Current research

The CHSS team carried out an evaluability assessment of a school-based mental health promotion intervention known as the ‘Fantastic Fred Experience’. The intervention was developed as part of the Kent Local Transformation Plan for Children, Young People and Young Adults’ Emotional Wellbeing and Mental Health. Delivered in primary schools, it uses an interactive performance format to demonstrate mental health promoting behaviours across four domains: Food, Rest, Exercise and Digital Devices (‘FRED’). The Fantastic Fred Experience and a provisional logic model was developed in collaboration with professionals from clinical psychology, general practice, educational psychology, commissioning and information and from health, education and university sectors. Implementation began in May 2019 and there are plans to deliver it to half of Kent primary school children between 2019 and 2021, as part of a wider mental health promotion programme (‘Good Mental Health Matters’) for all young people. The evaluability assessment will inform strategic decisions about whether and how to evaluate the intervention, with a view to potential long-term investment and wider dissemination. Start date: 8 May 2019; End Date: 8 August 2019 Funder: West Kent CCG Funding: £11,831  

Start date: 01/01/19 End date: 31/12/20 Funder: Oxleas NHS Foundation Trust Funding: £6,500

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

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)

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 Extended date: 1/4/19 to 31/3/20 Funder: RCGP Funding: £1,498

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  

Studies suggest that clinician engagement in research has the potential to improve healthcare processes and performance .Where research is led by the professionals who will use it, the resultant research has the potential to improve clinical practice. Eengagement in research can enhance job satisfaction, professional confidence and contribute to enhanced attitudes towards research. Building research capacity and supporting research engagement are key strategic goals for many healthcare organisations. While clinical engagement is seen as beneficial there are concerns that many health care practitioners are unable to be engaged in as much research as they would like. This Cancer Research UK-funded project is aimed at meeting the challenge of boosting research capacity in the NHS workforce. CHSS Director Professor Stephen Peckham leads a multi-disciplinary research team at CHSS in collaboration with the Kent Surrey and Sussex Clinical Research Network. It aims to find out what barriers and facilitators help or hinder health service staff to conduct research. It will propose practical solutions to improve and boost capacity within the current workforce, optimise the NHS research environment and support research at individual, organisational and systemic levels. Start date: February 2017 End Date: January 2020 Funder: Cancer Research UK Funding: £101,961  

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  

More than a million people in the UK seek or receive treatment for depression at any given time. Finding the right treatment can be difficult and for many, can take weeks or months to work. Professor Jenny Billings leads the evaluation of a digitally-enabled precision medicine approach to diagnosing and treating depression accurately and quickly. The two year project aims to reduce referrals to scarce secondary and crisis care services, freeing up GP time. ‘Wrapping’ care from GPs, specialist professionals and charities around the patient helps them return to healthy, productive lives. Specially designed web-based App; ‘i-SPERO’ helps patients assess their response to treatment and monitor their depression. It uses validated questionnaires and assessments including facial expression recognition testing. Developed by Oxford-based P1vital Products Ltd, i-SPERO will be piloted at selected GP practices in Canterbury and Coastal CCG. An improved triage style patient pathway adopted alongside the technology, will give greater choice and quicker access to quality care. Mental health charity MIND is supporting crucial patient involvement in this project. Start date: 01/01/19 End date: 31/12/20 Funder: Innovate UK Funding: £201,599  

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  

What are the features of Hospice at Home models that work, for whom, and under what circumstances? Offering people a choice about where they receive their care at the end of life is central to UK policy and the numbers of people wishing to die at home is increasing. We also know from work undertaken with the general public that care at home is an important concern for many people. Much effort has been invested in health services to support care at home, including services called “Hospice at Home” (HAH) which aim to offer hospice care in the individual’s home. The aim of hospice care is to improve the quality of life of people who have an incurable illness up to the point of death. This includes medical, emotional, social, practical, psychological, and spiritual care, as well as addressing the needs of the person’s family and carers. Currently a range of different HAH services exist in the UK and it is unclear which features of these services enable better care and outcomes at the end of life for patients and families. Professor Claire Butler based at CHSS is leading a national study to answer: What are the features of Hospice at Home models that work, for whom, and under what circumstances? The project is led by the University of Kent in collaboration with the University of Cambridge, University of Surrey, Oxford University Hospitals NHS Foundation Trust, Pilgrim’s Hospice and the National Association for Hospice at Home. The project is spearheaded by a team of post-doctoral researchers based at the University of Kent and the University of Cambridge. Start date: 01/02/2017 End date: 31/1/2020 Funding: National Institute for Health Research: Health Services and Delivery Research (project 14.197.44) £760,162 More about this project: 1. Study Design The study started with a national telephone survey of all HAH services to find out about the services they provide. We contacted hospice at home service managers identified through the Hospice UK and National Association of Hospice at Home directories to take part in a survey. We asked the service managers to provide information on how they are funded, which health care professionals work for them and what kind of roles they have, and whether they provide care overnight and at weekends. We had a fantastic response to our phase 1 survey with 70 HAH services taking part (see map of survey responders left). The results of this survey helped us to understand the different types of HAH services running nationally and to select a number of HAH services as case study sites for in depth investigation in Phase 2 of the project. A method called ‘realist evaluation’ is being used to gain an understanding of how the services delivered within the different models impact on patients and carers and whether they are supported and cared for as well as possible. We will also compare the costs of delivering services in the different models, and talk to providers of services about local issues that help or hinder the delivery of a good service. The final phase of the project (Phase 3) will involve presentation of our initial findings and discussion with stakeholders in two workshops to validate interpretation of the data and to refine our understanding of what works, for whom, and under what circumstances. These consensus events will help to develop our findings into guidelines for services and commissioners for developing HAH services matched to local needs. 2. How will we make sure the research is on the right track for patients and families? We are aware that the project needs to be conducted sensitively and we are experienced in undertaking research with bereaved people. We are working closely with patients and members of the public to advise us on the most sensitive approaches. Our team includes two lay co-applicants who are members of the project team and involved in co-producing the research with us. Both have experienced bereavement as a carer and they have a key role in the team to ensure a thoughtful and ethically sound approach. One of our lay co-applicants recently presented with Charlotte Brigden (Pilgrims Hospice), at the RDS South East/INVOLVE UK event in London.  They showcased the OPEL H@H study as an example of public co-production in research.  You can find out more about this event here. The project also benefits from input from independent experts and public members who sit on the Project Oversight Group for the study.  This group oversees the project progress and ensures the study delivers on its objectives, produce findings relevant to the public and national healthcare services.  It also ensures that the study has involved public and patient input throughout. Throughout the project we have been reviewing and documenting the PPI input in to the project and how this has changed the project and our approach over time. See a link to this overview below. PPI feedback Year 1 PPI feedback Year 2 3. How will we make the research findings available? Publication of the full and complete account of the research will be in the NIHR HS&DR Journal. This will allow the research to be freely and publically available via the NIHR journals library website. We will also publish our findings as they arise in peer reviewed journals such as BMJ, Social Science and Medicine and British Journal of General Practice to reach broad audience coverage in community services, and Health Services Journal to reach service commissioners. See below for links to what we have published so far. We will present our findings through presentations or posters at existing research forums such as the European Association of Palliative Care Congress; Clinical Research Network forums; Cicely Saunders Institute, King’s College, London; Hospice UK annual conference; National Association for Hospice at Home (NAHH) conference. See posters we have already below. Guidelines will be developed for services to help plan HAH services in the future. We also aim to engage with commissioners through the links and influence of our commissioner co-applicant, Professor Bee Wee as National Clinical Director for End of Life Care for NHS England. At the end of the project, a report and summaries for lay audiences will be produced. This will also be disseminated to our research participants. In addition, dissemination of findings aimed at the public will be facilitated through links with specific organisations including the National Council for Palliative Care, Hospice UK and the National Association for Hospice at Home (NAHH). These links with National organisations may also assist with bringing the results of the research to the attention of National Policy makers. Case Study Site Newsletters: Feb 2018 May 2018 July 2018 Sept 2018 Dec 2018 Mar 2019 Study Publications: Protocol paper Posters, presentations and other publications: Phase 1 poster Phase 1 findings A4 summary PPI poster Slides from RDS/INVOLVE UK co-production event – OPEL study project presentation The study data will also be available to researchers and the NHS on completion in line with national and international recommendations to benefit wider society.  4. Consensus Events 2020 Dates Leeds – 16 January 2020 Venue: The Met, King Street, Leeds, LS1 2HQ London – 23 January 2020 Venue: Wellcome Collection Event Spaces, 183 Euston Road, London NW1 2BE Our findings will be presented at two national workshops. At these workshops, we will seek feedback on the implications of our findings from the audiences including members of the public, carers, HAH providers, local health service planners. By combining all this information we will assess which models are likely to lead to the best outcomes and represent best value for money and create guidelines for planning HAH services in the future.    

More information on the PSSRU website: https://www.pssru.ac.uk/research/1022/  

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    

Public Health Collaboration. CHSS has been commissioned to conduct an external evaluation of Medway Public Health Department’s weight management projects. This collaborative project will assess how Medway’s initiatives and programmes could be built on and improved. In 2014 Medway Council hosted an Obesity Summit attended by private, public and voluntary sector partners, to help develop a framework for tackling obesity. Medway Council’s dedicated ‘Supporting Healthy Weight’ team (SHW) works with adults, families, children and young people to help them in achieving healthy weight. Within the National Child Measurement Programme (NCMP) classification, 23.3% of 4-5 year olds and 32.7% of 10-11 year olds in Medway are overweight or obese. The SHW team provide and commission a diverse range of interventions across Medway to help prevent and manage overweight.  These include four MEND programmes (2-4, 5-7, 7-13 and Graduates) and Fit Fix, a programme for 13 – 17 year olds. The team work across the Council to maximise opportunities to support obesity prevention in all aspects of the Council’s work, and in the revised Medway Local Plan. The evaluation will also focus on raising awareness of the SHW portfolio and developing its media profile to get the message out to a wide audience about obesity and public health initiatives in Medway.  Start date: 15/01/2015 End date: 14/01/2017 Funder: Medway Council Funding: £67,187 Poster presentation: Evaluability assessments as part of a ‘whole systems approach’ to evaluating Medway Council’s interventions to tackle obesity.

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