Taking a step back to examine overcrowding in emergency departments

Overcrowding in hospital emergency departments generates headlines and a perception that there is a “crisis” in services. It has a negative impact on staff and patients in the immediate environment and risks compromising the safety of care. There are also knock-on effects such as the widespread cancellation of elective (planned) surgery and has even led to calls for medical students to volunteer their services to their local emergency department.

A new paper published in the Royal Society Journal of Medicine entitled How can operational research and ethnography help to fix your emergency department? takes a considered view of the problem and what providers can do about it. Using insights gained from work in operational research and ethnography, and direct experience of being “embedded” in hospital care settings, CLAHRC researcher Sonya Crowe and colleagues provide a considered view of the issue and propose some actions hospitals can take to tackle the problem.

Read the paper below

Crowe, S., Grieco, L., Vindrola-Padros, C., Elkhodair, S., Walton, H., Fulop, N. J., & Utley, M. (2019). How can operational research and ethnography help to fix your emergency department? Journal of the Royal Society of Medicinehttps://doi.org/10.1177/0141076819856879


Celebrating Patient and Public Involvement in our research

A new short film celebrates the impact of involving patients and the public in our work! Some of our valued public contributors, alongside senior and early career CLAHRC researchers reflect on being part of the CLAHRC and look ahead to NIHR Applied Research Collaboration (ARC) North Thames.

#getinvolved #todaysresearchtomorrowscare

Reflections from contributors  and researchers below give a flavour of what involvement means to them

“Getting involved in research for me is a passion for furthering healthcare”

“The researchers and clinicians learnt from me and I learnt from them”

“Your views and opinions are equally important”

“They (researchers) might not have lived through what you have lived through”

“It’s like our own little community”

“The people I have met have been from everywhere. Different religions, different races different stories different jobs”

“Please do (get involved) we really want your advice you’re experts in your own health”

“It makes a material difference to research. You ask questions we would not think of”

“Today’s research is tomorrow care”

NIHR ARC North Thames 2019 PhD studentship: cancer and comorbidity

We are accepting applications to our 2019 PhD studentships 

Work with world-class researchers, leading universities, the NHS, local authorities, UCLPartners, industry & patients & the public.



We are funded to conduct high quality applied health research, focused on the needs of patients and the public to produce a direct impact on health and the way health care and public health is organised and delivered.

Led by Professor Rosalind Raine (UCL), we are a collaboration of 50+ partners, including leading universities, NHS trusts, local authorities, clinical commissioning groups, UCLPartners, industry and organisations representing patients and the public.

We invite applications for a 3-year PhD studentship starting in October 2019

Studentships will be based at the London School of Hygiene & Tropical Medicine

Details of the project and supervisors are given below.

Cancer and comorbidity: impact of comorbid conditions on equity of access and safety and outcomes of cancer treatments

Department Name: Department of Health Services Research and Policy at the London School of Hygiene & Tropical Medicine

Supervisors names

Dr J van der Meulen

Mr A Hutchings

Prof D Cromwell

Prof E Nolte

Project Description

The configuration of cancer services is rapidly changing. Service delivery is being re-designed in order to diagnose cancer earlier, accelerate access to treatment, improve patients’ experience, reduce side-effect of treatment and enhance cures for cancer. Two developments are at the centre of this change: 1) centralisation of services creating hub-and-spoke models and 2) increased use of specialist multi-modal treatments.

Existing research has shown that:

  • up to a third of cancer patients ‘bypass’ their nearest cancer centre (‘patient mobility’)
  • cancer centres that offer innovative treatments and employ clinicians with strong media profile are attractive to patients (‘patient choice’)
  • a hub-and-spoke configuration improves outcomes of specialist treatments but has a detrimental impact on equity of access (‘centralisation’)
  • comorbidities may create an ‘implicit barrier’ within referral pathways such that patients with comorbidities may get ‘lost’ to the system (‘equity and efficiency’).

This studentship would address the impact of comorbidities of cancer patients on access to specialist cancer treatments (especially, specialist multimodal treatments), safety (especially, side-effects), patient experience (patient-reported), and patient-centred outcomes (cancer progression, survival) in an era of ongoing top-down re-design of cancer services, which creates an increasingly complex structure of cancer services provision.

The student will mainly use existing data as we will analyse linked national data sets, including national cancer registry data, radiotherapy and chemotherapy data, and Hospital Episode Statistics. These analyses will build on our extensive experience in modelling patient mobility and care pathways, and short and long-term patient outcomes at national level.

A key innovative element is the use of data from geographic information systems for the purpose of location-allocation and patient-choice-and-demand modelling.

The student will have access to detailed national data on the current organisation and availability of specialist cancer treatment modalities and supporting services.


This work builds on our extensive portfolio of National Clinical Audits within the Clinical Effectiveness Unit, the collaborative unit of the London School of Hygiene and Tropical Medicine and the Royal College of Surgeons of England:



This will allow assessment of the impact of both patient and service characteristics on access to and outcomes of cancer services using multilevel modelling.

All candidates should hold a Master’s qualification (or complete their Master’s by September 2019) in an appropriate discipline and have a minimum of a 2:1 or equivalent in their first degree. Applicants should preferably have knowledge of the UK health and care system. All applicants are required to have excellent written and verbal communication skills. They should also be willing to work collaboratively in multi-disciplinary and multi-professional teams.


Project-specific skills and experience required


Essential: being able to carry out statistical analyses of large complex data sets (e.g. regression techniques, time-to-event analysis, choice analysis, multilevel modelling); the project will analyse English administrative hospital data linked to national cancer registration records.

Desirable: having experience in using geographic information systems; the project will include analyses of patient mobility patterns as well as location-allocation modelling.


Application Deadline: 6/10/19 


Interviews: 16/10/2019 


For general enquiries, please email: clahrc.academy@ucl.ac.uk

For project specific queries, please contact: Prof Jan van der Meulen: jan.vandermeulen@lshtm.ac.uk or Andrew Hutchings: Andrew.hutchings@lshtm.ac.uk

CLAHRC Research Area: Health Economics and Data


“It’s a matter of building bridges”…involving carers in the treatment of inpatients with severe mental illness

New research published by CLAHRC researchers based at the Queen Mary University of London highlights the value of family and friends being involved in the care of mental health inpatients.

The paper, published in BMC Psychiatry details how feasible it was to implement carer involvement in four inpatient wards across East London, and explores the experiences of participants.

The intervention was of particular value soon after admission to an inpatient ward, which can be a traumatic and frightening experience.

The researchers, working out of the University’s Unit for Social and Community Psychiatry, found that despite the challenges of implementing carer involvement in hospital treatment for mental illness, a simple structured approach can make a positive difference. The research also found that patients, clinicians and carers appreciated this approach to care.

The intervention will be of value to clinicians as it offers clear procedures to follow. The authors conclude that wider organisational support is vital to make the intervention work, in particular from senior managers and clinical leaders.

“It’s a matter of building bridges…” – feasibility of a carer involvement intervention for inpatients with severe mental illness
Kaselionyte et al. BMC Psychiatry (2019) 19:268

Event for applicants for NIHR Social Care call

Focus on social care research

The NIHR Research for Patient Benefit programme (RfPB) has funded £2.5 million of new research into social care, bolstering NIHR’s commitment to improving social care through high-quality evidence and building capacity for research in this field.

Following last year’s successful funding call, the NIHR will be investing in future social care research with annual funding calls via their RfPB programme, under the banner Research for Social Care (RfSC). The RfSC call, planned to launch in September, will have a budget of £3 million.

The call will be supported by launch events for potential applicants hosted by the NIHR Research Design Service.

For more information about the funding call, please visit the NIHR website.

Social care research funding roadshow

14 October, 14.00-17.00, NCVO, London N1 9RL 

Registration is now open

Attend this information session which will cover aspects of the social care funding call.


  • Registration – 2-2.30pm
  • Opening Remarks – 2.30pm
  • NIHR RfPB social care call specification – 2.35pm
  • Experiences of a previously successful applicant – 3pm
  • Support for applicants – 3.20pm
  • Audience Q&A – 3.30pm (Panellists to be confirmed)
  • Tea Break and Networking – 3.45pm
  • Finish – 17.00

Book a 1:1 session

If you wish to book a 1:1 with an RDS adviser, please email comms@rdslondon.co.uk. This is open to researchers based in London, Kent, Surrey and Sussex.

If you are intending to apply for the funding, we strongly encourage you to attend this event.

Attendance is free of charge, but you must register.

This event is co-hosted by RDS London and RDS South East.

Who is RDS?

Supporting researchers at all stages of preparing grant applications 

The National Institute for Health Research (NIHR) helps to improve people’s health and well-being through high-quality research. However, this requires strong research proposals which is where Research Design Service can help.  

Funded by NIHR, the service was first established in 2008. There are 10 regional services in England. We support health and social care researchers across England on all aspects of developing and writing a grant application. This includes research design, research methods, identifying funding sources and involving patients and the public in research. Our advice is confidential and free.

To find out more: www.nihr.ac.uk/rds



Sign up to the new NHS Innovation Update from UCLPartners

Are you an NHS lead with an interest in technological innovation?

Stay up-to-date with the latest news, products and services, events and opportunities from the innovation team at UCLPartners via a newly launched newsletter.

UCLPartners is an academic health science work with partners across research, education and the NHS working to speed up the pathway from scientific discovery and medical innovation to clinical application in health and care.

As well as being aligned to the CLAHRC (and its imminent successor NIHR Applied Research Collaboration North Thames) it is the Academic Health Science Centre (AHSC) and Academic Health Science Network (AHSN) for our patch.

Sign up to the quarterly e-newsletter at http://bit.ly/NHSInnovation-Update

Being socially active can protect against dementia

CLAHRC researcher Professor Gill Livingston among authors of research highlighting benefits of social contact

Regular contact with a friend at an older age can stave off dementia

New research published in PLOS One has shown the health benefits of being “socially active”. Using data from the WHITEHALL II study, Professor Livingston was among the authors of the paper highlighting the link between being socially active in your 50s and 60s and a lower risk of illness in later life.

WHITEHALL II tracked more than 10,000 people between 1985 to 2013, with those taking part surveyed every five years on the frequency of their social contact with friends and relatives. Participants underwent various cognitive tests, and their health records were monitored for a diagnosis of dementia.

Results showed that seeing friends almost daily at age 60 was associated with a 12% lower likelihood of developing dementia in later life, compared with those who saw only one or two friends every few months. By comparison seeing relatives did not show the same benefit.

The new evidence will be vital as part of the effort to identify lifestyle factors that affect the risk of developing dementia so that prevention efforts can be appropriately targeted.


Dr Kalpa Kharicha, Head of Innovation, Policy and Research at the Campaign to End Loneliness, said: “We welcome these findings that show the benefits of frequent social contact in late/middle age on dementia risk. As we found in our Be More Us Campaign, almost half of UK adults say that their busy lives stop them from connecting with other people. It’s important we make changes to our daily lives to ensure we take the time to connect with others. We need more awareness of the benefits that social wellbeing and connectedness can have to tackle social isolation, loneliness and reduce dementia risk.”

Fiona Carragher, Chief Policy and Research Officer at Alzheimer’s Society, said: “There are many factors to consider before we can confirm for definite whether social isolation is a risk factor or an early sign of the condition – but this study is a step in the right direction. We are proud of supporting work which helps us understand the condition better – it is only through research that we can understand true causes of dementia and how best to prevent it.”

There has been extensive media coverage for this new research

Read the paper below

Sommerlad A, Sabia S, Singh-Manoux A, Lewis G, Livingston G (2019)

Association of social contact with dementia and cognition: 28-year follow-up of the Whitehall II cohort study.

PLoS Med 16(8): e1002862. https://doi.org/10.1371/ journal.pmed.1002862


Success for Professor Deborah Swinglehurst

Professor Deborah Swinglehurst is supported by CLAHRC North Thames to investigate polypharmacy – a patient taking two or more medications – which can often mean drugs are prescribed that are not or no longer needed.

Professor Swinglehurst’s research investigates how professionals and patients organise polypharmacy, in particular, the use of multi-compartment compliance aids (MCAs or ‘dosette boxes’), and the contested evidence around their effectiveness or appropriateness for many patients.

Professor Swinglehurst, a practising GP, had her work recognised at the recent Society for Primary Care’s (SAPC) Annual Scientific Meeting in Exeter. Professor Swinglehurst, working out of Queen Mary University London, was awarded the Senior Prize for presenting her work at the meeting, which awards her a distinguished presentation slot at the NAPCRG (North America Primary Care Research Group) conference in Toronto this November.

Read Professor Swinglehursts’s abstract, entitled Organising polypharmacy: unpacking medicines, unpacking meanings

NEON short film highlights improved nutrition and feeding practices among East London’s Bangladeshi children

NEON (Nurture Early for Optimal Nutrition) is a participatory female health volunteer-led intervention to promote healthy nutrition in children of Bangladeshi origin in East London, who have a  higher risk of diabetes, obesity and heart disease in later life than the average child in the UK.

Childhood nutrition can impact adult health status and the likelihood of chronic diseases such as diabetes as well as oral health complications – making it important to act early to prevent long term problems.

NEON used a proven model from South Asia where the introduction of female health workers into local women’s groups has significantly improved maternal and neonatal survival rates.

A new short film highlights the impact of the NEON approach in local communities, and the improvements it has made to nutrition and feeding practices.

Podcast features CLAHRC evidence on extended thrombectomy treatment times to improve stroke care

CLAHRC researcher Dr Elena Pizzo is featured in a new podcast hosted by the International Journal of Stroke.

Dr Pizzo (below) a health economist discusses her work to improve the treatment of stroke patients in the crucial first 24 hours after the condition strikes with Managing Editor of the Journal Carmen Lahiff-Jenkin

Ischaemic stroke is the most common type of stroke, occurring when a blood clot blocks an artery cutting blood flow to part of the brain. Stroke can lead to coma, severe disability and eventually death if not treated promptly. The podcast is based on a paper Dr Pizzo published earlier this year which demonstrated the benefit of mechanical thrombectomy performed between 6 and 24 hours in acute ischemic stroke.

Mechanical clot retrieval (thrombectomy) is an intervention to remove clots when the current medical treatment (thrombolysis) is not sufficient to dissolve them.

Current economic evidence supports the intervention only within 6 hours, but the published research showed that extended thrombectomy treatment times, of up to 24 hours, may result in better long-term outcomes for a larger cohort of patients.

In the podcast, Elena presents the results of the paper and discusses the implementation of its findings in the UK

Pizzo, E., Dumba, M., & Lobotesis, K. (2019).
Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke.
International Journal of Stroke