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Theme: Person-Centred Care
An ageing population, with many people living with multiple complex health and social care issues, and austerity is putting increasing pressure on the NHS and social care services. As a response, national policy is promoting different models of service redesign to improve quality and experience of care and reduce demand.
Torbay and South Devon Foundation Trust (TSDFT) hosted two (part-time) Researchers in Residences (RiRs) (Research Fellows) to help support the evaluation of two specific service innovations: 1. the enhanced intermediate care service (EIC) looking to avoid hospital admission or bridging journeys back to people’s homes, and 2. rolling out multi-disciplinary health and wellbeing teams including wellbeing coordinators (employed by the voluntary sector), ideally preventing people to become unwell in the first place.
The Researchers-in-Residence role is a relatively new approach to co-producing evaluation and research in the NHS and to facilitate service implementation. The model embeds the researchers into the organisation, and aims to facilitate the translation of evidence into practice (where available) or develop the evidence base where this is weak or highly contextualised, and/or needs adapting to local context. The approach is action-orientated and participatory, seeking to impact the development and implementation of service innovations in real time by working alongside front line teams and managers.
How do the multiple service innovations within one locality of Torbay and South Devon contribute to creating a coherent and person-centred system for people with long-term conditions and their cares?
To develop generalizable mid-range theory about how whole system changes can support the creation of improved experience and better care for people living with long- term conditions within a case study which is engaged with different innovations within a rapidly shifting wider policy context.
To generate immediate feedback about individual innovations and the whole system to service leaders and innovators in order to support improvement work.
To use and develop the method of embedded researchers seeking to mobilise evaluation findings and other evidence addressing complex and shifting questions in a rapidly changing health services setting.
This is a mixed methods, prospective, comparative case study design by embedded researchers-in-residence using primary and secondary data.
Research includes a phased, iterative co-design moving from description to explanation to develop mid-range theory about organisational integration and implementing new care models.
It uses a mixed approach to data collection using semi-structured interviews, focus groups and workshops, ethnographic observations of naturally occurring events, studying documentary and publicly accessible material, and including findings from service evaluations and existing evidence.
Over the past three years (April 2016-19), the RiRs have engaged with over 150 stakeholders (as active partners, not research subjects) within acute and community services, general practice, the voluntary sector, the CCG and the wider health and social care system, including patients and the public. They have also inputted into 180 meetings, forums and events, presented emerging findings to system stakeholders on 40 occasions, presented at 8 regional and (inter-)national conferences, networked across the CLAHRC footprint regionally (STP, AHSN, CCGs, Healthwatch), facilitated NIHR Programme Grant Developments, and submitted or supported 11 funding bids to various research and NHS bodies (NIHR – HSDR/RfPB/PH, Wellcome Trust, Health Foundation, UoE Impact Fund, SDT-CCG, TSDFT; STP Devon – Life chances/Prevention streams).
The 6-month and 12-month reports were submitted to TSDFT in 2016, 2017 and 2018 respectively, with recommendations being implemented currently. We are currently in the process of writing five academic papers, two of which are in press.
A paper on the researcher-in-residence model took the runner up prize for best oral presentation at the inaugural Annual Implementation Science Conference in July 2018. https://twitter.com/CLAHRC_SL/status/1019972682828435458
The related academic publication is currently in press with Evidence&Policy, using an impact survey of engaged stakeholders and field notes to illustrate the direct and indirect impact of this particular form of embedded knowledge mobilisation locally. The researchers and QI improvement lead are also heavily invested in driving the embedded research approach internationally, amongst others through contributing to workshops and webinars in an ongoing NIHR study and network (https://www.embeddedresearch.org/resources.html).
Currently, the second paper is in press with Primary Health Care Research & Development on the evaluation of the voluntary sector ‘Wellbeing Coordination Programme’. Findings from this work were used to adapt the service to increase its impact (for example target cohort). RIRs were involved in driving the lengthy process of information governance around data sharing, resulting in exploring comprehensive cost and activity patterns across the sector, hereby pioneering for other services to follow suit at system level. Co-bidding and presenting findings led to the service being re-commissioned, while patient outcome data showed significant improvements, with cost/activity data showing a mixed picture. The mix of data produced included hard outcome data and qualitative case studies, the co-production of which built capacity across sectors, and implementation was facilitated through communications internally and externally (including features of our qualitative patient stories on ITV WestCountry News, and BBC Spotlight).
Findings were also co-presented with stakeholders at the First International Conference on Social Prescribing in June 2018, as well as the Southwest Social Prescribing Network Conference at the Eden Project in Cornwall in February 2019. On County-wide STP level, researchers are actively contributing to policy implementation around social prescribing as captured in the NHS Long Term Plan. The team are also involved in national social prescribing networks, and amongst others attended a social prescribing evaluation workshop facilitated by the NHS England Evidence Unit, and Personalised Care Departments, also informing recent guideline developments (https://www.socialprescribingnetwork.com/quality-assurance-consultation).
Health Services Journal finalist 2018: The co-produced data gained the team a nomination in the category ‘Community or Primary Care Services Redesign - London and the South’: “Torbay and South Devon FT, Our community, Our Patient. Our Problem. Our Solution. Fully integrated local health, social and voluntary care in South Devon“
Continued input to wider P3C programme (theory building, complex care for older people with multi morbidity), also contributing to emerging programme of social prescribing.
We see researcher in residence as a developing approach to bringing together research and improvement work - and hope in the next year to work closer with modellers and others working in that space in new ARC.
PCCC – programme (Helen Lloyd): The Newton Abbot Complex Care Hub
The Torquay Children and Families Hub (SWIFT)
Somerset Practice Quality Scheme (SPQS)
Somerset Test and Learn Pilots
Integrated Care Exeter (ICE)
Southwest Integrated Personal Commissioning (SW IPC)
Sheena Asthana (Executive lead), Dr Felix Gradinger (Project lead, Dr Julian Elston (Project lead), Susan Martin (Research manager)
Torbay and South Devon NHS Foundation Trust, Torbay Community Development Trust, Teignbridge Community & Voluntary Service, Volunteering in Health, Age UK Torbay, Healthwatch Torbay, The South West Academic Health Science Netowork, Devon County Council, Torbay Council, South Devon and Torbay Clinical Commissioning Group, Devon Partnership NHS Trust.