Helen is a consultant in public health medicine and a health services researcher. She is a member of the CLAHRC research partnership team, and Deputy Director of the CLAHRC Academy. Her research uses qualitative and quantitative methods to evaluate health care and public health services.
The work of CLAHRC researcher Dr Bélène Podmore has been highlighted as “high quality” by the National Institute for Health Research. Bélène’s work, recently published in BMJ Open investigated how having a long-term condition impacts access to and benefit from hip and knee surgery. The research was promoted by NIHR via their “Signals” service. NIHR Signals summarise the latest important research on health care, public health and social care, along with implications for practice.
Why was this study needed? In the UK, over 210,000 hip and knee replacements were performed in 2017 at an average age of 68 for hips and 69 for knees. One in six of these people had an illness affecting their day to day life.
Read the paper
Podmore B, Hutchings A, van der Meulen J, et al
Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis
BMJ Open 2018;8:e021784. doi: 10.1136/bmjopen-2018-021784
New knowledge generated by our research impacts commissioning and funding decisions on welfare advice
Our work to investigate the impact of locating welfare advisers in GP surgeries is bearing fruit as the new knowledge and evidence we have generated is influencing commissioning decisions for these services across London and beyond.
We know that a significant amount of General Practitioners workload is generated by patients approaching them with non-clinical issues such as debt, housing and immigration.
While these concerns undoubtedly impact health and wellbeing, doctors are not necessarily the best professionals to assist. Haringey Council trialled a scheme to locate welfare advice, and welfare advisers in GP surgeries to deal with these issues.
We evaluated the impact of this advice (provided by Citizen’s Advice Bureau staff) on both GP workloads and on the health, wellbeing and use of services by the patients affected.
Our evidence has been used to support the following decisions –
Haringey: our evidence was used to support retention of all except one primary care co-located welfare advice service in and to provide an additional more intensive service at a mental health hospital (St Ann’s Hospital);
Camden: although the CCG decided to cease funding for GP outreach two GP practices have used the study findings to support ongoing funding for services at their practices (including an application for Big Lottery funding)
Deryshire; Citizens Advice services in Derbyshire have requested study findings to support a business case for ongoing funding of GP outreach in the region
Sussex: our study has been used as a basis to develop an evaluation framework in Sussex
Read our evidence
Read more about the study:
GPs are often faced with patients seeking help and advice on non-clinical issues such as debt, unemployment and housing. Though these issues undoubtedly impact patients’ health and wellbeing, health professionals are not always the best qualified people to tackle them.
We investigated the impact of putting welfare advice, and welfare advisers in GP surgeries on
- the ability of low income groups to secure financial support they are entitled to
- patients’ anxiety and stress associated with financial related social worries;
- and, to GP time spent managing non-clinical issues
New CLAHRC BITEs offer a summary of two papers investigating the impact –
- A qualitative study to identify the processes by which co-located services can improve outcomes for GP practices
Co-location of welfare services has many benefits to patients including:
- Offering a signposting option for staff in contact with patients with ‘non-clinical’ social needs.
- Helping to address underlying patient social issues.
- Providing an alternative option for patients seeking help for such issues.
- Reducing bureaucratic pressures and time demands on practice staff.
Read the BITE
2. A quantitative study, using a controlled comparison, assessing the impact on mental health and service use of co-located welfare advice.
Key Findings – service users receiving welfare advice versus control group
- Had the advice service not been at the practice, nearly half of the advice group would not have sought help or consulted their GP instead.
- The majority of advice recipients reported improved circumstances after advice (e.g., stress, income, housing etc.)
Compared to those who did not get advice, after 3 months:
- Those in the advice group whose circumstances improved experienced a bigger improvement in their well-being.
- Those in the advice group experienced a bigger reduction in financial strain, reduced credit card and overdraft use.
- Those in the advice group experienced a bigger reduction in symptoms of common mental disorder, especially among recipients who were female, those who identified as Black and those who reported that their circumstances improved as a result of advice.
- There was, however no evidence for a reduced frequency of GP consultations.
- For every £1 of investment by funders, those receiving co-located advice gained £15 in entitlements on average
Read the BITE
Using patient information
How will this be operated?
Getting It Right First Time (GIRFT) is a national programme designed to improve care for patients within the NHS, by reducing unwarranted variations. Our evaluation of the NHS Getting it Right First Time programme could not happen without access to patients’ data and this will play a vital role in our ability to get a picture of how the programme is working and the difference it is making to patient care. We want to be clear about how your data is stored, used and protected in our research. One aspect of this study looks at ‘what works and at what cost?’
We are trying to look at whether the Getting it Right First Time programme in orthopaedic surgery has reduced variations in orthopaedic practice and costs, and improved outcomes for patients. To do this, we are requesting confidential patient data for a group of patients who have undergone elective orthopaedic surgery between 1st April 2009 and 31st March 2018.
The data we would like to use include Hospital Episode Statistics (HES), a database containing details of all admissions to NHS hospitals in England, which is collected so that hospitals can be paid for the care they deliver. We would also like to include Patient Reported Outcome Measures (PROMs) for patients who have had hip or knee replacements. NHS patients who have had these procedures have been invited to fill in Patient Reported Outcome Measures (PROMs) questionnaires as part of the Department of Health’s PROMs programme. The NHS asks patients about their health and quality of life before they have their operation, and about their health and the effectiveness of the operation afterwards at six months. These data can also be processed and used for other purposes, such as research and planning health services. We would also like to use data from the National Joint Registry (NJR). The NJR was set up by the Department of Health to collect information on all hip, knee, ankle, elbow and shoulder replacement operations across the NHS, to make sure joint replacement implants were working and to also ensure the different types of surgery for these operations were safe and effective.
Secure storage and processing of patient information
This study has already received research ethics approval – a process designed to make sure researchers’ can benefit from accessing data while minimising risk of any harm to patients – and Health Research Authority Confidential Advisory Group Section 2.51 approvals. The legal basis for processing are covered under Article 6 (1) (e) and Article 9 (2) (j).
Personal data of patients – including NHS number, date of birth, sex, postcode and the study ID will only be securely transferred between two organisations – Northgate Public Services (who control NJR data) and NHS Digital (who control HES and PROMs data). This is considered to be personal data according to European data protection rules – the General Data Protection Regulation (or GDPR). As these two organisations currently hold the data, and are involved in processing, they are called data processors. The purpose of sending this personal data between the two organisations is so NHS Digital can link these data together for the same patients, to provide more accurate and complete information for researchers who can track a patient’s journey through the NHS system. However, researchers will not have access to any personal identifiable data, and will not be able to identify patients, using the information that they are given by the two organisations (Northgate Public Services and NHS Digital).
Both organisations will securely transfer pseudonymised data to researchers at UCL. Pseudonymisation means the most identifying fields within a database are replaced with artificial identifiers, or pseudonyms so patient information can be processed without researchers being able to identify patients. This means that UCL will be the final and only data controller for the data that is disseminated for the purposes of looking at ‘what works and at what cost?’ UCL will determine the purposes for which and the manner in which any personal data are to be processed. All pseudonymised patient information will be stored on a secure network that is password-protected
The data will be stored by researchers at UCL until 2021 for analysis and dissemination purposes, and thereafter will be securely destroyed.
UCL Data Protection:
UCL is required by law to comply with data protection legislation. The UK’s regulator for the legislation is the Information Commissioner’s Office. It is the commitment of the university to ensure that every current employee and registered student complies with this Act to ensure the confidentiality of any personal data held by UCL, in whatever medium. This Act came into force on 25 May 2018.
UCL processes the personal data of living individuals such as its staff, students, contractors, research subjects and customers. UCL has a data protection policy as a commitment to the safeguarding of personal data processed by its staff and students, and to ensure compliance with the legislation. It is the duty of data controllers such as UCL to comply with the data protection principles with respect to personal data. This policy describes how UCL will discharge its duties in order to ensure continuing compliance with the Act in general and the data protection principles and rights of data subjects in particular.
Data Protection Officer Contact details:
Research Department Administrator
PA to Professor Rosalind Raine and Professor Naomi Fulop
Department of Applied Health Research, UCL
Visiting Address: 1-19 Torrington Place, London WC1E 7HB, Rm 112
Postal Address: UCL, Gower Street, London WC1E 6BT
Tel: 020 3108 3269
We are happy to discuss your rights to protect your data, and how exactly it will be used in our research. If you would like further information about the use of your data in this research study, or would like to lodge a complaint to a supervisory authority – please contact us on the details given below. If you would like to request that your confidential patient information is not included in this study, please aim to contact us between 1st May – 24th August 2018 to discuss.
Dr Sarah Jasim
NIHR CLAHRC North Thames
Department of Applied Health Research
University College London
1-19 Torrington Place
London WC1E 7HB
Tel: 020 3105 3233
There are big variations in care for people receiving orthopedic services in the NHS – orthopedics covers conditions involving the musculoskeletal system including hip and knee replacement surgery. We are evaluating the Getting it Right First Time programme – or GIRFT – which aims to improve services and make sure people get more consistent care across the whole NHS.
Part of our evaluation involves asking two sets of people –
i) patients over 60 who have had orthopaedic surgery in the last two years
ii) people over 60
about their views on orthopaedic surgery and improving outcomes.
We’re running focus groups in April and May at the UCL Farr Institute
UCL Farr Institute, 222 Euston Road, London, NW1 2DA
i) People who have had a hip or knee replacement in a NHS hospital within the last two years Aged over 60
ii) People over 60
Contacts to register your interest are below –