CLAHRC NDL Engage issue 6 (summer 2013)

July 2012 1

Research making a difference to practice

National Institute forHealth Research

CLAHRC NDLEdition 6

Summer 2013

“Engage magazine has helped to connect me to people, research projects and developments within the CLAHRC”

– Jane Terry, Diffusion Fellow

The Reflections Edition

Reflectionson CLAHRC

06Head to Head04 16

Outputs RIPple22

In this issue...

In this issue:Head to Head ................4Reflections on CLAHRC ................6Benefitting patient experiencesand outcomes ................8Research leading to innovation .......... 10Influencing or changing commissioning, organisations, practice or service delivery .......... 12Increasing research capacityin the region ............14Outputs ............16Benefitting the wider economy, society, culture, and public policy/health ............18Reducing or preventingharm, risk or costs ..........20RIPple ..........22Patient and Public Involvement ..........24Spotlight on Ageing and Older People’s Health and Wellbeing ..........25Awards, Honours and Prizes ..........26

Ideas, comments, suggestions? Get in touch:Ian KingsburyCLAHRC NDL, Institute of Mental HealthUniversity of Nottingham Innovation ParkTriumph Road, Nottingham, NG7 2TU

Email: [email protected]: www.clahrc-ndl.nihr.ac.uk Twitter: @CLAHRC_NDL

August 2013 3

Vision + Values

Strategic Objectives

From Vision to Impacts

Has the research/activity:

1. Benefited patient experience/outcome?

2. Led to an increase in research capacity?

3. Assisted implementation of research?

4. Contributed to policy or guidance?

5. Led to documented changes in organisational, management, practice or service delivery structures?

6. Influenced or changed commissioning?

7. Led to innovation?

8. Changed or benefitted the economy, society, culture, public policy or service, health, the environment or quality of life beyond academia?

9. Led to a reduction or prevention of harm, risk, cost or other negative effect?

10. Led to impacts on public awareness, attitudes, understanding or behaviour?

What other impacts can be reported?

ImpactsNIHR Definition: demonstrablechanges in NHS practice, service orpolicy. Effective translation of researchfindings into improved outcomes forpatient and carer benefit.

REF Definition: an effect on or changesto the activity, attitude, awareness,behaviour, capacity, opportunity,performance, policy, practice, process orunderstanding of an audience,beneficiary, community, constituency,organisation or individual.

Impacts must be a distinct and materialcontribution such that would not haveoccurred or would have beensignificantly reduced without thecontribution of that research.

Recruitment

Training (internal and external)

Conferences attended

Publication

Networks and outreach / public engagements

Grants

OutputsResults or KPIs

Definition: The quantitativemeasurement of a tangible activity orproduct directly attributable to a researchproject or programme of research.

To carry out more,locally relevant,applied healthresearch

To ensure the rapiduse, influence anduptake of thisresearch in localNHS systems of care

To build the capacityof local NHSpartners to take onand use researchbased information

CLAHRC NDL is a unique partnership between the NHS, University ofNottingham and partner organisations, delivering or commissioninghealth and social care in Nottinghamshire, Derbyshire and Lincolnshire.It improves patient outcomes by conducting and implementing highquality, clinically relevant research that matters to our partners.

A revised approach to understanding Impacts and Outputs, using definitions from both NIHR and the Research ExcellenceFramework which builds on the Vision, Strategy, Action and Metrics redesign of CLAHRC-NDL following the midterm review.

CLAHRC NDL · Engage4

Head to Head with RachelMunton and Richard MorrissSince January 2011 CLAHRC NDL has been led by Professor Rachel Munton, our Director, and Professor RichardMorriss, our Director of Research. Building on the firm foundations laid by our first Director, Professor Graeme Currie,Rachel and Richard have overseen numerous successes during the latter half of the CLAHRC’s 5 year lifespan. Many ofthese successes are highlighted throughout this sixth edition of Engage, which takes ‘reflections’ as its broad theme.Key to Rachel and Richard’s successful leadership has been the complementarity of their skills and experience, whichthey reflect on here – among other things – in conversation…

Rachel: A couple of years ago there wasa change in leadership of CLAHRCNDL, when the then Director, ProfessorGraeme Currie, left for another post.Graeme continues to do great work atthe University of Warwick and we thankhim for all he did during the first 2 yearsof CLAHRC. My appointment asCLAHRC Director in early 2011 wasperhaps unusual because I’m not anacademic – my background is as a nurseand in NHS executive roles. There weresome advantages to this, but clearlythere were some areas on which Icouldn’t lead and that’s where you comein, Richard…

Richard: Yes, I’d been involved withCLAHRC NDL from the very beginning.CLAHRCs were a bold new experiment –nobody had ever tried anything like thisin the UK. It became clearer over timethat it was very difficult for any oneperson to have all the skills required tolead such a novel and uniqueorganisation, which extends both intothe heart of the NHS and the heart ofuniversity research. Having beeninvolved in writing the initial CLAHRCbid, I think I lent it the academiccredibility. But what was perhaps missingwas buy-in from the NHS. I thinkyou’ve really helped to remedy that.

Rachel: Kind words Richard, I thinkthat’s one area I have definitely led on,but essentially I think we’ve worked wellas peers. There are issues on which youare best placed to lead. I hope you’dagree that it’s been a pretty formidablecombination which has brought the bestof both sets of skills together to provideauthoritative leadership – both inacademic terms but also in terms oforganisational development andlearning. It’s been a ‘how can I helpyou?’ model rather than a ‘let’s trip overeach other’ model, if you know what Imean!

When you think about the previous 5 years, and the whole CLAHRCenterprise, what are you most proud of?Rachel: Without a doubt I’m mostproud of the high calibre people thatwork here, and our success in bringingthem together and supporting them inthe delivery of some really impressiveimprovements to patient experiences andoutcomes.Richard: For me what’s been mostimpressive is a perceivable and very realcultural change that we’ve managed toencourage, particularly in terms of theNHS. We’ve managed to reach parts ofthe NHS that we never thought we’d tap

into. You’ll recall that when you wereappointed Director we took the

very timely opportunity tocarry out a mid-term

review of CLAHRCNDL, and whatemerged – verystrongly – was theextent of our reach.Even people whohad left, who wethought might

August 2013 5

reasonably be disaffected by theCLAHRC, had started to use and valuethings they’d learnt with us. Peoplewho had moved to another area ofresearch had taken the CLAHRCculture with them into their new role.They’d become more applied, moreinterested in getting service user andclinician perspectives, and I think that’sa huge achievement, to have spread theCLAHRC culture in this way.

What’s the most important thingyou’ve learned?Rachel: I think the most striking thingI’ve learned is that there is a role for anon-academic perspective within aCLAHRC and that there are benefits tohaving someone with a skillset that ismore akin to that in NHSorganisations, as opposed to havingacademic skills alone. But I wouldn’tsay one trumps the other, it’s a genuinepartnership. Richard: I didn’t appreciate just howmuch of a risk this was, or howdifferent it was. Some of what theCLAHRC was asking colleagues to do –such as working with service users –were things I was already doing withmy previous research projects, so I’vehad to constantly remind myself thatcolleagues are being asked to work innew ways, and potentially threateningways. Putting those people at their easehas been an important task.

Have there been any major surprisesalong the way?Rachel: How much fun it’s been!When I came I was anxious about howwell I could do the job, because herewere a group of very senior andrespected academics, and I was quitefrightened that I wouldn’t be able toadd value. But actually some of themost simple things I’ve done haveadded value, such as the basic teambuilding or ‘getting to know you’activities, and the work I did aroundconsulting about ways to move theCLAHRC forward. This has been one ofthe most challenging leadership rolesI’ve ever had because I had no directline management authority over any ofmy immediate senior colleagues, so ithad to be leadership through verydifferent approaches. I’ve beenpleasantly surprised to find that it’sbeen an effective approach – notunconditionally so of course – but Ihope you agree, Richard, that we have

succeeded and had some fun along theway.Richard: Absolutely, and what I thinkyou really brought with you, Rachel,was a professionalism in terms ofmanagement. Let’s not forget that therewas no blueprint for this collaborative,applied model of health and social careresearch.

What is the CLAHRC NDL heritage?Rachel: There’s a fantastic opportunitynow to move forward. Thanks to thenew East Midlands Academic HealthScience Network (EMAHSN), we’re inprime position to bring CLAHRCprojects and outputs to a wideraudience. There are many things that Ithink will ‘live on’. I hope that some ofthe things I’ve done for the CLAHRCwill be carried forward into the newEast Midlands CLAHRC. I’mparticularly thinking about some of themore ‘entry level’ offers that wedeveloped, such as the placementsallowing non-medical staff to explore,evaluate or implement a piece ofresearch in their own clinical area – ourResearch Into Practice, or RIPpleprogramme [see page 22]. Also makingresearch evidence available to healthand social care staff through BITEs [seepage 17], I think they will live on. Ihope that everyone who has worked inthe CLAHRC will carry on with a littlebit of CLAHRC inside them.Richard: We haven’t yet touched onthe University of Nottinghamperspective. In the area of methodology,we didn’t really have a health economicsfunction or statistics expertiseembedded in a clinical trials unit. Wedidn’t have proper integration across theBusiness School or the clinical areas. Allof those have been greatly facilitated bythe whole CLAHRC process. I thinkthese new structures and ways ofworking will live on. Also the CLAHRCreally gelled PPI [Patient and PublicInvolvement – see page 24] into everyaspect of its work.

What advice would you give to thenew East Midlands CLAHRCDirector?Rachel: I think we’re both very keen towish Professor Kamlesh Khunti verymany congratulations and the best ofluck in his role as Director of the newEast Midlands CLAHRC. It’s a greatopportunity for closer working withother groups and organisations across

the East Midlands, such as the AHSN.As I said earlier, Directorship of aCLAHRC is a leadership role like noother and one not to be underestimated,but I know Kamlesh is up for thechallenge.Richard: Yes, Kamlesh and hiscolleagues have been centrally involvedin running the CLAHRC forLeicestershire, Northamptonshire andRutland (LNR) so he is already aware ofthe issues and challenges involved. Mymain piece of advice would be not tounderestimate the relationships. One ofthe main challenges the new Directorfaces is lack of time, so delegation will beincredibly important when workingacross two universities and multipleNHS organisations.

Looking to the future and the nextround of CLAHRCs, can you talkabout some of the opportunities andchallenges that lie ahead?Richard: I often say that it took us 3years to work out what we were reallydoing, so as a result perhaps we didn’textract the maximum in terms oflearning and development. However, Ithink that we have set up the nextCLAHRC to learn much more about thethings which we only just started tograsp, particularly aroundimplementation. It’s an excitingopportunity to look at how to reallyapply research. And also within theNHS, there are a lot of people who haveresearch aspirations but haven’t knownhow to express or utilise them, and theCLAHRC will continue to reach out tothem.

What are you most excited about interms of your own future?Rachel: Well I won’t be disappearingcompletely, and I’m very much lookingforward to linking up the work of theEMAHSN and the EMCLAHRC. Moreimmediately I’m looking forward tomanaging a very positive and productivefinal few months of CLAHRC NDL.Richard: I agree, I think we’ll bothcontinue to be involved in the CLAHRC.For me, I’m hoping to focus morespecifically on some of the increasinglyimportant and exciting agendas withinmental health research, such as the roleplayed by technology. More broadly I’mexcited about the cultural change thatthe CLAHRCs have brought about, sothat research is more relevant to practicein the NHS. Long may this continue.


Reflections on CLAHRC…

The whole CLAHRC enterprise has been about bringingresearch findings into practice quickly and this has beenachieved in many areas, with notable examples in the fieldsof mental health and stroke rehabilitation. CLAHRC NDL hasalso achieved many great things in terms of bringing themost innovative, evidence-based research findings directly to those whobenefit from them the most – our patients and service users. With astrong service-facing approach, it has enabled the NHS, University andLocal Authority agencies to work in partnership across Nottinghamshire,Derbyshire and Lincolnshire. CLAHRC NDL has brought huge benefitsboth inside and outside the research arena.

Professor Mike Cooke CBEChief Executive, Nottinghamshire NHS Healthcare Trust

I’ve always been excited about the idea of CLAHRCs. I’d done enough‘applied’ research before I arrived to see that the ‘normal’ role for anapplied medical sociologist is to critique something that has beenimplemented, and find reasons why the innovation doesn’t work or isn’tused. Being able to do implementation research in real time, and make aclear difference, was what attracted me to the CLAHRC, and it’s been areal privilege to be able to do it. It hasn’t been easy, but I think that overthe last 4 ½ years we’ve learnt a lot about how to collaborate inmultidisciplinary academic and practice teams, and how to show thatimplementation research is useful, so that when innovations aredelivered into practice, they are likely to be used, not ignored.

Dr Emma Rowley, Implementation Research Fellow

The University of Nottinghamboasts a thriving NIHR researchportfolio – of which CLAHRC NDL is

a major component. Bylinking the oftendistinct worlds of theacademic and theclinician, the CLAHRChas enabled us toexploit clinical researchadvances in everydaymedical practice.

Together with the Institute ofMental Health, these have formedthe key vehicles for delivering theUniversity of Nottingham’s researchin the field of mental health for thelast five years.

Professor Ian HallDean of the Medical School,

University of Nottingham

CLAHRC NDL has offered me, as a service user, theopportunity to engage in real and useful ways withhealth research in the local area. This has been avery positive experience, both for the researchers Ihave been able to work with and for myself.

Trevor Jones, Service User Consultant

NUH has been delighted to be a partner in the CLAHRC. It hasconcentrated on improving clinical services by demonstrating whatworks and overcoming the barriers to adoption of best practice. It’shad a real impact, particularly on the way we rehabilitate peoplewho have had a stroke. The NUH staff that have been involved inCLAHRC, particularly the Diffusion Fellows and the Research intoPractice (RIPple) participants, have had great personal developmentopportunities that they will take with them into other aspects oftheir work in the Trust. I’m also very proud that the Older People’stheme has been introduced. Providing the best care for older peoplepresents lots of challenges for NUH, and the programme recognisesthe research and clinical excellence locally, whilst giving us practicaltools to do this vital part of our work even better in the future.

Peter Wozencroft, Associate Director of Strategy, Nottingham University Hospitals NHS Trust

CLAHRC has given me theopportunity to work with greatcolleagues from a wide range ofspecialties, as well as develop myknowledge. I have learned somuch about applying research to

practice in order tomake a realdifference. I have alsodiscovered theimportance of clearcommunication andcollaboration whenundertaking research.This is important

because it helps act as a vehiclefor change by getting serviceproviders and service users onboard. Working for CLAHRC hasbeen really enjoyable andworthwhile!

Mary Jinks, Research Fellow,‘Engaging people with personality

disorder in treatment’

August 2013 7

Being a Diffusion Fellow has enabled me, as a clinician, to beinvolved in a larger scale research project within my own area ofpractice, working with the University to try and improve practice. Ifeel that my closeness to practice has enabled me to be an integralpart of the research team and use my experience of the ‘nuts and

bolts’ of daily clinical work to influence how the research project has developedand is being implemented. I’d like to see more integration of the clinical work intoclinically focussed research projects so we can achieve more effective research withmore obvious practical applications. Putting research evidence into real worldpractice has to be better for patients and service users, and Diffusion Fellows (orwhatever else we call clinician/implementers!) has to be a way forward.

Dr Laurence Baldwin Consultant Nurse (CAMHS) and Diffusion Fellow for CATO

CLAHRC has been a lesson in crossing boundaries between theNHS and academic research. We all started with preconceptionsabout each other. The people who have made the greatestadvances have been those who were unafraid to leave their

comfort zone. Diffusion Fellows and Engagement Fellows led the way toincrease mutual understanding. A lot of understanding about research hasbeen gained by NHS colleagues, and researchers have kept abreast of reformsin the NHS during a period of exceptional upheaval. Wherever people work infuture they will do so better for having been part of a CLAHRC.

Professor Justine SchneiderPrincipal Investigator, Individual Placement and Support (IPS)

It's been myprivilege to beinvolved with theMood Disordersproject, not leastbecause of the

commitment of the peopleworking on it to apply researchinto practice. This has given mehope that this is the way that theNHS can get better. AnneGarland in particular has been aninspiration in her drive toimprove services throughengaging people with evidence.

Mat RawsthorneService User Consultant and

CLAHRC study participant

We knew treatment engagementwas a clinical problem and a topicworth researching. CLAHRC hassupported us in accessing theviews of service users and serviceproviders. As a result, weadapted our originalresearch plan to fit betterwith their needs. Inaddition to findings fromour research, we havebeen able to disseminategood practice that wehave learned fromothers. The project has developedinto a focal point for attracting,producing, and disseminatingknowledge. This is a new andimproved way of working for me.

Professor Mary McMurran, PrincipalInvestigator, ‘Engaging people with

personality disorder in treatment’

The partnership approach atthe heart of CLAHRC has beenkey to the translation of itsresearch findings intoeveryday practice. In order toensure that patients andservice users get the very beststandards of treatment andcare, we must first ensure thatthe very best researchevidence is used to inform,guide and adapt services. Ilook forward to building onthe work of CLAHRC NDLthrough the new EastMidlands CLAHRC, particularlyso more people with mentalhealth and learning disabilitiescan benefit from the fantasticwork flowing from thiscollaborative approach.

Chris SlavinChief Executive, Lincolnshire

Partnership NHS Foundation Trust

CLAHRC provided an opportunity to undertake research that I really feltshould be done – but which I knew had little chance of securing funding.I was in a Catch 22 – if I couldn’t do the research, I couldn’t show it waspossible and so I couldn’t get funding. The HOVIS (Home Visits afterStroke) study has been really important because it demonstrated that thisresearch was feasible and moreover showed that other research designscould be used successfully in rehabilitation research.Professor Avril DrummondPrincipal Investigator, Home Visits After Stroke

I was privileged to work asa Diffusion Fellow withinan evolving role. OurPrincipal Investigator,Professor Cris Glazebrook,involved me at every stage – fromproject development, to researchassistant interviews. Collaboration atthis level immersed me within theresearch environment despite mylimited time commitments and hashelped shape my future researchplans. I hope my contribution wasequally valuable to my co-conspirators/Trust and mostimportantly – the children within ourcommunities. It has been a highlyrewarding experience.

Dilip NathanConsultant Paediatrician,

Nottinghamshire NHS Healthcare Trust and

Diffusion Fellow


People with aserious mentalillness findemploymentThe Individual Placement and Support(IPS) study within our Mental Healththeme has helped to significantlytransform the employment prospects ofpeople in Nottinghamshire with asevere mental illness.

The IPS approach, alongside moretailored work-focused psycho-socialsupport, has delivered an overallemployment rate of 57% for patients inthe county living with a range of seriousmental health conditions. This compares to12% achieved by strategies currentlyemployed by local healthcare trusts and3% through Government back-to-workschemes.

The study is led by Professor JustineSchneider who said: “IPS works inNottingham, helping more than half ofyoung people with mental health problemstowards employment. Now commissionersneed to invest in the IPS approach as one

of the few non-medical interventions thatare known to work for this group.”

In the UK, of the 500,000 people with amental health condition, just 20,000 areestimated to be in employment. However,research has shown that socially,psychologically and economically, having apaid job is beneficial to people living withmental health problems.

IPS is focused on achieving paid work inthe ‘real world’ rather than shelteredemployment or lengthy job preparation.Employment specialists within mentalhealth agencies work directly with clientswith mental health disorders to explorejobs that they are interested in doing andthen provide support, coaching, CVdevelopment, interview training and on-the-job support. The study involveddeveloping and implementing IPS inCommunity Mental Health Teams (CMHTs)and Early Intervention Psychosis (EIP) teamsin Nottingham and will go on to comparethe outcomes for service users whoreceived IPS with those who also receivedadditional tailored work-focused, psycho-social support to explore whether thisincreases the rate of employment evenfurther.

The study team found that more thanhalf of those who received the IPS andadditional support – 42 out of 74 – were

successful in achieving a vocational aim.From that group, 31% started a new job,15% achieved voluntary work and 11%began studying for a long-termprofessional qualification. Additionally, thestudy has changed professionals’ attitudestowards employment support – carecoordinators have begun referring to thestudy team directly because they can seethe real benefits for study participants interms of employment outcomes.

Michael Osborne, Service UserConsultant (Voluntary) withNottinghamshire Healthcare NHS Trust,said: “The IPS Scheme has been a reallygreat success and many service users havegone on to have meaningful employment.IPS has been a boon to those who wantedto gain work and has shown other schemeshow to approach the service user.”

Erica Bore, a vocational specialist in theEarly Intervention in Psychosis team atNottinghamshire Healthcare NHS Trust,said: “IPS made a real difference to theclients within our EIP service. By having anon-clinical member of staff based with theteam and having a pure focus onemployment, clients’ employmentaspirations were placed highly on theteam’s agenda. Clients actively engagedwith the employment specialists andpositive results were seen by all involved.”

Benefitting patientexperiences and outcomesImproving patient outcomes andexperiences is at the heart ofeverything we do, and underpinsevery CLAHRC NDL research project.

Here we highlight just a few examplesof how our research is helping toimprove the health, and lives, ofpeople across the East Midlands…

August 2013 9

In primary care, the top threeper cent of attenders accountfor fifteen per cent of allconsultations. This presents asignificant challenge to theclinical professionals whohave to manage them.

Our Regular Attenders studyhas been testing a CognitiveBehavioural Therapy (CBT)formulation and treatmentapproach, delivered by mentalhealth professionals, to addressthe needs of this patient group.

Regularly attending patientsin the study and their GPs havereported improvements inconsultation patterns sincereceiving the CBT treatment andformulation. Patients havereported a reduction in their

attendance in primary care sincereceiving the CBT treatment.Many have specifically noted thatthey see their GP less now forhealth anxiety related symptomsbecause the CBT has allowedthem to recognise the linkbetween how their emotionaldistress may cause physicalsymptoms. Other benefitsreported by patients in the studyinclude:• Increased self-esteem and

confidence which has enabledthem to overcome difficultiesin their lives.

• Empowering patients tomanage their own health care issues.

• Improvements in their working life.

• Improvements in personal livesand relationships.

• Better understanding ofinformation which previouslyGPs were unable to explain inbrief consultations.

• Better self-management ofphysical pain andunderstanding of theinteraction between emotionaldistress and physical pain.

GPs in practices participating inthe study have also recognisedimprovements in patientattending patterns followingtheir CBT treatment andformulation, including areduction in patient attendancewhich has reduced the demandon GP time, and a newwillingness for patients to consultwith only one GP.

Gettingstrokesurvivorsback to work Our Return To Work after stroke(RTW) project has resulted in thecommissioning of a new service. Inearly 2013 Dr Kate Radford and DiffusionFellow Jane Terry spoke to NottinghamCityCare Partnership Trust Executives andCommissioners about the supportingevidence from the CLAHRC RTW project.As a direct result CityCare’s CommunityStroke Discharge and RehabilitationService has secured a year’s funding topilot the Early Stroke Specialist VocationalRehabilitation (ESSVR) model developedin CLAHRC NDL.

The pilot aims to increase the numberof stroke patients returning toemployment – where possible with theirexisting employer. Dr Radford, who willevaluate the success of the one-yearproject, said: “Although it is an illnessmost often associated with older people,around one-quarter of all people whosuffer a stroke every year are actually ofworking age. Currently, less than half ofstroke survivors – just 44% – return to

employment. For financial reasons manypeople who have suffered a stroke needto return to work.”

Under the new project, strokespecialist and occupational therapist(OT) Jane Terry will start working withpatients as soon as possible after theirstroke. Jane will carry out detailedassessments of the person, their job andtheir workplace and deliver specialistrehabilitation tailored to the patient’sspecific needs. She will also act as a casecoordinator to provide support,education and advice to patients, theirfamily and a range of other stakeholderssuch as employers, NHS professionals,specialist stroke rehabilitation services,social services, and Jobcentre Plus staffincluding Disability EmploymentAdvisors (DEA).

Patients will be seen initially inhospital but most of the interventions willtake place in the home, workplace or outin the community as often as is required.Jane will offer assistance with preparingfor work, for example helping patients toestablish structured routines withgradually increased activity levels and theopportunity to practice skills integral totheir job, such as concentrating on acomputer screen for extended periods.The therapist will also liaise withemployers, tutors or employment advisersto advise about the effects of stroke andto plan and monitor a phased return to

work in the same role or more suitablerole depending on the needs andcapabilities of the stroke survivor.

The CLAHRC Return To Work afterstroke study looked at gaps in existingservices for stroke survivors insupporting them back into work andthen developed the specialistintervention to assess whether it couldimprove outcomes for those strokesurvivors wishing to return toemployment. Although only a smallfeasibility study, it gave an earlyindication on its potential success,showing that – with the OT’s support –more stroke survivors returned to workthan those patients who only accessedcurrent NHS services.

The new pilot study in Nottinghamhas been welcomed by Marita Jenkinson,who suffered a stroke in her 30s andwho struggled to return to her job as abeauty therapist. She said: “It’sencouraging how through thisprogramme stroke survivors can receive athorough, caring and beneficialrehabilitation specific to their needs. I’mglad to see the inclusion of informationand education for stroke survivors,family and employers, as it is importantthat the employer has an understandingof what they might expect to see fromtheir stroke survivor employee. Similarlythe participant needs to know whatsymptoms are normal post stroke.”

CBT in a primary care setting


Upper Limbproject partnerswith medicaldevice companiesFollowing successful networking at the2012 UK Stroke Forum, the CLAHRC NDLUpper Limb project team establishedtwo fruitful collaborations withcompanies manufacturing medicaldevices. The CLAHRC team led discussionson technical developments with the co-founder and owner of US company Saebo,who provide innovative rehabilitationproducts for individuals suffering fromneurological injuries such as strokes. Thesediscussions are planned to lead toapplications for funding to support anevaluation.

In addition, an application for TSBBiomedical Catalyst funding together withViVO Smart has gone through to the secondround. This project would use themethodology the team established in theCLAHRC funded project to evaluate anotherhome rehabilitation device. ViVO SmartMedical Devices helps Medtech companiesand healthcare professionals bring new ideasto life by providing specialist design,engineering and manufacturing expertise tocreate new healthcare technologies andinnovative medical devices.

Inside Out of Mind isan innovative projectwhich has broughttogether researcherswith theatrepractitioners to tacklethe challenge ofdementia care. Basedon ethnographicresearch conducted bystudents at theUniversity ofNottingham, theresulting play (whichhad its opening run inJune 2013) illustratesthe multiple realitiesof life on a dementiaward from theperspective of thepatients, the staffand visitors. It is aunique collaborationbetween MeetingGround TheatreCompany, LakesideArts Centre, The University ofNottingham's Institute of Mental Healthand the NHS.

In accordance with the priorities ofCLAHRC, a central aim of the project hasbeen to seekengagementfrom localpractitioners,especially thosewho work withpeople withdementia.

With this goalin mind, eight ofthe fifteen performances were targeteddirectly at those working in the HealthCare Sector and these were run asConference Days in which the audiencesaw the production in the morning thenparticipated in a post-show discussionand in an afternoon workshop session.

The play aims to impact positively on thecare of those with dementia, toencourage empathy and intuitivelistening. As such, one of the primary

aims is to helpHealth CareWorkers findeffective new andmeaningful waysof engaging withand enhancingthe care ofpeople withdementia. The

play also offers an insight into dementiaand dementia care for members of thegeneral public for whom dementia is anissue.

CLAHRC NDL has assisted with theinitiation, planning and publicising of theproject and will also play a role in itsimplementation and evaluation.

Innovative training package

From the outset CLAHRC NDL adopted two straplines that reflected its core aims and ambitions: ‘Research makinga difference to practice’ and ‘From what we know, to what we do’. Both of these reflect the fact that innovation –in terms of ways of working but also the generation of new services, outputs and products – is at the heart of thewhole CLAHRC project. Here are some examples of how we’ve innovated over the last 5 years…

Research leading to innovation

August 2013 11

Professor Chris Hollis,Clinical Director,NIHR MindTech HTC

Others benefitfrom ourorganisationallearning

The CLAHRC NDL model ofknowledge translation andimplementation research has beensuccessfully translated and adoptedby the NIHR Mental HealthHealthCare Technology Co-operative(NIHR Mindtech HTC), hosted byNHS Nottinghamshire Healthcare Trustand the Institute of Mental Health.The organisational learning andknowledge translation model ofcarrying out research, together with theinclusion of Diffusion Fellows willensure that the technology that is co-produced by clinicians andmanufacturers is fit for purpose and canbe effectively utilised for increasedpatient benefit. The HTC is amultidisciplinary research group whichwill use the model to carry out appliedresearch and work with the medicaldevice industry to close the “campus toclinic” gap, and ensure that patients areable to benefit from innovativetechnology as part of their care.

Streamlining feedback to cliniciansOur Consensus Assessment and Treatment Outcome Measures (CATO) teamare working to develop consensus across NHS, Local Authority and voluntarysector service providers and commissioners on the implementation of standardisedassessment and outcome measures for child and adolescent mental health.

The team have developed a simple ‘dashboard’ electronic (and printable) systemthat provides easily accessible feedback to clinicians on outcome measures enteredinto the patient record system, crucially in a timely and accessible manner. Thesystem illustrates changes from Time 1 to Time 2 (follow-up) measures in a simple,user friendly format.

The CATO team have been working with the Nottinghamshire Healthcare NHSTrust’s Applied Informatics Department to produce an output template called CORs(Clinical Outcome Reports) that will plot changes in scores of routine outcomemeasures. It is anticipated that documenting changes on an individual level willprovide clinically meaningful feedback of benefit to both clinicians and service usersand increase completion rates of outcome measures. Clinician engagement withoutcome measures is a high priority for the Trust and Commissioners and it isenvisaged that such an initiative will help the Trust to more confidently meet itscurrent CQUIN targets associated with outcome measurement.

In collaboration with the CATO team and Diffusion Fellow, the informaticsdepartment have created a report which will allow health care practitioners to viewHONOS/CGAS/SDQS/SDQP scores over time for clients with open referrals on theircaseload. Users within Child and Adolescent Mental Health Services (CAMHS) areabout to begin the process of looking at the report as part of a ‘testing’ period beforesign-off. Feedback will be gathered on whether the report meets their needs and theinformation will be used to inform future developments. This work has the explicitsupport of – and has been given priority by – the Trust’s CEO.

The Action Before Conception (ABC)study – previously known as thePreconception Health study – is aboutexploring the effectiveness of apreconception health interventiondelivered by a nurse practitioner ingeneral practice. As part of theintervention, women were asked tocomplete a paper-based PreconceptionHealth Assessment (PHA) form and thentake this along to an appointment with apractice nurse at their local surgery todiscuss in more detail. Information fromthe PHA form is then added to thepractice clinical system by the nurse.

A bespoke electronic template,compatible with the two major clinicalsystems in general practice, was

developed by our ABC project team torecreate the paper-based PHA form, andwas added to the clinical systems of thenine local practices involved in the study.The programme enabled the practicenurse to efficiently enter data from thePHA questionnaire on one screen whichwould then automatically update thepatients’ medical records in the correctplace. To enter the data manually wouldhave been time consuming for the nurseas there are various screens to negotiate inorder to update each piece of information.

To date three practices across nine siteshave found the clinical system templatewe developed so useful that they havedecided to embed it into their ‘real world’practice and care of patients.

Helping GPs withpreconception healthassessments

CLAHRC NDL · Engage12 CLAHRC NDL · Engage12

Evidence-based serviceimprovementsin strokeservices Research led by Professor MarionWalker and Dr Rebecca Fisher hasfacilitated evidence basedimprovements in community strokecare across the East Midlands,achieved by a strong collaborativepartnership with the East MidlandsCardiovascular Network.

In 2010 the Early SupportedDischarge (ESD) consensus developedby the research team informed an EastMidlands ESD service specification,

launched by the Network, for use byservice providers and commissionersacross the region. In 2012 Dr Fishercontributed to a review of ESD servicesacross the East Midlands led by theNetwork. Data returned as part of thereview indicated that ESD teams acrossthe East Midlands have used both theESD consensus and East Midlands ESDservice specification, demonstrating theimpact of this research on stroke serviceprovision. Two key elements of thisimpact relate to the team composition ofESD services in the East Midlands,which feature a full multidisciplinaryteam complement of therapists, nursesand physician input. Secondly, asrecommended in the ESD consensus,ESD teams only accept patients whohave had mild to moderate strokes.Clinical trials showed that increases inhealth and well-being as a consequenceof the ESD intervention were onlyshown in this cohort of patients.

To address the needs of a wider strokepopulation Professor Walker and DrFisher completed a national consensusactivity in 2012 on the implementationof community stroke services. Prior tothis research there was a lack of evidencesupporting how best to organise thelonger term stroke care pathwayfollowing hospital discharge (and ESD)and as a consequence service provisionacross the East Midlands and the UKvaried considerably. This consensusactivity was conducted in collaborationwith the national NHS StrokeImprovement Programme and informedan East Midlands Strategic HealthAuthority Stroke Service specification.The launch of these regional guidelinesin June 2012 was followed bycommunity stroke services across theregion returning data based on thespecification and being mandated toagree evidence based plans forimprovements in 2013.

Improving outcomesfor severe depressionOur Chronic Mood Disorders team have disseminated theirfindings from an audit they carried out on adherence to NICEguidelines for treatment of long-term depression. The team’sfindings have already reached senior NHS Trust management andthe Executive Leadership Committee.

This work is already having an impact locally, and the team’sapplication for transformational funding to finance the new mooddisorder service for one year following the end of the CLAHRC studyhas been successful. The clinical team (including two DiffusionFellows and two PhD students funded by the CLAHRC) are currentlyin the process of establishing the service to run in the ‘real world’ asopposed to the limitations of the study protocol.

The CLAHRC NDL Mood Disorder study has enabled thespecialist service to be trialled with apparent success, although fullresults have yet to be analysed. Included in the protocol for thisstudy was the audit of usual care which has shown a significant lackof adherence to the NICE guidelines for the treatment of chronicand severe depression. This has been highlighted by the Diffusion

Fellows for the study who are also clinicians, and these findings havebeen extremely significant in highlighting the flaws in the currentservice, as well as helping to improve services for patients withchronic depression.

CLAHRC NDL has supported the dissemination of these findingsby the Diffusion Fellows by funding poster and oral presentations atsenior management meetings within Nottinghamshire HealthcareNHS Trust as well as at national conferences, including the MentalHealth Research Network (MHRN) conference in 2012 and theHealth Services Research Network (HSRN) conference in 2013.

Across the East Midlands our work continues to influence health and social care guidelines, achieving deep and lastingimpacts on policy and commissioning both locally and nationally. Below are just a few examples...

Influencing or changing commissioning,

August 2013 13

RegularAttenders inprimary care

A positive change has been reported in theway that GPs who are directly involved inour Regular Attenders study deal with theirregular attending patients. GPs now betterunderstand the needs of their patients andas a result they have changed their practicewith regards to prescribing.

In primary care, the top three per cent ofattenders account for fifteen per cent of allconsultations. This presents a significantchallenge to the clinical professionals whohave to manage them. Our RegularAttenders study has been testing thefeasibility and acceptability of a CognitiveBehavioural Therapy (CBT) formulation andtreatment approach, delivered by mentalhealth professionals, to address the needsof these patients. This also involves furthermanagement of the patient with the leadGP according to the formulation.

In those practices participating in the study,GPs have highlighted how the study hashelped them to better understand theneeds of their regularly attending patientsand has given them an increasedawareness about the psychological issuespatients may present with and how thistranslates into physical pain. As a result,GPs have described changes they havemade in how they prescribe medication totheir patients; specifically reducing theprescribing of analgesia and increasing theprescribing of anti-depressants.

13

organisations, practice or service delivery

Impact on aninternational basis hasbeen highlighted by use ofthe ESD consensusdocument to informservice provision inWestern Australia. Inaddition to reference inAustralian strokeguidelines, the ESDconsensus has informedresearch and serviceimprovements conductedby ESD teams in Perth,Australia. ProfessorWalker and Dr Fisherhave joined forces withresearchers from Australia and Canadato publish the paper: ‘From what weknow to what we do: translating strokerehabilitation research into practice’ inthe International Journal of Stroke. Theaim was to provide pragmatic examplesof facilitating evidence based practice in

stroke care and to forge internationalcollaborative links for future researchendeavours.

The success of this work and thelong-standing collaboration with theEast Midlands Cardiovascular Networkhas been highlighted by the award of

Health InnovationEducation Cluster (HIEC)funding; for thedevelopment of aneducational programmebased on our joint work sofar and developed incollaboration with ESD andcommunity stroke teams inNottinghamshire. Thisprogramme, which is nowbeing piloted inNottinghamshire,specifically addresses howteams within the stroke carepathway (ESD, longer termcommunity stroke teams,

social care) can work together to ensuretransition between services is seamlessfor stroke survivors. The aim is for thisprogramme to be adopted by the EastMidlands Academic Health ScienceNetwork so that it can be rolled-out toother teams across the East Midlands.

Training session developedby the CLAHRC study team

CLAHRCDiffusionFellows Through their secondment to CLAHRC-NDL as Diffusion Fellows, practitionershave gained first-hand experience ofdeveloping and utilising research skillsand research-derived evidence. Manyhave taken these skills back to theiremploying NHS Trusts, sharing these newskills and fostering a cultural change. Forexample, one Diffusion Fellow is now the“research champion” in her Trust, and alsoinstigated the use of evidence to inform thechoice of a county-wide assessment tool forcognitive assessment. Two Diffusion Fellowshave decided to further their researchlearning and development, by enrolling indoctoral study programmes, and thusfollowing a clinical-academic career notnormally accessible to non-medical staff.

Education and trainingA number of our project teams are involved in the education and trainingof health and social care staff from our NHS partners acrossNottinghamshire, Derbyshire and Lincolnshire.

Our Upper Limb team – who have pioneered an approach to home-basedrehabilitation for stroke patients using modified Nintendo Wii technology – areengaged in raising awareness among trainee therapists and influencing theeducation of future therapists. The team have given talks and demonstrations toOccupational Therapy (OT) students about home-based technology in strokerehabilitation. In November 2012 they presented to the OT student specialinterest group at Derby University. On 18th March 2013 both of our patientparticipants presented with the team to 1st year OT students, who were justabout to go on their first placement at the University of Derby.

Knowledge exchange and sharing has also been provided by the occupationaltherapist working with our Home Visits After Stroke (HOVIS) team. This hasbeen done through conducting a series of training and educational workshops toNHS colleagues at the Royal Derby Hospital, which has led to an increase inresearch capacity and a greater understanding of research.

Increasing research capa

High recruitmentto real-world trial


Buildingresearchcapacity in thePersonalityDisordercommunity Our Personality Disorders (PD) project islooking at ways to encourage peoplewith a personality disorder to remainin, and engage with, treatment. Researchhas shown that 37% of service users withpersonality disorder do not completetreatment, which usually takes the form ofpsychosocial, or “talking” therapies. Quitesimply, people who do not completetreatment have poorer outcomes thanthose who do.

The work of our PD project team has

Most trials have real difficulty whenit comes to recruiting participants.This is perhaps understandable, sinceentry criteria are selective, interventionsare complex and outcomes oftendetailed. The Three Shires Dental Trial –one of four studies within our MentalHealth theme – specifically tackled eachof those parameters at the design stage,with the help and support of front-lineclinicians and service users, therebyensuring significantly higher than usualrecruitment rates to the trial.

The Three Shires Dental Trial teamensured that their entry criteria werebroad, the intervention that the trial wasexploring remained simple (otherwisethe NHS would be unlikely to adopt it)and that the trial outcomes arestructured routine data of clinical

importance (otherwise nurses, doctorsand service users do not see the work aspersonally relevant). As a result, theteam got full recruitment from acrossNottinghamshire, Derbyshire andLincolnshire (the Three Shires) whichtotalled 1074 participants. The team alsoattracted keen early intervention teamsfrom Leeds, Northumberland, Durham,Wakefield, Bradford and Rotherham,with a further 2000+ participantsrecruited through these channels.

One of the principle aims of thisCLAHRC study was to demonstrate thatcost-efficient, real-world evaluation ispossible within a busy NHS environment.Thanks to their early work to tackletraditional barriers to high recruitment,the team have successfully achieved thisgoal.

Building the research capacity of our partners is a key CLAHRCgoal and the work we have done on this front will continueapace within the new East Midlands CLAHRC. All of our clinicalthemes are helping to build research capacity across the region,but here are just a few of our favourite examples…

August 2013 15

city in the regionClosing the“campus toclinic” gapThe work of our Home Visits AfterStroke (HOVIS) study team to close thegap between academia and clinicalpractice has received a positive responsetowards research in clinical practice on thestroke unit at Royal Derby Hospital. In turnthis has led to an increase in researchcapacity and altered attitudes towards and

the understanding of research.The HOVIS team developed a novel

research methodology using a parallelcohort and randomised controlled trail(RCT) design. In order to address theconcerns of clinicians regarding an RCTdesign only, researchers workedcollaboratively with ward basedOccupational Therapists to identifypatients for the cohort. If clinicianswere uncertain about whether apatient was in need of a home visitafter a stroke, the team recruited thatpatient to their randomised controlledtrial. During the first six monthsparticipants were recruited to botharms of the randomised controlled trialand the cohort in similar numbers.However, during the following tenmonths, many more patients wererecruited to the randomised controlledtrial. Findings from interviews with theOccupational Therapists suggest thatas they became more comfortable withrandomisation, they were more willingto enrol patients into the trial.

Supportingthe thirdsector CLAHRC NDL has providedacademic mentoring and support toindividuals working in research roleswithin third sector organisations,such as: The Ear Foundation, Women’sAid, Self Help Nottingham and OneEast Midlands. This has led to thedevelopment of more robust researchproposals, more accurate costings for theresearch, better research governanceprocesses and better quality researchpublications for theorganisationsinvolved.

CLAHRC NDLresearchers have alsoprovided one to onementoringopportunities(approximately onesession per month for90 minutes) as wellas ad hoc telephoneand email contactwhen required.

significantly increased the level of researchcapacity and application of the researchfindings within local and other MentalHealth services. One way in which this hasbeen achieved has been through thedevelopment of a pre-therapy preparationstudy of alexithymia (an inability to identifyand describe one’s emotions) withpersonality disorder in order to helpsubsequent engagement in group work.This has led to a number of mental healthprofessionals requesting and implementingthe intervention.

There have also been other researchoutputs from the Personality Disorderproject. These particularly relate to publicand practitioner involvement. Study leadProfessor Mary McMurran and ResearchFellow Dr Martin Clarke supervised amedical student, Peter Fardouly, on histhesis in the area of treatment engagementand Peter’s findings were fed back toclinicians at Rampton Hospital. In addition,Martin and Research Associate Mary Jinksare mentoring two professionals as part ofthe RIPple programme [see page 22] on

their applied research projects (related toengagement) which will have an impact ontheir respective services.

Mary Jinks and Professor MaryMcMurran presented the communicationstrategy at the Senior Leadership TeamMeeting as evidence of best practice and DrMartin Clarke presented it at the Universityof Nottingham Learning Knowledge event.A number of papers have been producedfor different audiences to ensure the work

associated with our project is disseminated.The alexithymia paper and one of theengagement papers was selected asprogress in the field of psychology. TheDelphi paper was selected for apresentation at July 2012 HSRN conferencewhich was well attended by staff workingin the NHS. A BITE [see page 17] has beenproduced based on related work whichothers in the field have utilised.

OutputsIn March 2013 the Department of Health published a report on‘Increasing research and innovation in health and social care’ whichasserted that “we can get more out of health and social care servicesif we encourage innovation and base more decisions on evidence aboutwhat works”. For the past 5 years CLAHRC NDL has been working totranslate research findings into innovative products, services and newways of working. Below is a snapshot of what we’ve achieved…


Real timefeedback forclinicians andservice-users Previous research conducted by ourConsensus Assessment andTreatment Outcome Measures(CATO) study team found thatclinicians do not currently find ituseful to complete questionnaires tomeasure their patients’ progress.

A significant reason for this wasbecause the measures available couldnot be easily used to provide instantfeedback to the clinician and theservice-user. In response the CATOteam developed a questionnaire –called e-PROMPT – for completion ona tablet device which can provide easilyunderstandable information abouttreatment progress at each session theservice-user attends. It is hoped thatthis information will be useful for

informing the clinician and service-user about treatment going forwardand will help them make beneficialdecisions about it.

The main aim of this phase of theCATO study is to see how well e-PROMPT works in a selection ofclinics and to find out what clinicians,service-users and administrators thinkabout it. The views of those involvedare being sought through interviews. Itis also hoped that it will be possible totest how well e-PROMPT measurestreatment progress by comparing it toestablished questionnaires that areavailable. The completion of suchmeasures is a high priority for theTrust and Commissioners and it isenvisaged that electronic feedback ofthis sort will encourage clinicians toengage much more readily in theprocess. The ultimate aim is to seewhether providing feedback in this wayhas a beneficial effect on patientoutcomes.

PROMPT is currently being trialledin several clinics in Nottinghamshireunder the direction of the CATOResearch Fellow, Charlotte Hall.

Local Educationand TrainingBoard evaluationCLAHRC NDL has worked in partnershipwith the East Midlands Local Educationand Training Board (LETB) to co-producea longitudinal evaluation frameworkwith a focus on process in year one andoutcomes in years two and three. Theevaluation framework incorporates a self-evaluation toolkit and a case study proforma.

This work has been positively received bythe LETB board and key stakeholders, andwill feed into the development of the LETBduring its initial phase. In working withCLAHRC NDL, the LETB has been able toclarify its strategic objectives and identifyhow these translate into their activities fromApril 2013. The CLAHRC’s activities haveensured a strong baseline from which tomeasure outcomes as the evaluationdevelops.

CLAHRC NDL facilitated a number ofworkshops to address key milestones in thedevelopment of the evaluation frameworkby:• Scoping and defining the research needs

of the LETB (workshop one)• Shaping the evaluation methodologies

and building research capacity for staffwithin the LETB and from key partneragencies (workshop two).

These workshops led to the creation of astrong evaluation approach. In the initialphase of the evaluation, CLAHRC workedwith LETB partners (including GPs andrepresentatives from the Deanery) to co-produce research tools and to support thesestakeholders to undertake their own researchsessions.

Participants complete e-PROMPT everytime they attend a clinic session and arerecruited into the study for 6 months oruntil their intervention finishes. Charlotte isstarting to conduct interviews with users ofe-PROMPT (young people and clinicians)participants’ parents/carers andadministrative staff facilitating the process.Attempts will also be made to assess thesensitivity of e-PROMPT in detectingchange in comparison to other establishedmeasures. The CATO team continues tocollaborate with the Institute of Psychiatry,London to develop and assess thismonitoring tool.

August 2013 17

TrainingPackagesOur Personality Disorder team haveproduced the Readiness EnhancementManagement Strategies (REMS) staff e-learning programme. The team have alreadycontacted educating bodies – such as theInstitute of Mental Health – to furtherdisseminate their work to practitioners. Theultimate goal is to help staff improve theirpractice by increasing their awareness andproviding them with strategies which mayhelp engage this client group. The teamhave also produced a series of 8 podcastsdescribing engagement strategies; theREMS e-learning training; the views of ourservice user representative; and theexperience of our Diffusion Fellow. You canlisten to the podcast on the PersonalityDisorder pages of the CLAHRC NDLwebsite.

Our Steps To Active Kids (STAK) teamhave developed a 15 minute DVD whichaims to improve children’s’ confidenceabout exercising, particularly for those with

risk factors for adult obesity.Intended for teachers,teaching assistants and schoolnurses, the DVD demonstratescircuit activities, street dance,diary completion and themotivational interviewing /goal setting aspects of theprogramme. The team areinvestigating ways to get theprogramme embedded in localauthorities more widely, and a STAK websiteis currently under development.

Early findings from our Impact ofInjuries study suggest that many peoplewho are hospitalised after an accidentalinjury suffer from mental health problems inthe year following their injury. Many serviceproviders are unaware of the full extent ofthis. A trauma workshop, delivered by aPsychotherapist from NottinghamshireHealthcare NHS Trust (and Diffusion Fellowfor the study), informed service providersabout the potential long term mental healthissues following injury, the impact of apatients’ psychological state on theirrecovery, how to talk to patients aboutmental health issues, and identifyingwhether patients require specialist support.

The workshop was delivered to 28psychotherapists and nurses atRoyal Surrey County Hospital. It ishoped that this workshop will berolled out to the other Impact ofInjuries Study recruitment sites(Leicester, Bristol and Nottingham)in autumn 2013.

The CLAHRC RegularAttenders study team developedan education and training package

which was delivered as a two hour sessionto five general practices involved in thestudy during summer 2013. The sessioncovered four main areas: Who are regularattenders?; Why do they attend?; Whatimpact does it have on staff?; What can bedone to help them? The session wasinformed by qualitative interviews withregular attenders recruited to the study,experiences of the Cognitive BehaviouralTherapists involved in treating studyparticipants, and interviews with serviceproviders at GP practices who helped theteam with the study. This education andtraining material will be developed furtherin the future to support GPs in themanagement of patients with long termconditions.

CLAHRC BITEs BITEs (Brokering Innovation ThroughEvidence) are an NDL initiative tohelp make research findings clear andaccessible to clinicians and health andsocial care staff. Each BITE is a two-sided A5 leaflet summarising the mostimportant conclusions, implications andrecommendations of a piece of research.

As of August 2013 we had produced28 BITEs from our own research. Instrengthening links with NIHRinfrastructure, we have produced 6 BITEs

on behalf of other NIHR-fundedprogrammes and initiatives, includingthose on treatment of eczema, verrucas,tinnitus, suicide prevention and liverdisease.

BITEs have also been adopted as ameans of disseminating research findingsby the other 8 CLAHRCs as well as theHSRN Network. The production ofBITEs is an ongoing project, and all ofour evidence BITES are available on ourwebsite: www.clahrc-ndl.nihr.ac.uk


Benefitting the wider economy, society, culture, and public policy/health


Each year our main funder – the National Institute for Health Research (NIHR) – asks us (along with the other 8 EnglishCLAHRCs) to demonstrate how we are benefitting the wider economy, society, culture or else benefitting public policyor health. Here we highlight how we’ve been doing just that with some of our favourite examples from 2013…

Helpingstrokesurvivors backinto workThe CLAHRC NDL Return To Workafter stroke (RTW) project hasresulted in better outcomes for strokesurvivors randomised to receive earlystroke specialist vocationalrehabilitation (ESSVR). More peoplewho received ESSVR support from anoccupational therapist as part of thisfeasibility trial were working one yearafter stroke. In addition, more ESSVRparticipants returned to full time work orresumed their pre-stroke working hoursthan did usual care participants. Of equalimportance, the ESSVR intervention wasdelivered in a way that was seen asacceptable and useful by those whoreceived it.

People who received the ESSVRsupport also appeared to be better offfinancially. Their earnings – as a

proportion of their pre-stroke earnings –dropped less than for participants inusual care. Furthermore, fewer ESSVRparticipants were claiming state benefitsat 12 months post stroke.

The RTW team worked closely withVR stakeholders (employers, serviceusers, service providers andcommissioners) and using evidence fromthe literature and a panel of expertsdeveloped an early stroke specialistvocational rehabilitation (ESSVR)intervention to address the unmet workneeds of stroke survivors inNottinghamshire.

With CLAHRC funding, thisintervention was implemented and testedin a single centre feasibility trial. Thefindings suggest that the ESSVRaddressed a gap in existing serviceprovision. People with milder strokes andhidden disabilities (such as cognitive orvisual impairments) whose needs arefrequently missed after stroke, wereincluded among those recruited to thetrial and were found to benefit from thesupport. We found that the ESSVRintervention could be delivered in a waythat was acceptable to service users andemployers and that its effectiveness and

costs could be measured usingstandardised and bespoke questionnaires.The results suggest the intervention hadan impact on stroke survivors’ lives. Twiceas many people who received the ESSVRsupport were in work at 12 months afterstroke than those in usual care and thesepeople were financially better off.

Another aspect of the project hasfocussed on the provision of informationand advice to employers. This activity hasled to a greater awareness andunderstanding of the impact of stroke. Asa result of advice and informationprovided to them, employers haveintroduced work place modifications –from changes in the workers role andresponsibilities to physical changes to thework environment – that have facilitatedreturn to work after stroke and increasedjob retention in those who received thesupport.

The RTW project identified thatstroke survivors who had receivedvocational rehabilitation from anOccupational Therapist felt that they andtheir employer had benefitted fromadvice on the impact of stroke and howto modify the job or the workenvironment.

August 2013 19

Within our Primary Care theme,researchers on our Step Out study areproviding members of the South Asiancommunity in Nottingham and Derbywith skills, knowledge, training andexperience to facilitate and deliver acommunity informed, culturally appropriateintervention to enhance physical activity forSouth Asian people at high risk ofdeveloping diabetes.

Eleven bilingual community members –who between them speak Punjabi, Urdu,Hindi, Mirpuri and English – were engagedas Community Link Workers (CLW) frominner city localities of Nottingham andDerby to recruit South Asian participantsfrom community settings to the Step Outstudy. In order to prepare them with thenecessary skills and knowledge required torecruit participants to the study, deliver theintervention, and conduct follow ups at

n Patient and PublicInvolvement Snapshots

A patient who contributed to the firstphase of our Upper Limb study has goneon to take a role in the StrokeAssociation and has become an advisoron a hearing research project as well asjoining our collaboration with a medicaldevices manufacturer. A second patientpresented with us at the Allied HealthProfessionals Research Network meetingat Leicester General Hospital in May2012.

Our ‘Research Engaging with Patientsand Public’ (REPP) network bringstogether researchers and PPIrepresentatives to share resources,coordinate development and respond tothe new NHS architecture. Service usersplan the agenda, invite speakers andfacilitate the exchange of information,allowing some to move frominvolvement in one study to another.Research staff in some agencies havegained a wider perspective throughattending the meetings.

Our Patient and Public Involvement workhas really started to link in with that ofother organisations and agencies. Somenotable examples include:• The Health Service Research Network

annual conference offered nobursaries to PPI reps in 2012.Following recommendations made byCLAHRC NDL, 10 bursaries wereoffered in 2013.

• Conference programmes heldelsewhere in the University ofNottingham have been approached toclarify that they are open to PPI repattendees. This has been confirmed,and the events are now advertised onour PPI Events Calendar (see the‘Getting Involved’ section of ourwebsite).

• Advice has been requested from, andprovided to the people developing PPIstrategy at the Local Education andTraining Board (LETB) and EastMidlands Leadership Academy.

• Discussions about increasingparticipation in research haveoriginated at CLAHRC NDL and beentaken into the Comprehensive LocalResearch Network (CLRN) andInstitute of Mental Health.

Reducing Diabetes Risk inSouth Asians

various time points, they were givencomprehensive training. This trainingcovered motivational interviewing,research skills (e.g. taking consent), andstudy specific skills for delivering thephysical activity intervention.

Link Workers report their involvementwith the project to have yielded a rangeof benefits, both personal andprofessional. For example, the majorityhave described developing increasedconfidence and improved self esteem as aresult of being involved, and others,having enjoyed and discovered anaptitude for this kind of work, have madea decision to pursue further education oreven a career in health promotion orcommunity development.

As of June 2013 the efforts of theCLWs helped the Step Out team recruit315 South Asian participants to the study.

See page 24 for more on PPI


Reducing or preventingharm, risk or costsThe NHS is facing unprecedented demands to deliver more efficient, cost-effective services. As well as improving patient outcomes and safety, our studieswork with Health Economists to ensure that they present our NHS partnerswith cost-effective services capable of being implemented in the ‘real world’ oftightening healthcare budgets. Below are just a few examples of how we’reworking to reduce harm, risks or costs…

Preventingproblems inpregnancy The Action Before Conception (ABC)study – also known as the FacilitatingPreconception Health study – is exploringthe feasibility and acceptability of apreconception health interventiondelivered in a general practice setting.The study team are particularly interestedin women from disadvantaged white,South Asian and African Caribbeancommunities who are at higher risk ofpoor maternal and child health outcomes.

The 87 women who have taken partin the study have been provided with

Researchers in our Primary Caretheme have been working across theregion to raise awareness in SouthAsian communities about therelationship between physical activityand diabetes prevention. Elevenbilingual Community Link Workers,speaking a mixture of Punjabi, Urdu,Hindi and English, were tasked withrecruiting and delivering a community

informed, culturally appropriateintervention to enhance physical activityto South Asian participants fromdisadvantaged communities inNottingham and Derby.

In total 315 participants wererecruited and received the intervention,which involved a group educationsession about the importance of physicalactivity in preventing diabetes; an

Diabetes awareness amonglocal South Asian communities

informative DVD containing local‘stories’ to help engage participants;provision of a pedometer to measuresteps; and advice on setting dailyactivity goals. Whilst it is too early tosay whether or not the intervention hashad an effect on physical activity, it hasgiven the project team the opportunityto provide information and support tohelp these 315 people embark onlifestyle change to improve their health.In particular it has demonstrated ahighly promising method of engagingmore ‘difficult to reach’ South Asiancommunities at high risk into healthpromotion intervention.

August 2013 21

information relating to preconceptionhealth, completed questionnaires and metwith practice nurses at their local GPsurgery. Early findings suggest thatwomen’s participation in the study hasbeen a catalyst to improved preconceptionhealth, both in terms of knowledgeimprovement and subsequent relevantbehaviour change, and in terms of healthissues they would have otherwise beenunaware of and for which consequentremedial action was taken. For example, forsome woman participation in the study hasensured that they received testing forrubella immunity or genetic carrier testingbefore pregnancy.

In addition, practitioners at each of thenine study sites report their involvement inthe study to have improved their ownknowledge and practice in relation topreconception health issues.

Early StrokeRehab benefitsbudgets,patients andsociety

The Early Stroke Specialist VocationalRehabilitation (ESSVR) modeldeveloped by our Return to workafter stroke (RTW) team mayresult in reduced length of hospitalstay and cost savings to healthservices and to society. As a resultof ESSVR, the length of acutehospital stay has been reduced(and work productivity hasincreased) in stroke survivorswho received the ESSVRsupport.

The feasibility ofdelivering ESSVR andmeasuring its costs andcost effectiveness wastested in a pilottrial funded by

CLAHRC NDL. In broad terms, morepeople who received ESSVR returned towork resulting in increased productivityand greater financial gain, as measuredfrom a societal perspective. The observedmean total societal cost was £14,370 at12 months after stroke, compared with£16,257 in the usual care group.

From a health and social careperspective, people who received ESSVRsupport from an Occupational Therapiston the trial spent seven days less inhospital than participants in usual care,

on average. The mean total cost in theintervention group was £8,157 comparedwith £9,359 in the control group. Thisrepresents a cost saving, per patient, of£1,200 to the NHS or social careprovider.

At a personal level, from theperspective of the stroke survivor,ESSVR participants lost less of their pre-stroke earnings compared withparticipants in usual care and fewer wereclaiming state benefits at 12 monthspost stroke.

RIPple

In its first year 11 research projects werecompleted, with 18 projects completedin 2013. Participants establish their ownresearch topic, carry out research withcolleagues or examine secondary evidenceto build up their knowledge, analysefindings and utilise their insights to suggestor implement service changes. CLAHRCcolleagues with expertise in researchmethodology, ethics, evaluation and patientand public involvement support theprogramme’s researchers in their work.

Year 1Eleven successful applicants – includingphysiotherapists, nurses, occupationaltherapists and ophthalmologists – spent 13days over 13 weeks conducting Researchinto Practice including implementingexisting research, further developing existingresearch or commencing original research intheir area of practice. Participants camefrom NHS Trusts – Nottingham UniversityHospitals, Nottinghamshire Healthcare andSherwood Forest Hospitals – as well asDerbyshire Children's Hospital, the RoyalDerby Hospital and Ashgreen SpecialistLearning Disability Service. Here wehighlight four case studies from Year 1…

Alisa Timmerman, OccupationalTherapist, NottinghamshireHealthcare NHS TrustProject Sensory sensitivities in AutismSpectrum Disorders.Outcomes Alisa's review of assessmentsand treatment found gaps in the service –for example there is no assessment fordyspraxia in adults. She further foundthat (as of 2012) there was no expertisein Developmental Coordination Disorderin the Trust which resulted in a memberof the team attending training regardingassessment tools. Through conversations


Since 2012 our Research into Practice people(RIPple) programme has seen therapists, nurses andNHS managers undertake work to effectively reducehospital stays, re-design care pathways and improveclinician and patient engagement. Put simply,RIPple encourages health and social care staff toundertake research that leads to better outcomesfor patients, themselves and their organisations.

with clients, carers, colleagues and experts,Alisa developed two new pathways: aclient pathway on referral, throughassessment and support; and a servicepathway and selection of services offered.As a result 20 new information leafletshave been designed and distributed, atraining package has been developedwhich has been delivered to colleagues,occupational therapists and clients, andAlisa gave a presentation to a group atSheffield University and disseminated herfindings to Sensory Integration Network UKand Ireland.

Julie Coulson, Respiratory SpecialistNurse, Sherwood Forest Hospitals NHSFoundation Trust (SFHT)Project Implementation and assessment ofEarly Supported Discharge for ChronicObstructive Pulmonary Disease.Outcomes After carrying out a survey ofstaff knowledge about COPD, Juliedeveloped new documentation which iseasier to read and complete. She alsoprepared a staff training event on thedischarge bundle and ultimately found thatimplementing these changes effectivelycould reduce the length of stay by 2 days,where the national average hospital stayfor COPD is 6 days.

Mike Bullock, Physiotherapist, Nottingham University HospitalsProject Evidence and therapyinterventions around osteoarthritisand falls in the older frail patient.Outcomes Mike reviewed guidelinesand Cochrane reviews to explore theeffect of exercise on falls. He furtherdiscussed research with a patientsupport group. Mike has wonresearch funding to continue thisproject and is now looking into thefeasibility of long-term support forexercise – for example bydeveloping an expert patient.

August 2013 23

Year 2Eighteen successful applicants – includingpsychologists, midwives, community healthworkers and speech and languagetherapists – spent 13 days over 13 weeksconducting Research into Practice includingimplementing existing research, furtherdeveloping existing research orcommencing original research in their areaof practice. Participants came from anumber of NHS Trusts – NottinghamUniversity Hospitals, NottinghamshireHealthcare, Derbyshire Community HealthServices, Derbyshire Healthcare FoundationTrust, Leicestershire Partnership andLincolnshire Partnership Foundation Trust –as well as Nottingham City Council andWomen’s Aid Integrated Services. Here wehighlight four case studies from Year 2…

Sarah McDonald, Clinical Psychologist, NottinghamshireHealthcare TrustProject Accessing Psychological Therapy:Helpful and Unhelpful Factors forStep4Psychological Therapies Service Users.Outcomes Service users were consulted todevelop a questionnaire to collect feedbackon Step4Psychological Therapies. The aim ofthe questionnaire was to evaluate factorshelping and hindering access to the therapy.The key aspect raised in the focus groupswas information available to service users atpoint of referral from their GP. To addressthis issue, Sarah has developed a briefing forGPs about the Step4Psychology programme.

Monique Burgin, Nurse, NottinghamUniversity HospitalsProject Impact on children of travellingto renal specialist centres.Outcomes Families of children whoreceived renal care as part of EastMidlands, East of England and SouthYorkshire (EMEESY) network wereinterviewed to understand theirperceptions of the quality of the clinicalservice, as well as inconvenience oftravelling to a central specialist centre.Some families had to travel many hours,sometimes including an overnight stay,which was a considerable inconveniencefor work and school life. However manyfamilies expressed reassurance that theywere receiving the best care available.This study will inform future programmeswhich will enable families to attend localclinics to see the same specialists whowill travel around the region.

Jon Carroll, Community MentalHealth Nurse, LincolnshirePartnership FTProject Development of an interactiveassessment tool and workbook for use inan early intervention for psychosis service.Outcomes Engaging service users, Jondeveloped a workbook and iPadapplication to assess understanding ofcannabis as an early intervention foryoung people with psychosis. At thesame time the material presentsinformation on cannabis and is interactivewhich can help service users self-monitortheir use of cannabis and hopefullyreduce or quit use.

Daniel Roberts, Nurse, AshgreenSpecialist Learning Disability Service(Derbyshire Community HealthServices)Project Measuring patient and carersatisfaction with care in learning disabilitysettings.Outcomes Daniel undertook a review ofcurrent practice and literature aboutmeasuring patient satisfaction. Hedeveloped a new survey tool with the helpof two service users and piloted it with 3patients. The tool includes photos ratherthan drawings and is administered by apatient advocate rather than a member ofstaff. Daniel’s recommendations are thatthe reliability and validity of the tool shouldbe further tested, and that the tool befurther developed. Daniel disseminated hisfindings within the Trust and also tothe Patient Advice and Liaison Service(PALs) and LINk.

Lorna Manger, Quality and ResearchWorker, Women’s Aid IntegratedServices (Nottingham and Region)Project Development of a befriendingservice following support for womensurvivors of domestic violence.Outcomes Feedback from survivors ofdomestic violence indicated that therewas a lack of continued supportfollowing Women's Aid services. Lornagathered views on how best to create aBefriending service, by reviewingliterature and seeking advice from staffin similar areas of work. Six previousservice users gave their views onpriorities for a befriending service. Thisstudy will inform a training programmeand policy development.

Patient and PublicInvolvement (PPI)

opportunities for involvement across thewhole East Midlands region.

The dateline shown below gives someof the landmarks from an organisationalperspective, but here’s what Glen saidabout his longstanding involvement. “Igot involved with PPI activities about tenyears ago and have been active across anumber of healthcare organisations inNottingham including the CLAHRC.Sometimes this means I can help by tellingstaff about something going on ‘next door’ thatthey don’t know about. I used to attend somemeetings in another place where I wasn’t givena speaking part, but the CLAHRC Boardhave been really friendly, asking my opinionand using what I say. Regular meetings atCLAHRC provide opportunities for

Each study proposal was discussed in thePopulos meetings before approval, andsome steering groups invited acommunity representative to join theirregular meetings throughout the life ofthe study. In addition, CLAHRC hasheld regular meetings for communityrepresentatives and researchers to meetone another, consider findings from theresearch and think about how to embedinvolvement across the wholeorganisation.

Now, as the individual studies aredrawing to a close, communityrepresentatives are contributing to thedissemination of findings, consideringhow to carry forward the lessons learntwithin our CLAHRC and shape new

The National Institute for Health Research (NIHR) requires that all researchprojects take advice from patients and the public. When CLAHRC NDL began itswork in 2008, it responded to this agenda by convening a group called Populos.


networking. Some of the ideas we had arecoming to fruition, and that is good, but weare still only scratching the surface. As thefirst CLAHRC comes to an end and newthings start, we want to help PPI get evenstronger and help to make a smooth transitionto the new arrangements.”

Naomi has got involved more recentlyand done different things. Here are herreflections. "I have a background in healthand social care, and retired rather abruptlyafter the death of my husband. I enjoy theopportunity to exercise my brain, and tocontinue with some of the themes of my career.At the monthly PPI catch-up meetings weidentify issues for implementation or furtherstudy. It was through CLAHRC that I wasinvited to be a lay member on a majorresearch project about living with dementia.As I am not beholden to anyone, I am in abetter position to challenge professionals thanI was when I was working - a key strength ofPPI. One thing bothers me though. Nearlythirty years ago I was working at the cuttingedge of consumer involvement in research anddevelopment, battling to get the conceptaccepted by the establishment. I still sit inmeetings where we talk about this. Afterthirty years!”

Spotlight on Ageing and OlderPeople’s Health and Wellbeing

Dementiaplay unitesarts andacademia

Throughout June and July 2013 anew play about dementia – InsideOut of Mind – had its first run at theLakeside Arts Centre in Nottingham,receiving national press coverage,including a feature on BBC Radio 4’sToday Programme, as well as glowingreviews.

Written and directed by TanyaMyers, the often darkly comic playlooks at life on a dementia wardfrom the perspectives of patients,their families and carers and is apowerful illustration of the largelyunseen world of dementia care.Tanya drew on extensiveethnographic research (over 600,000words of notes) conducted byUniversity of Nottingham researchersSimon Bailey, Kezia Scales andJoanne Lloyd whilst working in localdementia wards, under the guidanceof Professor Justine Schneider. Theplay aims to impact positively on thecare of those with dementia, and toencourage empathy and intuitivelistening.

Excerpts from the play will bedeveloped into a new learningresource and hosted on the IDEAwebsite www.idea.nottingham.ac.ukthanks to a grant from the RoyalCollege of Nursing Foundation Trust.

Older People Knowledge HubThe good news: increased life expectancy, the not-so-good news: long term conditionsand multiple conditions should now be the main concern of healthcare, the bad news: itis very difficult to reshape health services for integrated and community care rather thanbeing centred on acute hospitals.

The Knowledge Hub for Frail Older People aims to help with the latter issue bycreating a forum where clinicians and managers can discuss issues and share ideas tosupport rapid service improvement. We will kickstart the initiative by sharing findingsfrom our five year study of Medical Crises in Older People, along with integrated carestudies within CLAHRC. The core part of the Hub will be the programmes of the newEast Midlands Academic Health Science Network (EMAHSN). The priority will be tosupport Comprehensive Geriatric Assessment (CGA) across the East Midlands. Our firstfocus will be emergency and urgent care; aiming to facilitate assessment and rapidprovision of a multidisciplinary care plan for either hospital or community.

Further programmes will focus on care of people with dementia and also addressinghealth and social needs in the community in order to maintain health. If you would liketo be informed when the Knowledge Hub goes live, please contact Neil Chadborn [email protected].

With an ageing population and the fact that one person in four over the age of 80 islikely to develop dementia, the number of people in the UK with the disease is set todouble to 1.4m by 2040. This is why improving dementia care is of vital importance…

August 2013 25

Awards, honoursand prizes

Marion Walker, Professor in StrokeRehabilitation at The University ofNottingham’s Division of Rehabilitation andAgeing, was awarded an MBE in theQueen’s 2012 New Year Honours List.Marion, who is also the Principal Investigatoron our Early Supported Discharge (ESD) afterstroke study, said: “I am absolutely thrilledto receive this honour. Improving the qualityof life of stroke survivors is central to all ourefforts.”

CLAHRC Diffusion Fellow Stephen Regel,who works on our Impact of Injuries Study,was awarded an OBE in the Queen’s 2013New Year Honours List. Stephen received hishonour for services to victims of trauma.Stephen is a principal psychotherapist atNottinghamshire Healthcare NHS Trust andco-director with Stephen Joseph of theCentre for Trauma, Resilience and Growth.The honour recognises Stephen’s 30 years ofexperience working with trauma and PostTraumatic Stress Disorder (PTSD).

In 2012 Professor Avril Drummond wasmade a Fellow of the College ofOccupational Therapists. Avril is thePrincipal Investigator on our Home VisitsAfter Stroke (HOVIS) study. The award ofFellowship is the highest honour theCollege can bestow on one of theprofessional members of the BritishAssociation of Occupational Therapists inrecognition of exceptional service andoutstanding contribution to theprofession.

Every year the Emerald publishing groupgive awards for one best paper, and up tothree outstanding papers, for each of their280 academic journals, to celebrateoutstanding contributions. Award winnersare chosen by each journal’s EditorialTeam. Three NDL colleagues triumphed inthe Emerald Literati Network Awards2013:• Mary Jinks and the Personality Disorders

study team won an Outstanding PaperAward for "Engaging clients withpersonality disorder in treatment",published in Mental Health Review.

• Research Fellow Elaine Argyle's paperon "Person centred dementia care:Problems and possibilities" was a HighlyCommended Award winner. The paperwas published in Working with OlderPeople.

• Peter Bates (CLAHRC PPI Lead) won an


Below we provide just a brief snapshot of some of the many awards,honours and prizes won by CLAHRC staff and Diffusion Fellows since 2008.Hopefully these very varied achievements will give you a flavour of howproductive our studies have been, as well as the drive, determination anddynamism of everyone involved in the CLAHRC.

Outstanding Paper Award for "Almostinvisible – providing subtle support incommunity settings", published in TizardLearning Disability Review.

In February 2012 Stroke Rehabilitationresearcher Phillip Whitehead was awardeda Graduate School Building Experience andSkills Travel Scholarship (BESTS) to travel toSydney as part of his work on the HomeVisits After Stroke (HOVIS) study, and inFebruary 2013 Phillip was awarded anMPhil.

In June 2012 our Steps To Active Kids(STAK) study team presented the STAKproject at the University of Nottingham’s‘Research Rely’ event. Ten projects werepresented on the day, and ResearchAssociate Luke Hogarth picked up firstprize for best project on behalf of the STAKteam, as voted for by the public.

CLAHRC doctoral student Bridget Roe wasawarded one of only ten Sociology ofHealth and Illness (SHI) Travel Prizes given in2012. The scheme supports post-graduatestudents to present a medical sociology orsociology of health and illness paper at aconference outside the UK.

In August 2013 our CommunicationsOfficer, Ian Kingsbury, was awarded ahigher degree (with distinction) in Scienceand Environmental Journalism by theUniversity of Lincoln.

August 2013 27

Blerina Kellezi from the Impact ofInjuries studyInformation provision and needs ofinjured patients: A service providerperspective from the Impact of InjuriesStudy – Poster at the Nursing MidwiferyResearch Strategy Group’s Research andEducation Meeting, June 2013

Chris Sampson, Health EconomistCost implications of treatment non-completion in personality disorder –Presentation at the East Midlands &South Yorkshire MHRN Annual ResearchMeeting, March 2012

Bridget Roe, Doctoral studentLearning to nurse: Preceptorship inpractice – Presentation at the Institute ofMental Health Research Day, May 2013

Sam Malins from the Regular Attenders studyHelping a ‘Heart Sink’ patient with HeartFailure – Poster at the Midlands HealthPsychology Conference, February 2013

Kate Radford and the Return toWork After Stroke studyDeveloping Stroke Specific VocationalRehabilitation: Mapping Current ServiceProvision – Poster at Northern IrelandMultidisciplinary Association for StrokeTeams/UKSF Stroke Conference, ~Lisburn, 2012. This research wassubsequently selected by the StrokeAssociation for exhibition during a Royal visit at the Stroke Association HQ in London.

Mary Grant and the Return to WorkAfter Stroke studyVocational rehabilitation followingstroke: describing intervention andoutcome – Poster at the UK StrokeForum, Harrogate, December 2012

Alison Seymour, ImplementationResearch FellowDiffusion Fellows scrambling over fencesin CLAHRC NDL – Poster at the CLAHRCSouth Yorkshire ImplementationConference, October 2010

n CLAHRC IN NUMBERS

88Fitness DVD licences sold to schools by our STAK

project team

17yearsAverage time taken for

practice-based research to get into practice

3.5yearsTime many CLAHRC-NDL studies have taken to get

research into practice

46PhD students attached

to the CLAHRC

14Other higher degree (MD, MPhil, MSc, etc.) studentsattached to the CLAHRC

110+peer-reviewed publications

130+presentations to key

stakeholders

4,000people directly

recruited to studies

10,000people recruited through

medical records

81training events in the

last 2.5 years

2,519people attended

these events

Poster andpresentationprizes

34active and completed

implementation projects

81active and completed

research projects

12,500People visit our website

each year

A partnership of: CLAHRC is a member of:

Collaboration for Leadership in AppliedHealth Research and Care – Nottinghamshire,Derbyshire and Lincolnshire (CLAHRC-NDL)C Floor, Institute of Mental HealthUniversity of Nottingham Innovation ParkTriumph Road, Nottingham, NG7 2TU

Email: [email protected]: www.clahrc-ndl.nihr.ac.uk Twitter: @CLAHRC_NDL

Documents

CLAHRC NDL Engage issue 6 (summer 2013)