Centre for Health Services Studies

Excellence in Health Research


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Professor Jenny Billings

Professor of Applied Health Research

 

With a background in nursing and health visiting, I am a Professor in Applied Health Research and am an experienced researcher and lecturer in health and social care. My special interests lie in vulnerable groups with complex needs, integrated care and mixed methodology and my skills lie in managing and co-ordinating methodologically challenging projects that focus on providing evidence for practice. My research has led to sustainable service developments, particularly in the field of integrated care for older people, but also in teenage pregnancy and continence services. Within the University I chair both SSPSSR and the Faculty Research Ethics committees.

I have been a successful recipient of funding awards from NIHR, The Big Lottery and health and social care agencies over a number of years both solo and in collaboration with partners. I have also been involved in European research for over a decade and have achieved funding through programmes such as Horizon 2020, EU Framework Programmes, DG Sanco and Interreg, focusing largely on long term care of older people. I am a methodological reviewer for a number of research funding bodies such as the Horizon 2020 programme, NIHR and The Big Lottery, and am also a reviewer for several journals such as the Journal of Advanced Nursing, International Journal of Integrated Care and International Journal of Qualitative Methods. I am author and co-author of two books on integrated care for older people and have several publications.

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Articles
MacInnes, J., Billings, J. R., Coleman, A., Mikelyte, R., Croke, S., Allen, P. and Checkland, K. (2023) 'Scale and spread of innovation in health and social care: Insights from the evaluation of the New Care Model/Vanguard programme in England', Journal of Health Services Research and Policy. Sage, pp. 128-137. doi: 10.1177/13558196221139548.

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Objective: Little is known about how to achieve scale and spread beyond the early local adoption of an innovative health care programme. We use the New Care Model - or 'Vanguard' - programme in the English National Health Service to illuminate the process, assessing why only one of five Vanguard programmes was successfully scaled up. Methods: We interviewed a wide range of stakeholders involved in the Vanguard programme, including programme leads, provider organisations and policymakers. We also consulted relevant documentation. Results: A lack of direction near the end of the Vanguard programme, a lack of ongoing resources, and limited success in providing real-time monitoring and evaluation may all have contributed to the failure to scale and spread most of the Vanguard models. Conclusions: This programme is an example of the 'scale and spread paradox', in which localism was a key factor influencing the successful implementation of the Vanguards but ultimately limited their scale and spread.
Gadsby, E. W., Wistow, G. and Billings, J. R. (2022) 'A critical systems evaluation of the introduction of a "discharge to assess" service in Kent', Critical Social Policy. doi: 10.1177/02610183211065028.

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Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.
Checkland, K., Hammond, J., Coleman, A., MacInnes, J., Mikelyte, R., Croke, S., Billings, J. R., Bailey, S. and Allen, P. (2021) '"Success" in policy piloting: process, programmes and politics', Public Administration. doi: 10.1111/padm.12790.

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Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgement against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing programme success from process and political success. We adapt Boven's modification of this framework and apply it to policy pilots, arguing that pilot process, outcomes and longer term effects can all be judged in both programme and political terms. We test this new framework in a pilot programme in the English National Health Service, the Vanguard programme, showing how consideration of these different aspects of success sheds light on the programme and its aftermath. We consider the implications of the framework for the comprehensive and multi-faceted evaluation of policy pilots.
Wilson, P., Billings, J., MacInnes, J., Mikelyte, R., Welch, E. and Checkland, K. (2021) 'Investigating the nature and quality of locally commissioned evaluations of the NHS Vanguard programme: an evidence synthesis', Health Research Policy and Systems. doi: 10.1186/s12961-021-00711-3.

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Background: With innovation in service delivery increasingly viewed as crucial to the long-term sustainability of health systems, NHS England launched an ambitious new model of care (Vanguard) programme in 2015. Supported by a £350 million transformation fund, 50 Vanguard sites were to act as pilots for innovation in service delivery, to move quickly to change the way that services were delivered, breaking down barriers between sectors and improving the coordination and delivery of care.Methods: As part of a national evaluation of the Vanguard programme, we conducted an evidence synthesis to assess the nature and quality of locally commissioned evaluations. With access to a secure, online hub used by the Vanguard and other integrated care initiatives, two researchers retrieved any documents from a locally commissioned evaluation for inclusion. All identified documents were downloaded and logged, and details of the evaluators, questions, methodological approaches and limitations in design and/or reporting were extracted. As included evaluations varied in nature and type, a narrative synthesis was undertaken.Results: We identified a total of 115 separate reports relating to the locally commissioned evaluations. Five prominent issues relating to evaluation conduct were identified across included reports: use of logic models, number and type of evaluation questions posed, data sharing and information governance, methodological challenges and evaluation reporting in general. A combination of resource, data and time constraints means that evaluations often attempted to but did not fully address the wide range of questions posed by individual Vanguards.Conclusions: Significant investment was made in independent local evaluations of the Vanguard programme by NHS England. This synthesis represents the only comprehensive attempt to capture methodological learning and may serve as a key resource for researchers and policy-makers seeking to understand investigating large-scale system change, both within the NHS and internationally.
Billings, J. R., De Bruin, S. R., Baan, C. A. and Nijpels, G. (2020) 'Advancing integrated care evaluation in shifting contexts: Blending implementation research with case study design in Project SUSTAIN.', BMC Health Services Research. Biomed Central. doi: 10.1186/s12913-020-05775-5.

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Despite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat 'illusive' impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015–2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators.
Billings, J., De Bruin, S. R., Baan, C. and Nijpels, G. (2020) 'Advancing integrated care evaluation in shifting contexts: blending implementation research with case study design in project SUSTAIN', Bmc Health Services Research. Biomed Central. doi: 10.1186/s12913-020-05775-5.

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Background: Despite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat 'illusive' impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015–2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators. Conclusions: Lessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analysi
MacInnes, J., Gadsby, E. W., Reynolds, J., Cayuelas Mateu, N., Lette, M., Ristl, C. and Billings, J. R. (2020) 'Exploring the team climate of health and social care professionals implementing integrated care for older people in Europe', International Journal of Integrated Care. Ubiquity Press. doi: 10.5334/ijic.5467.

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Background and problem statement: Team climate describes shared perceptions of organisational policies, practices and procedures. A positive team climate has been linked to better interprofessional collaboration and quality of care. Most studies examine team climate within health or social care organisations. This study uniquely explores the team climate of integrated health and social care teams implementing integrated care initiatives for older people in thirteen sites across seven European countries, and examines the factors which contribute to the development of team climate. Theory and methods: In a multiple case study design, data collected as part of the European SUSTAIN (Sustainable Tailored Integrated Care for Older People in Europe) project were analysed. The short-form Team Climate Inventory (TCI-14) was administered before and after implementation of the integrated care initiatives. Qualitative data was used to explain the changes in TCI-14 scores over time. Results and discussion: Overall, team climate was found to be high and increased over time in eight of the thirteen sites. The development of a shared vision was associated with a strong belief in the value and feasibility of the initiative, clear roles and responsibilities, and a reflective approach. Strong inter-personal relationships, shared decision-making, and high levels of commitment and motivation contributed to the development of participative safety. Support for innovation increased when staff had the 'space' and time to work together. Conclusion: This mixed methods study offers significant insights into the development and maintenance of team climate in complex, integrated care systems in Europe.
MacInnes, J., Gadsby, E., Reynolds, J., Nuria, C., Lette, M., Haeusler, C. and Billings, J. (2020) 'Exploring the team climate of health and social care professionals implementing integrated care for older people in Europe', International Journal of Integrated Care. Ubiquity Press, pp. 1-13. doi: 10.5334/ijic.5467.

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Background and problem statement: Team climate describes shared perceptions of organisational policies, practices and procedures. A positive team climate has been linked to better interprofessional collaboration and quality of care. Most studies examine team climate within health or social care organisations. This study uniquely explores the team climate of integrated health and social care teams implementing integrated care initiatives for older people in thirteen sites across seven European countries, and examines the factors which contribute to the development of team climate. Theory and methods: In a multiple case study design, data collected as part of the European SUSTAIN (Sustainable Tailored Integrated Care for Older People in Europe) project were analysed. The short-form Team Climate Inventory (TCI-14) was administered before and after implementation of the integrated care initiatives. Qualitative data was used to explain the changes in TCI-14 scores over time. Results and discussion: Overall, team climate was found to be high and increased over time in eight of the thirteen sites. The development of a shared vision was associated with a strong belief in the value and feasibility of the initiative, clear roles and responsibilities, and a reflective approach. Strong inter-personal relationships, shared decision-making, and high levels of commitment and motivation contributed to the development of participative safety. Support for innovation increased when staff had the 'space' and time to work together. Conclusion: This mixed methods study offers significant insights into the development and maintenance of team climate in complex, integrated care systems in Europe.
Gautun, H., Bratt, C. and Billings, J. R. (2020) 'Nurses' experiences of transitions of older patients from hospitals to community care. A nation-wide survey in Norway', Health Science Reports. Wiley. doi: 10.1002/hsr2.174.

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Moving older patients from hospitals to community services is a critical phase of integrated care. Yet there has been little large-scale research on the quality of these transitions. We investigated how Norwegian nurses working in community care services (N = 4,312) and at in-patient wards at hospitals (N = 2,421) experienced the quality of transitions of older patients from hospitals to community care. We tested hypotheses derived from qualitative research and consistent with predictions, we found that compared to hospital nurses, the nurses working in community care experienced lower quality of patient transitions and were less satisfied with information exchange on patients' condition and needs. Further, when comparing groups of community nurses, we confirmed the hypothesis that nurses in home nursing were more dissatisfied with the quality of transitions and information exchange than nurses in nursing homes. We conclude that hospital nurses should have more face-to-face or telephone contact with community nurses, and specifically with home nurses. Further, we suggest that means are implemented to promote a mutual understanding of the older patients' pathway from one service to the other, and to improve co-ordination across the services.
MacInnes, J., Baldwin, J. and Billings, J. R. (2020) 'The Over 75 Service: Continuity of integrated care for older people in a United Kingdom primary care setting', International Journal of Integrated Care. Emerald. doi: 10.5334%2Fijic.5457.

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Continuity of care is concerned with quality of care over a period of time. It describes a process by which service users and their families are co-operatively involved with health and social care professionals in managing their care needs. Continuity of care can be divided into informational, managerial and relational and has been associated with improved user- and service-related outcomes. To date, there have been few studies which examine how continuity of care is developed and maintained in integrated primary care systems. This paper explores continuity of care in an integrated Over 75 Service for people living at home with complex health and social care needs. Using a case study approach, qualitative data was collected from multiple sources including interviews with managers and professionals, users and carers, care plans, steering group minutes and field notes. Data was analysed thematically. A number of factors are identified which characterise continuity of care, namely: information sharing through direct communication between providers and the development of trusted relationships within the team; identified care co-ordinators who acted as a conduit for information and communication; the development of ongoing relationships with users and carers requiring dedicated time and accessible and flexible services delivered in the users' own home.
de Bruin, S. R., Billings, J. R., Stoop, A., Lette, M., Ambugo, E. A., Gadsby, E. W., Häusler, C., Obermann, K., Ahi, G.-P., Reynolds, J. and others. (2020) 'Different Contexts, Similar Challenges. SUSTAIN's Experiences with Improving Integrated Care in Europe', International Journal of Integrated Care. Ubiquity Press, pp. 1-5. doi: 10.5334/ijic.5492.

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MacInnes, J., Jaswal, S. K., Mikelyte, R. and Billings, J. R. (2020) 'Implementing an Integrated Acute Response Service: Professional Perceptions of Intermediate Care', Journal of Integrated Care. Emerald. doi: 10.1108/JICA-03-2020-0016.

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Purpose: The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital. Design/methodology/approach: A qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically. Findings: The key to successful implementation was that the service was co-created from the "ground-up" with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique in intermediate care settings. Referrals into the ART service were dependent on awareness of the service at the interface with mainstream services. Transitions out were sometimes delayed due lack of availability of social care packages. To ensure sustainability of the ART and other integrated intermediate care services, continued resources, especially skilled staff members, are necessary. Originality/value: This study adds to the intermediate care and acute response service literature by offering insights into "what works" from a professional perspective in terms of service implementation, care processes and sustainability, in an integrated care system.
Morciano, M., Checkland, K., Billings, J. R., Coleman, A., Stokes, J., Tallack, C. and Sutton, M. (2020) 'New integrated care models in England associated with small reduction in hospital admissions in longer-term: a difference-in-differences analysis', Health Policy. Elsevier, pp. 826-833. doi: 10.1016/j.healthpol.2020.06.004.

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Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models' programme. The programme, running from 2015-2018, was one of the largest pilots in English history, covering around 9% of the population. It was largely intended to design prototypes aimed at reducing hospital utilisation by moving specialist care out of hospital into the community and by fostering coordination of health, care and rehabilitation services for (i) the whole population ('population-based sites'), or (ii) care home residents ('care home sites'). We evaluate and compare the efficacy of the population-based and care home site integrated care models in reducing hospital utilisation. We use area-level monthly counts of emergency admissions and bed-days obtained from administrative data using a quasi-experimental difference-in-differences design. We found that Vanguard sites had higher hospital utilisation than non-participants in the pre-intervention period. In the post-intervention period, there is clear evidence of a substantial increase in emergency admissions among non-Vanguard sites. The Vanguard integrated care programme slowed the rise in emergency admissions, especially in care home sites and in the third and final year. There was no significant reduction in bed-days. In conclusion, integrated care policies should not be relied upon to make large reductions in hospital activity in the short-run, especially for population-based models.
Lloyd-Sherlock, P., Billings, J. R., Giacomin, K., Aredes, J., Bastos, J., Camarano, A., Coelho Filho, J., Firmo, J., Kalache, A. and Sempe, L. (2020) 'Meeting the complex challenge of health and social care provision for rapidly-ageing populations. Introducing the concept of "avoidable displacement from home".', Cadernos de Saude Publica. Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. doi: 10.1590/0102-311X00162819.

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The increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of "avoidable displacement from home" (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.
Coleman, A., Billings, J., Allen, P., Mikelyte, R., Croke, S., MacInnes, J. and Checkland, K. (2020) 'Ambiguity and Conflict in Policy Implementation: The Case of the New Care Models (Vanguard) Programme in England', Journal of Social Policy. Cambridge University Press. doi: 10.1017/S0047279420000082.

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Policy driven change is challenging, with a significant gap between theory and practice. A key tension in enacting such change is achieving a balance between bottom-up development of local, context-specific approaches, and top-down, centrally determined policy solutions and their mutual sequencing. Ideal type models of the policy-making process envisage a rational ordered approach, driven by evidence and accompanied by ongoing evaluation of outcomes (Parsons, 1995, p77); however, the reality is far more complex. We examine the implementation and early operation of the New Care Models (NCM) Vanguard programme in England, using Matland's (1995) ambiguity-conflict model, to explore the aims and expectations of the programme. We consider the relationship between top-down and bottom-up approaches to policy development and draw attention to the pressures coming from what was initially perceived as a permissive policy approach of encouraging experimentation, whilst also requiring rapid learning, scale and spread. We suggest that future programmes for large-scale policy implementation initiatives could be crafted differently to take account of the environment of implementation and render ambitions more realistic. Rather than aiming to create a set of definite products and templates, it may be that a set of principles for design and implementation should be developed and spread.
Lloyd-Sherlock, P., Billings, J. R., de Souza Aredes, J., Bastos Freire Neto, J., Amélia Camarano, A., Oliveira Araújo Firmo, J., Kalache, A., Macinko, J., Sempé, L. and Cristina Giacomin, K. (2020) 'Meeting the complex challenge of health and social care provision for rapidly-ageing populations: introducing the concept of "avoidable displacement from home"', Cadernos de Saude Publica. Cadernos de Saúde Pública. doi: 10.1590/0102-311X00162819.

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The increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of "avoidable displacement from home" (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.
Billings, J. R., Mikelyte, R., Coleman, A., MacInnes, J., Allen, P., Croke, S. and Checkland, K. (2020) 'Supporting integrated care in practice: Perceptions of a national support programme for the development of New Care Models in England', Journal of Integrated Care. Emerald, pp. 27-40. doi: https://doi.org/10.1108/JICA-05-2019-0018.

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Purpose: This paper investigates the perceptions of key informants on a national support programme for the development of New Care Models in England (2015/16 to 2017/18). It focuses on the perceived facilitators and barriers affecting the development and implementation of the New Care Models programme and offers some insight into the role of national level support in enabling local integration initiatives. Design/methodology/approach: A set of 29 interviews were carried out with a variety of respondents at the national level (including current and past programme leads, strategic account managers, advisors to the programme and external regulators) between October 2017 and March 2018, and analysed thematically. Findings: A set of facilitative elements of the programme were identified: the development of relationships and alliances, strong local and national leadership, the availability of expert knowledge and skills, and additional funding. Challenges to success included perceived expectations from the national Vanguard programme, oversight and performance monitoring, engagement with regulators, data availability and quality, as well as timetables and timescales. Crucially, the facilitators and challenges were found to interact in dynamic and complex ways, which resulted in significant tensions and ambiguities within the support programme. Originality/value: The paper demonstrates that analysis of facilitators and challenges with respect to the national support of implementation of integrated care initiatives should move beyond the focus on separate influencing factors and address the tensions that the complex interplay among these factors create.
Stoop, A., De Bruin, S. R., Wistow, G., Billings, J., Ruppe, G., Leichsenring, K., Obermann, K., Baan, C. A. and Nijpels, G. (2019) 'Exploring improvement plans of fourteen European integrated care sites for older people with complex needs', Health Policy. Elsevier, pp. 1135-1154. doi: 10.1016/j.healthpol.2019.09.009.

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Integrated care programmes are increasingly being put in place to provide care to older people living at home. However, knowledge about further improving integrated care is limited. In fourteen integrated care sites in Europe, plans to improve existing ways of working were designed, implemented and evaluated to enlarge the understanding of what works and with what outcomes when improving integrated care. This paper provides insight into the existing ways that the sites were working with respect to integrated care, their perceived difficulties and their plans for working towards improvement. The seven components of the Expanded Chronic Care Model provided a conceptual framework for describing the fourteen sites. Although sites were spread across Europe and differed in basic characteristics and existing ways of working, a number of difficulties in delivering integrated care were similar. Existing ways of working and improvement plans mostly focused on three components of the Expanded Chronic Care Model: delivery system design; decision support; self-management. Two components were represented less frequently in existing ways of working and improvement plans: building healthy public policy; building community capacity. These findings suggest that broadly-based prevention efforts, population health promotion and community involvement remain limited. From the Expanded Chronic Care Model perspective, therefore, opportunities for improving integrated care outcomes may continue to be restricted by the narrow focus of developed improvement plans.
Sempé, L., Billings, J. R. and Lloyd-Sherlock, P. (2019) 'Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review', BMJ Open. BMJ. doi: 10.1136/bmjopen-2019-030687.

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Objectives: To synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy. Design: A systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. Results: The search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature (LILACS). The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions; (2) composition of teams; (3) intervention effectiveness; and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines. Conclusions: The review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection.
MacInnes, J., Baldwin, J. and Billings, J. R. (2019) 'Think local, act personal: lessons from an integrated primary care initiative for frail, older people', International Journal of Integrated Care. Ubiquity Press, p. 408. doi: 10.5334/ijic.s3408.

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Research reports (external)
Checkland, K., Coleman, A., Croke, S., Billings, J. R., Mikelyte, R., MacInnes, J. and Allen, P. (2021) National Evaluation of the Vanguard New Care Models Programme Report of qualitative case studies: understanding system change. The University of Manchester. Available at: https://prucomm.ac.uk/assets/uploads/NCM_qualitative_case_study_report.pdf.

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Conference or workshop items
Stevens, A., Hendrie, N., Marchand, C., Vass, R., Newbury-Birch, D., Billings, J. and Coulton, S. (2022) 'How does risk prevention (not) work? Learning from the realist, pragmatic, cluster-randomised trial of the RISKIT-CJS Programme (with a null result)', in. Lisbon Addictions Conference: European Conference on Addictive Behaviours and Dependencies. Available at: https://www.lisbonaddictions.eu/lisbon-addictions-2022/.

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Background - RISKIT-CJS was a cluster randomised trial of a multi-component risk reduction programme for adolescents (aged 13-17), involved with the criminal justice system in England. Its main quantitative finding was acceptance of the null hypothesis of no effect on alcohol and substance use. Here we report on the realist, qualitative evaluation of the RISKIT-CJS programme to explore what can be learnt about how such programmes may not produce effects for their target group. Methods - the qualitative evaluation used: records of meetings and focus groups (purposive sample), practitioner interviews and observational fieldnotes of programme delivery. Data were abductively coded, using a realist framework to identify the configurations of context, mechanisms, moderators and outcomes through which the programme worked in practice. Results - This paper presents that refined realist programme theory. Relevant contexts included: geographical and institutional setting of the intervention sites (organising group work, staff ability, motivation and capacity), and the individual participant contexts (complex needs, maturity, motivation and risk profile). The intended mechanisms included: motivation to change; learning consequences; educational engagement; better communication; improved self-efficacy; and positive peer influence. The triggering of these mechanisms was affected by positive moderators (strong local programme champions, ageing out of crime for older participants) and negative moderators (disorganised, understaffed setting, and ageing into crime for younger participants). Potential negative mechanisms, included: negative peer effects and treatment fatigue. Different combinations of contexts, mechanisms and moderators led to different outcomes for different participants which are not adequately explained by an interpretation of the null quantitative result that the programme had 'no effect'. Conclusion - The paper demonstrates how realist, qualitative research can provide useful learning for policy and practice, even when the overall, quantitative result of a trial of a preventive intervention is null.
MacInnes, J., Jaswal, S. K., Mikelyte, R. and Billings, J. R. (2019) 'An evaluation of an integrated intermediate acute response team (ART) in delivering person-centred, co-ordinated care', in. Ubiquity Press. doi: 10.5334/ijic.s3406.

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Others
Billings, J. R., Rees-Roberts, M., MacInnes, J., Saloniki, E.-C., Jaswal, S. K., Mikelyte, R. and Borthwick, R. (2021) 'Lay Project Summary. Enhancing Depression & Anxiety Care: Combining a Walk-In Clinic and Remote Symptom Tracking'. CHSS, University of Kent.

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Billings, J. R., Rees-Roberts, M., MacInnes, J., Saloniki, E.-C., Jaswal, S. K., Mikelyte, R. and Borthwick, R. (2021) 'Executive Summary. Service Evaluation: Optimising the Depression Pathway Enabled by Novel Digital Assessment Technology'. CHSS, University of Kent.

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Showing 25 of 163 total publications in KAR. [See all in KAR]
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Applied health research, health and social care evaluation, vulnerable groups, complex health needs, long term care of older people, integrated care, mixed methodology, qualitative research, children's hospices, European research, health visiting

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My motivation for mentoring

One of the main reasons that I have been able to achieve the planned milestones in my career is because I was lucky to have had the experience of others along the way, to counsel and guide me at the right times. So I want to be able to be in a position to do the same for you, to help you to achieve your potential. Having been an academic for 27 years and in CHSS for 17 of them, I understand how tough it can be working in a unit dependent upon external funding (although the social jollies help!) and getting the right work-life balance. Although I am gender neutral in how I would mentor, I especially understand the challenges that women may face at the university with their career prospects in our particular setting.

My mentoring style

My style of mentoring is first and foremost informal and relaxed. I will listen, help you reflect, and challenge you if necessary, all with the aim of making your opportunities clear. Whatever your ambition, as a mentor I would be keen to assist you with choices you may have in relation to where you are heading and where you want to be.

Apply for mentorship

If you would like me to be your mentor, please fill in the mentor application form here.

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Centre for Health Services Studies, University of Kent, Canterbury, Kent, CT2 7NF

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Last Updated: 24/01/2020