Community Health - CLAHRC Community e-newsletter Issue 87

Published Date: 27 Sep 2019

Welcome to the community e-newsletter for the NIHR CLAHRCs, bringing you news from across the thirteen collaborations and the health services research community. 

It's goodbye from CLAHRCs....

The 13 NIHR CLAHRCs come to an end 30th September 2019, so this is the last newsletter from the CLAHRC community. You can read all about the CLAHRCs on the CLAHRC Projects website. Thank you to our readers for your support during the 5 years of the current CLAHRCs.

....but it will soon be hello from ARCs

From 1st October, there will be the 15 new NIHR Applied Research Collaborations (ARCs) to support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. Much of CLAHRCs research and impacts will be taken forward into the ARCs, in addition to new areas of research being developed.
The next newsletter will focus on the launch of the ARCs, but til then, you can read more on NIHR Wesbite

CLAHRC East Midlands
Community champions invited to help spread the prostate cancer message
A toolkit to help community champions raise awareness of prostate cancer among African and African Caribbean men in their community will be launched at a Leicester event later this month.
The Prostate Cancer Toolkit has been put together by experts at the Leicester-based Centre for BME Health, supported by CLAHRC EM, as part of the Health Matters #PlayDominoTalkProstateinitiative.
The free 23-page booklet contains research statistics alongside resources such as case studies and YouTube video links to empower community leaders to help spread the Prostate Cancer message. It also offers tips on staging and publicising events to provide opportunities for discussion on the subject.
The resource will be launched at the Highfield Sports and Social Club in Gleneagles Avenue, Leicester on Saturday, 28 September, between 1pm and 8pm.
The toolkit will also be made available online on the CLAHRC store webpage.

Fitness sessions for Leicester’s BME population
The Centre for BME Health, supported by CLAHRC EM, are delivering new fitness programmes for Leicester’s BME population, by working closely with Leicester City Football Club and Leicestershire County Cricket Club.
The Healthy Goals programme is a 12-week education and physical activity programme which includes education around lifestyle and diet designed to suit the audience and is delivered by educators from the Leicester Diabetes Centre. The education session is then followed by one hour of fun and exciting physical activity led by the Leicester City Football Club Community Trust.
Walking Cricket is a 90-minute session held at Leicester Arena, the venue of the Leicester Riders Basketball based in the heart of the community. The programme runs for 10 weeks and includes coaching from the Leicestershire County Cricket Club followed by a game of walking cricket.

CLAHRC East of England 
Volunteer activities with older people in care homes
Meaningful interactions and enjoyable activities are fundamental to the wellbeing of care home residents. They help to maintain residents’ cognitive and physical abilities and reduce their risk of social isolation. However, care home staff can struggle to make time for these aspects of residents’ lives when staffing resources are limited. One approach to meeting care home residents’ interpersonal and social needs is by using volunteers. Several volunteer activities in care homes have been researched, including support at mealtimes, befriending, animal visits and intergenerational activities. However, to date the impact of such initiatives is unclear.  We are reviewing all the available evidence on volunteering in care homes to understand what the outcomes are for residents, volunteers and care home staff.  Our review will also clarify what preparation, resources, and ongoing support are needed for the use of volunteers to be successful and sustainable in care home environments.   
Contact: Frances Bunn or Melanie Handley

Addressing obesity among children, young people and families in Hertfordshire
Hertfordshire’s approach to addressing obesity is based on the successful ’10 pillars’ framework, first developed by public health teams in Amsterdam. The aim is to reverse trends in rates of obesity among children and young people through a consideration of a broad range of factors that might influence weight. During the summer/autumn of 2019, researchers and health improvement leads in Hertfordshire are working with six groups of young people aged 15-17 years who are undertaking the National Citizen Service (NCS) programme. The consultation is focusing on ‘growing up in Hertfordshire’ and issues raised so far include antisocial behaviour, access to public transport and eating outside the home. The young people taking part attend schools in Stevenage, one of the ‘populations in focus’ of the ARC East of England from October 2019.
Contact: Wendy Wills or Elspeth Mathie

CLAHRC Greater Manchester 
Improving Leg Ulcer Management In community Nursing
We’re pleased to report the completion of the ILUMIN (Improving Leg Ulcer Management In community Nursing) project. This project has supported NHS community services in Greater Manchester and East Lancashire to make improvements in leg ulcer management, with a focus on three quality markers:

  • ensuring appropriate (and timely) doppler assessment;
  • the use of suitable compression therapy;
  • the use of compression hosiery (where appropriate).

Final reports are currently being written up and will be available on our website soon, so watch this space!

CLAHRC North Thames
NEON – Nurture Early for Optimal Nutrition
NEON saw CLAHRC North Thames observe a participatory approach to optimise infant nutrition, complimentary feeding and care practices in British Bangladeshi families.
The model is successful in South Asian lower-income countries, and was adapted with communities in an urban UK context. East London’s Tower Hamlets hosts Britain’s largest -Bangladeshi population with above average obesity rates and high rates of chronic disease and deprivation. Local services identified the need for an early intervention for infants aged 6-24 months.
After investigating current feeding practices, a Participatory Learning and Action (PLA) group approach was applied, involving meetings delivered by community facilitators offering advice about recommended infant feeding and care practices. A short film highlights how well-received these were.
Next steps are to scale up the PLA model, which has the potential to be applied to other communities and other health issues, to other local South Asian participants.
Contact: Monica Lakhanpaul

CLAHRC North West Coast
Integrated Asthma service: Assessing the possibility and need for future post emergency department, hospital attendance or walk in centre follow up.
The National Review of Asthma Deaths (NRAD) published in 2015 suggested a high proportion (46%) of asthma deaths were preventable. Certain risk factors were highly associated with asthma mortality: inappropriate medication leading to abrupt asthma attacks, lack of engagement with medical services, lack of specialist input, history of previous emergency asthma admissions and discharge from hospital within 28 days following asthma exacerbations.
Access to good quality specialist services needs to be improved to reverse such health inequalities.
CLAHRC NWC worked with Liverpool Heart and Chest Hospital on a review of the impact of NRAD as part of a scoping process using national guidelines to assess current local standards of asthma care.
Read more

The Impact of the Community Connectors Project on Adult Social Care and residents in Sefton
The Community Connectors project is a borough wide service, which helps to reduce the levels of loneliness, social isolation and low level mental health experienced by residents in Sefton. This evaluation focused on the outcomes of the Community Connectors project, specifically its impact on Bootle
township residents and Adult Social Care. Using both quantitative and qualitative data, the impact of the initiative in terms of early intervention and prevention was measured by the number of clients referred to Community Connectors from Adult Social Care, whether the client’s loneliness and mental wellbeing scores improved during their time with the project, and whether they still required Adult Social Care’s input.
Read more

CLAHRC North West London
Ascertaining differences in the ‘assessments for frailty’ in nursing homes
A recently published study led by NIHR funded PhD student, Mr David Sunkersing, suggests that frailty may still be primarily viewed only in terms of physical health – and not all physical, social, mental and environmental domains of frailty may be routinely assessed. The study used an online survey to ascertain the ‘assessments for frailty’ used in nursing homes across North-West London, where there is a current lack of research. Great variation existed in the characteristics of the reported ‘assessments for frailty’ in nursing homes, including the professions using the assessments and how they were stored. Notably, the study additionally identified a significant difference in the number of assessments used in corporate chain owned nursing homes versus independently owned nursing homes. Continuing to view frailty only in terms of physical health could result in severe consequences for patients, staff and healthcare settings.
Read more


CLAHRC-supported DROPLET study informs NHS action to tackle obesity and type 2 diabetes
Hundreds of thousands of people will receive help to battle obesity and Type 2 diabetes under new NHS plans to trial very low-calorie diets for the first time. The plans follow two recent studies of very low calorie diets, the CLAHRC Oxford supported DROPLET study and DiRECT, where overweight individuals achieved significant weight loss.
Both the DROPLET and DiRECT trials showed that unselected people in primary care lose an average of over 10kg at one year, and nearly half of everyone with newly diagnosed diabetes will be in remission after 1 year following treatment with a very low-calorie diet plus behavioural support. Crucially, these results were achieved either with the support of GPs and nurses in primary care, or by referring patients to a provider in the community.
Read more about DROPLET here and here.

Positive experiences of care in an Emergency Multidisciplinary Unit
Emergency Multidisciplinary Units (EMU) are day units based in local community hospitals treating older patients with complex medical and social needs, without keeping them in bed overnight. 
CLAHRC Oxford supported researchers explored the experiences and views of care of patients and carers at the EMU during their time in the care of these services innovations.
The main findings of the study were that patients regarded the EMU as a more acceptable alternative to hospital care, and many of our participants were surprised and delighted at what could be done for them there. Overall, patients' and carers' responses showed that they viewed this type of ambulatory care as a model of service provision, which was especially suited to the needs and priorities of older people living with frailty.
Read more here and here.


Reducing waiting times across Devon
Before Devon Partnership Trust implemented a new centralised ‘choose and book’ telephone booking system, allowing patients to book an initial assessment at their referral location, they worked with PenCHORD to investigate how to make the system work most effectively. Using simulation techniques PenCHORD illustrated how making small changes to the way queues were managed across a geographical area could cut waiting times. The team were able to assess the likely demand at each centre, predict the number of appointment slots needed, and determine the best location for each site. This analysis proved that a queue-sharing model – where patients can choose to attend one from several of their closest centres, would reduce waiting times significantly. The new system also allowed staff to manage the system and patient flows better and increased the choice for patients and resulted in a significant reduction in waiting times for appointments across Devon.
Read more and watch the video

Empowering residents through Connecting Communities
Connecting Communities (C2) is a community development project that seeks to transform disadvantaged neighbourhoods by empowering residents to lead change. It was developed and is delivered by a multidisciplinary team.
Ten years of community transformation research underpins the project and indicates that resident-led, multi-agency neighbourhood partnerships can have a dramatic effect on the results of multiple deprivation. For example the regeneration of housing stock as part of Plymouth Council’s application of C2 research resulted in an increase of 100% educational attainment of KS2 SATS for boys, a 40% decrease in child protection issues, 71% increase in employment and a 52% reduction in overall crime.
C2 is achieved through the formation of a resident–led neighbourhood partnership, central to the success of which is the belief that communities know what they need to support their health and wellbeing and that building relations with service providers can create new ways of working and behaving.
Read more

CLAHRC South London
Improving health and social care services for children and young people
Researchers in CLAHRC South London’s maternity and women’s health theme, working alongside implementation specialists in the Centre for Implementation Science, are helping to implement and evaluate a new programme that is designed to improve the way health care is delivered for the 190,000 children and young people living in the boroughs of Southwark and Lambeth.  
The Children and Young People Health Partnership (CYPHP) model of care has been co-designed by local clinicians, parents, carers, children and young people, researchers, commissioners and providers. The aim is to bring about change by testing and proving the benefits of a new model of care and new approaches to the way health care is delivered. The new model of care aims to ensure that health services are shaped around the needs of children and their families, and this means delivering more of children's health care closer to home and schools.
Read more
Improving rehabilitation for people living with COPD and frailty
 Patients with a combination of chronic obstructive pulmonary disease (COPD) and frailty have poorer health outcomes. They are also less likely to complete pulmonary rehabilitation – a tailored physical exercise and education programme that helps people to better understand and manage their condition and symptoms. A team of researchers in CLAHRC South London’s palliative and end of life care theme - are designing and testing a pulmonary rehabilitation intervention that is specifically modified to offer better support to people living with COPD and frailty.
The rehabilitation is delivered in local communities by a specialist team of healthcare professionals, such as physiotherapists, nurses and occupational therapists. Evidence shows that 90% of patients who complete a pulmonary rehabilitation course have higher activity and exercise levels, and report an improved quality of life.
Read more

Finding and treating people with Hepatitis C
Hepatitis C is an easily treatable blood borne virus. NHS England have set a target for eliminating Hepatitis C by 2025. Many people who have the virus don’t know they have it, but left untreated, it can progress to cause liver scarring (cirrhosis) and liver cancer. A new approach is being taken in Wessex to find and treat people who traditionally may not engage with the health system. People can access hepatitis C testing at pharmacies in Southampton, with a fingerprick blood test. The test is sent off and if positive an alert is sent to a specialist doctor at the local hospital who will link the client to a treatment programme. People at risk include anyone who has ever injected drugs, received blood products before 1991, or has had health treatment abroad or a tattoo in a place with poor hygiene.
Contact: Charlotte Cook

Tackling loneliness
Around 30% of the UK population experience loneliness. Feeling lonely and isolated can have a negative impact on a person’s emotional and physical health, but evidence has shown that feeling connected to the community can help protect against loneliness. The PALS study is testing if it is possible to reduce the negative impacts of loneliness and social isolation by using an online tool called GENIE to help map the support networks that people have around them, and connect them with local activities. It’s hoped that using  GENIE will improve social networks, to provide emotional and physical health benefits to participants. The team is working with local organisations centred around Southampton and Liverpool to recruit almost 400 people aged 18+ over the next few years. Half of the people in the study will be randomly selected to use GENIE.
Contact Rebecca Band -

Evaluating Gloucestershire Moves: a whole system approach to addressing physical inactivity in Gloucestershire
In Gloucestershire, two thirds of people don’t meet the physical activity recommendations. Active Gloucestershire, a charity based in Gloucester, has secured funding over three years to develop and deliver a whole systems approach to address physical inactivity called Gloucestershire Moves.
Gloucestershire Moves aims to help 30,000 people become active, which is defined as doing 150 minutes or more of activity a week. To achieve this, they want to make physical activity the norm across Gloucestershire. They are targeting the physical environment including transport infrastructure, workplaces, communities and schools. This requires help and support from everyone working in Gloucestershire, including the County Council, the NHS trusts, the voluntary and community sector and citizens themselves.
NIHR CLAHRC West and colleagues from the University of Bristol’s School for Policy Studies are Active Gloucestershire’s evaluation partner for Gloucestershire Moves.
Read more

Integrated respiratory services in South Gloucestershire
The North Bristol Lung Centre at Southmead Hospital supports patients with respiratory disease living in South Gloucestershire, including those with chronic obstructive pulmonary disease (COPD), the fifth most common cause of death in the UK.
North Bristol NHS Trust, which runs Southmead Hospital, is working with Sirona Care and Health, a community health provider, on an integrated respiratory pathway. This new pathway aims to support and treat more patients in community settings rather than visiting hospital.
We are evaluating the effectiveness of the integrated respiratory pathway in treating people in the community. We will compare what happens to patients in South Gloucestershire to those in other areas, including Bristol and North Somerset. We will also look at how North Bristol NHS Trust and Sirona work together and support each other, which could provide an effective blueprint for other healthcare organisations to follow.
Read more

CLAHRC West Midlands
Evaluating the Coventry out of hospital care model
CLAHRC theme 4 were commissioned by Coventry Warwickshire Partnership Trust to evaluate the first 18 months of implementation of the Coventry out of hospital care (OOHC) model. The aims were to identify factors of success or otherwise of previous whole system changes, to identify the concepts and assumptions of the OOHC model and to develop a programme change theory in order to provide a framework for subsequent evaluation. Seventeen interviews with staff and documentary analysis were conducted. We found that large-scale change within the NHS is complex, takes time and requires adequate resources. Specialist skills are required for activity and service mapping, IT systems development and workforce strategy, plans and engagement. Realism must be maintained as to what can be achieved within the limitations of time, resources, and organisational readiness. The organisations leading change must not be held as a hostage to fortune by overly ambitious aims and short-term targets.
Contact: Janet Jones