Dr Melanie Rees-Roberts BSc (Hons), PhD
- 01227 816433
I joined CHSS in November 2016 as a Research Manager providing research support across 2 projects.
I facilitate research undertaken across the 16 GP practices that make up the Encompass Multispecialty Community Provider group providing primary care services across the Canterbury and Coastal Clinical Commissioning Group (CCG). Our aim is to embed research within Canterbury and Coastal CCG in order to make research part of the normal everyday primary care and commissioning activity.
My academic interests lie in self-management of minor illnesses resulting from infectious diseases, public health research and clinical research. I have ten years of experience in clinical research management within the NHS and University setting.
After completing my PhD, I worked at Barts Health NHS Trust supporting the running of NIHR portfolio cancer clinical trials. In 2011, I moved to Imperial College London to run an NIHR portfolio study investigating new diagnostics tests for tuberculosis. In 2014, I became Research Manager for the NIHR Health Protection Research Unit in Respiratory Infections. This new partnership between Imperial College London and Public Health England created a centre of excellence for public health research in Respiratory Infections.
I undertook my undergraduate training in Biological Sciences at the University of East Anglia before moving to Imperial College London to complete a PhD in HIV vaccine research.back to top
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
Innovate: optimising the depression pathway through novel digital assessment technology
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
Embedding research into Encompass, an NHS England Five Year Forward, New Models of Care, Vanguard site
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: 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).