Current research

This is a collaboration with the Public Health Team of the London Triborough Authorities (Hammersmith and Fulham, Kensington and Chelsea and City of Westminster) on the design and delivery of a research evaluation of a new pilot project aimed at preventing obesity in childhood. The project forms part of a wider programme in the three boroughs to halt and reverse levels of childhood obesity and improve associated outcomes for children and their families. ‘Go Golborne: eat happy, move and play’ was launched in May 2015. With many schools, preschools, youth clubs and parks, Golborne - one of London’s most deprived wards – offers potential to reach large numbers of children and young people and explore the environment’s role in supporting healthy behaviours. This pilot takes a ‘whole place’ community approach through a local network of individuals and organisations. Using training opportunities, environmental improvements, consistent messages, community development and a series of social marketing campaigns, Go Golborne encourages children and their families to ‘eat happy, move and play’ by helping to create supportive environments that make healthier choices around eating and physical activity easier.  Their themed campaigns will focus on simple messages such as sugar swaps, snack checks, active travel, and reduced screen time. CHSS is taking a ‘theory of change’ approach to the four-year evaluation, which will study the links between activities, outcomes and contexts of the initiative.  It will incorporate a detailed process evaluation, as well as evaluating outcomes on healthy weight, changes in behaviour, awareness of and attitudes to physical activity and healthy eating, and changes in home, school and community environments. Evidence suggests that healthy lifestyles initiatives work best when targeted at a local level to respond to the unique needs of communities. Learning from other areas also highlights the importance of taking a ‘whole system’ approach where everyone who lives and works in a community plays their part to make it a healthier place for children to grow up.  This pilot, as part of a multi-agency approach to tackling child obesity, will test the feasibility of replicating the intervention in other areas. The research team will: Assess impact and costs of the pilot at child and family, community and local authority level, Identify the least and most effective elements of the project - for who, in what contexts, and how. Inform the progress of the project over the three years to maximize the likelihood of greatest impact. Make recommendations on whether and how the intervention could be rolled out in or adapted for other wards.   Start date: 25/05/2015 End date: 31/03/2019 Funder: Royal Borough of Kensington and Chelsea Funding: £189, 653

A three year study to develop and pilot a physiotherapy intervention for boys with haemophilia, an inherited condition (mainly in boys) affecting the blood's clotting ability. It causes bleeding into muscles and joints resulting in weakness and pain. One of the things which affects this group is being able to participate in games and activities with friends. Patients and physiotherapists are working together to design a programme of exercises to help strengthen muscles and help boys with haemophilia with their movement potential.   Funder: NIHR Research for Patient Benefit via East Kent Hospitals University Foundation Trust   £247,816

Identifying stroke/TIA survivors' needs and preferences KeMIST This new project puts patients’ long-term needs and preferences at the heart of a new NHS service to improve patient outcomes. Specifically, it aims to reduce the chance of recurrent strokes or cardiovascular events and develop a long term support service for patients beyond stroke rehabilitation. Little is known about how stroke/TIA survivors’ perceive the burden of using long-term medicines, their needs and preferences for medicines support, or how these change over time.  Qualitative interviews with survivors of stroke or TIA (and their hospital and community carers), and community pharmacists. The data gathered around problems encountered and support needed by those prescribed life-long, multiple medicines will inform the design of a toolkit for patients, carers and Health Care Professional (HCPs) to identify the medicine support needed by individuals. The research will inform design of a suitable pharmacy support service making use of relevant available technologies. People affected by stroke/TIA and HCPs will be involved at all stages of the project to ensure the new service is fit for purpose. Start date: 01/02/2016 End date: 31/01/2018 Funder: Stroke Association Funding: £58,198

A three-arm, Randomised Controlled Trial of the effectiveness and cost-effectiveness of adjunctive medication management and contingency management to enhance adherence to medications for relapse prevention in alcohol dependence. Alcohol dependence relapse is common following conventional psychosocial interventions. Routine NHS prescription of acamprosate to maintain abstinence from alcohol is now recommended by NICE and its effectiveness in conjunction with psychosocial therapies for relapse prevention is well documented.   Limited evidence exists to guide clinical practice on effective interventions and NICE have prioritised clinical trials of strategies to increase relapse prevention medication adherence. Supporting and educating patients about the role of acamprosate in relapse prevention through medication management (MM) may improve adherence and increase clinical effectiveness. Pharmacists are ideally placed to deliver MM in this context, though the effectiveness of local pharmacy delivery is currently not known. Following a simple behavioural reinforcement schedule, contingency management (CM) can be delivered at relatively low cost compared to other psycho/behavioural interventions and with greater clinical effectiveness in substance misuse. If shown to be effective CM has potential to be adopted within NHS services and the pharmacy to enhance alcohol dependence treatment. Aim of the trial: To evaluate the acceptability, effectiveness and cost-effectiveness of adjunctive MM with/without CM in improving acamprosate adherence in alcohol dependence. Objectives: To conduct an internal pilot study to assess the feasibility, recruitment and acceptability of the MM and CM interventions for pharmacists and service users. To conduct a definitive three-arm, randomised controlled trial of the effectiveness of MM with and without CM compared to standard support alone (SS) in enhancing adherence to acamprosate To estimate the cost effectiveness of MM with and without CM compared to SS alone in enhancing adherence To assess the impact of adherence to acamprosate for alcohol dependence relapse prevention on abstinence and reduced alcohol consumption. Start date: 01/12/2014 End date: 30/11/2018 Funder: NIHR Health Technology Assessment via Kings Funding: £24,112

CHSS is working with Yale School of Public Health as part of a global project to promote breastfeeding in Britain. Sally Kendall, Professor of Community Nursing and Public Health, is leading the Becoming Breastfeeding Friendly (BBF) programme for England, Scotland and Wales. The BBF programme involves a five-step process, including application of a suite of benchmarks to accurately assess barriers to successful breastfeeding on a country-wide level. It also provides case studies to assist decision-makers in implementing it most effectively. The BBF programme helps countries identify gaps in their own breastfeeding programmes, thus enabling focused resource allocation, ultimately leading to improved breastfeeding results. Breastfeeding rates must improve around the world to meet the WHO’s 2025 global target of increasing the rate of exclusive breastfeeding in the first six months to at least 50%. As well as Great Britain, Germany, Myanmar, Samoa, Mexico and Ghana, have accepted the challenge to reach this target by implementing the BBF programme. Start date: 1/11/2017 End date: 28/02/19 Funding (joint): Public Health England, Wales and Scotland (£42,500) and the Family Larsson Rosenquist Foundation (unrestricted grant to Yale University) ($32,000)

A major NIHR-funded study of alcohol consumption and associated problems among adolescents. UK adolescents are among the heaviest drinkers in Europe, but there is a gap in the evidence around identifying and intervening with alcohol use among this group. Many adolescents present to hospital emergency departments (EDs) having experienced alcohol-related harm, but effective public health strategies for early interventions to reduce this harm are hampered by this lack of research evidence. The study follows on from the SIPS (Screening and Brief Intervention Pilot Study) research programme examining adults in health and criminal justice settings. A £2 million grant has been awarded to a research consortium led by King's College London, including Universities of Newcastle, Kent, Swansea, Glamorgan, Imperial College, and St Mary's Hospital, the South London and the Maudsley NHS foundation trust, Humber NHS teaching trust, and Newcastle NHS Mental Health Trust. Start date: 01/09/2015 End date: 31/12/17 Funder: NIHR (via Newcastle University)

A major NIHR-funded study of alcohol consumption and associated problems among adolescents. UK adolescents are among the heaviest drinkers in Europe, but there is a gap in the evidence around identifying and intervening with alcohol use among this group. Many adolescents present to hospital emergency departments (EDs) having experienced alcohol-related harm, but effective public health strategies for early interventions to reduce this harm are hampered by this lack of research evidence. The study follows on from the SIPS (Screening and Brief Intervention Pilot Study) research programme examining adults in health and criminal justice settings. A £2 million grant has been awarded to a research consortium led by King's College London, including Universities of Newcastle, Kent, Swansea, Glamorgan, Imperial College, and St Mary's Hospital, the South London and the Maudsley NHS foundation trust, Humber NHS teaching trust, and Newcastle NHS Mental Health Trust. The study, conducted over five years, is examining 5000 young people to develop, implement and evaluate screening and alcohol interventions for 10-18 year olds attending hospital emergency departments (ED). The study will have important implications for the management of adolescent drinkers in ED, and on alcohol-related harm prevention. Results will inform development of strategies and conclude with a pilot study of interventions to reduce use in this population. Start date: 01/06/2011 End date: 14/03/2017 Funder: NIHR (via King's College London) Funding: £56,757 Publication: Linked randomised controlled trials of face-to-face and electronic brief intervention methods to prevent alcohol related harm in young people aged 14–17 years presenting to Emergency Departments (SIPS junior)

Evaluating and analysing integrated service development Local Clinical Commissioning Groups (CCGs), in collaboration with providers, are currently developing programmes of transformational change, with a particular focus on strengthening integrated health and social care initiatives. These programmes aim to be evidence-based and include research and evaluation workstreams. These workstreams, led by Professor Billings, Director of the Integrated Care Research Unit (ICRU), demonstrate a commitment to ensuring an evidence-based approach, alongside the generation of local evidence of the effectiveness of the integrated care initiatives. Such evidence has the potential to provide a body of transferable knowledge to support the programmes as they roll out across the CCGs and influence developments in the rest of Kent. Researchers are applying the Evidence Integration Triangle, which is based on the methodological approach of “implementation science” (Glasgow et al 2012). This approach is centred on involving a multi-agency stakeholder group from the onset to support the design and evaluation of a specific service through the use of best-practice evidence supplied by the researchers. A key part of this approach is to determine what works for whom, in what circumstances, and with what effects. The overall aim of this methodology is to: Develop realistic person-centred and service-level outcomes Create and source a menu of appropriate indicators for the evaluation and monitoring of interventions Use a participatory approach that focuses on speedy results of processes and outcomes As part of this methodology, the researchers have developed and validated an evaluation framework (the Kent Evaluation Framework) that is relevant to integrated care initiatives being developed and implemented across Kent. ICRU has been supporting the development and evaluation of the following integrated health and social care services: Integrated Intermediate Care (IIC) pathway A bespoke IIC KPI and monitoring framework has been developed which consists of indicators from the Kent Evaluation Framework and local KPIs.  This framework is being used by providers to feed the relevant data to the CCG who are compiling the information in order to address any issues within the pathway. Focus groups with staff and managers have been conducted  to investigate staff perceptions of the pathway and to highlight areas for improvement. Multidisciplinary Teamwork In Deal, researchers have worked with GP practices, the CCG and other stakeholders to develop an evaluation framework for an integrated multidisciplinary team (MDT) initiative to improve the care of frail, older people who are high users of health and social care services. This initiative involves referrals to a Town GP who leads an MDT involving health, social and voluntary care organisations. A bespoke evaluation frameworkhas been developed based on the Kent Evaluation Framework and the availability of local data. A patient survey has also been developed to determine the extent to which care is perceived to be integrated and person-centred. End of Life Care (EOLC) Pathway Two literature reviews were carried out to inform the development of the pathway and researchers worked with stakeholders to develop the KPI and monitoring framework to support the evaluation of the pathway. This framework has been agreed by the steering group and is now in use for providers to collect the data, which will be analysed by the CCG. This will enable the CCG and the providers to identify areas of EOLC, which require further development within the pathway. The Acute Response Team (ART) This clinical team operates from the Emergency Department at QEQM Hospital in Margate and Westbrook House. The service focuses on older people with long term conditions, preventing hospital admissions and keeping people in their homes for as long as possible. Researchers at ICRU are working with ART and other stakeholders to co-design and deliver an evaluation strategy, which measures the patient experience with respect to person-centred, co-ordinated care, and the experiences of a wide range of professionals and managers associated with the service.   Start date: 01/11/2015 End date: 31/10/2018 Funder: Kent & Medway NHS Social Care Partership Trust et al Funding: £61,500 Funder: All Seasons Amount: £9,000

Dr Kate Hamilton-West and Tracy Pellatt-Higgins are working with GP Dr Neil Pillai to conduct an evaluation of an 8-week mindfulness course for GPs. The evaluation is funded by the Royal College of General Practitioners - South East Thames Faculty. Analysis will focus on change in measures of wellbeing from baseline (before the course) to follow-up (after the 8 week course). GPs will also be asked to report on their experiences of the course. Start date: 01/04/2016 End date: 29/07/2019 Funder: RCGP Funding: £1,498

Integrating Community Pharmacy into the Urgent and Emergency Care Pathways:  Evaluation of the Urgent Care Community Pharmacy Projects With funding from the Health Education Kent, Surrey and Sussex (HEKSS), CHSS Public Health Specialist Linda Jenkins is working with Dr Trudy Thomas at Medway School of Pharmacy to find out what pharmacies are already doing to support demands for urgent care, especially during evening and weekend opening times, and whether training for this has helped. A focus group of experienced pharmacists will be held to identify key issues and questions for the research.  These will form the basis for telephone interviews to a sample of around 50 pharmacies in Surrey, Sussex and Kent.  The study will ask about the services offered by pharmacists working outside core hours, when access to healthcare is more difficult.  It will also explore the impact of a specific Centre for Pharmacy Postgraduate Education (CPPE) training pack, as well as more general questions about the kind of training that community pharmacists need to gain skills and confidence in delivering urgent and emergency care. Start date: 01/07/2015 End date: 01/05/2016 Funder: Health Education Kent, Surrey and Sussex Funding: £13,343.28

General Practice is central to the NHS, and is where people first seek non-emergency health advice. GPs deal with a wide range of health and social care issues for local people. They have traditionally employed a staff team of e.g. nurses, care assistants, receptionists, managers and liaise with community services such as midwives and health visitors. Many GPs are retiring or leaving the NHS. More newly-trained doctors work in hospitals and there is a shortage of GP practice nurses. NHS general practice is under pressure. At the same time, more people with long-term conditions need regular care from GP teams. Tasks formerly done in hospital are being transferred to general practice. It is vital that GPs organise teams efficiently to treat as many patients as possible. General Practices’ staffing arrangements vary widely. Practices have tended to become larger over time, and include a wider range of staff (e.g. physiotherapists, pharmacists). Some GPs have combined into ‘super-practices’. There is little evidence to show GPs and service commissioners what size or structure of practice, or professional staff mix, works best for patients. This NIHR Health Services & Delivery Research-funded project aims to provide such evidence, exploring how the composition of GP teams and team relationships (‘climate’) affects quality of care and health outcomes for patients, and practice costs. Professor Stephen Peckham leads the project team, who will: Survey the literature to learn about skill mix in countries with healthcare systems resembling our NHS. Analyse existing big data sets and use statistical methods to investigate the relationship between differences in the organisation and skill mix of practices in England and quality of care and effectiveness. Quality measures will be based on inspection data. Effectiveness will be measured using number of patients hospitalised for conditions that should be general practice managed. Conduct a staff survey in a nationwide sample of practices to explore how workforce issues affect staff wellbeing and job satisfaction Observe/interview staff to investigate how team climate affects daily working and patient experience. Work with GPs and commissioners to review project findings and create guidelines for all practices on optimum professional staff mix and good team working. Find novel ways to publicise research results to GPs, NHS managers, government organisations, academics and the public. Patient and public opinion provided valuable input to the research application and a service user group will contribute at all stages of the project. Start date: 01/10/2018 End date: 30/09/21 Funder: NIHR Funding: £404,316  

The difference between formulating a policy and making it work in practice, the ‘policy-implementation gap’, has long been recognised as a problem by policy makers and those responsible for putting policy into practice. To date, little attention has been paid to identifying the best ways of improving successful implementation in practice. The Department of Health, together with other central and local government organisations and professional bodies, developed a partnership programme for the Care Act 2014 involving innovative implementation support systems at national and regional levels to ensure local areas were well-placed to deliver the changes required. We will evaluate the extent to which these support arrangements have been successful and identify those elements that supported successful implementation and explore how they can be replicated for other major government policy programmes and initiatives. We will review what has been done previously in other national programmes to assess their respective strengths and weaknesses. We will consider what constitutes good practice across a range of centrally driven national programmes designed to support the introduction of new social care related policy initiatives. We will also undertake research in a number of local authorities to examine the experiences and impact of the Care Act implementation support arrangements. We will examine evidence at four levels – national, regional, local strategic and local frontline, including the views of users and carers – in order to build a comprehensive picture of what works under what circumstances when viewed by policy makers, local service providers and the users of services and their carers. Finally, we will pull all this evidence and learning together to develop guidance for central and local governments for supporting new policy initiatives in social care and health. We are especially keen to establish links between the Care Act support and the early experience of NHS Improvement – the new NHS agency for supporting service improvement in the healthcare sector. We recognise that any framework will have to be adapted to specific contexts and issues, but anticipate that the components will serve as a guide to governments on actions most likely to bring about favourable results. The CHSS team is working with Newcastle University partners Professor David Hunter and Samantha Redgate on this project, along with CHSS Visiting Professor Bob Hudson.   Start date: 01/10/2016 End date: 30/09/2018 Funder: Department of Health Funding: £212,653 Interim report        

Professor Jenny Billings will be working with lead investigator Professor Peter Lloyd-Sherlock at the University of East Anglia (School of International Development) on this timely and valuable research project. Brazil’s large public healthcare system aims to provide good care to all, but in common with the UK is facing mounting financial pressures due to the needs of a rapidly ageing population. This MRC-funded project aims to support policy and practice to reduce unneeded admissions of older Brazilians to hospital and care homes, and reduce unnecessarily long stays. This will improve efficiency of service provision and optimise the health of the older population. Unnecessary hospital stays expose older people to new risks such as acquired infections. Drawing on studies and experiences in other countries, such as the UK, and talking to Brazil’s policymakers and practitioners, the study will develop a clear strategy to identify whether admissions could have been averted or length of stay reduced. A new national survey (ELSI) will produce data showing which older people are most likely to experience these problems and identify which situations trigger unnecessary admissions/lengthy stays. As well as analysing the data, the research team, working closely with social care practitioners, will develop detailed case studies of two Brazilian cities in different regions, talking to selected ELSI survey participants and their families about their experiences to gather a clear picture of the problem and focus on solutions. They will carry out a review of a pilot project offering temporary homecare services for frail people and carefully assess this, considering how well it has worked (in the eyes of practitioners, as well as older people and families) and any impact on unneeded admissions/long stays. The project represents an excellent opportunity for CHSS to apply extensive research expertise gained in the UK and elsewhere, to a Brazilian context. Specifically, the aspects of our work relating to the development of new models for integrated health and care provision for older people are highly relevant to similar challenges now facing Brazil’s health system. Funder: The Newton Fund, Medical Research Council (MRC) £32,000  

This evaluation of an innovative three year Kent Community Health Foundation Trust project focuses on migrant communities who have settled in Kent, living predominantly in Dover, Folkestone and Margate and Gravesend. The aim is to reduce barriers and increase access to health services by local migrant families to address inequalities and encourage take-up of preventive services. Evidence shows particularly low engagement by Roma communities with family planning, dental care and general practice. KCHFT will employ and train staff largely from the Roma community as community based health advisers. The evaluation will be supported by 'Roma in the Lead', a project managed by Red Zebra which is working closely with Roma families to build trusting relationships. Led by Prof Sally Kendall, the CHSS research team will use realist evaluation and social justice frameworks. In the first project year they will work with community representatives and other key partners to develop a logic model and research methodology, and start data collection to find what works best for whom and in what context. Start date: 07/01/19 End date: 31/10/20 Funder: Kent Community Health Foundation Trust Funding: £20,000  

Project information to follow.   Start date: 25/9/2017 End date: 24/12/2018 Funder: Health Foundation (via East Kent Hospitals University Foundation Trust) Funding: £37,017

Dr Kate Hamilton-West and Annette King are working together with collaborators at Canterbury Christ Church University (CCCU) and East Kent Hospitals University NHS Foundation Trust (EKHUFT) to conduct research into a postural care education programme for parents and teachers who are responsible for the postural care needs of disabled children at home and school. The collaborators will deliver a number of ‘train the trainer’ workshops using materials developed from their previous NIHR-funded study. Feedback from the workshops will enable further refinement of the materials and data collected will be used as part of the programme’s ongoing evaluation.​   Start date: 04/04/2016 End date:30/06/2016 Funder: EKHUFT Funding: £4,271

Adolescence is a critical developmental stage when young people make behavioural and lifestyle choices that have the potential to impact on their health and wellbeing into adulthood. While risk-taking is important for healthy psychological development, for many, inappropriate risk-taking is significantly associated with health and social harm during adolescence and these harms persist well into adulthood. Young people involved in the criminal justice system are a particularly vulnerable group with a greater propensity to take risks that are likely to have long term impact on their future health and wellbeing. The RISKIT-CJS programme is a multi-component intervention encompassing both individual and group work and includes elements of motivational enhancement, psycho-education, psychosocial approaches, cognitive behavioural therapy and mindfulness. The study is a major multi-centre evaluation of RISKIT-CJS. The methodological approach is a mixed method, prospective, pragmatic randomized controlled trial with individual allocation, combining both quantitative and qualitative evidence. The study will be conducted across three geographical areas; South East England, South London, North East England, covering a diverse socio-economic and ethnic population. Start date: 01/09/2016 End date: 31/08/2019 Funder: NIHR Public Health Research Funding £892,675    

Integrated care (IC) is defined as those initiatives that proactively seek to structure and coordinate care in home environments and improve health outcomes while constraining health care expenditures. ‘Older people’ are defined as European citizens aged 65+ with multiple health and social care needs. The focus on this group reflects the general increase in complexity of care with age. SUSTAIN’s overall aims are to improve established IC initiatives for older people living at home with multiple health and social care needs and to ensure that these improvements can be adapted and applied to other health systems and regions in Europe. Core elements are: a well-coordinated and proactive approach to health and social care needs; patient-centredness involving older people in decision-making and taking their individual needs into account delivery of multiple interventions at the same time involvement of professionals from multiple disciplines. The project will Identify established integrated care initiatives and conduct baseline assessments to examine their patient-centredness, prevention orientation, efficiency, resilience to crises, safety and sustainability; Improve established integrated care initiatives based on the outcomes of the baseline assessments in co-creation with local key stakeholders and implement these improvements; Evaluate the implementation process and identify how the established integrated care initiatives have improved; Assess the applicability and adaptability of improved integrated care initiatives; design and implement dissemination strategies. Start date: 01/04/2015 End date: 30/03/2019 Funder: EC Horizon 2020 Funding: €584,119

Health and care services are usually provided by different types of organisations, which operate separately and do not communicate well together. This harms patient experiences and can lead to unnecessary costs.   The 2014 NHS England Five Year Forward View saw the beginning of an ambitious programme to develop new models of care to address longstanding problems in the UK health system. Integration of health and social care services will ultimately meet patients’, service users’ and carers’ needs more effectively. 50 ‘Vanguard’ sites were established around the country piloting new ways to organise health services. They have been developed, implemented and evaluated locally, helped by a national support team. They aim to improve: population health and wellbeing; quality of and access to care; service efficiency. The Government has now commissioned a national programme evaluation of the Vanguards. Working with the University of Manchester (lead organisation), The London School of Hygiene and Tropical Medicine and PSSRU at the University of Kent, CHSS will be part of the evaluation team. It will investigate the overall effects of the Vanguards on the NHS. How well have they been able to implement changes? What are the major barriers and facilitators? What are effects on service users and NHS costs. There are four stages to the evaluation: explore the national backdrop, interviewing members of the national support team and regulators and build a picture of economic issues, analyse the local evaluations, conduct an in depth analysis of six chosen Vanguards’ experiences and carry out a national evaluation of outcomes, costs and cost-effectiveness, after combining data, clear messages about this approach to service improvement will emerge which the team will share to ensure rapid learning from the evaluation. Start date: 01/06/2017 End date: 31/05/2021 Funder: Department of Health, Policy Research Programme (via University of Manchester) Funding: £285,901