, bringing all the stakeholders needed to work up a proposal for funding together in a workshop format. Workshops can run concurrently so we can be effective in developing our research proposals and action plans together, making greater use of people’s time, talents and productivity.

We're hoping to grow our partnership and welcome new organisations to join us. We've developed our Associate Member criteria and are delighted to be in a position to welcome charities and small social enterprises as associates. We hope to launch this exciting news on our new web platform in September so watch this space…… - Carrie Jackson

THANK YOU TO OUR PARTNERS FOR A FANTASTIC THIRD YEAR

East Suffolk and North Essex NHS Foundation Trust James Paget University Hospitals NHS Foundation Trust NHS Norfolk and Waveney Clinical Commissioning Group Norfolk and Norwich University Hospitals NHS Foundation Trust Norfolk and Suffolk NHS Foundation Trust Norfolk Community Health and Care NHS Trust Suffolk CCG Representation The Queen Elizabeth King's Lynn Hospital NHS Foundation Trust West Suffolk NHS Foundation Trust