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

Women with advanced CKD (chronic kidney disease) have high rates of all pregnancy complications which increase incrementally according to how severe their disease is. Around one in three suffers permanent additional kidney damage during or after pregnancy, and may need dialysis to survive. This is extremely challenging for a new mother and her family, and shortens life expectancy. At the moment, there is no reliable way to work out which women with kidney disease are likely to have pregnancy-associated disease progression. Current risk estimates for progression of pregnancy-associated CKD are based on a small study including pregnancies from up to 40 years ago. They do not reflect current practice nor allow accurate individual risk prediction. Professor Chris Farmer is now working in collaboration with Kings College, London and partners on a project developing an online calculator to predict how much kidney function women with pre-existing disease are likely to lose in pregnancy. With the UK Renal Rare Diseases registry (RaDaR) and PreKid clinic, Toronto they will use data from from around 54,000 pregnancies complicated by CKD to develop this tool. Women with CKD face stressful conflict between preserving kidney function and having a family. Recent Patient and Public Involvement work shows that the women view prediction of pregnancy outcomes as a research priority. The PREDICT tool will be validated externally in individual patient data from three population cohorts from the UK, Canada and Sweden. The research team are developing the predictive tool interface in partnership with patients and it will be available on the RaDaR (UK Renal Rare Diseases registry) website for clinicians and patients to use. Start date: 01/10/2018 End date: 30/09/21 Funder: Kidney Research UK Funding:  

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

Further information on this project on the Canterbury Christ Church University website >   Start date: August 2019; End Date: December 2020 Funder: Funding: £149,786  

After the Health and Social Care Act of 2012, councils took over responsibilities for public health from the NHS. This included promoting and improving health (e.g. sexual health clinics, health visitors, promoting physical activity, and promoting good health through its other activities such as transport, urban planning and education). Research is recognised to be a key part of NHS activity, with research active NHS organisations having better patient outcomes. There are concerns that councils do not use research evidence and take part in as much research, not seeing it as part of their role, or useful. Councils may not have the research knowledge, experience and culture that is generally embedded in the NHS. There are concerns that councils’ established ways of working do not always give research evidence sufficient prominence in decision-making, which tends to focus on local context and political constraints. This project aims to understand how to develop a system to support councils to use research evidence more effectively and to develop, usually in collaboration with university research departments, good quality applications for funding. We will use Kent County Council and Medway Council as study sites and have secured the collaboration of both Directors of Public Health. We will develop a questionnaire in collaboration with members of the public and the council employees. We will survey council employees to map out how research is used, what research has been carried out, and investigate what they know about research and their attitudes to it. We will then interview council employees and councillors to gain further insights into these issues and explore what they think might work to promote research culture. We will run a workshop bringing together university researchers, council employees, councillors and members of the public to identify the possible structure and function of such a research system and a plan for implementation. The outputs of this would be a design for a research system to enable better use of research evidence and to facilitate more research being carried out in Kent, an estimate of resources needed to make it happen and a framework to guide other councils to do the same with their local universities. We will work with the councils to implement the findings. In the long run we hope that this will enhance the process of council decision-making and improve outcomes for the communities served. Start date: 1/8/20; End Date: 30/11/20 Funder: NIHR Public Health Research Programme (20/30 NIHR Local Authority Research System call) Funding: £48,406  

Around 420,000 people in England and Wales live in care homes. Many have multiple health problems. Care homes, commissioners and regulators collect and hold data on residents’ medical history, needs and care. Data is not linked up, so there can be difficulties in meeting care needs as residents move between health and social care settings. Without the right data it is difficult to plan future needs or find the best treatments. An agreed data set would help researchers - and those working in or funding care homes - to improve resident care and quality of life. Professor Claire Goodman (University of Hertfordshire) leads the four-year, NIHR-funded DACHA study . It aims to explore and enhance the sharing of care and quality of life data between health and social care organisations working with care homes. DACHA findings could deliver a step-change in understanding care home population needs by avoid unnecessary duplication, both by researchers and those interested in improving care-home quality. DACHA has five linked project work packages . Ann-Marie Towers (University of Kent) and Professor Adam Gordon (University of Nottingham) lead Work Package 5: Testing a Minimum Data Set (MDS) in Care Homes in England. WP5 will test a prototype Minimum Data Set (MDS) developed in work packages 1-4 by collecting resident data directly from care homes and matching it to information already held by the NHS. Longitudinal data will be collected using the prototype MDS in 40 care homes for older adults in two areas of England. Care home staff will be trained and supported to complete the MDS at baseline, 6 months and 12 months. We will give homes feedback on their data, benchmarked against other participating homes.  Focus group interviews with staff will explore their experiences completing the MDS and whether they found the feedback and data helpful. Findings will inform changes and improvements to the MDS. We will assess the quality of the MDS data as well as using it to answer research questions of local importance to participating areas, such as how well the MDS predicts changes in residents’ health and social care needs. This study/project is funded by the National Institute for Health Research (NIHR) Health Service Research and Delivery programme (HS&DR NIHR127234) and supported by the NIHR Applied Research Collaboration (ARC) East of England. Start date: 01/11/19 End Date: 31/10/23 Funder: NIHR

A three-year study looking at whether muscle strengthening helps improve the long-term health of children with haemophilia. Boys with haemophilia will be allocated at random to two groups: a group that is asked to complete the 12-week exercise routine to strengthen their leg muscles, and another group that does not do exercises. Boys will be monitored throughout the study by measuring their muscle strength, how far they can walk in six-minutes and time taken to ascend and descend 12 steps. A wrist band will be used to record how physically active the boys are as well as how satisfied they are with their health. The study will be managed by a group of health care professionals and researchers with experience and expertise in carrying out this type of research. Development Of a haemophiLia PHysiotherapy INtervention for optimum musculoskeletal health in children (DOLPHIN-II) - a randomised controlled trial Start date:October 2020 End date:October 2023 Award: £343,536 Funder: NIHR for Patient Benefit via East Kent Hospitals University NHS Foundation Trust More information on the NIHR website.  

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

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.     Read the Final Evaluation Report 30/11/20.   Read the Lay Summary Report   Read the Executive Summary Report

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: 22/03/2021 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.  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. The draft report was submitted to NIHR on 22/3/21 and we expect it to be publicly available in early 2022. 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.  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 May 2019 June 2019 Study Publications: Hashem, F., Brigden, C., Wilson, P. and Butler, C. (2020) "Understanding what works, why and in what circumstances in Hospice at Home Services for End of Life Care: applying a realist logic of analysis to a systematically searched literature review", Palliative Medicine. Sage, pp. 16-31. doi: 10.1177/0269216319867424. Abstract | View in KAR Rees-Roberts, M., Williams, P., Hashem, F., Brigden, C., Greene, K., Gage, H., Goodwin, M., Silsbury, G., Wee, B., Barclay, S., Wilson, P. and Butler, C. (2019) "Hospice at Home services in England: a national survey", BMJ Supportive and Palliative Care. BMJ Publishing Group, pp. 1-7. doi: 10.1136/bmjspcare-2019-001818. Abstract | View in KAR Butler, C., Brigden, C., Gage, H., Williams, P., Holdsworth, L., Greene, K., Wee, W., Barclay, S. and Wilson, P. (2018) "Optimum hospice at home services for end-of-life care: protocol of a mixed-methods study employing realist evaluation", BMJ Open. BMJ. doi: 10.1136/bmjopen-2017-021192. Abstract | View in KAR Selected Conferences, posters and presentations: Abrahamson V, Butler C, Wilson P, Mikelyte R, Brigden C, Silsbury G, Goodwin M. 2021 International Conference for Realist Research, Evaluation and Synthesis. Feb 2021. Optimum Hospice at Home Services for End-of-Life care: realist evaluation and co-production. https://www.youtube.com/watch?v=fQX6-ka1VwU&feature=youtu.be Brigden C, Goodwin, M, Silsbury, G, Rees-Roberts M, Butler C, Greene K, Hayes C, Hashem F, Gage H, Williams P, Wee B, Barclay S, Wilson P, Mikelyte, R. Oct 2018. National Association for Hospice at home Annual Conference 2018. Patient and public involvement in hospice research: an example of co-production in action. PPI poster Brigden C and Silsbury G, July 2018 NIHR Research Design Service South East / INVOLVE. Co-production in the OPEL Hospice at Home Study Slides from RDS/INVOLVE UK co-production event – OPEL study project presentation Rees-Roberts M, Mikelyte R, Hayes C, Hashem F, Brigden C, Gage H, Williams P, Greene K, Wee B, Barclay S, Wilson P, Butler C. 2017. National Association for Hospice at Home annual conference 2017. Poster & presentation. Phase 1 poster Phase 1 findings A4 summary 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 2B Our findings were presented at two national workshops. At these workshops, we sought feedback on the implications of our findings from the audiences including members of the public, carers, HAH providers and health service commissioners. We combined all this information to assess which models of service provision are likely to lead to the best outcomes, represent best value for money and create guidelines for planning HAH services in the future. A summary of the consensus events can be found in the Phase 3 summary (pdf).  

Realist Evaluation of Autism Service Delivery: (RE-ASCeD) How should child development and child and adolescent mental health teams provide timely and cost-effective, high quality diagnostic assessments of children with possible Autism? Autism is a complex neuro-behaviour condition. People with autism have difficulty with social interaction and in communication with others. They may struggle with change, and repeat actions over and over. Life may be very anxious or stressful. The signs of autism can occur at any age but often appear in the first two years of life. There is no one type of autism, but many, so the condition is now called autism spectrum disorder (ASD). Autism is lifelong but this study is only about children. Caring for a child with autism can be difficult and can sometimes be tough on the whole family. Specialist doctors diagnose autism. When general practitioners think a child might be on the autism spectrum, they refer them to a specialised team. These specialist teams carry out assessments. The number of children referred for assessment has been increasing recently. Diagnosing autism is not easy. One reason is that different specialist professionals might need to assess children. Another reason is that professionals might assess children for more than one condition. Our recent survey found some families spend over one year waiting for a diagnosis. The 2019 NHS England Long Term Plan made services for people with autism a priority. The Long-Term Plan aims for more families to get the right help, quicker. To do this, waiting times need to be shorter so children will get the right support sooner. This project aims to guide the people who plan services for families and children. Different teams and services that do autism assessments will help us. We will ask teams and services: What speeds up diagnosis? What delays diagnosis? The study comprises four work packages: 1. We will review research in the UK and abroad to find evidence and ideas that will help speed up diagnosis. 2. We will survey professionals who work for the specialist teams who diagnose autism. The survey will be about each step in the process and ask which professionals get involved. We will ask about the number of children they see and the time it usually takes to reach a diagnosis. This will give us a picture of the national situation. 3. After the national survey, we will select around six or eight teams. These teams will be using different and innovative approaches. We will study those approaches. We will talk to clinical staff, managers, referrers, parents and young people. Parents and young people will have gone through the diagnostic process. We will ask parents and young people about their experiences and views. We will review the steps in the diagnosis process for about 70 children in each service. We will find out how long each assessment takes, how much clinical time it takes, and how much it costs. We will compare findings across teams and services. 4. We will have national meetings with autism experts and patient groups. We will show them our findings. These groups will agree recommendations for practice. Clinical teams, service managers, commissioners, parents’ groups, and NHS England will receive recommendations. The research team has specialist expertise in autism, health services, economics, and statistics. The team includes public and NHS England partners. This will ensure we take account of the needs of families and we send the findings to people who plan services. This study is a collaboration with University of Surrey, Newcastle University, Council for Disabled Children, Autistica and others. See https://www.sussexcommunity.nhs.uk/get-involved/re-asced-research.htm for details. Research Team: PI: Dr Ian Male, Consultant Community Paediatrician, Sussex Community NHS Trust, Honorary Senior Lecturer Brighton and Sussex Medical School Co-PI/project manager: Dr William Farr, Senior Research Fellow in Paediatric Neurodisability, Honorary Clinical Research Fellow Brighton and Sussex Medical School Methodological expertise, realist evaluation: Tricia Wilson, Professor of Primary and Community Care, CHSS, University of Kent Start date: 31/10/19 End Date: 30/6/22 Funder: Sussex Community NHS Foundation Trust Funding: £66,463 Publication: Abrahamson, V., Zhang, W., Wilson, P., Farr, W. and Male, I. (2020). A Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD): Which diagnostic pathways work best, for whom and in what context? Protocol for a rapid realist review. BMJ Open [Online] 10:1-8. Available at: https://bmjopen.bmj.com/content/10/7/e037846.

Funded by the Health Foundation's Efficiency Research Programme, this project aims to tackle persistent high staff turnover in social care, to help the industry meet growing demand for high-quality and sustainable services. Working with Dr Eirini Saloniki and PSSRU colleagues, (project lead) Dr Florin Vadean and Professor Shereen Hussein, Ann-Marie will compare social care with other low-wage industries and explore staff characteristics, job commitment and retention. This will help commissioners, providers and policy-makers to understand the drivers behind staff leaving their jobs and influencing choices of subsequent jobs. As well as defining 'quality jobs' in social care, the research will help to develop pathways to achieve these nationally. More information on the Health Foundation website >

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

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

CHSS and partners will design an integrated curriculum for health care professionals that addresses how to communicate with service users/patients about staying in and returning to work. To increase health professionals’ confidence in discussing health and work with patients, having acquired the skills, knowledge, tools and techniques to undertake this activity. To increase the uptake of health professionals broaching the issue of Health and Work in their patient consultations, including giving professionals the capability and confidence to use the fit note as a system for practical advice as well as a process for sickness certification To increase patients’ experience of feeling more supported by health professionals. To increase the number of patients understanding the value of work to their own health and well-being, including their expectations of the fit note, by receiving advice from health professionals. An external academic and professionals steering panel will include the following representatives: CHSS GMC Health Education England Academic Occupational Health Physician National Occupational Health Network Medical Schools Council Start date: 19/10/18 End date: 31/12/17 Funder: Public Health England Funding: £149,871