UEAHSCP's 'together' magazine - Spring 2021

together

UEA Health and Social Care Partners' quarterly magazine Spring 2021

New project to support mental health of children in care Digital art exhibition showcases pandemic experiences of health and social care staff Leading researcher addresses Parliament on links between sport and long-term brain injury

Improving Care Through Collaboration

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WELCOME TO OUR SPRING EDITION OF 'TOGETHER' MAGAZINE This month, UEA Health and Social Care Partners celebrates two years since we began our work to increase collaborative research in the region, and I was recently asked what I’d learned in that time.

Primarily it’s that such partnerships can only be successful with a strong foundation of mutual respect, effort and purpose. Our sustained investment of staff time and resources demonstrates the importance of those values. Identifying service users and health and social care professionals as the beneficiaries of our work and placing them at the heart of our research, was a vital step in ensuring a common purpose for what has become a large and diverse alliance of organisations.

Almost 400 partnership staff have engaged in over 130 projects focused on countering the most pressing health and social care challenges facing our local population.

Despite the disruption of the pandemic, we’ve seen our projects achieve some great outcomes towards our key strategic themes: Improving young people’s mental health; Developing more effective ways of managing long-term conditions; Designing innovations to support healthy ageing.

What better foundation to build upon than that?

We will continue to grow in 2021 and look to renew our three-year commitment with partners and continue our association with over 50 other organisations who work with us.

In our Spring 2021 edition of Together magazine, we showcase our continued combined research efforts through various exciting initiatives, including an account of Dr Michael Grey’s recent parliamentary address, a new mental health project for children in care, and a digital art exhibition by health and social care staff.

If our second anniversary is the beginning of the next chapter of UEAHSCP’s story, I cannot wait to read on.

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.

Mark Hitchcock, Managing Director UEA Health and Social Care Partners

In Today's Issue: LANTERN's 'Life Story Work' Intervention Study...........................................................................................p.3 Pandemic's Influence On Non-COVID Serious Illness Study........................................................................p.4 Unplanned Out of Hospital Births Evaluation.................................................................................................p.5 Frailty's ACB Tool...............................................................................................................................................p.5 Talking Mental Health Project..........................................................................................................................p.6 Health and Social Care Staff Virtual Art Exhibition.......................................................................................p.7 Parliamentary Address On Links Between Sport And Long-Term Brain Injury...........................................p.8

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New project aims to support mental health and wellbeing of children in care The LIMITLESS study examines the use of ‘life story work’ as an intervention to support the mental health of adolescents in care.

Funded by NIHR, the study is led by Looked After Children’s Mental Health Research Network (LANTERN) lead researcher Dr Simon P Hammond, a lecturer at UEA’s School of Education and Lifelong Learning and Honorary Associate Professor at Norfolk and Suffolk NHS Foundation Trust (NSFT). It includes a paper ‘Life story work for children and young people with care experience: A scoping review’ recently published in the journal Developmental Child Welfare.

“Unaddressed mental health needs are one of the biggest issues facing children and young people who have experience of living in care.”

- Dr Simon P. Hammond, LIMITLESS Study Lead

LIMITLESS will be a collaborative study conducted by researchers from UEA and UEAHSCP partner organisation NSFT. Life story work is thought to help those in care to understand who they are and how their experiences have shaped them. Currently, life story work is delivered as a ‘high-intensity’ intervention, often reliant on specialist professional input over a number of months; it also focuses mostly on younger children.

The study will review published literature and gather views from young adults who have lived in care, carers, social workers, and mental health professionals, with an aim to provide better evidence on using life story work with adolescents as a low-intensity intervention to improve mental health and wellbeing at an early stage.

Another project collaborator The Care Leaders will work closely with researchers to help develop innovative projects for children currently in care. The Care Leaders are a social enterprise that harnesses lived experience to create innovative projects to support vulnerable young people.

Mr Luke Rodgers BEM, Director of Strategy at The Care Leaders, underlined how vital the research is to our community, particularly vulnerable children: “Life story work is important because not every child will know about people in their family or have pictures or information about their own childhood and places they have lived.

“These things are taken for granted for many people but are massively important and can be devastating if they become lost. I’m thrilled to be a part of this project and the way it will go about tackling this problem by working with those who have experienced children’s social care and life story work.

“By understanding and giving a platform for the voices of those with lived experience, the project will gain knowledge to develop our services to best serve young people. This will help ensure children’s social care is meeting the needs of young people with experience of living in care.”

LIMITLESS will be led by UEA in collaboration with primary partner Norfolk and Suffolk NHS Foundation Trust with The Care Leaders, The Fostering Network, the University of Oxford, and the University of Bath.

Keep up to date with our projects on Twitter @UEAHSCP

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New study seeks to understand impact of pandemic on non-COVID serious illness UEAHSCP is supporting a new study to better understand helpseeking for acute or new potentially serious symptoms during COVID-19, with future findings looking to contribute to improving healthcare in pandemics.

During the COVID-19 lockdowns in England, people have been asked to stay at home, with rapid changes in healthcare access.

There were significant reductions in A&E department and GP surgeries attendances after the first lockdown. Concerns have emerged that people might not be seeking help when needed, and what that may mean for managing conditions unrelated to COVID-19. Late diagnoses of serious conditions, like heart attacks, may seriously harm people’s health and wellbeing.

Evidence from previous epidemics shows significant morbidity and mortality from non-outbreak related problems and the Office for National Statistics data showed that 27.8% (12,900) of the excess deaths between March and May 2020 did not involve COVID-19. Healthcare service delivery changed significantly after lockdown, and direct patient access reduced due to triage and remote systems. Given the ongoing restrictions and changes to healthcare access and capacity, seeking help for non-COVID-19 problems has the potential to become a longer-term issue and indeed deaths involving diabetes, hypertension and cardiac arrhythmias remained above the five-year average after the first lockdown. This is of particular relevance to Norfolk and Suffolk, which have high proportions of older people compared with other areas in England (North Norfolk 32.8% >65 years; 18.2% in England). This older population is more likely to experience serious nonCOVID-19 health problems and need to seek help. However, across the region capacity to provide routine healthcare remains reduced with waiting lists continuing to increase.

Results of the study will contribute to improving healthcare in pandemics and may contribute to developing a bigger study.

The choices people make about seeking help for new, urgent health problems during COVID-19 are not easy. We need a good understanding of this so we can better support people who need help during a pandemic. The Help in COVID research team will conduct a qualitative study with adult participants with the capacity to give informed consent, inviting potential participants to take part through targeted online recruitment and professional, patient and community networks.

They are actively recruiting adults to take part in the study and are looking for individuals who have sought help for a new, serious symptom or were diagnosed with a serious condition during COVID-19. The team are also interested in speaking to people who didn’t seek help at all or delayed seeking help.

Research conversations to discuss experiences with participants will be conducted via video call or telephone, and participants are welcome to include a support person or carer. The study’s results will contribute to improving healthcare during pandemics and a summary of the results will be publicly available as well as presented in academic papers and meetings.

This study is being led by researchers from UEAHSCP’s Changing Behaviour and Implementing Best Practice Group, with support from UEA School of Health Sciences, Norwich Medical School, NHS Norfolk and Waveney Clinical Commissioning Group, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, NHS Ipswich and East Suffolk Clinical Commissioning Group, East England Ambulance Service NHS Trust, Norfolk and Suffolk NHS Foundation Trust, Norfolk Community Health and Care NHS Trust, and the University of Edinburgh.

Find out more information here.

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Unplanned out of hospital births evaluation provides valuable insights and recommendations UEAHSCP supported a collaborative service evaluation to explore the factors associated with unplanned out of hospital births, including decision making about when to come to hospital in labour.

Researchers conducted a thematic literature review and gathered experiences from regional service users, ambulance staff and community midwives via online interviews and assessed information provided to pregnant women by local providers. Service users, ambulance staff and midwives were also given the chance to provide their valuable insights on areas to make beneficial service changes.

Key recommendations included: 1. Regular check-in calls between women in early labour or planned home births and their midwife; 2. Provision of face-to-face, interactive opportunities for preparing for birth with opportunities for service users to ask questions; 3. Clear advice about when to call in labour should be provided to all women including multiparous women and discussed at each antenatal appointment; 4. Consider guidance for maternity staff receiving women from ambulance service. The handover and reception could be improved; 5. Enhanced guidance to enable timely support in transferring women in labour from the ambulance service to maternity services; 6. Further training for paramedic staff in managing complicated births.

The collaborative evaluation was conducted by Norfolk and Norwich University Hospitals NHS Foundation Trust, East of England Ambulance Service and the University of East Anglia, with thanks to Maternity Voices, the service users who told their stories, midwives and ambulance crew who agreed to share their experiences and knowledge. The full report will be made available shortly.

ACB TOOL SEEKS FEEDBACK UEAHSCP's Multimorbidity research group (formerly known as 'Frailty') have teamed up with our Medicines Optimisation research group, Norwich Medical School, Eastern AHSN, and the University of Kent to develop a web-based anticholinergic burden (ACB) calculator which has now been shared to health and social care networks for feedback.

Using machine learning techniques, the tool helps clinicians tailor safer prescriptions to improve patient outcome. The tool, which is still in development, aims to optimise medications for individual patients and lessen complications from overuse of anticholinergics, resulting in safer prescribing and improved patient safety as well as a reduced financial burden on the NHS. Researchers invited specialists to provide feedback regarding the tool via a survey.

Receiving valuable feedback from pharmacists and GPs will help to make improvements to the tool.

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School-based intervention set to support anxiety management in children

Alongside professional help, it is essential that parents, guardians and school staff have a good understanding of effective strategies and interventions of how to support and maintain a child’s mental health and wellbeing. Good mental health allows children and young people to develop the resilience to cope with life’s challenges and grow into wellrounded, healthy adults.

Researchers seek to implement and evaluate this model being translated and adapted to a school setting delivered by pastoral staff across a group of primary schools. The project team aims to design a process across schools to identify children with anxiety difficulties that may benefit from parent-delivered CBT intervention, and to adapt and implement this intervention in a codelivered model between clinicians and school staff.

Born from collaborative discussions at UEAHSCP’s 2019 Young People’s Mental Health and Wellbeing conference, the Talking Mental Health (TMH) project arose through the dedicated work of staff at the Nebula Federation to support primary school pupils and their families address anxiety as early and effectively as possible.

Going forward, the project aims to produce process case studies, key learnings and recommendations, and participant feedback, as well as materials to explain how the intervention might be successfully employed across the region. The project team are meeting with other agencies, including Suffolk County Council, for wider roll-out of the project.

Nebula Federation staff have a unique role within the pathway for identifying and treating young people with emerging mental health difficulties. They are well placed to identify young people and have trusted relationships with both the young person and their family or carers. This should facilitate better engagement with the treatment whilst also training and supervising teaching staff in evidence-based interventions to run alongside their current menu of supportive interventions.

Nebula staff report seeing an increase in parents and carers seeking support from the school for children who are experiencing mental health problems, particularly anxiety. If left untreated, mental health problems in children can lead to an inability to focus on schoolwork or emotionally regulate, which impacts a child’s learning progression.

TMH aims to develop engaging training resources and sessions to upskill school staff to support programmes for pupils experiencing low-level mental health problems and to train their parents and carers in strategies to improve their child’s mental health. Norfolk and Suffolk NHS Foundation Trust and Ormiston Families are part of the project team working to deliver training sessions, including using Parent-Led CBT effectively to reduce levels of anxiety in their children.

The Nebula Federation's Ashley Best-White, Executive Head Teacher, and Natalie Brown, Pastoral Manager, on the core aims of the intervention: "Talking Mental Health is a collaborative, sustainable, early intervention to support children’s mental health.

Using the Parent-Guided CBT approach, we are able to work with parents to guide them through adopting strategies, working with their child to manage behaviours, regulate emotions, and change their way of thinking about anxiety."

A multi-partner group across education, clinical, social care and academic sectors are driving this project, and the potential to maximise support to primary-age children and their families, and influence policy and practice more widely, is extensive.

Researchers from Nebula Federation, NSFT, Norfolk County Council, UEA, and Ormiston Families are continuing to develop the project.

“Our project aims to embed training and awareness across the Federation to improve and maintain mental health, offer high quality interventions at the earliest possible opportunity, and avoid onwards referrals to external agencies, therefore reducing the strain on services.”

- The Nebula Federation's Ashley BestWhite, Executive Head Teacher, and Natalie Brown, Pastoral Manager.

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Digital art exhibition showcases health and social care staff experiences UEAHSCP’s ImpACT research group were among those who produced an engaging virtual art exhibition, ‘A Centenary of Caring’, showcasing the effect of COVID-19 on public mental health and on health and social care staff experiences. Frontline staff collaborated with art students to create moving art pieces to express their experiences of working during the pandemic. The joint project saw members of our ImpACT group work with academics and students from UEA’s School of Health Sciences, Norwich University of the Arts (NUA), Norfolk Community Health and Care NHS Foundation Trust, and Norfolk and Waveney Health and Care Partnership to create this poignant exhibition which ran from February 12 until March 12 2021.

"Focussing on good health and wellbeing has never been more important than now for our people who have all experienced very different ways of working and personal challenges since the start of the pandemic. The opportunity to collaborate with both our health care professionals and local art students to share experiences and gain insights into the impact of the pandemic has been incredible.

Taking the time to visit a virtual gallery allowed me some time for personal reflection and again be thankful for the amazing NHS, Social Care, and wider communities we have in Norfolk and Waveney. We look forward to building on the exhibition with UEA and NUA over the coming months with more artwork and expression as a living history of the pandemic.”

The launch of the digital exhibition coincided with the centenary year when nursing and midwifery became a registered profession and originated from a series of remote discussions between UEA Health Sciences students, NUA and NHS staff on what they were experiencing day-to-day in the community and their emotional response to the pandemic.

Professor Sally Hardy, UEAHSCP ImpACT group member and Dean, School of Health Sciences at UEA said: “We have witnessed a massive outpouring of support for the UK NHS from local communities sharing their appreciation through many different activities such as weekly clapping for NHS workers, rainbow banners and blue ribbons, whilst tolerating social isolation and lockdown. As the pandemic progresses, we have a great deal to learn about the impact on community mental health and wellbeing strategies that promote the resilience of our health care workforce, alongside the communities they serve.”

With input from NUA and UEA academics, initial discussions led to the creation of art in various forms: from painting, textiles and poetry to video and photography. UEAHSCP’s ImpACT Research Group helped to facilitate the creative workshops, manage the project and supported the co-creation of two of the exhibits: Behind Closed Doors and the film from the Brooklands Care Home.

Emma Wakelin, Head of Workforce Transformation for the Norfolk and Waveney Health and Care Partnership, said: “The health and wellbeing of our workforce is a key priority for the Norfolk and Waveney Health and Care Partnership and one of the four objectives in our #WeCareTogether People Plan.

Carl Rowe, Associate Professor and Course Leader in Fine Art at NUA, said: “What we originally set out to achieve was purposeful, creative, cathartic dialogue and something quite simple in terms of a physical outcome. We didn’t expect art from everyone, because not everyone involved is an artist. But the results are astounding, ranging from performance, film, poetry, infographics, portraiture, drawing, prose, photography, and textiles. All of the resulting artworks reveal an insight into the ravages of the COVID-19 pandemic. To that end, we can say with confidence that art and creative thinking has the power to make at least some sense of the profoundly incomprehensible.”

"Few projects of this kind have attempted to bridge a gap between wellbeing and creative arts during a pandemic, of which we all are experiencing."

- Prof Sally Hardy ImpACT research group member and Dean, School of Health Sciences at UEA

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Research lead addresses Parliament on links between sport and long-term brain injury

Concussion Action Programme (CAP) research group lead Dr Michael Grey addressed Parliament's March inquiry into the links between sport and long-term injury, referring to evidence from a recent survey conducted by CAP. The Digital, Culture, Media and Sport (DCMS) Select Committee considered the scientific evidence linking sport and longterm brain injury and the role national governing bodies should be taking, including their responsibility to understand the risks involved for players and the actions that could be taken to mitigate these risks.

He then reiterated the recommendations noting sportrelated brain injury is not just an issue for professional sport it is a public health issue and government needs to take the leading role: Research funding in this area should be awarded using procedures similar to government funding bodies like the Medical Research Council. Research must be independent, transparent and involve all stakeholders; Rather than rely on NGBs to deliver different sportspecific guidelines and practices for concussion protocols, campaigning and awareness, government Five witnesses presented evidence over two sessions, with Dr should take the lead. Dr Grey argued the need for an Grey speaking in the second session, alongside evidence approach led by organisations such as the Department of presented by the CEO from Alzheimer’s Society and Education, Department of Health and Social Care, Public Headway.

Health England/Wales and/or Sport England/Wales; Finally, based on evidence from a recent survey of the A Trustee of UK Acquired Brain Injury Forum (UKABIF), Dr East of England conducted by UEAHSCP’s Concussion Grey highlighted the need for government to drive change Action Programme, Dr Grey suggested we need and the importance of independent research to help tackle concussion awareness CPD training for GPs and the issue.

Ambulance staff, and better management for postconcussion follow-up and care that would include known Dr Grey’s aim was to remind the committee of a report return to play/learn/work guidelines. Dr Grey also noted produced by UKABIF for the All Party Parliamentary Group the key finding that physical education teachers are not (APPG) in Brain Injury in 2018, which made several required to have basic first aid training (although many recommendations regarding sport-related brain injury: do) and that physical education teachers typically do not The Government should ensure that there is have any concussion awareness training whatsoever. collaborative research to evaluate and improve practical assessment tools, develop objective diagnostic markers, "My hope is that the inquiry and gain a deeper understanding of the recovery process will result in government and long-term risks of sport-related concussion; taking a leading role in this An enhanced education campaign should be issue." implemented in schools to improve awareness and understanding of sport-related concussion with the - Dr Michael Grey, SCORES support of government departments; Sport, government and professional clinical bodies must Study Lead. work collaboratively to improve health professionals’ knowledge of concussion management; The second oral session of the inquiry will involve governing The NHS should develop better pipelines for the bodies and individual players. There was also an opportunity diagnosis and care of sport-related concussion. for written submissions to the inquiry, invited by the DCMS Committee.

This information was sourced from the SCORES March newsletter with permission, read more here.

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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 NHS Trust East Suffolk and North Essex NHS Foundation Trust James Paget University Hospitals NHS Foundation 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 and Suffolk NHS Foundation Trust Norfolk Community Health and Care NHS Trust Norfolk County Council The Queen Elizabeth King’s Lynn Hospital NHS Foundation Trust University of East Anglia West Suffolk NHS Foundation Trust

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