Dr Rasa Mikelyte PhD, BSc, MSc, PDip
- 01227 823666
My principal research interests are in dementia care and policy, with my doctoral research looking into improving mealtimes for people with dementia, their relatives and staff in NHS Continuing Care facilities. I am also interested in micro-cultures in long-term care, mental health in later life, as well as sexuality and gender diversity in later life.
Since joining CHSS in July 2017, I have been part of research teams evaluating Hospice at Home services for end of life care in England, the New Models of Care national Vanguard programme, local Vanguard initiatives, integrated care services, services for carers, and patterns of opioid prescribing for older people in the UK, further broadening my research interests. I specialise in mixed-methodology research, service evaluation and action research.
My professional background is in work with People with Dementia in a variety of clinical and care settings, including an Assistant Psychologist post for Older Adult Psychological Services (NHS). As well as this I have worked as an Assistant Lecturer at the University of Kent’s School of Social Policy, Sociology and Social Research, held a number of research positions, and continue to guest-lecture for trainee mental health social workers nationally.
I have a PhD in Social Policy, an MSc in Social and Applied Psychology, BSc degree in Applied Psychology with Clinical Psychology and a Postgraduate Diploma in Methods of Social Research; all at the University of Kent. I joined CHSS as a Research Assistant in July 2017.
• Optimum Hospice at Home Services for End of Life Care
• The New Models of Care National Vanguard programme Evaluation projects
• GP perceptions on Opioid Prescribing as Regular Pain-Management Medication for Older People
• The contribution of Multidisciplinary Meetings (MDMs) towards improving patient outcomes and preventing the need for health and social care support: A mixed-methods evaluation employing an implementation science approach.
• Evaluation of the Acute Response Team (ART) Service in Thanet
Current collaborations outside CHSS:
• In search of a good death: What would a good death in dementia look like? A qualitative study comparing views of people with dementia in Brazil & UK – with Dr Edison Iglesias de Oliveira Vidal (UNESP), Dr Francelise Pivetta Roque (UFF), Dr Luciano Magalhães Vitorino (UFJF) and Dr Karen Harrison Dening (Dementia UK)
• Utilisation of 'Carers Star' as Indicator of Carer Need and Service Impact – with Prof Alisoun Milne at SSPSSR
• Evaluation of service user-led role play feedback for social work students – with Dr Eleni Skoura-Kirk and Sarah Brown
• Professional-personal identity congruence and social work student wellbeing - with Dr Eleni Skoura-Kirk and Prof Alisoun Milne
• Social work student value profile - with Dr Eleni Skoura-Kirk and Prof Alisoun Milne
Past CHSS projects:
• Evaluation of the Kent & Medway One Care Pilot
• Exploration of the Factors Influencing Opioid Prescribing as Regular Pain-Management Medication for Older People
• Service Evaluation of the Encompass Community Hub Operating Centres
Also view these in the Kent Academic Repository
Published in 2014, the NHS England’s Five Year Forward View saw the beginning of an ambitious programme to develop new models of care. The result has been the establishment of new ways to organise health services being piloted in a number of ‘Vanguard’ sites around the country. The Encompass Vanguard sits within the Canterbury and Coastal Clinical Commissioning Group (CCG) and involves general practices in Whitstable, Faversham, Canterbury and surrounding areas including Ash and Sandwich. Serving a population of 170,000 people, Encompass is formed into a new model of integrated care known as a Multispecialty Community Provider and is focussed on moving specialist care from hospitals to the community and in particular emphasising on integrated care for older people – a key element within the Five Year Forward View. The new models of care aim 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. Whilst shifting services from hospital to community settings, and closer health and social care service integration are far from new concepts, developing effective new ways of community working to address health and social care demands remains a challenge. A research office has been established as a joint partnership between the Encompass Vanguard and CHSS. The office supports research undertaken within the 16 practices that make up the Encompass group and also conducts and supports research and evaluation of aspects of Encompass’ activities. The research function ensures delivery of high quality national portfolio studies working in collaboration with the NIHR Clinical Research Network and generates and facilitates research activity within all the member practices. The aim is to make research part of the normal everyday activity of the practices and use the knowledge generated by new research to improve care quality. The research will ultimately contribute to the development of the new model of care, provide educational and development opportunities for practice staff and improve staff recruitment and retention. Start date: 01/02/2016 End date: 31/03/2018 Funder: Encompass Vanguard Funding: £164,000
Optimum Hospice at Home services for end of life care
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.
Evaluating and analysing integrated service development
Evaluating and analysing integrated service development Local Clinical Commissioning Groups (CCGs), in collaboration with providers, are currently developing programmes of transformational change, with a particular focus on strengthening integrated health and social care initiatives. These programmes aim to be evidence-based and include research and evaluation workstreams. These workstreams, led by Professor Billings, Director of the Integrated Care Research Unit (ICRU), demonstrate a commitment to ensuring an evidence-based approach, alongside the generation of local evidence of the effectiveness of the integrated care initiatives. Such evidence has the potential to provide a body of transferable knowledge to support the programmes as they roll out across the CCGs and influence developments in the rest of Kent. Researchers are applying the Evidence Integration Triangle, which is based on the methodological approach of “implementation science” (Glasgow et al 2012). This approach is centred on involving a multi-agency stakeholder group from the onset to support the design and evaluation of a specific service through the use of best-practice evidence supplied by the researchers. A key part of this approach is to determine what works for whom, in what circumstances, and with what effects. The overall aim of this methodology is to: Develop realistic person-centred and service-level outcomes Create and source a menu of appropriate indicators for the evaluation and monitoring of interventions Use a participatory approach that focuses on speedy results of processes and outcomes As part of this methodology, the researchers have developed and validated an evaluation framework (the Kent Evaluation Framework) that is relevant to integrated care initiatives being developed and implemented across Kent. ICRU has been supporting the development and evaluation of the following integrated health and social care services: Integrated Intermediate Care (IIC) pathway A bespoke IIC KPI and monitoring framework has been developed which consists of indicators from the Kent Evaluation Framework and local KPIs. This framework is being used by providers to feed the relevant data to the CCG who are compiling the information in order to address any issues within the pathway. Focus groups with staff and managers have been conducted to investigate staff perceptions of the pathway and to highlight areas for improvement. Multidisciplinary Teamwork In Deal, researchers have worked with GP practices, the CCG and other stakeholders to develop an evaluation framework for an integrated multidisciplinary team (MDT) initiative to improve the care of frail, older people who are high users of health and social care services. This initiative involves referrals to a Town GP who leads an MDT involving health, social and voluntary care organisations. A bespoke evaluation frameworkhas been developed based on the Kent Evaluation Framework and the availability of local data. A patient survey has also been developed to determine the extent to which care is perceived to be integrated and person-centred. End of Life Care (EOLC) Pathway Two literature reviews were carried out to inform the development of the pathway and researchers worked with stakeholders to develop the KPI and monitoring framework to support the evaluation of the pathway. This framework has been agreed by the steering group and is now in use for providers to collect the data, which will be analysed by the CCG. This will enable the CCG and the providers to identify areas of EOLC, which require further development within the pathway. The Acute Response Team (ART) This clinical team operates from the Emergency Department at QEQM Hospital in Margate and Westbrook House. The service focuses on older people with long term conditions, preventing hospital admissions and keeping people in their homes for as long as possible. Researchers at ICRU are working with ART and other stakeholders to co-design and deliver an evaluation strategy, which measures the patient experience with respect to person-centred, co-ordinated care, and the experiences of a wide range of professionals and managers associated with the service. Start date: 01/11/2015 End date: 31/10/2018 Funder: Kent & Medway NHS Social Care Partership Trust et al Funding: £61,500 Funder: All Seasons Amount: £9,000
The new models of care Vanguard programme in England:national programme evaluation
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