Your SlideShare is downloading. ×
0
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Stroke Event 13 Sep - Afternoon presentations
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Stroke Event 13 Sep - Afternoon presentations

543

Published on

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
543
On Slideshare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. CLAHRC Impact- Influencing change in practice. Chair: Prof Avril Drummond A partnership between Nottinghamshire Healthcare NHS Trust and the University of Nottingham Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 2. Dawkins’ Law Dawkins’ Law of the Conservation of Difficulty states that obscurantism in an academic subject expands to fill the vacuum of its intrinsic simplicity. Influencing change in practice Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 3. • My name is Fred Higton • Age 65 - Retired (more or less) • Over 35 years developing medicines and as a pharmaceutical consultant • Cartoonist and caricaturist for 40 + yrs FRED’S STORY Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 4. Hobbies: • Gardening especially vegetables • Music. Classical and folk • Played: Banjo, mandoline, mandola, clarinet, crumhorn, dulcimer • Art FRED’S STORY Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 5. THE STROKE • 11th Jan 2011 ca 4:00pm • Lost all feeling and movement, right side • Bleed • Seacole ward City Hospital 7 weeks • Moderate to Severe FRED’S STORY Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 6. • Private physio once a week • Use SAEBO brace every day • Carer am to help me wash and dress FRED’S STORY Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 7. Involvement in the Wii STAR project • Initially involved in hospital • Further work in Rehab Unit • Work at Home • Two television appearances FRED’S STORY Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 8. PROGRESS: • I can walk a little • I have learned to draw left handed • I drive a modified car • I cook • I now sing unaccompanied folk • I volunteer FRED’S STORY Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 9. LIVING WITH A DISABILITY IS A LOT BETTER THAN THE ALTERNATIVE FRED’S STORY Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 10. The Diffusion Fellow and the Service Manager Jane Terry - Occupational Therapist and CLAHRC Diffusion Fellow Kate Hooban - Team Manager Community Stroke Discharge and Rehabilitation Service Nottingham CityCare Partnership
  • 11. Background to Diffusion Fellow Role • 2009 new DF role identified within CLAHRC which was highlighted as an opportunity by Pip Logan (Research Lead for Nottingham CityCare) and staff encouraged to apply • Sought approval from Team Manager and organisation to apply • Informal interview then began in post May 2009. • Backfill for post secured (I day per week of Band 5 OT) • Allocated to individual Stroke theme project (Return to Work) • Project Lead (Kate Radford) identified from Nottingham University • Initial training and development opportunities together with other Diffusion Fellows took place • Organisation mentor identified to guide role.
  • 12. Intention of Diffusion Fellow role • Crucial mediator between research and practice with dedicated time, knowledge, motivation and support to get research findings into practice • Fully integrated member of RTW research team within stroke rehabilitation theme. • Help inform design and execution of the Return to Work (RTW) after stroke project • Identify relevant stakeholders and disseminate CLAHRC information to healthcare partners and commissioners • Translate information into appropriate language for all stakeholders
  • 13. Diffusion Fellow Role- Return to Work 1 • Clinical knowledge and experience of working with stroke survivors helped inform and shape the early development of the study e.g. questionnaire • Using extensive clinical contact network as reference points • Mapping key stakeholders in NDL for Phase I • Commissioner focus group early in study • Qualitative interviews with trial participants /employers /commissioners /stakeholders
  • 14. Diffusion Fellow Role-Return to Work 2 • Assisting with thematic analysis of qualitative interviews • Contribution to publications and presentations • Acting as member of Expert Panel and Steering Group • Ongoing involvement in shaping the role of the CLAHRC Diffusion Fellow • Assisting other stroke theme projects with recruitment • Assisting with development of ideas for future research projects.
  • 15. Benefits to Nottingham CityCare Organisation • Development of body of research aware staff (already championed by Pip Logan in CityCare). • Established body of clinicians and patients to inform and shape the development of future research bids. • Delivery of evidence based clinical interventions and best practice which improves patient experience and more importantly OUTCOMES. • Cost savings through working more effectively and moving away from non proven traditional practices. • Enhanced reputation of the organisation through DF contribution to posters/presentations at national conferences and publications.
  • 16. Opportunities for CityCare Stroke Service • Stronger links with researchers and Nottingham University • Opportunities to engage with other CLAHRC Stroke theme projects (Wii Star and ESDT consensus • Raised profile of research which benefits patients • Development of research culture within the service leading to new research projects (RCAS) • Commissioned Return to Work OT pilot service with I year funding and evaluation by Nottingham University
  • 17. Benefits for Nottingham CityCare Staff • DF role developed communication channels between researchers and clinicians and provided a conduit for information and innovation. • Greater opportunities for clinicians to be involved in research projects by contributing to recruitment to stroke projects. Formal and informal links were fostered. • Personal development for diffusion fellow through contribution to posters, presentations and publications
  • 18. Challenges • Managing time within 2 roles and clinical caseload pressures. Difficult to limit to one day a week. • Working within two very different work cultures and environments. • Demands of new training requirements in role. • Pressure of achieving 2 sets of objectives. • Practicalities of organising and managing backfill- extra supervision, training • Loss of Band 7 clinical knowledge, skills and expertise in team • Organisational changes throughout period (TCS, new manager, new mentor, several staff changes on RTW project, new commissioning structures and commissioners) • Uncertainty of time length of role (Extended towards end of period)
  • 19. Going Forwards Negatives: • Lack of continuation of DF role due to end of CLAHRC • No current opportunity to build on skills learnt and carry forward experience and knowledge • Time limited push of CLAHRC not continued . Research and practice links could be lost. Positives: • Nottingham CityCare presentations were completed at strategic level to raise profile of CLAHRC project and potential benefits to CityCare patients. • Business case for pilot RTW service was developed in partnership with Nottingham City commissioners and has been shared with Derbyshire to support bid in that area. • New Return to Work service commissioned as a one year pilot. OT transferred skills and knowledge into this project.
  • 20. • What is diffusion? – In the CLAHRC context it is spreading research knowledge to aid take up of evidence in practice • How did CLAHRC try to do it? – Diffusion Fellows • Almost 30 people seconded by CLAHRC‟s partner organisations to be attached to a CLAHRC study for 0.5 – 1 day a week for five years • Included nurses, physiotherapists, managers, consultant psychiatrists, psychologists, occupational therapists, City Council employees Diffusion Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 21. • No – Some diffusion fellows left early on – Some study teams did not gel with their diffusion fellows – Some studies didn‟t produce results to be diffused – Some organisations didn‟t give enough support (e.g. backfill or showing interest) • Yes – Success in developing networks – Studies that made a difference to practice, e.g. Return to Work and key role of diffusion fellow Did it work as originally conceived? Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 22. • From „yes‟ and „no‟ we learned – It helps to have a fit between diffusion fellow and study – Getting to know each other is important and varied between themes – Personal characteristics of diffusion fellows – no template but there are some characteristics that help – There are characteristics of study teams, managers and organisations that help the process – Support and development is important – Diffusion happens both ways, into research as well as into practice – It is a brilliant way to develop research receptiveness in organisations – capacity, capability, knowledge, understanding, ensuring feedback loops, engaging teams on the ground Huge benefits beyond original idea Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 23. …… they are one part of a big system and other things need to be in place: • Timeliness • Politics • Mutual respect • Relevant, quality evidence • Support and interest from all parts of the system Diffusion fellows are not the only answer Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 24. Thank you for listening alison.seymour@nottingham.ac.uk www.clahrc-ndl.nihr.ac.uk Twitter: @CLAHRC_NDL Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 25. Influencing cultural change; becoming a clinical academic Phillip Whitehead NIHR Doctoral Research Fellow phillip.j.whitehead@nottingham.ac.uk
  • 26. Background • Occupational Therapist • Social Care - Nottingham City Council • Researcher - Psychiatry, Business School 10/8/2013 26
  • 27. How do you combine a clinical and research career? 10/8/2013 27
  • 28. CLAHRC – The HOVIS Study • Excellence in Occupational Therapy Research • Methods: RCT, Qualitative Interviews, Survey • Ethics, Research Governance, Research Procedures • Publications and Conference Presentations • MPhil • BESTS – Travel Scholarship 10/8/2013 28
  • 29. NIHR Fellowship Scheme • Personal Awards • Health Research - Clinical and Generic • Person, Project, Place, (Training) Plan • Highly competitive application and interview process 10/8/2013 29
  • 30. 10/8/2013 30
  • 31. Project – Occupational Therapy in Homecare Re-ablement - OTHERS • Homecare Re-ablement Services “in-vogue” • Social Care Institute for Excellence • Systematic Review • Qualitative Interviews • RCT
  • 32. Training • Building research skills • University of Nottingham Modules/Courses • National Courses (e.g. Oxford University, DLF) • Conferences • Collaborations/Networks • International Travel
  • 33. Place • Reputation of Institution • Mentorship • Departmental Links • Networking Opportunities • Developing New Links
  • 34. • PhD • Develop clinical and research skills • Practitioners involvement in research • More collaborations with Social Care • Challenges
  • 35. What have we achieved in stroke rehabilitation through CLAHRC NDL? A partnership between Nottinghamshire Healthcare NHS Trust and the University of Nottingham Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 36. Four successful projects Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 37. What are our learnings? Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 38. Doing things differently Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 39. • Existing expertise in stroke rehabilitation research • Consultation with patient partnership group • Consultation with NHS and social care service providers and commissioners How were stroke projects decided? Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 40. • Innovation – Addressing issues that are key in the NHS – Exploring feasibility/acceptability of specific stroke rehab interventions • Homevisits • Return to work • Upper limb • Implementation – Moving what we know into what we do • Early Supported Discharge Innovation and implementation Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 41.  Direct input into service specifications e.g ESD service specification  Meaningful contribution to reviews of service provision  Trust and respect......stronger synergy  Inter dependency absolutely crucial! Output Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 42. Key ingredients for success Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 43. • Publications – 25 publications • Conference/meeting Presentations – >60 Traditional research output Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 44. International collaboration (Int J Stroke) Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 45. • Phillip Whitehead – MPhil • Karen Fellows – Mphil • Matt Horrocks – MSc • Louise Bramley – PhD • Kate Hooban – MPhil • Andy Richardson – MPhil • Phillip Whitehead – NIHR Fellowship award • Kate Threapleton – Senior Stroke Association Fellowship Award • Christine Cobley – Clinical Psychology Training • Clare Edwards – Clinical Psychology Training • Emma Ford – Clinical Psychology Training • Hazel Sayers – PRINCE2 Foundation and Practitioner (Project Management) & City and Guilds Senior (Level 4) award in Professional Practice (HE Administration • Karen Fellows – CLAHRC RIPPLE award • Rachel Tomasevic – CLAHRC RIPPLE award Increasing capacity Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 46. • Research Into Practice people • Fully funded places to: – Conduct original research – Evaluate practice – Service Review • 13 days over 6 month period • Mentored by lead researchers • Additional £500 to work with patients and public RIPple Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 47. First cohort of RIPples Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 48. • Local Health Trusts and Social Care partnerships also providing funding • Funded secondments • Examples of current stroke projects – Implementing a return to work intervention – Cognition and TIA – Homevisits • Rehab staff embarking on research degree’s Success is catching Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 49. BITES - Engagement Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 50. Diffusion Fellows Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 51. • What is expected of me? • What skills do I have to offer the CLAHRC? • I don’t understand the language used • How much time will it take? • Who will I be working with? • Will I have a desk within CLAHRC? • Where is the CLAHRC stroke theme based? • What happens when the research project ends? • What’s in it for me? What is my role? Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 52. • Act as crucial mediator between research and practice with the time, knowledge, motivation and support to get research findings into practice. • Takes time to grow into this role!!! • Fully integrated into the stroke rehabilitation theme • Help inform the design and execution of research in the NHS • Four key roles………… Diffusion Fellow ………. Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 53. • Passionate about building a research friendly culture • Sustainability of research beyond life of CLAHRC – Take lessons learnt and experiences gained during their involvement in CLAHRC to act as champions for future change and innovation Capacity Builder Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 54. • Lead implementation activities in clinical setting – Facilitate workshops – Chairing and leading sessions – Regular update review meetings Change Agent Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 55. • Spread the work of the CLAHRC and the project to healthcare partners and commissioners • Translate it into appropriate language • Identify and recruit appropriate CLAHRC Associates • Access point for clinical staff to discuss research and CLAHRC activities Public Ambassador Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 56. • Become involved in capturing data – E.g. conducting interviews, helping recruit patients, gathering data, conducting follow –up assessments. • Helping with analysis • Writing up for publication • Presenting research findings Hands on research Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 57. Academic Health Science Network Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL 15 AHSN’s throughout England In set up Accelerating Adoption and Diffusion ‘Getting evidence into practice’ Older people and stroke rehabilitation East Midlands budget £3 million per year Pop 4.8 million
  • 58. • Two projects determined from strategic clinical network objectives • A checklist for the regular follow-ups for stroke survivors • National Stroke Strategy Quality Marker 14 All stroke survivors should have a regular follow up at 6 weeks, 6 and 12 months. • CCG required to return data on „People with stroke who are reviewed at 6 months.‟ • Development of post stroke checklist – endorsed by WSO • National Survey • Roll out of 6 month reviews across East Midlands AHSN Stroke rehabilitation Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 59. • Build on CLAHRC and Health Innovation Education Cluster (HIEC) • To equip MDT in the community to monitor quality and demonstrate their effectiveness. • Interactive workshops – focus on data collection, data sharing across organisations and analysis. • HIEC pilot project Effectiveness programme for CS services Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 60. • Caring for older people and stroke survivors • Research to Implement EVidence Based In-Hospital Stroke Rehabilitation (REVIHR) AIM : Develop and evaluate a change programme designed to facilitate the delivery of evidence based stroke rehabilitation in hospitals across the East Midlands East Midlands CLAHRC Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 61. • Robust evidence exists – Early/ High intensity/Task specific/Specialist • Challenges in implementation – Delivery interventions vague – Benefit in trials found in practice? • Clinical Guidelines go some way to addressing but……. • Behavioural change • Organizational context • Structure and resources of the institution • Economic and political context etc REVIHR Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 62. • Phase 1 What is evidence based rehabilitation in a hospital setting? (SSNAP 2 high achieving hospitals) • Phase 2 How and why is rehabilitation delivered? (Behavioural and qualitative mapping) • Phase 3 Improving delivery of rehabilitation – Construct theory of change • Phase 4 Pilot and evaluation of change programme. REVIHR Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 63. • High quality research output that has informed service delivery • Developed a research active workforce in the NHS • Developed a culture of joint collaboration addressing key issues in NHS and social care. • Focus, Time and Resource to make it happen!! Summary Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL
  • 64. Thank you for listening Marion.walker@nottingham.ac.uk www.clahrc-ndl.nihr.ac.uk Twitter: @CLAHRC_NDL Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire CLAHRC NDL This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire (NIHR CLAHRC NDL). The views expressed in this presentation are those of the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

×