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

CHSS, as part of a multi-agency collaboration, is evaluating the five year 'Ageless Thanet' project (as part of the Big Lottery's national 'Ageing Better' programme) to reduce social isolation and ensure a better old age for Thanet residents. The evaluation design draws on the RE-AIM framework which explores impact on process and individual outcomes. A mixed methods approach will be used, gathering data from individuals accessing services and the agencies delivering them. The evaluation will be dynamic with continuous assessment and testing of the initiatives to determine which work in having a meaningful impact on social isolation. There is a strong emphasis on stakeholder involvement and empowering the community. The project will equip local community researchers with the requisite skills to take forward the evaluation process beyond 2020. The project, led by SEK (Social Enterprise Kent) will deliver services and activities across five project workstreams: wellbeing - educational, fitness, social and craft activities to enhance health and wellbeing active citizenship - volunteer 'ageing better' champions target and help isolated people in the community planning for later life - advice, support, guidance and life coaching from 'life planners' older entrepreneurs - helping those 50+ to set up or develop small businesses age-friendly businesses - 'Ageless Thanet' kite mark to be developed for display. Start date: 01/04/2015 End date: 31/03/2020 Funder: Big Lottery Fund via Social Enterprise Kent Funding: £199,172

The e-GFR Study. Accuracy of glomerular filtration rate (GFR) estimation using creatinine and cystatin C and albuminuria for monitoring disease progression in patients with stage 3 chronic kidney disease: an observational study in a multiethnic population. The aims of the research are to evaluate glomerular filtration rate (GFR)- estimating equations in assessing and monitoring measured GFR in people with stage 3 chronic kidney disease (CKD) over three years. A focus of the research is the impact of ethnic group, baseline diabetes and proteinuria in the estimation and evaluation of how accurately these equations reflect change in GFR over three years. A further aim of the research is to estimate and model disease progression and compare the effectiveness and costs of monitoring strategies for identifying people that have progressive loss of kidney function utilising different GFR-estimating equations and test schedules, accounting for differences in risk of progression. An accurate knowledge of GFR is required to identify and manage CKD. Measurement of GFR using reference procedures is impractical for large scale application, and GFR-estimating equations are widely used. There is little data addressing the ability of estimated GFR to detect change in true GFR, and no data addressing the accuracy of these equations in British ethnic minority populations. The evidence base on the frequency of monitoring is also very poor for some of the newer estimating equations, and whether the benefits of these new equations are outweighed by the increased costs. This study has been designed to address these questions. A prospective multi-centre longitudinal cohort study to estimate accuracy in eGFR and changes in eGFR. 1300 people will be followed for 3 years with reference (measured) GFR and test (estimated GFR – eGFR) measurements at baseline and 3 years. Test measurements are also undertaken every 6 months. The target population are adults with stage 3 CKD proportionally enriched to include people more likely to have progressive kidney disease (i.e. those with proteinuria and/or diabetes) and including Asians and African-Caribbeans. A sub-study of 300 people (100 each of Caucasian, Asian and African-Caribbean origin; in each case containing subjects at high and low risk of kidney disease progression) will also be undertaken. Reference GFR will be measured yearly in the sub-study population and patterns of disease progression assessed. Start date: 01/08/2013 End date: 31/01/2019 Funder: NIHR via EKHUFT Funding: £25,912 Publication: The eGFR-C study

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 two phase, three year development study of an isometric exercise programme to benefit patients who have undergone abdominal and thoracic cancer surgery. Cancer surgery is associated with risk of some loss of physical function and muscle wastage. Isometric exercise has long been established as effective in increasing muscle strength. Phase one will consist of patient focus groups and an online Delphi survey which will develop the exercise intervention and identify suitable functional outcome measures. Phase two will be a mini pilot and evaluation (effectiveness and cost effectiveness) study, based on two groups randomised to either intervention or usual treatment. The programme will be delivered in hospital but the nature of the exercises means that patients can continue at home after discharge.The programme needs little equipment and space, so can be performed when patients are bed-bound in hospital or at home.   Start date: 02/03/2015 End date: 31/03/2018 Funder: NIHR via Maidstone and Tunbridge Wells NHS Trust Funding: £76,130

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

Across Kent 28.1% of adults are classed as physically inactive. KCC Public Health department wants to commission a programme to reduce inactivity in high risk individuals, especially those with, or at high risk of acquiring, diseases caused or exacerbated by physical inactivity. CHSS has been commissioned to conduct an evaluation of KCC’s pilot programme targeting physical inactivity through selected GP surgeries. The evaluation, led by Dr Sarah Hotham, Chartered Psychologist and Research Fellow at CHSS will inform the design of a county-wide programme due to be rolled out in primary care in 2015/2016. The first pilot is designed to successfully deliver a programme based on ‘Let’s Get Moving’ (LGM) a Department of Health intervention based on motivational interviewing (MI) and long term support for behaviour change around inactivity. Recruitment will be in selected GP surgeries in catchment areas with high deprivation and high levels of inactivity. The focus is on high risk physically inactive individuals with conditions caused or exacerbated by their low activity levels. UK active, a not-for-profit health body for the physical activity sector, will  screen and invite participants to receive 12 weeks of MI and support (with follow up at 6 and 12 months), delivered by a network of specially recruited practitioners. The programme aims to: increase and sustain regular physical activity levels county wide. reduce reliance on costly medication for conditions which could be affected by adopting an active, healthy lifestyle. ensure maximum return on existing public health Investment by linking to wider primary care services build on successes to embed scalable, replicable physical activity interventions in partner services and networks and as a preventative in disease pathways The evaluation team will gather qualitative and quantitative data, including semi structured interviews with primary care staff involved in the screening and recruitment process. A framework analysis will be undertaken to identify emerging themes from the interviews. As well as identifying characteristics in patients who changed behaviours (in order to predict future success), the evaluation will address questions around feasibility, scalability, effectiveness and cost effectiveness of patient screening, and the recruitment of practitioners to deliver the interventions. A final report will be provided when 12-month follow-up monitoring is complete. It will provide details of the findings and recommendations for future commissioning of a county-wide physical inactivity service. Start date: 03/03/2015 End date: 31/03/2017 Funder: Kent County Council Funding £4,000 Evaluation of KCC physical inactivity pilot final report here

CHSS is working with the University of Kent’s Centre for Professional Practice on the use of enhanced technology in education.  A course in telesupervision is to be piloted with experienced GP supervisors and other educators in primary care. The course aims to develop their supervision, mentoring and coaching skills to work through the medium of online technologies such as Skype.  CHSS will evaluate the course against its learning objectives. Start date: 01/01/2016 End date: 31/03/2017 Funder: HEKSS (Health Education Kent Surrey Sussex) Funding: £9,000          

Government policy has highlighted the need to extend NHS mental health service provision to meet the needs of those with co-morbid mental and physical health conditions. To work effectively with this population, mental health workers require specialist training in supporting people with long-term conditions (LTCs). We worked with NW London Collaboration of Clinical Commissioning Groups to develop, deliver and evaluate training focusing on three common conditions: diabetes, chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD). Training was delivered to 60 NHS mental health workers via 2-day interactive workshops. An online version of the training programme was also developed. Training was developed with input from stakeholders including clinicians, service managers and service users. Participants’ knowledge of the three conditions significantly following training, along with their understanding of the role of psychological therapies in supporting people with LTCs and confidence in using specific assessment and intervention methods. The online training programme launched in October 2017 and is available at http://www.trainingltcs.org.uk/ Start date: 1/3/17 End date: 31/12/17 Funder: NHS NW London CCG Funding: £110,678 Improving competencies of PWPs/counsellors to work with people with LTC - Read the Final Project Report (December 2017) (pdf)

This funding supports a research collaboration between CHSS and Kent Community NHS Trust Weight Management Service, in order to co-develop a research bid to NIHR around mindfulness and weight management/maintenance. The collaboration will also facilitate the development of future studies and research proposals. Weight management team staff will provide input towards the design of the intervention and the evaluation framework. Funding for Dr Sarah Hotham's time at CHSS for one day a week during Feb-March 2016 will enable her to lead on the deliverable, the written research proposal detailing the co-developed intervention, how impact and processes will be evaluated, and next steps. Start date: 01/02/2016 End date: 31/05/2016 Funder: Kent Community Health NHS Foundation Trust Funding £4,702

What are the features of Hospice at Home models that work, for whom, and under what circumstances? Offering a choice about where people receive care at the end of life is central to UK policy and the numbers of people wishing to die at home is increasing. There are a range of “Hospice at Home” (HAH) services and most operate within non NHS settings, but are funded to provide NHS specialist care. Gaps exist in the evidence around what works best in terms of outcomes. This three year project, funded by the NIHR Health Services and Delivery Research Programme is a collaboration between CHSS, Pilgrims Hospices East Kent, and the Universities of Cambridge and Surrey. The team will conduct a realist evaluation of a range of UK ‘Hospice at Home’ service models to understand their impact on patients and carers, and identify which features work for whom, under what circumstances. A project PPI (patient and public involvement) advisory group will advise on sensitive approaches to working with bereaved people. The project team includes two lay members. The project incorporates three phases. Phase 1: A national telephone survey of all HAH services in the UK on funding, staffing levels and roles, extent of service and care, local demographics etc. Data will inform the design of a typology of services, patterns and models using a CMOc framework (Context-Mechanism-Outcome configuration). 1-2 case studies per service model will receive in-depth investigation. Phase 2: An economic evaluation to compare the costs of delivering services in the different models and assess which models are likely to lead to the best outcomes and represent best value for money. Phase 3: Stakeholder validation Two national workshops will gather feedback on the implications of data findings from HAH providers, local health service planners and service user representatives. Guidelines will be developed to help plan HAH services in the future. Dissemination strategy includes a project report, conference presentations and peer reviewed journal articles aimed at professional audiences. Start date: 01/02/17 End date: 31/01/20 Funder: NIHR Health Services and Delivery Research programme. 14/197/44 HS&DR Researcher-led Funding: £760,162 Project team: CI: Dr Claire Butler Contractor: University of Kent Co-investigators: CHSS, Uni of Kent: Prof Tricia Wilson, Dr Ferhana Hasham, University of Cambridge: Dr Stephen Barclay University of Surrey: Prof Heather Gage, Dr Peter Williams Pilgrims Hospices East Kent: Ms Charlotte Brigden NHS England: Prof Bee Wee, (Nat Clin Dir. End of Life Care/Assoc Prof Uni of Oxford) Nat Assn for Hospice at Home (NAHH): Ms Kay Greene, Chair & Trustee PPI/Service users: Ms Mary Goodwin, Mr Graham Silsbury

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