America Is the Target; Israel Is the Front Line _ Andy Blumenthal _ The Blogs...
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1. Professor Rachel Munton, Director, NIHR CLAHRC-NDL
Dr Sarah Rodgers, Senior Research Fellow, NIHR CLAHRC-NDL
Rachel Illingworth, Head of Research & Development, NHS Nottingham City
Research into Practice: Practice into Research
National Institute for Health Research
Collaboration for Leadership in Applied Health Research and Care
for Nottinghamshire, Derbyshire, Lincolnshire
(NIHR CLAHRC-NDL)
2. Aims of the presentation
• Introduce NIHR CLAHRC initiative
• Showcase NIHR CLAHRC-NDL as a vibrant, distinctive strategic
local partnership addressing the three core aims of CLAHRC
• Bring to life one project in some detail, demonstrating its co-
production, outputs and impacts on the patient experience
• Outline the outputs, impacts and vision for the next period
3. Joint NIHR BITEs - Brokering Innovation Through Evidence
Suicide prevention
NIHR CLAHRC Cambridgeshire & Peterborough
Treatment of verrucas
NIHR Centre of Evidence-based Dermatology
Eczema
NIHR Centre of Evidence-based Dermatology
4. NIHR CLAHRC-NDL Vision and Purpose
“NIHR CLAHRC NDL is a unique partnership between the NHS,
University of Nottingham, and partner organisations delivering or
commissioning health and social care in Nottinghamshire,
Derbyshire and Lincolnshire. It improves patient outcomes by
conducting and implementing high quality, clinically relevant
research that matters to our partners.”
6. Steps to reduce diabetes risk in South Asians (STEP OUT)
• People of South Asian origin are 4-6 times more likely to
develop diabetes than people of European origin
• Lifestyle interventions, in particular increasing physical
activity, can prevent or delay the onset of type 2 diabetes
Research urgently needed on
developing culturally appropriate
community level interventions to
prevent diabetes among most at
risk (NICE, 2011)
NICE public health guidance 35
Diffusion Fellow input
Engagement with
community leaders
Review of the literature
One-to-one and
family interviews
Focus groups with
health professionals
STEP OUT
Intervention
Collaboration with
NHS stakeholders
7. STEP OUT Study
Unique aspects of intervention:
• Co-produced with target communities
• Facilitated by bilingual community workers
in community settings and home
• Educational sessions, delivered in multiple
languages, to promote walking, to reduce
the risk of developing type 2 diabetes
• Using local stories to engage/support
intervention
Discussions facilitated by multilingual
“Talking Heads” DVD
9. NHS partner organisation’s perspective
• Positive collaboration between Public Health, R&D and NIHR CLAHRC-
NDL
• Decade of Better Health (health promotion) Team facilitated links with
South Asian community volunteers and groups
• The STEP OUT and ABC (pre-conception care) studies both relate to
important public health issues in Nottingham particularly re: Black and
Minority ethnic groups [“Make Every Contact Count”]
• Key outcomes: research in areas of need, collaborations developed for
future joint working, capacity building (for staff and volunteers)
10. NIHR CLAHRC-NDL Strategic Objectives
• Objective 1: To improve patient outcomes through the co-production of
applied health research with our NHS and social care partners
• Objective 2: To conduct high quality applied health research and
implementation science which is locally relevant and nationally important
• Objective 3: To optimise research in areas important to partners, so that
academic staff can achieve their required goals supported by strong
corporate governance, performance and stakeholder management.
• Objective 4: To achieve ongoing funding for NIHR CLAHRC – NDL so
we can continue to contribute to a sustainable legacy of research and
implementation that is of benefit to patients
11. Research Into Practice (RIP) Initiative
Research into Practice Placements
11 placements; 6 organisations;
7 disciplines - selected from
37 applicants
Research into Practice Awards
3 Trusts
12. Selected NIHR CLAHRC-NDL Impacts
Mental Health
Children &
Young People
Stroke
Rehabilitation
Mood Disorders:
• Safer and more effective treatment regimes
• Service user run support group
• Health Economics data show less cost through inpatient
stays and medication in specialist arm
Medication optimisation Strategy for ADHD in childhood
[MOSAIC]:
• Adoption of evidence based medication strategy to
optimise treatment outcome based on service user and
clinician consensus
Early Supported Discharge:
• Findings used to guide East Midlands ESD service
specification
• Informed guidance for national audit by NHS Stroke
Improvement Programme & Stroke Networks
13. Sustainability and the POSITIVE future
• Partnership: CLAHRC LNR; LETB, Leadership
Academy; Academic Health Science Networks
• Opportunities: AHSNs and future funding
• Sustainability: legacy of research and implementation
• Innovation: rapid adoption and spread
• Timeline: consultation, preparation
• Impacts: consolidation, articulation, return on
investment
• Value added: best research for best health
• Engagement: with Industry, new partners
14. CLAHRC Senior Team
Prof Chris Hollis
Children & Young People’s
Theme Lead
Prof Joe Kai
Primary Care
Theme Lead
Prof Marilyn James
Health Economics
Prof Marion Walker, MBE
Stroke Rehabilitation
Theme Lead
Prof Min Yang
Medical Statistics
Prof Richard Morriss
Director of Research and Mental Health Theme Lead
Editor's Notes
Introductions if needed –each to do own RM ER RI Welcome and thank you - not only for opportunity to present today but for the opportunity that is the CLAHRC initiative.Thank you to the University also for this opportunity Showed considerable prescience to support 9 CLAHRCS to address the second translational research gapFrom what we know to what we do – and I am delighted to have an opportunity to show off a bit today.
I will intersperse with slides that illustrate the contribution of our CLAHRCto enhancing absorptive capacity in the NHS and our collaboration with other parts of the NIHR infrastructureStarting with an introduction to CLAHRC BITES :snapshots of existing research and emerging findingsSuicide prevention with NIHR CLAHRC Cambridgeshire and Peterborough, and the others with the NIHR Centre for Evidence Based dermatology, here in Nottingham -in your pack And this also illustrates us leading and influencing nationally - our BITE approach and guidance on how to author them has been adopted by all CLAHRCS and a National library created.
A brief mention of our unique approach to knowledge mobilisation and dissemination strategy closing the research into practice gap Our Diffusion Fellows - 23 actively engaged from 10 organisations ensuring “pull through” to NHS The integration of research & implementation is central : using the expereince of real world implementation can identify where further research is needed - and the implementation process itself identifies ways it can be improved Strategic localism - work that is strategy tailored to local circumstances; nationally relevant, locally important amply illustrated through the Step Out study, Sarah, Rachel…….
Background and purpose of the project Type 2 diabetes is a growing public health issuePeople of South Asian ethnic origin are 4-6 times more likely to develop diabetes than those of European origin. They also develop diabetes earlier, have greater complications and higher death rates from diabetes. Large research trials have shown that lifestyle interventions in particular increasing physical activity, can prevent or delay the onset of diabetes. However these interventions have tended to involve European-origin ‘middle class’ participants making them less applicable for use with more socially disadvantaged and ethnically diverse populations. Guidance from NICE (May 2011) recommends research is urgently needed on developing, implementing and assessing culturally appropriate community level interventions to prevent diabetes among those at most riskThis is exactly what we are doing in the Step Out study. We have:Conducted interviews with a purposive sample of etc
Unique aspects of the intervention: Co-produced with commissioners and target communities Facilitated by bilingual community workers in community-based faith and other social centres, and the home Educational sessions, delivered in multiple languages, to promote walking, to reduce the risk of developing T2DMLocal stories are used to support the intervention and discussions are facilitated by a multilingual “Talking Heads” DVD which offers patient stories developed from our exploratory qualitative workPLAY DVD
This work has been:Innovative: co-produced affordable intervention that addresses public health priorities including health inequality and associated costsCommunity-centric: Engaging the community to bring practice into research and research into practiceStrategically collaborative: Developing joint work with nascent Health & Wellbeing Boards and local public health commissioners Included in local Joint Strategic Needs AssessmentsWe are working with NHS partners to identify high priority areas for future research
You have heard from Primary care –probably the most difficult slide to produce – so much to chose from. Mental Health : not only safer and more effective treatment regimes, simpler drug regimes and easier access to psychological therapies as a result of psychiatrists and psychotherapists working closely together; but also enabled service user self determination and reduced costs; led to the adoption of a stepped care approach and a formal proposal has been submitted to local commissioners for a service plan CYP implementation of NICE guidelines in ADHD medication management -and are incorporated best research evidence in developing with clinician consensus methods, an evidence based medication strategy designed to optimise treatment outcome in children and young people with Attention Deficit hyperactivity disorder. The protocol is developed from earlier stages of the study which investigated regional prescribing practices and what service users and clinicians felt would be achievable in the real world. The pilot study will determined whether increased contact with families and teachers and more careful monitoring, particularly during titration, is more efficacious than treatment as unusual and the financial viability of this approach . If successful, the team will bid for further money to inform a nationwide RCT which may in time influence national policy Stroke rehabilitation: the Early Supported Discharge study has directly contributed to national policy, impacts on regional commissioning behaviour, and as another example of a range of impacts, improved data collection locally We are just developing a publication outlining all the impacts and outputs and will be pleased to share this with you when it is in print
So to our finalObjective 4: sustainable that is of benefit to patients I have “borrowed” our lead partner organisations acronym for this final piece Partnershipthe future is POSITIVE in Partnership: in the new NHS architecture We are working more closely with the Leicestershire Northamptonshire and Rutland CLAHRC –the “old” East Midlands footprint , and the LETB - 2 CLAHRCs and one Leadership Academy means we are in a pretty strong position . Opportunities offers opportunities as well as potential challenge –particular relevance to the CLAHRC are the Academic Health Science NetworksThe unique and specific role of CLAHRCs contribution within ASHNs as well as a discrete entity cannot be underestimated: centres of excellence able to inform the work of ASHNs at the second translational interface. Not every AHSN will have a CLAHRC or an AHSC - but the knowledge they develop can be exported to all AHSNs. Sustainability -what difference have we made? for economic generation , job creation, as well as the rapid spread and adoption of….. Innovation across the NHS. Timeline of initiatives important to get best fit and buy in : consultation and collaboration with NHS and other organisations : 85% of all organisations in our three counties have told us what we are doing well and what they want more of in the next period Impacts : demonstrating outcome from the investment in this initiative, and real impact.Value added :best research for best health through competition for funds and cutting edge peer review Engagement –and more to do with Industry -ready to go –business engagement
So finally, thank you to my colleagues - my senior team depicted here- it is a privilege to work with them and to be able to share their successes and aspirations with you today. We are securing sustainable impacts from our current funding, and are optimally positioned to play a part in the future landscape making a real difference to patients. Thank you again for the chance to do so
