As part of a series of blogs from prominent members of the research community CLAHRC Director Professor Rosalind Raine pays tribute to Michael Marmot, who has consistently and eloquently pointed out the unequal distribution of the social determinants of health.
Professor Raine’s piece in the British Medical Journal, the last of a series of”research legends” blogs highlights the ongoing relevance of Marmot’s work in light of the widening health gap between the socially advantaged and disadvantaged.
Describing Professor Marmot as an “iconic figure” Rosalind highlights his drive to keep health inequalities high on the policy agenda, and his impact on the NHS, in particular the 2010 Marmot review examining health inequalities in England.
What is the role of evidence in decisions about introducing or spreading innovations in health care?
Faced with a myriad range of innovations – in technology, medicine, ways of working and in organising services what do those who plan and commission services have to call on?
We know that a range of evidence informs healthcare decision-making, from formal research findings to ‘soft intelligence’ or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice.
New guidance from the“DEcisions in health Care to Introduce or Diffuse innovations using Evidence” (DECIDE) study has been published to support decision-makers and evaluators in the use of evidence in their work.
A team funded by the Health Foundation and led by researchers at the University of Manchester and University College London has investigated decision-makers’ use of diverse forms of evidence, exploring how and why some evidence does inform decisions to introduce health care innovations, and why barriers persist in other cases. The guidance was developed in consultation with clinicians, health managers, commissioners, patient representatives, and researchers.
The guidance is the end point of two years work involving a review of current evidence; examination of three case studies of real world decision-making on innovations in NHS acute and primary care; and a national survey and discrete choice experiment of decision-makers’ preferences for evidence, including providers and commissioners.
The accessible document – available as an interactive PDF, is aimed at anyone concerned with informing or making decisions about introducing or spreading innovations within the UK National Health Service, including providers and commissioners of care. It provides a summary the team’s findings, questions for decision-makers to consider, and potential ways of addressing them using examples from case studies. The document also sign-post users of this guidance to further resources where appropriate.
Read more from the DECIDE team below –
Turner S. (2018) ‘Accelerating innovation in new ways of delivering health and social care’, Manchester Policy Blog, published 28 March 2018.
Turner S, D’Lima D, Hudson E, Morris S, Sheringham J, Swart N, Fulop N. (2017) ‘Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback’, Implementation Science 12:145. View bite-size summary.
Turner S, Morris S, Sheringham J, Hudson E, fulop NJ. (2016) ‘Study protocol: DEcisions in health Care to Introduce or Diffuse innovations using Evidence (DECIDE)’, Implementation Science 11:48.
Current debates on the NHS workforce include discussions on the best balance between
- specialists – with highly specialised skills who are brilliant at doing a small number of things extremely well
- and generalists – who can do a wider range of things in less depth
Rising multimorbidity, an ageing population, and the increasing specialisation of medical treatment are all seen as driving the need to increase the number of doctors with generalist skills. Generalists breadth of expertise enables them to manage both acute and chronic health problems and have been put forward as the way to provide better care for the increasing numbers of older and more complex patients requiring emergency medical admission.
A team of researchers from University College London and the Nuffield Trust is investigating the models of medical generalism currently in use in smaller acute hospitals in England and need your help.
A brief survey is asking for patient, professional and service perspectives on the balance of care between specialist and generalist models in hospitals for patients with acute medical conditions.
- If you are a hospital doctor working at a hospital that admits patients with acute medical conditions, please access the online survey here: http://www.dcdo18co.myonlinesurvey.co.uk/
- If you are a patient, carer or a member of the public, you can access the online survey here: http://www.dcpa18co.myonlinesurvey.co.uk/
- If you are a manager working at a hospital that admits patients with acute medical conditions, you can access the online survey here: http://www.dcma18co.myonlinesurvey.co.uk/
We would be very grateful if you could complete the survey within the next three weeks please, and we would like to encourage you to complete it at your earliest convenience. This will ensure we capture your views on models of care in small hospitals. The survey will take at most 5-10 minutes to complete. All responses will be handled securely, kept strictly confidential and anonymous, and stored in line with the Data Protection Act 1998 and new General Data Protection Regulation (GDPR).
Further details about the study are available here:
Your views will provide vital evidence as part of this research, which will impact decision making around ways of working in hospitals relating to
- issues around workforce education
- continuing professional development and contractual arrangements
- and the future of smaller hospitals and their role in the wider healthcare system.
Do you need to demonstrate the economic impact of projects in your organisations?
Do you want to assess the outcomes and sustainability of a new service?
Are you tasked with carrying out an economic evaluation, but don’t know where to start?
This one day, hands-on workshop aims to provide an introduction to addressing these challenges. It is run buy the NIHR CLAHRC North Thames Academy. The course is aimed at staff in frontline services in the NHS and local governement, who have limited experience of conducting economic evaluations and decision making analysis.
After attending this course, you will have the skills and knowledge to undertake your own simple economic evaluation of a local intervention or service, and be able to appraise other evaluations.
The course will cover:
introduce the basic principles of economic evaluation methods
explain how to assess the costs of an intervention/service
explain how to measure and value outcomes of an intervention/service
give practical examples of economic evaluation analysis
help to understand how to use economic evaluation in decision making
offer the opportunity to discuss in small groups the economic evaluation you are doing or thinking of doing. A facilitator will help scope your economic evaluation, draft its core elements, identify the data you will need to use, think how you could overcome information or data gaps
This worksop is suitable for staff from NHS Trusts, Local Authorities and CCGs who need to evaluate local programmes or service from an economic perspective as part of their work. It is not aimed at academics and/or researchers.
In order to be most beneficial for the participants, we invite applications from individuals who are carrying out or soon will need to carry out an economic evaluation of a service/intervention. In the selection process, we will give priority to applications providing a detailed description of such projects. Groups of people working on the same project are encouraged to apply.
No previous knowledge of economics is required (or experience of study design and statistics), however an interest in economics and being comfortable with numbers is desirable.
All participants will receive a certificate of attendance.
Cost – This course if free for staff working in NIHR CLAHRC North Thames partner organisations (please click here to see a list of our partners). There is a delegate fee of £250 for other attendees.
Please note, a cancellation fee of £100 will be charged to both partner and non-partner delegates in the event of non-attendance without notice after 5pm, Wednesday 24th October 2018.
For more information please contact firstname.lastname@example.org
New CLAHRC research highlights a simple intervention that could improve detection of atrial fibrillation (AF) – a potentially dangerous heart condition affecting a million people in the UK and associated with 1 in 8 strokes (1 in 3 strokes among those aged over 80 years).
East London GP and CLAHRC researcher Dr John Robson led an investigation into the impact of regular pulse checks in general practice on AF detection among patients aged 65 and over. This work, published in the British Journal of General Practice, offers evidence that these checks – a cheap and straightforward intervention – rapidly improved the detection and prevalence of AF, meaning quicker access to treatment and reduced risk of stoke for those diagnosed.
The condition causes an irregular and often abnormally fast heart rate and is a leading cause of stroke – with strokes caused by underlying AF twice as likely to be fatal. AF is common in older people, but often shows no symptoms – meaning earlier detection and access to treatment means reduced risk of stroke and the health problems stroke victims have to live with afterwards.
Dr Robson and his team checked historical GP records to investigate the impact of a programme promoting pulse regularity checks across three groups of East London GP practices (or Clinical Commissioning Groups) – City and Hackney, Newham, and Tower Hamlets.
An analysis of electronic primary care patient records before (2007–2012) and after (2012–2017) checks were introduced showed significant increases in AF detection.
Br J Gen Pract. 2018 Jun;68(671):e388-e393. doi: 10.3399/bjgp18X696605
Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records.
Cole J, Torabi P, Dostal I, Homer K, Robson J
As we reflect on five years of CLAHRC research, and look forward to the transition to their successor – Applied Research Collaborations (or ARCs) – we welcomed staff and patient and public contributors from CLAHRC South West Peninsula (PenCLAHRC) – for a learning exchange visit on July 4th.
The meeting was a follow up to our trip to PenCLAHRC last September where we established relationships between the respective involvement teams and patient/public partners on the start of a journey where we will collaborate and share good practice wherever we can.
CLAHRC North Thames Deputy Director Professor Mike Roberts (below) opened the meeting by welcoming our guests and highlighting their vital role in shaping the ARCs. Mike outlined the part they could play in implementation and adoption of research – a new area for ARCs compared to CLAHRCs and a part of the research cycle where patient and public involvement does not traditionally happen.
CLAHRC North Thames researchers Dr Darren Sharpe (University of East London, below) and Chloe Edridge (Anna Freud National Centre for Children and Families) joined the meeting to bring some researcher’s perspective to discussions, and both spoke of the impact involving people has made on their work.
We then welcomed Dr Helen MacDonald (below, left) a Public health registrar working across UCL and the London Borough of Islington on research funded by the Health Foundation. Helen is investigating Linking health and local government data at household level to understand social determinants of health. Linking local government information with health data offers an opportunity to better understand the local population’s combined health and social needs and to improve health and wellbeing in the widest sense across the Borough.
Specialist innovation and technology firm Snap Out are working with the Council on this programme – they facilitated a co-design session to shape the approach to seeking advice from the local Islington public and patient population about the linked dataset and the acceptable use of data as a result of the linked dataset.
This led to some in-depth discussions on how Islington might do this.
To close the meeting we then worked on what involvement in ARCs could look like, how we can collect and demonstrate the impact of involvement and how we can collaborate to improve research and make the most of the skills and experience across both CLAHRCS.
Our thanks to everyone who attended, to Steph Hume from the CLAHRC North Thames team, to Dr Kristin Liabo from PenCLAHRC for helping plan and facilitate the day, to Darren and Chloe for taking the time from their busy schedules to join us, and to UCL Estates and Security for helping make the meeting accessible.
What triggers asthma symptoms?
Can you identify celebrities who live with the condition?
How much lung capacity do you have?
These were just some of the questions we asked visitors to our stall at the 2018 Barts and Queen Mary Science Festival held at Queen Mary University of London’s Mile End campus on 20 June.
The CLAHRC was represented by the My Asthma in School project team at the event aimed at secondary schools and young people interested in a career in science and medicine.
We took the chance to give visitors information on symptoms and managing the condition in schools, and raising awareness among young people they can better understand and support fellow pupils with asthma.
They could also test their lung capacity and put their results on a peak flow rate chart to see how they rated against other young people (below). The team is looking for schools to take part in their work. Signing up your school is quick and easy and will help your school support & empower young people with asthma.
The Exhibitors at the festival provided hands on activities to encourage students to learn more about careers in science.
Now in its eighth year, the 2018 festival was supported by the NIHR Biomedical Research Centre (BRC) at Barts Health NHS Trust and Queen Mary University of London, and Trials Connect.
Thank you to the team and for the invite from Barts and QMUL.
The CLAHRC was represented at the annual University College London Hospitals NHS Foundation Trust (UCLH) research open day held on July 5th at the hospital. The 2018 edition of the event had special significance in the year we celebrate the NHS’ 70th birthday.
We were one of over 30 stalls at the event, which celebrates research going on across UCLH, one of the CLAHRC’s key NHS partners.
Joining our public and patient involvement officer Steven (below left) at the stall were two CLAHRC researchers Emma Dunphy and Dr Rachel Muir.
Dr Muir (below left) gave visitors an opportunity to take part in a LEGO Serious Play demonstration. LEGO Serious Play is an innovative and engaging way to construct and share knowledge and stories in research, and was initially designed to be used in the corporate world to map complex problems through shared models and landscapes. Visitors got the chance to construct mini-models in 3 minute Lego Serious Play exercises. To find out more about Rachel’s work email email@example.com
Emma (below left) is a Senior Physiotherapist based at Homerton University Hospital NHS Foundation Trust, and supports patients in their journey back to health after injury. Emma has developed TRAK, a web based resource to help with rehabilitation from Anterior Cruciate Ligament injuries – particularly common among active sportspeople.
TRAK includes diagrams and short films demonstrating exercises included in a patients rehab programme, and can complement face to face therapy for those in recovery from ACL injuries. For more info on TRAK contact Emma at firstname.lastname@example.org
Our thanks to Emma and Rachel for their time and for UCLH for inviting us to take part and for running an excellent event as ever.