CLAHRC research has Europe-wide impact

Dr Werner Leber, an East London GP with a passion for driving earlier identification and diagnosis of HIV, has seen his work recognised by the European agency responsible for the continent’s defences against infectious disease – the European Centre for Disease Prevention and Control (ECDC).

Dr Leber (above) is a practising GP in Tower Hamlets as well as being an NIHR Clinical Lecturer in Primary Care. His work with the CLAHRC, based at the Queen Mary University of London, aims to improve the identification and management of people with HIV.

Werner’s research among East London’s GP practices will now have a Europe-wide impact after being highlighted as good practice by the ECDC in its first integrated European hepatitis B virus (HBV) hepatitis C virus (HCV) and HIV testing guidance. The trial is summarised on page 71 of the guidance.

“The results support the hypothesis that an education programme promoting rapid HIV testing in general practice leads to increased and earlier HIV diagnosis.”

Public health guidance on HIV, hepatitis B and C testing in the EU/EEA;
An integrated approach
European Centre for Disease Prevention and Control, 2018

The project consortium and a panel of experts highlighted work published by Dr Leber and his team – Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial as a case study to support the published evidence and advice for implementation for the new guidance.

Read the RHIVA2 case study as a stand-alone document.

In this trial in Hackney, general practices were randomly assigned to offer either opt-out rapid HIV testing to newly registering adults or continuing usual care. The study found that promotion of opt-out rapid testing in general practice led to an increased rate of diagnosis, and might increase early detection, of HIV.

In developing the guidance the ECDC looked for excellent examples of HBV, HCV and HIV testing services across EU/EEA Member States, reviewing the latest evidence and putting out two published calls for submissions of good practice.

Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial
Lancet HIV. 2015 Jun;2(6):e229-35. doi: 10.1016/S2352-3018(15)00059-4. Epub 2015 Apr 28.
Leber W, McMullen H, Anderson J, Marlin N, Santos AC, Bremner S, Boomla K, Kerry S, Millett D, Mguni S, Creighton S, Figueroa J, Ashcroft R, Hart G, Delpech V, Brown A,
Rooney G, Sampson M, Martineau A, Terris-Prestholt F, Griffiths C

Prof Kamaldeep Bhui

Professor Kamaldeep Bhui is Professor of Cultural Psychiatry & Epidemiology at Queen Mary University of London and an Honorary Consultant Psychiatrist in East London Foundation Trust.  He is an psychoanalytic psychotherapist.  He is Editor of the British Journal of Psychiatry and the International Journal of Culture and Mental Health.  Professor Bhui trained at University College London and at Guys and St Thomas’ qualifying in 1988.  He proceeded to train in London, completing his higher psychiatric training by 1992, secured a Wellcome Training Fellowship to progress research and secured a first consultant appointment in 1999 followed by a Senior Lecturer and Professorial post at Queen Mary University of London in 2000 & 2003 respectively.  His research and practice interests on health include social exclusion, work characteristics, cultural psychiatry, epidemiology, health services research and psychological therapies.  He has undertaken original research with communities to understand this complex process called radicalisation and provides evidence on how it works and who is vulnerable.

Professor Bhui heads the Centre for Psychiatry at Barts & the London Medical School.  He is also the Director of the Cultural Consultation Service (Culturalconsultation.org), Director of the QMUL MSc Programme, the co-founder of Careif (www.careif.org), an international mental health charity based in London that promotes work for young people and their health through culture, sport and arts and, more recently, the Director of the Synergi Collaborative Centre, a new initiative to transform ethnic inequalities in mental health services, (synergicollaborativecentre.co.uk).

In 2016 he received a CBE (Commander of the British Empire) in the Queen’s New Years’ Honours List for services to mental health care and research.

What do hospitals need for a board-level quality improvement intervention to work?

Healthcare systems around the world are becoming more concerned with strengthening board level governance of quality. In England, national healthcare regulators are developing approaches, resources and interventions aimed at supporting senior hospital leaders in their role in the governance of quality.

New CLAHRC research investigates the organisational response to an improvement intervention in six hospital boards across England. The research, published in a new BMJ paper and BITE-sized summary shows the results a 30-month period of fieldwork, involving interviewing NHS board members, observing board meetings and analysing relevant documentation.

The findings will be relevant to NHS Boards, the staff and clinicians they lead and all those in the NHS working to improve the quality and safety of care.

As well as researchers, the results will be of interest to policymakers, regulators, knowledge mobilisation organisations and thinkers on boards and leadership across all sectors.

Read the iQUASER paper

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

Background Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Read a BMJ editorial highlighting the paper as “an example of an empirical study that successfully enters into dialogue with management theory

Engaging with theory: from theoretically informed to theoretically informative improvement research

Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1-4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of

Read our “need to know” summary

What do hospitals need for a board-level quality improvement
intervention to work?

Clinicians and research leaders’ views on barriers to involving children and families in research

Within the UK, 32 out of every 10,000 children are living with a life-limiting condition or life-threatening illness (LLC/ LTI).

Research, from genetic studies to drug trials is vital to improving care for these children and their families, but the inclusion of this vulnerable population into research studies has been difficult.

Barriers to Research Access: Voices, Experiences, and Solutions (BRAVES) is a CLAHRC study focusing on improving access and participation in research for children and young people with LLC/LTI and their families.

A new BITE – a postcard “need to know” summary of our published research – shares the perceptions of clinicians and research leaders on their perceptions of the barriers preventing children and their families becoming involved in research.

The BRAVES team surveyed palliative care clinicians, often “gatekeepers” to children and their families getting involved in research asking them

‘In your experience, what have you found to be the biggest barriers to palliative care research with children?’

We also consulted Chief Investigators (CIs) – leaders of NIHR research studies involving CYP with LLC/LTI and their families. CI’s were invited to complete an anonymous, web-based questionnaire and three key barriers to research were emerged, alongside four potential solutions.

 

Supporting our partners in Becoming Research Active

Local research bodies join forces with patient partners to deliver an introduction to research

We ran our Becoming Research Active course on November 14th offering our partners in front-line care a primer in research and the research process.

CLAHRC North Thames Academy collaborated with other NIHR funded research organisations in the region – the Clinical Research Network and Research Design Service – to deliver the training, with vital contributions from patients and members of the public.

The day-long course is structured to reflect the research cycle – from defining a problem, through securing funding to dissemination and evaluation. Attendees, who came from across the NHS and local authorities were encouraged to bring a research idea they could develop over the course of the day.

“The course has provided me with lots of resources and a clearer sense of direction, which is what I hoped for.”

We joined forces with NIHR infrastructure across the North Thames region – the Research Design Service which provides support to those preparing research proposals for submission to peer-reviewed funding competitions for applied health or social care research; and the local Clinical Research Network which makes it possible for patients and health professionals across England to participate in clinical research studies.

The training aimed to highlight the processes involved in planning and carrying out successful research, in partnership with patients and the public, and signpost attendees to the support available to them.

We were also very fortunate to have some patients and members of the public bringing their unique lived experience – of working with researchers, leading research and being a clinical trial participant respectively to offer tips to attendees.

CLAHRC Research Advisory Panel member Ayath Ullah (below left) joined the CLAHRC’s involvement officer Steven Towndrow to offer a lay perspective on how researchers can make patient/public advisers welcome and valued.

One of the CRN’s Patient Research Ambassadors (PRAs) Phillip Wingfield spoke about his experience of taking part in two clinical trials, offering a perspective from a participants point of view. 

We were also joined by community researchers Sultana and Farzana from the NEON project, where they have led research into improving nutrition practices among the Bangladeshi community in East London.

“Useful to have a range of speakers with varied experience. Great place to come prior to starting research.”

Researchers, staff and health professionals delivered a range of presentations with small group work and regular exercises to reinforce learning, and were on hand to facilitate each part of the day.

Feedback from attendees was overwhelmingly positive;

“Very useful and informative.”

“Lots of information to move forward my idea. Thank you very much.”

“A good overview of processes. Helpful to know all the help/support available.”

“Very well designed and delivered. It kept my attention throughout. The content/sessions were well balanced and provided me with the basis to build on”

We are offering follow up sessions with attendees to support the development of research ideas into action, and we plan to run the course again in summer 2019. Get in touch to join our mailing list to find out when courses are planned – clahrc.academy@ucl.ac.uk.

CLAHRC researcher’s run half-term residential training event for second cohort of young commissioners

Young Commissioners residential training for Dudley Council Integrated Commissioning hub, 2-4 November 2019

The “Young Commissioner” model – which sees children and young people work with funders and planners of local services to ensure they meet the needs of those in their age group  – is gaining traction among local authorities and the NHS.

CLAHRC North Thames child and adolescent researchers are training and supporting staff and young people based at Dudley Council, West Midlands to establish and embed the Young Commissioner model in their Integrated Commissioning Hub. This follows our work with a previous cohort of young people in East London to improve diabetes services.

Over the weekend of 2-4 November this residential event kicked-off the training programme for the young people using the principles of ‘learning by doing’. This has involved blending training with real-time commissioning activities.

The Young Commissioners worked with graphic facilitator Penny Mendonca on public speaking and presentation skills, and the different communication channels they could use.

Adult learners have also accessed project-specific eCPDs developed by the team to help them better align Council systems, structures and processes to optimise the impact and sustainability of this initiative. The adoption of the Young Commissioners model marks an area of innovation in how they work together with the public to commission children and young people’s services.

There is a strong commitment in Dudley Children’s Services to the active involvement of children and young people – the initiative forms part of Dudley Children’s Services Active Involvement strategy 2017, and the Children and Young People Market Position Statement 2018-2022.

“Dudley is a Borough where co-production with children and young people’s their rights are realised, and their views shape decisions made about their lives and those of their families.”

Dudley Children’s Services Active Involvement strategy 2017