The Impact of Delayed Discharge

The impact of delayed discharge—defined as ‘the period of continued hospital stay after a patient is deemed medically fit to leave hospital but is unable to do so for non-medical reasons’— is an important problem for health-care providers internationally. Costs to the National Health Service (NHS) in England associated with delayed discharge are approximately £100m per year.

Beyond the financial burden this places on a hard-pressed NHS and other services, there are real implications for inpatients’ health and safety as well as the stress levels of staff and different staff groups involved in the process.

Newly published CLAHRC research – summarised in our latest BITE – assesses the impact and experiences of delayed discharge at multiple levels, from the perspective of patients, health professionals and hospitals; and associated costs of delay.

Read the full paper

Rojas-García A, Turner S, Pizzo E, Hudson E, Thomas J, Raine R.
Impact and experiences of delayed discharge: A mixed-studies systematic review.
Health expectations : an international journal of public participation in health care and health policy. 2017. DOI: 10.1111/hex.12619

Two PhD studentships jointly funded by CLAHRC and the School for Public Health Research

Two National Institute for Health Research funded PhD studentships available

The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames and the NIHR School for Public Health Research (SPHR) based at UCL invite applications for two jointly-funded 3-year PhD studentships at UCL to begin September 2018. Supervisors are drawn from across both the NIHR CLAHRC North Thames and NIHR SPHR. PhD projects align with the following NIHR CLAHRC North Thames and NIHR SPHR themes:

  • Children and Young People
  • Public Mental Health
  • Inequalities

The benefit of this collaborative initiative include joint funding from two high profile NIHR research collaborations, which facilitates the opportunity for unparalleled access to leading applied and public health experts, supervisors who are leaders in their field, channels for dissemination of research and participation in bespoke training and a strong network and community of graduate students and researchers. From the four topics outlined below, two will be funded through these joint studentships.

PhD Research Topics

  1. Integrated legal advice and health services

Supervised by Prof Rosalind Raine (NIHR CLAHRC North Thames, NIHR SPHR, UCL), Prof Dame Hazel Genn (UCL Centre for Access to Justice) and Dr Charlotte Woodhead (NIHR CLAHRC North Thames, NIHR SPHR, UCL)

  1. Exploring the value of linked health and council data to examine associations between adverse childhood experiences and its consequences using linked population and health datasets

Supervisory panel includes Dr Jessica Sheringham (NIHR CLAHRC North Thames, UCL), Dr Manuel Gomes (UCL) and Dr Sarah Dougan (London Borough of Islington)

  1. Exploring the value of linked health and council data to examine the clustering of multimorbidity and associated unplanned service use

Supervisory panel includes Dr Jessica Sheringham (NIHR CLAHRC North Thames, UCL), Dr Manuel Gomes (UCL) and Dr Sarah Dougan (London Borough of Islington)

  1. Closing the gap in adverse physical health outcomes for people with poor mental health: exploring the role of healthcare provision and care pathways

Supervised by Dr Kate Walters (NIHR SPHR, UCL) and Prof David Osborn (NIHR SPHR, UCL)

Further details of all topics and methodological expertise or experience required can be found here: PhD Studentships – CLAHRC SPHR Full Description 2018 

Eligibility

Candidates should hold a Master’s qualification (or complete their Master’s by September 2018) 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.

Due to funding restrictions applicants must be UK/EU nationals. Please refer to UK Council for International Student Affairs (UKCISA) for details of these criteria.

How to apply

Your application should consist of a CV, contact details of two academic referees, and a personal statement (1,000 words maximum) describing your suitability for the proposed project(s) including how your research experience, skills and interests relate to the NIHR CLAHRC North Thames and NIHR SPHR project(s). In your application, please indicate which project(s) you wish to be considered for.

Please send your application or queries about projects to Dr Silvie Cooper, NIHR CLAHRC North Thames Academy Teaching Fellow (silvie.cooper@ucl.ac.uk).

Closing date for applications: 17.00, 15 May 2018

Interviews: 25 May 2018

PhD start date: 01 September 2018 (or earlier if desired)

Duration: 3 years, full time

Stipend:  £19,158

 

Results of Brian Turley Patient and Carer Involvement Awards announced

The votes are cast and the results are in the winners of the inaugural London wide Brian Turley Patient and Carer Involvement Awards have been selected!

The Awards were created in memory of Brian Turley (pictured below) , a dedicated and committed patient advocate and disability rights campaigner who worked closely with our colleagues at NIHR CLAHRC North West London. The awards aim to sustain Brian’s values and commitment to partnerships between professionals and patients, carers and the public in research and service improvement work across the Capital.

All candidates have been informed of the results.

Winners will be officially announced on April 26th at the NIHR CLAHRC NWL Spring Learning Event at the Congress Centre in Central London.

We look forward to the presentation of the Awards by Simon Denegri, National Director for Patients and Public in Health Research.

 

Visit http://clahrc-northwestlondon.nihr.ac.uk/ to register for this free event.

Our thanks to researchers, NHS and Public Health staff and of course patients, carers and users of services who took the time to put together nominations and entries,

We also recognise the work of judges from each CLAHRC who took the time to consider each award carefully, and provide detailed and constructive feedback for entrants.

 

CLAHRC Director Prof Rosalind Raine starts work with Joint Lancet/LSE Commision on the future of the NHS

The future of the NHS is a massive issue and always at the top of the public agenda.

While the Service is the topic of fierce debate at election times, and is often used as a political football to criticise or discredit opponents, the need for a longer-term more considered view is vital to help ensure public debate is better-informed.

In this spirit the Lancet has launched a new joint Commision with the London School of Economics and Political Science on the future of the NHS. The Commission will examine how well placed the NHS is to deliver high-quality care free at the point of need in light of the massive demographic and political changes that have occured since its launch in 1948.

CLAHRC North Thames Director Professor Rosalind Raine (below) is one of the prominent thinkers recruited to be part of the Commision.

The Service’s 70th anniversary provides a timely opportunity to review how much the NHS can still fulfil its aspiration, set out in the 1942 Beveridge Report  to be “a national health service for prevention and for cure of disease and disability” that “will ensure that for every citizen there is available whatever medical treatment he requires, in whatever form he requires”.

Over the next 18-month period, Professor Raine will join commissioners from a wide range of disciplines across England, Scotland, Wales and Northern Ireland to focus on the pertinent challenges facing the NHS, culminating in the release of a report containing a series of policy recommendations in 2019.

External organisations can submit written evidence  to the Commission on their perspectives regarding the biggest challenges facing the NHS.

An opinion piece in the Lancet marks the start of the Commission’s work.

The future of the NHS: no longer the envy of the world?

Mossialos, Elias et al.

The Lancet , Volume 391 , Issue 10125 , 1001 – 1003

DOI: https://doi.org/10.1016/S0140-6736(18)30574-9

Improving NHS orthopedic care – your views and experience needed

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
and
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 –

Dr Jean Ledger: j.ledger@ucl.ac.uk or 020 7679 2000 / x53274
Dr Sarah Jasim: sarah.jasim@ucl.ac.uk or 020 7679 2000 / x53233

Introduction to Evaluation Online: 16 April – 13 May 2018

Do you need to demonstrate the impact of projects in your organisation?

Do you want to improve the design and implementation of your programmes?

Are you tasked with carrying out an evaluation, but don’t know where to start?

Consider enrolling in our four-week online course run by the NIHR CLAHRC North Thames Academy to address these challenges. It is aimed at staff in frontline services at NHS Trusts, CCGs and Local Authorities, who have limited experience conducting service evaluations.

After participating in this course, you will have the skills and knowledge to undertake your own evaluation of a local programme or service. Inspired by the content of our popular face-to-face evaluation course, the online course will cover:

  • Different types of evaluation, including their pros and cons

  • How to select suitable methods and approaches for evaluating a local programme or service

  • Practical skills and tips in using evaluation methods and approaches

  • Ways of sharing your evaluation findings to make an impact

Teaching will be delivered entirely online, by expert tutors. You’ll learn by watching videocasts; interacting through activities and questions; and learning from others by taking part in the discussions that accompany each step. You’ll also develop a plan for a real life evaluation you may have to conduct.

 

Who is this workshop suitable for?

Staff from NHS trusts, local authorities and clinical commissioning groups who need to evaluate local programmes or services as part of their work. The course is not aimed at academics or researchers.

 

What preparation is needed?

Participants should attend the course with an evaluation in mind that they may have to carry out.  No previous knowledge of evaluation is required, or experience of study design and statistics.

Participants will receive a certificate of completion if they undertake at least 80% of the course activities.

 

Dates – Monday 16 April – Sunday 13 May 2018.

Learning hours 3 hours per week (12 hours in total)

Cost – £100 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.

Registration – Registration will open in February 2018, when an application form will be available here. Applications will be selected to ensure a diverse range of participants.  The closing date is Friday 30th March, 5pm.

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, Sunday 8th April 2018.

 

For more information, and to be added to our mailing list, please contact clahrc.academy@ucl.ac.uk

New research – Improving the response to domestic violence and abuse in sexual health clinics

The findings of the joint CLAHRC West and CLAHRC North Thames study of the IRIS ADViSE pilot, which aimed to improve sexual health professionals’ response to women who have experienced domestic violence, are now available as a CLAHRC BITE.

Women who have experienced domestic violence and abuse (DVA) are three times more likely to have gynaecological and sexual health problems such as sexually transmitted infections, urinary tract infections and unintended pregnancy. Forty-seven per cent of women attending sexual health services will have experienced DVA at some point in their lives.

These services can be the first point of contact for women who have experienced DVA, so sexual health practitioners can have a key role in supporting women to access advocacy services. But most sexual health professionals haven’t had much training in identifying and responding to DVA, despite National Institute for Health and Care Excellence (NICE) recommendations.

The IRIS (Identification and Referral to Improve Safety) programme is an evidence-based training intervention for general practice staff to identify, respond and appropriately refer women who are affected by DVA. It is being implemented in general practice nationwide. IRIS ADViSE (Assessing for Domestic Violence in Sexual Health Environments) adapts the IRIS approach for sexual health staff.

This project looked at the feasibility and acceptability of the IRIS ADViSE pilot in sexual health clinics in Bristol and East London. The pilot aimed to encourage sexual health staff to ask patients whether they were experiencing DVA, and to make referrals to specialist services.

IRIS ADViSE included all staff training, patient information materials, an enquiry prompt in the electronic patient record and a simple referral pathway to DVA advocacy services.

In the east London clinic over seven weeks:

  • 267 out of 2,568 women attending were asked about DVA
  • 16 of those (6 per cent) said that they were affected by abuse
  • Overall, eight of the women affected by abuse (50 per cent) were referred to specialist services

In the Bristol clinic over 12 weeks:

  • 1,090 out of 1,775 women attending were asked about DVA
  • 79 of those (7 per cent) said they were affected by abuse
  • Overall, eight of the women affected by abuse (10 per cent), were referred to specialist services

During the three months before the pilot started, there were no referrals to DVA specialist services at either site.

We also interviewed sexual health clinic staff and DVA advocate workers in Bristol.

All the people we interviewed felt that asking about and referring women on to DVA services was appropriate and valuable in a sexual health setting. They responded favourably to the training and felt more confident about asking about DVA and managing disclosures.

Staff said that patients’ welcomed being asked about it, even if they’ve not ever been involved in an incident of domestic abuse themselves, that they appreciate that people are asking that question.

The staff reported that some disclosures were considered relatively simple and easy to handle, where patients can be easily referred to the partner DVA organisation or given information.

However, cases with an immediate risk of harm to the patient or their children were more complex in terms of managing the patient’s wishes and navigating existing safeguarding procedures. This added to staff’s already limited time and busy workloads.

Dr Jeremy Horwood (pictured below), lead researcher from the Centre for Academic Primary Care at University of Bristol and NIHR CLAHRC West, said:

“Sexual health staff are definitely supportive of asking their patients about domestic violence and abuse. But it’s crucial that they have support to do so, as these patients must be dealt with sensitively and referred on appropriately.

“At the policy and commissioning level, stronger recognition of the issues around domestic violence and abuse referrals, and resources to support them, are needed. Commissioners and local NHS trusts need to engage and commit to support domestic violence and abuse training, and to support programmes such as IRIS ADViSE.”

The study shows that it is feasible and acceptable to develop and implement the IRIS ADViSE training and referral package for sexual health clinics. At the policy and commissioning level, stronger recognition of the issues around DVA referrals, and more resources to support them, are needed. Commissioners and local NHS trusts need to engage and commit to financially support IRIS ADViSE to maximise its potential.

This study is part of CLAHRC North Thames’ wider collaboration with our colleagues at CLAHRC West.  Researchers and staff work across London and Bristol sites each bringing their own expertise and experience to produce high-quality research.  Our teams regularly meet to coordinate their work, and develop bids for funding for future work.

For this IRIS ADViSE project CLAHRC North Thames led on the work at the initial pilot site, focusing on the quantitative analysis; whereas CLAHRC West led on the qualitative analysis.

Links and downloads

BMJ talk medicine
Domestic violence affects a quarter of UK women: the role of sexual health practitioners
Listen to a podcast hosted by Editor in Chief of Sexually Transmitted Infections Jackie Cassell who is joined by Neha Pathak (Wellcome Trust Clinical PhD Fellow, Institute for Epidemiology & Healthcare, University College London) and Gene Feder (University of Bristol, Centre for Academic Primary Care) to discuss the various forms of the abuse and how healthcare practitioners can intervene.

 

Read our CLAHRC BITE summarising the research
Improving the response to domestic violence in sexual health clinics

Read the full research papers –

Sohal AH, Pathak N, Blake S, Apea, V. Berry, J. Bailey, J. Griffiths, C. Feder, G. (2018)
Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention
SexuallyTransmitted Infections doi: 10.1136/sextrans-2016-052866

Horwood J, Morden A, Bailey JE, Pathak, N and Feder, G. (2018)
Assessing for domestic violence in sexual health environments: a qualitative study
Sexually Transmitted Infections. doi: 10.1136/sextrans-2017-053322

Pathak N, Sohal AH, Feder G.(2017)
How to enquire and respond to domestic violence and abuse in sexual health clinics.
Sexually Transmitted Infections. 2017 May;93(3):175-178. doi: 10.1136/sextrans-2015-052408. Epub 2016 Jul 25.

Deadline Extended – Introduction to Evaluation: 20th June 2018

Do you need to demonstrate the impact of projects in your organisation?

Do you want to improve the design and implementation of your programmes?

Are you tasked with carrying out an evaluation, but don’t know where to start?

This one day, hands-on workshop, run by the NIHR CLAHRC North Thames Academy, addresses these challenges. It is aimed at staff from NHS Trusts, CCGs and Local Authorities, who have limited experience of conducting service evaluations.

After attending this workshop, you will have the skills and knowledge to undertake your own evaluation of a local programme or service.

The course covers:

  • Different types of evaluation, including their pros and cons

  • How to select suitable methods and approaches for evaluating a local programme or service

  • Practical skills and tips in using evaluation methods and approaches

  • Ways of sharing your evaluation findings to make an impact

This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs. It is not aimed at academics and/or researchers. Participants should attend the course with an evaluation in mind that they may need to carry out. No previous experience of study design, statistics or evaluation is required.

All participants will receive a certificate of attendance.

Cost – This course is 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.

Registration – Registration is open, and you can find the application form here. Applications will be selected to ensure a diverse range of participants

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 13th June 2018.

For more information, and to be added to our mailing list, please contact clahrc.academy@ucl.ac.uk

Becoming Research Active: 22nd May 2018; 9am-5pm


Are you a nurse, allied health professional, public health or local government member of staff who is interested in research or who has had some exposure to research*? Our new workshop is suitable for staff from NHS Trusts, NHS CCGs, and Local Authorities who are keen to become involved in research.

Engaging in research is a great way to address the questions that often arise in health care. It can also play a vital role in producing new evidence and new knowledge for decision-making to improve health care.

This one day, practical workshop provides an introduction to the research process to enable NHS and local government staff to engage in research activity. The course is run by the NIHR CLAHRC North Thames Academy, together with the Research Design Service London (east London arm) and Clinical Research Network North Thames.

This introductory level course is a first step on the journey towards becoming “research active”, either by developing your own small project or getting involved in other ways e.g. collaborating on research studies, assisting clients/ patients in your care to take part in research, being a (critical) research ‘consumer’ or helping to shape research priorities, design and delivery. We ask that participants attend the workshop with a research idea, innovation, or change that they would like to plan for, or collaborate on with researchers.

By the end of the course participants will:

  • Understand the research process, including the principles behind good research design and planning for dissemination and impact

  • Understand the different roles within a research team and identify the points at which you can become involved

  • Be able to apply criteria to judge the potential value and feasibility of a research project idea

  • Have a basic understanding of research governance and ethics requirements, and know where to find out more

  • Know how to involve patients and the public in every stage of research, and understand how it could benefit the research

  • Know how to access relevant resources or the help available across North Thames to design, plan and fund research

This workshop is not aimed at academics and/or researchers.

* e.g. you might have done a Masters level module in collecting and analysing data, or critical appraisal of research, or have helped to support research in your organisation or attended another one of our Academy courses.

All participants will receive a certificate of attendance.

Cost – This course is free for staff working in NIHR CLAHRC North Thames partner organisations (a list of our partners is available on our website). There is a delegate fee of £250 for other attendees.

Venue – Central London

Registration – Please complete the registration form and email to clahrc.academy@ucl.ac.uk by 5pm, Friday 23rd March

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 on 15th May 2018.

Introduction to Evaluation Online: 16 April – 13 May 2018

Do you need to demonstrate the impact of projects in your organisation?

Do you want to improve the design and implementation of your programmes?

Are you tasked with carrying out an evaluation, but don’t know where to start?

Consider enrolling in our four-week online course run by the NIHR CLAHRC North Thames Academy to address these challenges. It is aimed at staff in frontline services at NHS Trusts, CCGs and Local Authorities, who have limited experience conducting service evaluations.

After participating in this course, you will have the skills and knowledge to undertake your own evaluation of a local programme or service. Inspired by the content of our popular face-to-face evaluation course, the online course will cover:

  • Different types of evaluation, including their pros and cons

  • How to select suitable methods and approaches for evaluating a local programme or service

  • Practical skills and tips in using evaluation methods and approaches

  • Ways of sharing your evaluation findings to make an impact

Teaching will be delivered entirely online, by expert tutors. You’ll learn by watching videocasts; interacting through activities and questions; and learning from others by taking part in the discussions that accompany each step. You’ll also develop a plan for a real life evaluation you may have to conduct.

Who is this workshop suitable for?

Staff from NHS trusts, local authorities and clinical commissioning groups who need to evaluate local programmes or services as part of their work. The course is not aimed at academics or researchers.

What preparation is needed?

Participants should attend the course with an evaluation in mind that they may have to carry out.  No previous knowledge of evaluation is required, or experience of study design and statistics.

Participants will receive a certificate of completion if they undertake at least 80% of the course activities.

Dates – Monday 16 April – Sunday 13 May 2018.

Learning hours 3 hours per week (12 hours in total)

Cost – £100 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.

Registration – Registration will open in February 2018, when an application form will be available here. Applications will be selected to ensure a diverse range of participants.

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, Sunday 8th April 2018.

 

For more information, and to be added to our mailing list, please contact clahrc.academy@ucl.ac.uk