UEAHSCP's 'together' magazine - Winter 2020/21

together

UEA Health and Social Care Partners' quarterly magazine Winter 2020-21

SCORES study attracts support of high profile former footballers Norwich Institute for Healthy Ageing's Partner Symposium New Rheumatology research group launches

Improving Care Through Collaboration

together | p. 2

WELCOME TO OUR NEW LOOK MAGAZINE 'together' As we approach our second anniversary of the partnership's formation this coming spring, we look back at 2020 and reflect on what has been a turbulent and difficult year for all of us.

Yet, our strong relationships have brought together hundreds of the best people across our health and social care community to tackle a myriad of rapidly changing regional challenges under exceptional circumstances.

From supporting much needed hand sanitiser production and distribution at the start of the COVID-19 pandemic, to co-directing an ambitious mass asymptomatic testing initiative at a time when the national testing system was focused on symptomatic testing – the success of our partnership's approach to innovate care is all down to the support and collaboration of our partnership staff and associates.

In this, our first issue of 'together' magazine, we spotlight just some of our partnership achievements, including some fantastic work to provide effective digital support packages to care home staff and carers, and the continued impact of Dr Michael Grey's exciting SCORES study exploring the link between heading footballs and brain health degeneration, which continues to attract a growing list of high profile supporters, including former Norwich City legends Jeremy Goss and Iwan Roberts.

If you'd like to find out more about any of the work featured, or you're interested in working with our team to grow your research, please get in touch to see where we can support you - ueahscp@uea.ac.uk.

We look forward to sharing even more of our partnership success stories throughout 2021.

Mark Hitchcock, Managing Director UEA Health and Social Care Partners

In Today's Issue: Norwich Institute for Healthy Ageing's Partner Symposium...........................................................p.3 Palliative Care's Storytelling Initiative..............................................................................................p.3 New Rheumatology Research Group...............................................................................................p.4 AI Automated Chest X-Ray Diagnosis Project.................................................................................p.5 'Carecoach' Initiative Supporting Dementia Carers........................................................................p.5 Frailty's Online Training Project For Care Home Workers.............................................................p.6 World Cancer Day 2021.................................................................................................................... p.6 'SCORES' Study Developments........................................................................................................p.7 NRP COVID Testing Project Success..............................................................................................p.8

together | p. 3

Norwich Institute of Health Ageing - Symposium Did you catch NIHA's Partner Symposium in February, featuring keynote speaker Professor Sir Michael G. Marmot ? The event celebrated the breadth of healthy ageing related research happening across Norwich Research Park and beyond.

Watch the symposium on demand here in case you missed it.

NIHA is a new research centre based at UEA and will aid ambitious collaboration to support improvements in a range of behaviours to ensure healthier and longer lives for the East Anglian population and beyond. Researchers will work collaboratively on areas including nutrition, physical activity, smoking cessation, sleep, social activity and medication adherence, and the implications of behaviour change on health and wellbeing.

Healthy Ageing has been identified as one of UEAHSCP’s research priorities and we're supporting NIHA as a major tool in helping to achieve better outcomes for all.

School storytelling intervention successfully supports conversations around loss Led by UEA’s Dr Guy Peryer, the Palliative Care research group have gone from strength to strength since their establishment, working with a multitude of high-profile health and social care organisations across the region to expand community involvement in palliative and end of life care across the Eastern region. ‘Compassionate Communities’ is a concept vital to the group's work: facilitating community action to raise awareness of death literacy and increase community-based support for those nearing the end of life and the people close to them, aiming to encourage open conversations around dying, death and loss.

Research group members and supporters across UEA, Norwich School, and the Norfolk and Waveney NHS Palliative and End of Life Care Collaborative worked together to co-produce a storytelling intervention implemented in an independent school in Norwich where pupils wrote up to 1,000 words in response to the title ‘I wish we’d spoken earlier’, encouraging pupils aged 12-15 years to independently explore ideas of death, loss and grief in a controlled and creative format.

The study published a peer-reviewed journal article, 'Using a storytelling intervention in schools to explore death, dying and loss' in the Journal of Public Mental Health, demonstrating the feasibility of the storytelling intervention. Researchers agree that there is strong potential to implement a wider public health intervention in schools to encourage pupils to independently explore ideas of death and loss in a creative format. Introducing discussion in an imaginative way, such as storytelling, can open lines of communication and help dispel fears or misunderstandings.

Dr Guy Peryer said that the study showed the successful use of storytelling as a structured way for young people to explore ideas of loss. Importantly, the intervention prompted family conversations around preferences and wishes for end-of-life care.

The group are looking to build upon this momentum and make further steps towards a Compassionate Community by supporting community stakeholders and developing a new public health approach to palliative and end of life care.

Schools are an important community asset that can be empowered to raise awareness of the need to support bereaved children and their families affected by death, dying and loss.

IN OTHER NEWS Facilitated by the Palliative Care research group, St Nicholas Hospice presented an online workshop at the Good Grief Festival: ‘Life’s Questions: Talking to young people about grief’.

The three-day event, billed as ‘a virtual festival of love and loss’, attracted over 12,000 participants, and explored the unique form of grief during the pandemic. The ‘Life’s Questions’ initiative has run for three years, and received a Nursing Times Award in November 2020.

You can pay to watch the workshop here.

together | p. 4

Rheumatology research group launched The Rheumatology research group is a collaborative initiative of clinicians specialising in rheumatology to develop new opportunities to initiate regional centred research. Placing local needs at the centre of the group’s focus areas, researchers aim to improve the standard of care for service users in our region.

Over 30 years, the Norfolk Arthritis Register (NOAR) observational study into the cause and outcome of inflammatory polyarthritis has accumulated a wealth of data and research into arthritis and related conditions. Using the model of NOAR, the research group will expand the recruitment of participants, to allow for comparison of outcome of patients living with musculoskeletal disease across our region, to achieve improvements in care, engagement in research, and shared learning.

Throughout the pandemic, NOAR has been providing insight into the impact of social isolation in inflammatory diseases and those who are immunosuppressed. This collaboration will enable practice innovation studies as well as building upon timely research around the impact of COVID-19.

In support of the group’s overall vision for ambitious research, leading clinicians and academics from seven UEAHSCP partner organisations have identified several key focus areas centred on regional challenges, including: Use of biologics; Improvement in the speed and accuracy of diagnosis; A review of patient quality of life measures, including anxiety, depression, and fatigue; Research and care in this area for health inequalities and ethnic minorities; contrast between rural, costal, and urban communities; Impact of COVID-19 on care and patient experience; Inflammatory rheumatic disease.

NOAR researchers have also carried out pilot work investigating cognitive decline and causes of frailty in ageing groups, applying new imaging methods to examine muscle changes in patients with chronic inflammation. The strength of the collaboration will enable this work to expand across the region and to address new research challenges.

together | p. 5

AI driven web tool looks to automate chest Xray diagnosis UEAHSCP is supporting a call to help improve service usability and impact of a unique new UEA web-platform for automated chest X-ray diagnosis of bacterial, viral and COVID-19 specific pneumonia.

AI has been providing insight into the impact of social isolation in inflammatory diseases and those who are immunosuppressed. This collaboration will enable practice innovation studies as well as building upon timely research around the impact of COVID-19. Chest X-ray is one of the most common and effective methods of triaging patients with suspected pneumonia due to its availability, cost, and sensitivity. Amid the current COVID-19 pandemic, it is an invaluable tool due to the rapid saturation of lab capacity required for other testing methods.

Led by Dr Saber Sami at UEA’s Norwich Medical School, researchers have developed an online machine learning solution to COVID-19 chest X-ray diagnosis, available at https://icdt-app.herokuapp.com/.

Based on individually uploaded scan data, the AI model is capable of categorising patients into 4 different categories: COVID-19, Bacterial Pneumonia, Viral Pneumonia, and Clinically Normal.

The model is built on a deep convolutional neural network (AI algorithm) that extracts image features and then makes predictions based on the features extracted. The upload method is very easy and just needs a jpeg image to be uploaded. There is no stored personal data within the current process. The training data set used 6,045 anteroposterior chest X-rays including 144 open-source images of patients with COVID19. Results show that with limited training, data accurate multi-class detection can be achieved, with world-leading accuracy of 98% and a system response time of less than 5 seconds from upload. The algorithms’ decision-making is powered by visualising regions within the image most important for diagnosis. UEAHSCP will support the website development for the project and will recommend the tool to partner organisations with a view to active facilitation/contribution.

including

144 images of patients with COVID-19

Training data used

6,045 anteroposterior chest X-rays

'Carecoach' initiative set to support dementia carers

An innovative new project launched late last year will see researchers from UEA and Norfolk and Suffolk NHS Foundation Trust (NSFT) working together to improve the lives of dementia carers in the UK. Hosted

by UEAHSCP’s Frailty research group, the team will work with carers and health and social care workers to co-develop and test a new ‘Carecoach’ support package - thanks to a £1.93M funding grant from the National Institute for Health Research (NIHR).

Frailty group research lead Prof Chris Fox from Norwich Medical School is co-leading the initiative along with Dr Jane Cross from UEA’s School of Health Sciences, working alongside researchers from NSFT to co-develop the digital support package, building on work carried out in the Netherlands, where a ‘Partner in Balance’ intervention has already been shown to reduce the burden and stress of caring for a family member or friend with dementia.

The aim of the blended care initiative is to provide online coaching to help dementia carers stay emotionally and physically well, crucial for both the carer and the person they support. The project is particularly important in the midst of the coronavirus pandemic, which has left many people with dementia and their carers more isolated than ever and cut off from their wider support network of family, friends, health services, and support groups.

Having already carried out a national survey of 400 carers from Together in Dementia Everyday (TIDE) and with experience in working with people with dementia and their families, the research team will co-develop a UK adaptation of PiB that supports carers with a blended care approach combining online resources with a health professional ‘coach’.

together | p. 6

Online training resources will provide support to care home workers UEAHSCP's Frailty research group are part of a national consortium that will deliver a £1.2m online training project ‘e-WHELD’, a virtual resource developed in rapid response to support care workers in residential homes who have been hard-hit by the COVID19 pandemic. Researchers will help develop an online staff training platform to improve and personalise care, which will be rolled out to almost 1,500 care homes nationwide.

The online resource is an adapted digital version of the WHELD intervention (Improving Wellbeing and Health for People with Dementia) which has proven to increase the quality of life and mental health of care home residents with dementia. The new online adaptation includes virtual support specifically developed for the challenges presented by the pandemic, including access to peer networking, digital resources, online group supervision calls, easy reference guides, activities to foster connection during this time of isolation, evidence-based person-centred care, and personalised activities.

The intervention will initially be available as a pilot trial to staff in 160 care homes in the first 4 weeks of the project; this will be followed by rapid evaluation and optimisation before officially rolling out the intervention to care homes nationwide, including every care home in Norfolk. Led by the University of Exeter and Kings College London, the project involves our Frailty research group and the London School of Economics, and draws funding from NIHR and UKRI.

"IT IS VERY IMPORTANT THAT CARE STAFF ARE SUPPORTED BECAUSE THEY ARE GOING THROUGH A DIFFICULT TIME IN TRYING TO PROVIDE CARE IN HUGELY CHALLENGING CIRCUMSTANCES. THIS FUNDING WILL ALLOW US TO ADAPT THE WHELD TRAINING PROGRAMME INTO A DIGITAL FORMAT THAT CAN BE USED DURING THE COVID-19 PANDEMIC –TO SUPPORT MENTAL HEALTH AND PRIMARY CARE SERVICES TO DELIVER BETTER CARE FOR RESIDENTS." - PROF CHRIS FOX

World Cancer Day 2021 - 'I am and I will' Our social media channels champion our partners' leading researchers, practitioners and innovation services. Did you catch the content we shared around #WorldCancerDay? This World Cancer Day, we highlighted some of our regions most accomplished leaders across health and social care and provided a platform to amplify their fantastic work.

One of our key research areas is healthy ageing - how to prevent, reduce and delay chronic ill health to help live healthier lives for longer. This year's theme for World Cancer Day was 'I Am and I Will', centred on individuals and their commitment to act. Through positive action, the theme emphasised that we can collectively reduce the number of premature deaths from cancer.

WOMEN WHO ARE AT GREATEST RISK OF We showcased the work of Maggie MISSING THEIR SCREENING Tween and her team at Norfolk and A P P O I N M T E N T A R E C O N T A C T E D A N D Waveney STP who are leading a O F F E R E D S U P P O R T T O B O O K W I T H T H E I R LOCAL PRACTICES. system-wide cancer THIS IS ALSO AN OPPORTUNITY FOR transformation programme to WOMEN TO SHARE ANY BARRIERS THEY support women most at risk of E NCOUNTERED TO ACCESS SCREENING missing screening appointments SO THAT WE CAN EFFECTIVELY RESPOND and identifying any barriers to AND SHARE LEARNINGS. access screening to improve uptake and coverage of cervical - MAGGIE TWEEN NORFOLK AND WAVENEY CANCER PROGRAMME ALLIANCE MANAGER, screening.

NHS NORFOLK AND WAVENEY CCG & NORTH EOE CANCER ALLIANCE

We also promoted the commendable support provided by ESNEFT and West Suffolk who are making regular phone call check ins with patients on a cancer pathway who are having to wait longer for treatment due to current Covid restrictions. These touch points provide much needed reassurance and support. ESNEFT's Pat Harvey (Cancer Performance Lead) and Morven Angus (Macmillan Lead Cancer Nurse) said that feedback is extremely positive "Patients are feeling well informed by our teams and welcome the additional reassurance that the call provides, as well as the advice and signposting information that is available to them should they need it".

Make sure you engage with our future campaigns on Twitter at @UEAHSCP.

together | p. 7

'SCORES' study moves ahead, attracting high profile supporters The next phase of the SCORES project is now well underway, with over 200 active participants engaged in the study including 53 former professional footballers and 74 former amateurs. Launched in January 2020, Concussion Action Programme (CAP) research group lead Dr Michael Grey and his team are conducting a trailblazing research study to better understand the cognitive health of former professional football players as they age to see whether there is a connection between heading footballs and dementia later in life.

The study has attracted keen interest from the press and members of the public, along with the enthusiastic support of an impressive list of former footballers including Mark Bright, Freya Holdaway, Dan Parslow, Dorian Dugmore and former Norwich City stars Iwan Roberts and Jeremy Goss.

The study has featured in some of the most high-profile press publications in the UK and internationally, featuring on BBC News, CNN, The Guardian and more. Dr Grey was also interviewed by award-winning journalist Jane Garvey on BBC’s Woman’s Hour radio programme; an insightful conversation on whether women may actually be at a higher risk of developing sport-related dementia, an area the team are keen to focus on going forward. Research shows that women are more likely to develop dementia than men and also have a higher incidence of concussions. By including female participants, the study aims to address this gap in the literature and investigate how both males and females are affected by mild repetitive head injuries.

Along with the UEA press team, researchers pushed a focused recruitment drive in late 2020 to specifically engage more amateur and professional women footballers in the study, with an aim to increase existing knowledge on the long-term effects on women’s cognitive health as the vast proportion of studies investigating sport-related neurodegeneration have been restricted to professional male athletes.

The research team continue to nurture important links across the sector, partnering with high profile organisations including the League Managers Association, Alzheimer’s Research UK, and Active Norfolk; all of whom are actively providing support to raise the study’s profile to help increase participant numbers by encouraging players to sign up and become involved in the study.

Looking at study methods during phase two, the team are using cutting-edge technology to test for early signs of cognitive decline that are identifiable long before any memory problems or other noticeable symptoms become apparent. So far, the study has measured the cognitive health of participants over a 3-month long period between October - December 2020, with small groups of 30 participants completing online assessments.

The SCORES project was born during a discussion between Dr Michael Grey and Dawn Astle from the Jeff Astle Foundation. 18 months on, the study has gone from strength to strength and in early 2021, a first report is set to be published.

THE PROJECT WILL ADDRESS THE FOLLOWING QUESTIONS: 1. Is the normal age-related decline in brain health better, similar, or worse in athletes who have played contact sport compared with athletes who participated in non-contact sport?

2. For the subset of participants who experience more rapid decline, is the onset of this decline different depending on the type of sport played?

3. Does age-related cognitive health differ in former professional athletes compared with those who competed at the amateur or recreational levels?

4. Are there differences in age-related cognitive decline of female vs male athletes within the same sport?

together | p. 8

Success and innovation of Norwich Testing Initiative proves regional collaboration is key The successful conclusion of phase two of the Norwich Testing Initiative (NTI) produced an effective template for establishing community testing, taking advantage of regional knowledge and infrastructure, and readying our community for another surge in cases in winter. The pilot project was delivered by leveraging expertise across Norwich Research Park (NRP) through collaborative working with the Earlham Institute, the University of East Anglia (UEA), the Norfolk and Norwich University Hospitals NHS Trust (NNUH), the John Innes Centre, the Quadram Institute, and The Sainsbury Laboratory. Sample analysis was carried out at the Earlham Institute and UEA labs with project management and support from UEA Health and Social Care Partners.

The initiative reported into Public Health England and involved close liaison with officers in the Norfolk Public Health team. Funding for the pilot came from the organisations involved, with support from local charities and philanthropists.

With students returning onto campus in autumn, phase two of the NTI built upon the lessons learned in phase one around logistics and efficiency, and UEA continued working closely with Earlham Institute and the NNUH to provide mass community voluntary asymptomatic testing to students and staff to provide reassurance to our students, staff and local communities and to reduce transmission on campus.

The initiative focused on slowing transmission on the park by testing frontline staff groups and prioritising testing of placement students ahead of visits to health, care, and education settings.

The project has joined a network of ‘testing universities’ to share data on transmission trends and to lobby government for an enhanced approach to using valuable facilities in regional COVID-19 plans. Phase two also saw partners working closely with NNUH to assist with the rollout of LAMP testing at NNUH and is also investigating the ability to sequence positives with Quadram Institute and addition of LAMPORE testing platforms .

Between September-December, phase two of the NTI saw 8,000 registrants, 6,650 people tested, 11,200 tests run, ~65% ease of selfswabbing, 191 positive tests, and 31 inconclusive. To date, 67% of positive cases either had COVID-19 symptoms or were isolating in the belief they may have been infected.

The University also launched the government-led lateral flow testing in December and UEAHSCP has since worked to advise Norfolk Public Health and a number of schools and colleges in the region to either access tests at UEA or build on the learning gained to assist in community roll-out.

In total, 20,000 tests were run to Christmas 2020 with potential for almost 50,000 more to be run across lateral flow and PCR platforms in 2021.

together | p. 9

How can we work together?

With an established network across health and social care organisations within Norfolk, Suffolk and North East Essex, UEAHSCP makes it easier for you to do more research and innovation with clinicians and health and social care professionals.

The Partnership’s focus is on increasing collaboration to improve care and support to both service users and professional staff. Membership includes clinicians, academics, health and social care professionals, service user representatives and associates.

Get in touch to see how we can work together ueahscp@uea.ac.uk.

Our Partners East of England Ambulance Service East Suffolk and North Essex NHS Foundation Trust James Paget University Hospitals NHS Foundation Trust Norfolk Community Health and Care NHS Trust NHS Ipswich and East Suffolk, NHS West Suffolk and NHS North East Essex Clinical Commissioning Groups NHS Norfolk and Waveney Clinical Commissioning Group Norfolk and Norwich University Hospitals NHS Foundation Trust Norfolk County Council Norfolk and Suffolk NHS Foundation Trust The Queen Elizabeth King’s Lynn NHS Foundation Trust University of East Anglia West Suffolk NHS Foundation Trust

CENTRED ON POPULATION NEEDS

COLLABORATION AT OUR CORE

WE HELP MOBILISE IDEAS

REPUTATIONAL IMPACT