Premature mortality twice as high in most deprived areas compared to most affluent

A major new paper in the Lancet highlights rates of premature mortality that are two times higher in the most deprived areas of England (Blackpool) compared to most affluent (Wokingham).

Dr Harry Rutter, Clinical Research Fellow at the London School of Hygiene and Tropical Medicine was among the prominent experts in the field who authored the paper.

Dr Harry Rutter

Dr Rutter, a public health physician, was Principal Investigator of the CLAHRC’s evaluation of the Greater London Authority’s Healthy Schools London programme. 

All-cause age-standardised years of life lost due to premature mortality (YLL) and years lost due to disability (YLD) per 100 000 population by UK country and English Upper Tier Local Authorities, 2016

The work presents findings from a new Global Burden of Disease (GBD) Study funded by the Bill & Melinda Gates Foundation and Public Health England. 

The Global Burden of Disease includes evidence collected and analyzed by a consortium of more than 3,000 researchers in more than 130 countries and provides a tool for goverments and policy makers to measure health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and inequalties tackled

The authors of the Lancet paper used the data to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. They estimated the burden of disease by cause of death, condition, year, and sex.

You can view via an interactive ‘Lost Years’ map – which reveals the extent of health inequality across the UK.

Changes in health in the countries of the UK and 150 English
Local Authority areas 1990–2016: a systematic analysis for
the Global Burden of Disease Study 2016
Nicholas Steel, John A Ford, John N Newton, Adrian C J Davis, Theo Vos, Mohsen Naghavi, Scott Glenn, Andrew Hughes, Alice M Dalton, Diane Stockton, Ciaran Humphreys, Mary Dallat, Jürgen Schmidt, Julian Flowers, Sebastian Fox, Ibrahim Abubakar, Robert W Aldridge,Allan Baker, Carol Brayne, Traolach Brugha, Simon Capewell, Josip Car, Cyrus Cooper, Majid Ezzati, Justine Fitzpatrick, Felix Greaves, Roderick Hay, Simon Hay, Frank Kee, Heidi J Larson, Ronan A Lyons, Azeem Majeed, Martin McKee, Salman Rawaf, Harry Rutter, Sonia Saxena, Aziz Sheikh, Liam Smeeth, Russell M Viner, Stein Emil Vollset, Hywel C Williams, Charles Wolfe,  Anthony Woolf, Christopher J L Murray

How can we improve dementia care in UK black elders?

Black elders dismiss the warning signs of dementia until the condition becomes too severe to ignore or a crisis strikes. They are also less likely to receive a diagnosis of their condition, resulting in delayed treatment and
less time to plan for the future.

Our latest BITE – a summary of published CLAHRC research provides an overview of our work with black elders, their families and carers to;

  1. identify barriers and facilitators to seeking help for dementia.
  2. based on what we found, work with dementia patients and their          carers, volunteers from the public, clinicians and experts in the treatment and research of dementia to develop an intervention – a leaflet entitled Getting help for forgetfulness (below)
  3. trial the intervention with GP registered patients, who were asked to rate it and evaluate its effect on their intention to seek help from their doctor.

What are the challenges of knowledge co-production in embedded research?

The concept of knowledge co-production is used in health services research to describe partnerships (which can involve researchers, practitioners, managers, commissioners or service users) with the purpose of creating, sharing and negotiating different knowledge types used to
make improvements in health services.

The CLAHRC has researchers “embedded” in a number of our partner organisations in the NHS and local government. The “researcher in residence” model has the advantage of allowing academics to be close to the ground and gain insight into how an organisation really operates. It also presents challenges in creating and maintaining key relationships and professional independence.

In a newly published BITE-sized summary of our research we present the results of our examination of three case studies and the wider implications for this model of working.

One to one specialling and sitters in acute care hospitals; reviewing the evidence

One to one nursing, or specialling is a way of caring for patients by providing continuous observation (by “sitters”) for an individual for a period of time during acute physical or mental illness.

Some patients need more than a general level of observation on a ward, often with the primary aim of reducing risk and protecting the patient.

Our review, published in a BITE, examined published evidence on the topic of specialling and sitters, aiming to identify the challenges and concerns relating to the cost effectiveness and quality of care.

Medication adherence in asthma: can pharmacists help?

Preventer inhalers (inhaled corticosteroids) are a common medication for asthma, and people get the full benefit of the medication by taking their prescribed doses correctly. We know many patients struggle to take enough doses effectvely, which impacts their ability to manage the condition.

Could pharmacists hold the key to helping patients take medicines effectively and in the right doses?

Our latest BITE – a postcard “need to know” summary of our research – presents the findings of our review of the evidence on whether pharmacists involved in asthma care could help people take their preventer inhaler as prescribed, therefore giving them the full benefit of their medication.

CLAHRC evidence influences decisions on front-line services

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: 

Does locating welfare advice in GP surgeries improve health and reduce strain on the NHS?

Our work is award winning

CLAHRC researchers enjoyed success at the recent Public Health England Annual Conference in Warwick.

They were among the authors of an award winning poster representing our partnership work with Islington Council.

We are working with the borough as it seeks to link NHS data with its own datasets to build a clearer picture of  local population needs and better target services and interventions.

Linking these sources of data can build a picture of how social determinants of health – the conditions in which people are born, grow, live, work and age – might impact on residents’ wellbeing and use of health services. Examples would include how housing conditions impact on hospital admissions or how serious childhood illnesses could affect school attendance and attainment.

The poster was presented by Laura Scott, Principal Data Specialist at Islington Council and highlights how 90 data sources within the council are being joined up, already proving valuable in understanding local risk factors for ill health and improving access to services.

Islington insights population register: linking council data to understand local population needs for a fairer, healthier society

Laura Scott, Helen McDonald, Mahnaz Shaukat, Lawrence Vandervoort, Logan Robertson, Jessica Sheringham, Sarah Dougan

Over 1500 participants visited the PHE annual conference representing a wide range of organisations working to improve the health of the public. 

The CLAHRC’s Dr Jessica Sheringham (Senior Research Associate) was an author of the poster chosen from over 350 submitted – the award was presented at the conference dinner.

The project is funded by the Health Foundationas part of its Advancing Applied Analytics programme, aimed at improving analytical capability in support of health and care services.

Read more about this work via the link below

Linking health and local government data at household level to understand social determinants of health

Mayor launches school programme developed to improve self-management of asthma in young people

The Mayor of London, Sadiq Khan has launched a programme to improve the self-management of asthma by school children in the Capital. My Asthma in School was developed by CLAHRC researchers based at the Blizard Institute within Queen Mary University of London.

My Asthma in School

The programme uses educational workshops and theatre performance to improve asthma control and peer support for asthma in London secondary school.

Asthma affects approximately one in 11 children and young people in the UK; and young people with asthma have higher rates of school absences and visits to their doctor or the hospital. According to the data collected for the study, nearly half of young people (aged 11-18 years) with asthma did not have control over their condition.

Dr Gioia Mosler, Outreach and Learning Manager for the ‘My asthma in school project’, said: 

“The number of deaths from asthma in the UK rank among the highest in the EU. Many of these deaths could be prevented with better self-management.”

She added: “Improving the ability and motivation to self-manage asthma gives many young asthma sufferers the opportunity to improve their asthma control. As a result they would suffer less from common symptoms like coughing at night or breathlessness.”

My asthma in School is one of the first school-based interventions for asthma self-management in the UK. Similar trials have been undertaken outside the UK, however, given that the health and education systems differ, results from these interventions may not be transferable to a UK setting.

The programme has been approved and supported by Sadiq Khan, Mayor of London. Mayor Khan was himself diagnosed with the conditon as an adult –  which he attributes to London’s poor air quality and pollution levels.

He said: “The Greater London Authority and I believe that the ‘My Asthma in School’ programme is likely to promote the necessary education young people require to effectively self-manage their asthma.”

He added: “I encourage all London secondary schools to take part in this programme.”

Using behavioural change theories as a framework, researchers have developed a variety of engaging and entertaining media, such as apps, videos, and interactive games.

The intervention includes an interactive theatre performance (below), lasting approximately two hours, to help raise awareness of asthma among peers. The performance has been developed with partners at Greenwich and Lewisham Young People’s Theatre.

Dr Mosler added: “The theatre intervention addresses asthma from a new angle, focusing on peer awareness and support around young people with asthma. The questionnaire data we collected during phase one showed many barriers related to a perceived stigma around asthma. The theatre intervention addresses stigma around asthma in the peer group.”

The intervention will be trialled in London during the next few months. Given a positive result of this intervention it could be adopted as a wider programme to improve asthma in young people.

The programme is run as part of the My Health in School initiative which aims to improve life and health of young people at school. The team works with Professor Jonathan Grigg, who leads several studies about asthma and lung health in children and young people.

Using Virtual Simulation to Improve Endovascular Aneurysm Repair: Patient Advisor

Background

A common surgical treatment for abdominal aortic aneurysm (AAA) is called Endovascular Aneurysm Repair, or “EVAR”. EVAR uses wires and catheters to insert a stent graft inside the aorta to divert blood away from the aneurysm. EVAR has good short term outcomes, including low complication rates during surgery and shortly after. However, there is a need to improve the long-term success of EVAR, which frequently leads to complications after approximately 5 years. We plan to develop a virtual computer modelling system that can predict the likelihood of success or failure of an EVAR graft, tailored to the individual patient. This tool will be useful for planning EVAR, especially in time-constrained situations like emergency AAA treatment, and for training vascular specialists to improve their skills.

We are preparing a grant application to carry out research on this topic. This research will

  • explore the patient experience of undergoing EVAR and associated follow-up;
  • explore how clinicians who carry out EVAR make decisions around the procedure
  • seek to understand how a computational modelling system can be designed to best meet the needs of key stakeholders (e.g., clinicians and device manufacturers) and improve patient care

We are inviting a patient representative who has previously undergone EVAR to repair an AAA to join our team and shape this work.

Though we recognise the value of individual experience of health and care, we hope you will be able to raise a broader range of viewpoints beyond your own personal experience.

Working alongside our research facilitator, and team of clinicians and researchers, your involvement will ensure that the patient perspective is at the heart of what we do.

Time commitment:                

We ask for a time commitment of approximately 1 hour per week from start until then. Most of this time will involve checking documents or emails from your home, and is flexible. You will be asked to attend three 60-90 minute meetings in September, October and November 2018.

Venue:                                     

Meetings will be typically held at a Central London location.

Remuneration and Expenses:

Out-of-pocket expenses for travel. A stipend of £30 per meeting. Reimbursement for review of documents subject to the size and scale of the forms (£15 for brief documents; £30 for full grant application).

Supported by:                        

The CLAHRC Research and Implementation Facilitator and Patient and Public Involvement (PPI) officer

Tenure of Office:                     

Through to December 2018 initially with an opportunity to join the research team if the grant bid is successful and/or to become involved in a related research project.

Role description:

The patient advisor will be required to contribute by:

  • Share your ideas, from your own experience, to help prepare a grant application to conduct this research in the UK. If our grant application is successful we will invite you to be part of the research team.
  • Prepare for and attend meetings in central London to discuss plans as a team, or give feedback via a phone call or email
  • Comment on research documents, such as scripts and questionnaires we plan to use to interview patient participants in the research

Role requirements

  • Diagnosis of abdominal aortic aneurysm and previous endovascular aneurysm repair (EVAR)
  • Knowledge and understanding of patient, public and service user perspectives, with an ability to raise a wider range of viewpoints beyond your own personal experience
  • Good communication skills with an ability to listen to others and confidently and constructively express your own views
  • An ability to work effectively and positively as part of a team
  • Assisting the research team in bringing an understanding of the viewpoints of patients to this work
  • Respecting any requests for confidentiality and declaring any conflicts of interest if they arise

Further Opportunities

The patient advisor will have the chance to

  • Get involved in our research grant application
  • Help to steer the research project if the grant application is successful
  • Have input to help direct our wider research plans and ideas in this area
  • Meet and work with world-class researchers in some of the UK’s most prestigious education institutions

Attendance fees and expenses

A stipend for preparation and attendance at meetings of £30 and for review of key documents (£15 or £30 subject to the size of the forms) will be paid to the role-holder. Travel expenses to and from meetings will also be reimbursed.  Those in receipt of state benefits and allowances are advised to contact the Benefits Advice Service for involvement in research. Contact INVOLVE by email: benefits@invo.org.uk or phone 02380 651088 and quote NIHR CLAHRC North Thames.

Support to Panel members

All members will be supported by an experienced Patient and Public Involvement Officer and the project’s Research & Implementation Facilitator. The role-holder will be expected to identify any personal learning and development needs with the CLAHRC PPI Officer either in advance of formally taking up the role or during their tenure. Advice and help will also be available from the CLAHRC core team.

Recruitment and Selection Process

NIHR CLAHRC is committed to diversity of lay representation and applications are encouraged from individuals based throughout the North Thames region, from all backgrounds, and all age groups (from sixteen upwards). Interested candidates will be asked to complete a short supporting statement.

Contact details

Melissa N Galea Holmes

NIHR CLAHRC North Thames Research & Implementation Facilitator

UCL Department of Applied Health Research

1‐19 Torrington Place, London WC1E 7HB, Rm 112

Postal Address: UCL, Gower Street, London WC1E 6BT

T: +44 (0)20 3108 3269 (Ext. 53237)

E: melissa.galea‐holmes@ucl.ac.uk or stephanie.hume@ucl.ac.uk