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At-home blood oxygen monitors could prompt timely and life-saving treatment for COVID-19 patients

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The use of pulse oximeters to monitor the health of home-based COVID-19 patients in Greater Manchester is likely to have saved lives, according to a new study.

An analysis of patient data from the innovative Greater Manchester Care Record (GMCR) collected during the COVID-19 pandemic indicates that patients who were offered pulse oximeters to monitor their blood oxygen levels as part of the NHS COVID-19 Oximetry at Home programme (CO@h) were more likely to have been hospitalised for necessary treatment than those who did not.

The study suggests that the CO@h programme reduced the risk of mortality by as many as two deaths for every 1000 patients after 28 days, and by 10 deaths for every 1000 patients a year later.

This research — led by academics funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) — adds to a growing body of evidence worldwide supporting the use of pulse oximeters as a valuable tool for health services, allowing COVID-19 patients to monitor their condition at home.

Pulse oximeters were widely used during the pandemic to detect low oxygen saturation levels in COVID-19-diagnosed patients at home, enabling healthcare workers to provide appropriate care, including same-day clinician review or even hospitalisation.

NHS England launched the CO@h programme in November 2020, offering pulse oximeters to patients diagnosed with COVID-19 who were deemed at risk of deterioration due to silent hypoxia. These included patients who were symptomatic and aged over 65, citizens who were ‘clinically extremely vulnerable’ to COVID-19, and those identified as being at high risk of deterioration by a health professional.

To assess the effectiveness of this intervention, researchers carried out a target trial using anonymised patient data collected from the GMCR. The GMCR brings together information from NHS and care services across all 10 Greater Manchester boroughs into one joined up record to help improve health and care services.

The analysis of data collected between February 2020 and June 2022 reveals that:

The odds for an “unplanned” admission following COVID-19 diagnosis were between 50% and 80% higher among CO@h patients compared to those who were not enrolled on the programme.
The expected reduction in mortality among CO@h patients was estimated at two deaths per 1000 after 28 days, six at 90 days, and 10 after a year.
The mean length of stay for those admitted within 90 days of COVID-19 diagnosis was the same across both groups, at nine days.

Due to the sudden impact of COVID-19 on both clinical services and research, capacity to properly assess the impact of oximetry was limited at the time. However, subsequent studies have explored its benefits. These include research by the University of Southampton, Imperial College London and the University of Pennsylvania. This Greater Manchester study features a larger sample size and is the first to assess outcomes up to a year later, compared to 30 days.

While the analysis is encouraging, the research team believe more assessment is needed on factors such as cost-effectiveness and patient quality of life.

Senior author Professor Evangelos Kontopantelis, Professor in Data Science and Health Services Research in the University of Manchester’s Division of Informatics, Imaging and Data Sciences, said:

“While not definitive, our study suggests that the use of pulse oximetry at home is likely effective for early detection of clinical deterioration, which could lead to timely and potentially life-saving intervention.

“Some work remains to be done, since it is important that we learn more about the effectiveness of measures such as this, particularly as we look to build our resilience against evolving pandemic threats around the world.

“To do this, we need to work together and share valuable insights and data. Resources such as the Greater Manchester Secure Data Environment are an excellent example of what can be achieved when collaboration is encouraged for the greater good – and it could provide the foundation for a range of transformative research in the future.”

Professor Peter Bower, Lead for Evaluation at NIHR ARC-GM and Chair in Health Services at The University of Manchester, said:

“At-home technologies such as pulse oximeters have the potential to play an important role in helping patients maintain their independence, while protecting the ongoing capacity of our health and care system.

“However, while their possible benefits are evident, so is the responsibility to ensure that they are an effective and efficient way to monitor and manage our health. As the report acknowledges, we need to rigorously consider the cost-effectiveness of this intervention, as well as its impact on patient quality of life and hospital capacity and efficiency.

“We want to ensure that communities such as Greater Manchester benefit from advances in technology, while receiving the best and most responsive healthcare possible. Through research such as this, we believe we can help give decision-makers the insights to make the right decisions for patients.”

The full study – entitled Patient use of pulse oximetry to support management of COVID-19 in Greater Manchester: a non-randomised evaluation using a target trial approach - has been published in the PLOS One journal.

Read the report in full here: journals.plos.org/plosone/article?id=10.1371/journal.pone.0310822

The research was also supported by a grant from the Manchester Academic Health Science Centre (MAHSC), part of Health Innovation Manchester.

Published 15/11/2024

'Perfect storm’ of distrust deepened inequalities during COVID-19 pandemic

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The COVID-19 pandemic and subsequent vaccination rollout enabled a “perfect storm” for deepening health inequalities in Greater Manchester, the results of a study have shown.

Research led by University of Manchester academics funded by ourselves at the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), examined the attitudes of people from minoritised ethnic groups, young adults and those with long-term physical and mental health conditions toward the COVID-19 vaccination programme.

Researchers found that a “perfect storm” of marginalisation and experience of structural inequalities led to distrust of the COVID-19 vaccination drive – and that marginalised communities felt ‘left behind’ by policy and decision-makers prior to and during the pandemic.

The study, which is published in BMC Public Health, concludes that wider social inequalities, combined with experiences of marginalisation and discrimination, have long-lasting and widespread implications for vaccination uptake and health outcomes.

During the pandemic, Greater Manchester experienced higher levels of mortality from COVID-19, higher case rates and greater impacts to productivity than the national average – with disproportionately high COVID-19 mortality rates in the most deprived areas and amongst Black African, Pakistani and Black Caribbean groups.

For some study participants:

The choice to not have the vaccine became almost a metaphor for political dissent against institutionalised failures.
Elements of distrust appeared to be established prior to the pandemic – and enhanced due to intensified episodes of racism experienced over the course of the pandemic.
Feelings of distrust were emphasised via the perceived mishandling of the pandemic by the government and paradoxical government policy-responses to aspects of the pandemic, including U-turns and mixed public messaging.
Culturally insensitive public messaging and practices during the pandemic heightened longstanding and widespread disenfranchisement.
Longer-term injustices were perceived to be further intensified during the COVID-19 pandemic - links were made between long-term failings for underserved communities and the disproportionate impact of the pandemic.
Pushback against the vaccine was articulated via a sense of establishing boundaries against an oppressive system.

Stephanie Gillibrand, Research Fellow at The University of Manchester, said:

“Existing research in this area tends to focus on the psychological or socio-economic factors that influence an individual’s uptake of vaccination. We sought to understand the complexities around vaccination motivations, exploring broader social and historical contexts or people’s experiences of marginalisation.

“We found that wider social inequalities, intersecting with experiences of marginalisation during the pandemic, have long-lasting and widespread implications when it comes to vaccination – and public health policy must recognise this broader context for future public health crises and vaccination drives.

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“These implications may already be apparent, where new data has suggested that MMR vaccination rates are at a ten-year low since the start of the pandemic, and other childhood immunisations rates have also fallen.”

Read the full research paper in BMC Public Health here.

Published 28th October 2024

Regional inequalities in community resilience exposed in new research

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Coastal, rural and areas in the North of England are less able to withstand and recover from adverse events, according to new research which highlights regional disparities in community resilience.

The analysis shows that regionally, Yorkshire and the Humber and the North East had the lowest resilience scores, while London and the South East had the highest.

In addition, rural and coastal areas showed significantly lower resilience compared to urban and inland areas of the country.

Led by academics from Health Equity North (HEN), the University of Manchester and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), the study examined local authority data to identify geographical patterns in different communities’ ability to navigate and thrive in the face of prolonged challenges.

The research, which has been published in the International Journal of Environmental Research and Public Health, provides the first detailed assessment of community resilience in England at a local authority level.

The timely findings come off the back of a number of “chronic shocks” in the UK including the global financial crisis, the social and economic impacts of leaving the European Union, the COVID-19 pandemic and an ongoing cost of living crisis.

Researchers developed a Community Resilience Index (CRI) which measures multiple elements, such as employment, education, social and community context and housing, to measure resilience in local authorities, enabling them to be ranked from most to least resilient.

It is hoped the framework will serve as a tool for policymakers to identify priority areas and to guide the equitable allocation of funding to address geographical inequalities.

The study found that:

The average community resilience index score for local authorities in England was 83.1, ranging from 53.3 in Tendring to 108.9 in Elmbridge.**
Yorkshire and the Humber and the North East were the least resilient regions, with CRI scores of 75.2 and 77.5, respectively. Comparatively, London and the South East were the most resilient regions, with scores of 95.2 and 87.3 respectively.
A North-South disparity was evident with the North of England having lower resilience scores (80.6) than the South (including the Midlands) at 83.9.
Coastal areas featured heavily in the lowest ranking local authority areas with significantly lower resilience scores (76.0) compared to inland areas (84.9).
Similarly, rural areas were less resilient scoring 79.1 compared to 85.1 in predominantly urban areas.

When examining the specific social and environmental measures assessed as part of the overall index, there were further geographical disparities found:

Access and infrastructure: London achieved the highest score followed by the North West and North East. The North of England scored higher in this domain than the rest of the country conversely, coastal and rural areas scored lower.
Economic wellbeing and opportunity: The South East and London scored highest, indicating robust economic activity and employment opportunities. The North overall and coastal areas had lower scores, suggesting lower economic resilience.
Social capital and connectivity: London again scored highest. There was no significant North-South divide or difference between coastal and inland areas. However, rural areas scored lower.
Diversity and inclusion: There were higher scores for the North of England and rural areas, while coastal areas had significantly lower scores.
Equity and stability: London was the most resilient and the North East was the lowest. Northern and coastal areas scored lower in this domain, but urbanicity did not significantly affect the scores.

Academics behind the research are now calling on government to prioritise targeted interventions to build resilience where this is most needed.

Christine Camacho, lead author and PhD Fellow at NIHR ARC-GM, said:

“Understanding a community’s capacity to cope, adapt and transform in the face of adversity is critically important to create a more resilient country.

“The Community Resilience Index we developed offers an invaluable insight into the social, economic and environmental factors that can hold communities back making them less able to overcome unexpected challenges. Perhaps unsurprisingly, the findings of our research highlight yet further regional inequalities with the North, rural and coastal areas among the least resilient in the country.

“Addressing these challenges requires both bottom-up approaches, such as community empowerment, and top-down strategies from central government to provide the necessary infrastructure and economic opportunities to enable these communities to thrive.”

Dr Luke Munford, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at the University of Manchester, said:

“The CRI provides a framework that could be used to explore associations between community resilience and health outcomes. This makes it a potentially valuable tool for examining inequalities in broad aspects of people’s everyday lives, therefore offering a more nuanced understanding of the factors that contribute to health inequalities.

“We hope that policymakers take advantage of this opportunity to enhance understanding of how resilient communities foster better health and well-being, providing insights for targeted public health interventions and policies that are data-driven and effectively targeted.”

Read the full paper, which has been published in the International Journal of Environmental Research and Public Health, here.

Published 11/10/25

NIHR awards £7.8m to drive knowledge mobilisation across Applied Research Collaborations

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The NIHR has awarded £7.8m to its Applied Research Collaborations (ARCs) to build knowledge mobilisation capacity and capability within the health and social care system.

The initiative aims to reduce the time it takes to roll out effective interventions, policies and models of care to address high-priority national and regional challenges, and maximise the impact of research.

Key priorities for the initiative include:

supporting proven strategies, interventions and models of care to be implemented into practice, responding to high-priority areas from national policymakers, the health and care systems and patients and the public
proactively engaging key stakeholders
building a knowledge mobilisation community to share learning
evaluating knowledge mobilisation activities to evidence what works, for whom and why

The ARCs will also appoint knowledge mobilisation “fellows” in local systems. These fellows will form a bridge between the ARCs and the health and care organisations they work with. They will be supported to enhance their skills so they can capture and communicate the needs of local decision makers. They will work with the ARCs to identify existing evidence-based treatments and models of care, and support them into practice, working with practitioners and service users.

The aim is to create a dynamic loop in which knowledge needs are met with evidence in real time, creating an improvement-focused, evidence-based culture.

To deliver on this initiative, the ARCs will work closely with their established partners across the health and care system, including:

Health Innovation Networks (HINs)
Integrated Care Systems (ICSs)
local authorities
Voluntary Community and Social Enterprise (VCSE) organisations
health and care providers
community groups, patients, service users and the public

Why is knowledge mobilisation important?

Promoting impact is core to the NIHR’s mission to improve the health and wealth of the nation. It is one of the five operating principles set out in Best Research for Best Health: The Next Chapter.

Knowledge mobilisation is an iterative, long-term, and two-way process to create the conditions to enable the right people to use the right information at the right time. It involves a two-way dialogue between researchers and research users. By sharing information with and learning from each other, a deeper understanding capable of catalysing change can be achieved. It is one of the processes that facilitates and amplifies the contribution of research to real-world settings.

The NIHR is committed to maximising impact by enabling and supporting the translation of research findings into evidence-based action that transforms the lives of the public, patients, service users and carers.

Strategic leadership

As part of the funding, and additional £599,966 has been awarded to outselves at NIHR ARC Greater Manchester (ARC-GM) to provide leadership for this initiative. We will coordinate a strategic approach to knowledge mobilisation across the ARCs, uniting them behind an agreed vision and strategy, and measuring impact.

We will also establish a knowledge mobilisation community among the cohort of award holders, enabling networking and sharing best practice around prioritised areas of interest.

Professor Dame Nicky Cullum, Director of NIHR ARC-GM, said:

"Whilst maximising research impact is everybody’s business, this crucial initiative brings a coordinated, consistent approach to ensuring that our publicly funded research is visible, is used to support health and social care decision-making and can improve the health and care of the public. We are delighted to be leading on this work from Greater Manchester.”

Head of NIHR Research Infrastructure, Dr Natalie Owen, said:

“Ensuring that effective, evidence-based interventions and models of care reach people living with the greatest burden of disease is vital. This capacity and capability building initiative will enable the ARCs to support work at the interface of research and practice for population benefit.”

ARC-GM welcomes new cohort of future researchers

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On 10th September, we formally welcomed our 2024/25 cohort of Pre-doctoral Fellows, Interns and Social Care Research Champions at an in-person induction led by Dr Penny Lewis, ARC-GM Academic Career Development Lead.

As part of our ongoing efforts to enhance capacity in applied health and care research, this year we welcome 12 Interns and four funded Pre-doctoral Fellows. Two Research Champions also joined as part of our new programme of Capacity Building in Social Care, funded by the NIHR. Staff join from a range of employing organisations, including four NHS Trusts, three Local Authorities, a GP surgery, charity and a private adult social care provider.

The induction day provided an excellent opportunity for all candidates to introduce themselves, present their ideas and gain insight into the offerings of our programmes. Following an overview of NIHR ARC-GM and its research themes, candidates were given the opportunity to network over lunch. In the afternoon, a breakout session was held for each of the three groups to provide greater focus on their respective programmes.

We were particularly pleased to welcome Dr Caroline Leah, Senior Lecturer in Mental Health Social Work from Manchester Metropolitan University, who, alongside Alison Littlewood, ARC-GM Programme Manager, led the session for our new Social Care Research Champions. The role of the Research Champions will be to promote applied research in social care and explore new opportunities for capacity building in the sector.

Dr Penny Lewis commented:

“We are delighted that such a fantastic range of candidates applied and were successful on this year’s programmes. There are in excess of 10 professional groups represented, which shows we are making strides towards our goal of widening our reach and providing opportunities for those in practice who wish to explore and develop a career in applied research. Applied Research Collaborations have a key role in helping these people develop their skills who might not otherwise have chance to do so. We are grateful to all those who make this happen – not only those who apply, but their supervisors, the recruiting panel and our partner organisations who support their staff in taking up these opportunities.”

For more information about the ARC-GM Pre-doctoral Fellowships and Internship Programmes, please visit the ARC-GM website or contact Ross Atkinson, Programme Manager for Capacity Building, at ross.atkinson@manchester.ac.uk.

In the coming nine weeks, we’ll be sharing a series of blog posts featuring insights from our former and current Pre-Doctoral Fellows and Interns. These posts will highlight their experiences with the NIHR ARC-GM’s applied health and social care research training and development programme. Check out the blogs here...

Hard-hitting report exposes vast inequalities faced by women in the North of England

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Women in the North of England live shorter lives, work more hours for less pay, are more likely to be an unpaid carer, and more likely to live in poverty than women in other regions of England, according to new research published today.

The damning research – published by Health Equity North – has laid bare the unequal challenges faced by women living in the North of England.

It exposes the growing regional inequalities over the last decade and the impact this has on women’s quality of life, health, work, their families and communities.

‘Woman of the North: Inequality, health and work’ finds that women living in the North have lower healthy life expectancy, fewer qualifications, worse mental health, and are more likely to suffer domestic violence or to end up in the criminal justice system than their counterparts in the rest of England. In addition, infant mortality is higher and abortions are more common.

The economic cost of these inequalities is also explored in the report which estimates women in the North lose out on a staggering £132m every week, compared to what they would get paid if wages were the same as women in the rest of the country.

Women in the North also contribute £10bn of unpaid care to the UK economy each year.

The report, which has been backed by the North’s two female Mayors Tracy Brabin and Kim McGuinness, puts into sharp focus the devastating effects that austerity, the cost-of-living crisis, economic uncertainty, the pandemic and unequal funding formulas have had on women in northern regions.

The research found:

Girls born in the North East, North West and Yorkshire and the Humber between 2018 and 2020 can only expect to live in good health until 59.7, 62.4 and 62.1 years, respectively. This is up to four years less than the national average and up to six years less than girls born in the South East.
Women in the North are paid less for their work. They lose out on £132m every week, around £6.86bn a year, compared to what they’d get if they were paid the same wages as women in the rest of the country.
The average weekly wage for a full-time working woman in the North East is £569, £598 in the North West and £567 in Yorkshire and the Humber - much lower than the national average (£625) and considerably lower than for women in London (£757).
Women in the North contribute £10bn of unpaid care to the UK economy each year. This is £2bn a year more than if they provided the national average of unpaid care.
One in five women aged 55-59 in the North of England provides care to a family member because of illness, disability, mental illness or substance use.
The North showed the biggest increases in abortion rates between 2012 and 2021. There has been a demonstrable relationship between austerity, the implementation of the two-child limit, and increased rate of abortions.
Over 25% of pregnant women in the northern regions of England are living in the most deprived 10% of areas with 40% living in the top 20% most deprived areas. In contrast, fewer than 5% of pregnant women in the South East live in the most deprived 10% of areas.
There is higher prevalence of severe mental conditions, such as bipolar disorder and schizophrenia the North West and North East compared to the South and Yorkshire and Humber. The proportion of women with a diagnosis of a mental health condition who were receiving a treatment was lower in the North West and North East than in the South and Yorkshire and the Humber, indicating a treatment gap between regions.
Women in the North of England suffer the highest rates of domestic violence abuse in the country. The highest rates are in the North East at 19 per 1,000 population followed by 17 in Yorkshire and the Humber then 15 in the North West. The average for the rest of England is 11.
Of the recorded deaths per 100,000 from alcohol-specific causes in 2021, women in the North East (13.9), North West (13.8) and Yorkshire and the Humber (11.7) had the highest rates of deaths in women in England.
In 2022, nine of the 10 police areas with the highest rates of female imprisonment were in the North of England.

A team of more than 70 academic, health, social care and policy professionals from across the North contributed to the report to explore some of the social determinants of health for women, and how they play out in the overall health of women in the region.

The extensive research covers employment and education, Universal Credit, poverty, caring, health and life expectancy, pregnancy and reproductive health, sexual health, mental health, domestic violence, criminal justice involvement, stigma, and marginalised women.

The report recommends a wide range of evidence-informed policy solutions for central government, regional government and the health service which, if implemented, could improve the current situation for women’s health.

Hannah Davies, Executive Director at Health Equity North, said:

“Our report provides damning evidence of how women in the North are being failed across the whole span of their lives. Over the last 10 years, women in the North have been falling behind their counterparts in the rest of country, both in terms of the wider determinants of health and, consequently, inequalities in their health.

“There is a lot of work that needs to be done to turn the tide on the years of damage detailed in this report. But the situation for women’s health in the North can be changed for the better through evidence-based policy interventions.

“We need to see policymakers build on the ambitions outlined in the Women’s Health Strategy for England with focused effort to understand and address the regional inequalities in the many different facets of women’s health.”

Professor Kate Pickett OBE, Academic Co-Director at Health Equity North, and Director of the Public Health & Society Research Group and the York Cost of Living Research Group at the University of York, said:

“This report unpacks some of the wide-ranging challenges women face across many aspects of their lives, and the impact of these on their health. For women in the North, these challenges are often felt more deeply.

“We know that much of the inequality we see affecting women in the North is a direct consequence of poverty, which is completely unacceptable in the 6th largest economy in the world. Cuts to welfare and public health funding, the pandemic and the cost-of-living crisis have hit the most deprived communities and the North hardest.

“We hope that the findings and recommendations act as a wake up call for government to make health and addressing health inequalities central to policies going forward.”

Dr Luke Munford, Academic Co-Director at Health Equity North, and Health Economist from the University of Manchester, said:

“The significant economic impact of regional health inequalities relating to women in the North is made staggeringly clear in the findings of our report.

“Women across northern regions have heavy burdens placed on them – they work longer hours and are paid less, and they provide some of the highest levels of unpaid care for their loved ones. But all too often, this can come at a price as we can see in the health outcomes detailed in this research.

“To ensure a more economically prosperous region, we need policies that target the widening health inequalities faced by women in the North.”

Tracy Brabin, Mayor of West Yorkshire, said:

“While the findings of this report will resonate with every woman and girl in West Yorkshire, they must now act as a vital wake up call to everyone in a position of power.

“As political leaders, we all have a responsibility to listen to and act on the lived experience of women and girls, and devolution is helping us to turn the tide in West Yorkshire, with the first ever women’s safety unit in the country and bold action to deliver a Sure Start renaissance.

“I welcome this timely and significant report, and pledge to do all I can to continue building a brighter region that works for all, by always working in partnership with the women and girls of West Yorkshire.”

North East Mayor Kim McGuinness said:

"From leaving school to the boardroom, at home and at work, women and girls across the North bear the brunt of failings in our economy, society and public services. The lack of equality and opportunity that remains ingrained in modern Britain is unacceptable.

"As Mayor I'm determined to make the North East the home of real opportunity - and that means breaking down barriers which hold women and girls back. I will drive wholesale reform of the support we provide in schools, in our skills system, in childcare and in industries where too often women are shut out or overlooked. I welcome this report as a roadmap to a fairer, more equal North of England."

Woman of the North: Inequality, health and work will be launched at an event in parliament on Wednesday, September 11, with the Women’s Health Ambassador for England, Professor Dame Lesley Regan, speaking.

The report recommendations include:

Regional government

Targeted support delivered to 11–18-year-olds through Careers Hubs at areas of greatest deprivation.
Negotiate for higher levels of the Adult Education Budget in the North of England than counterparts in the South of England.
Support benefits uptake for women and help claimants navigate the benefits system. Financial support beyond the current social security system should be extended to groups most in need.
Support needed for women to transition back to their families and integrate into the community after involvement in the criminal justice system.

Central Government

Deliver a national health inequalities strategy, convening government departments across Whitehall to put health at the heart of all policies.
Make a long-term commitment to update benefits in line with inflation. Additionally, policies that punish families, such as the two-child limit, sanctions and the benefit cap must be abolished.
The Treasury should improve targeted support for pregnant women including reversing restrictions to the Sure Start Maternity Grant and reintroducing the Health in Pregnancy Grant.
Deliver a sustainable childcare model – linking in with family hubs and next generation Sure Start centres - that enables more women to access education and work opportunities. Also, abolish zero hours contracts to ensure jobs provide stability and security.

Health System

NHS England should provide additional financial support and investment for Women’s Health Hubs that are established across the North.
Health services need to be supported to collect routine data on ethnicity and other key demographic data as standard to help deliver better information for service development and improve our understanding of different health needs.
Explore ways in which their work can be adapted to address health inequalities across different population groups (cultural sensitivity training, adopting a trauma-informed approach to care, and promoting person-centred approaches, including for transgender people and sex workers).

Health Equity North is a virtual institute focused on place-based solutions to public health problems and health inequalities across the North of England. It brings together world-leading academic expertise from the Northern Health Science Alliance’s members of leading universities and hospitals.

Read the report in full here.

Published 03/09/2024

ARC-GM Hosts "Dragons' Den" Session for Pre-Docs and Interns

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On 7th May 2024, the Capacity Building and Public & Community, Involvement & Engagement Teams jointly held a "Dragons' Den" session to give Pre-Doctoral Fellows and Interns an opportunity to present their project ideas. The event was a way of helping ARC-GM early career researchers to engage with members of the public and get feedback on their project and public and patient involvement plans.

Several members of the ARC-GM Public and Community Involvement and Engagement (PCIE) Panel and the Young People Advisory Research Group (YPAG) attended on the day. Rather than panel members ‘investing’ in a project, they provided valuable feedback and recommendations to help researchers refine their work.

Presenters and their projects:

Sophie Chalmers, a Highly Specialist Speech and Language Therapist at Manchester University NHS Foundation Trust, presented her mixed methods study on the Characteristics and Identification of Laryngeal Hypersensitivity in Medically Unexplained Dysphagia. Sophie commented on her experience from the session:

“As a clinician, it was really valuable to be able to openly discuss thoughts and ideas on specific research topics. It was amazing to hear how topics resonated with individuals, the public and YPAG members.

These individuals would not necessarily be included within patient involvement so this was incredibly valuable to hear their thoughts as lay-persons. I have used the feedback specifically within healthcare communication, symptom communication, and dissemination of complex topic areas in my subsequent applications and have incorporated this into future project planning. “

Lisa Barrington, an Alcohol Specialist Nurse at Manchester University NHS Foundation Trust, discussed her Feminist exploration of women military veterans’ experiences of harmful alcohol use in the context of identity. Lisa said:

“Although my project topic is very specific, the session was valuable for me in understanding how the research may be perceived by different groups of people, particularly around language and inclusivity. For example how terms like ‘veteran’ and ‘fashion’ can be perceived.

The session generated some interesting and creative ideas to guide the research delivery and involve members of the wider community. It was an enjoyable and insightful experience.”

Jessica Keen, the Pharmacy Lead at North West Genomic Medicine Service Alliance, presented her research on Pharmacogenomic panel testing for people with cancer. Jessica commented:

“The session was really valuable for me as an early career researcher, to learn about different ways to engage with patients and members of the public to plan research. I got many ideas about how to explain my research topic in a simple way so that people can give me their views, and suggestions about different approaches to get people’s insight.

What also became clear is that it’s really important for researchers to feed back their progress and findings to groups that have supported their research design, so they can see the results of the research they have been a part of. Based on the input from the session I am planning to conduct a focus group in my target population and keeping some of the suggestions in mind for doctoral studies. It was a relaxed environment which helped reassure me that my research will be of value.”

Sadia Mir, a young person from our Young Person's Advisory Group shared her thoughts on the day:

"It was great to see the benefits that an everyday person can contribute to research. Usually when researchers are looking for layman representatives, they ask for people with relevant lived experiences (e.g. asking for cancer patients when it's a project on cancer).

It was nice to see that there is actual benefit in talking things through with people who don't have those experiences, because it does take out the emotional factor. Very interesting! I loved how casual it felt. It truly felt like we were regarded as being on the same level as researchers.

It was lovely to see that they were human just like us! They had worries, likes and dislikes. I think we can be very focused on the types of projects we get involved in, and don't realise that there are so many different types of research projects and some can be very niche. It was interesting to see what other topics are out there. I didn't know that there was funded PhD research, so it was a new learning point!"

This session highlighted the value of community involvement in research and displayed a variety of innovative projects plans. NIHR ARC-GM aims to support and enhance research infrastructure across Greater Manchester, through our Internship and Pre-doctoral Fellowship Programmes.

Find out more about these opportunities here: arc-gm.nihr.ac.uk/training-and-development

Peer Support "Uncle" Russ

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Russ Cowper is a member of our Public and Community Involvement and Engagement Panel and provides peer support to our Young People's Advisory Group.

Below he writes his thoughts on supporting the YPAG.

Just before July 2022, I was approached by Aneela McAvoy (ARC-GM PCIE Manager) to ask if I would consider becoming a mentor to a brand new young persons group. Pat Walkington and Angela Ruddock were also asked and we met up with Aneela and Joanna Ferguson to discuss how to take it forward. I think we were excited at the prospect but also a little out of our comfort zone, I certainly felt that way, but in for a penny in for a pound was attitude.

We discussed how to pitch the initial meeting, bearing in mind we were all very experienced patient public engagement people and part of the wider ARC-GM patient and public panel. We came up with a plan, it must have worked as the YPAG are still with us, but I remember feeling a real depth of trepidation and nervousness before the initial meeting. If we had got it wrong, we could have lost our fantastic YPAG and they could have dismissed us as not understanding their concerns and underestimating their combined abilities. I'm pleased to say I think we as mentors got it right mostly as they are still with us.

What's been a pleasure for me, is seeing the growth of them all in terms of confidence, they always had the ability and their knowledge and compassion whilst not surprising me has certainly exceeded my expectations.

They really are a joy to be with and should be celebrated within the ARC-GM. They offer perspectives I would not have considered and that is the value of having an inclusive and diverse YPAG, they see things differently to us old ones, they are tech savvy and happy to work in today's world of social media. It's second nature to them, whilst me as a mentor still doesn't know how to use it properly.

I had the real pleasure of introducing some of them at the Greater Manchester Accelerator event and they stole the show, they also charmed the Lord Mayor of Wigan and I was so proud of them.

Oh and I should say your YPAG are the future of health research and I will endeavour to guide them if need be, not that they do anymore, I'm their friend now and being in their company is so enjoyable it makes me feel alive.

We have our "in jokes", yes Shuhaney you love cake!

Russ Cowper, May 2024.

Devo Manc led to significant improvements across health system, study finds

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The devolution deals which granted Greater Manchester increased control over a range of public services enabled them to make significant improvements in many parts of the health system, a unique study led by University of Manchester researchers has shown.

The study, which evaluated changes in Greater Manchester from 2016 to 2020 compared to the rest of England, is published in the journal Social Science & Medicine today(25/03/24).

It builds on previous evidence by investigating how changes in the health system may have led to increases in life expectancy in Greater Manchester over this period, analysing 98 measures of performance.

It was funded by The Health Foundation and supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM).

According to the study, there were 11.1% fewer alcohol related hospital admissions, 11.6% fewer first time offenders, 14.4% fewer hospital admissions for violence, and 3.1% fewer half school days missed from 2016 to 2020.

Same day GP appointments increased by 1.8% and unplanned A&E re-attendances were 2.7% lower, in line with increases in the GP and hospital workforce. Cancer screening rates also improved.

Adult social care effectiveness and overall satisfaction also improved by 17.6%, despite decreases in expenditure and staff.

However, adult obesity increased by 7.6% and median wait times for A&E treatment worsened by 12.2%. There were also mixed impacts of devolution on outpatient, mental health, maternity, and dental services.

The positive changes, argue the researchers, are likely to have been a result of different aspects of the Greater Manchester devolution deals.

These include the transfer of control over transformation funding for improving services to the Greater Manchester Health and Social Care Partnership, the development of collaborative relationships between the NHS agencies and local governments represented on the Greater Manchester Health and Social Care Partnership Board, or the impact of wider devolved public services.

The negative changes on other indicators, they add, are likely to be a result of difficulties local decision-makers had in re-prioritising how they used their resources given their limited powers to raise additional revenue through taxation or other means.

Lead author Dr Philip Britteon from The University of Manchester and NIHR ARC-GM said:

“This study provides new evidence on the impact of devolution on health and care services , focusing on a large set of performance measures.

“Our findings suggest that devolution in Greater Manchester was associated with broad improvements in health services, social determinants of health, and subsequently, health outcomes.”

Co-author Professor Matt Sutton from The University of Manchester and Deputy Director of NIHR ARC-GM said:

“These improvements were achieved despite limited formal devolved authority and control over health and care resources, suggesting that other features of the health and wider devolution deals played an important role.

“However, improvements were not universal. Restricted formal powers are likely to have made it harder to fully reprioritise resources.”

Co-author Dr Yiu-Shing Lau from The University of Manchester said:

“Unlike what we have seen in other devolved places, enhancements were observed in Greater Manchester even with limited health and social care powers, and without the ability to significantly raise revenue through taxes.

“The success of future devolution initiatives to improve population health might depend less on the devolution of formal powers, and more on alignment and collaboration between health and other public services within the region.”

Adam Briggs, Senior Policy Fellow at the Health Foundation, said:

“The past decade was incredibly challenging for health and social care services across England, so it is very positive that this research finds that life expectancy in Greater Manchester has been heading in the right direction. But devolution is complex and, as the researchers point out, it’s hard to know what aspects of the approach taken in Greater Manchester have helped - untangling causation from correlation is very difficult.

“Ultimately, much of what makes us healthy sits outside of health care services and is instead driven by the building blocks of good health – such as secure housing, good work and education. As public finances get increasingly stretched, closer partnership working between the NHS, local government and communities is needed now more than ever, whether that’s a result of devolution or any other form of local collaboration.”

Chair of NHS Greater Manchester Integrated Care Board, Sir Richard Leese said:

“This latest research reinforces what we know, that working together in partnership, locally has better outcomes and supports people to live healthier and happier lives.

“It’s encouraging that our approach has seen increases to healthy life expectancy and better access in some services. However, we recognise where we haven’t seen improvements or the change we hoped for, including against the national average. We’re continuing to work together as a system to improve health and care for everyone. Our commitment to partnership working will give us the best chance of success and tackling health inequalities.”

The full paper can be accessed here:

Britteon P, Fatimah A, Gillibrand S, Lau Y-S, Anselmi L, Wilson P, Sutton M, Turner AJ. (2024). The impact of devolution on local health systems: Evidence from Greater Manchester, England. Social Science and Medicine

Published 25th March

Over £150,000 funding awarded for Applied Health and Care research projects

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The Manchester Academic Health Science Centre (MAHSC) Applied Health and Care Research Group, a joint initiative between MAHSC and the NIHR Applied Research Collaboration Greater Manchester (ARC-GM), has awarded over £150,000 in funding to support cross-discipline, multi-institution, research-led projects that have the potential to generate health and social care impact and benefits to people and communities, patients, and carers.

This follows a funding opportunity developed to support projects that focus on topics allied to applied health and care and consider the specific health needs of the Greater Manchester area

.

Projects were required to align with the Greater Manchester Integrated Care Partnership strategy 2022-2028 and Greater Manchester’s 5-year Joint Forward Plan. They were also encouraged to tackle health and social care inequalities, including but not limited to, the inclusion of under-served groups in research, and it was key that they included a named sponsor from the local health and care system and demonstrated Public and Community Involvement (PPIE).

The opportunity received a fantastic response, with 42 high-quality applications received from across Greater Manchester universities, NHS Trusts, the Greater Manchester Integrated Care Partnership, the Greater Manchester and Eastern Cheshire Strategic Clinical Networks, and multiple applications made in partnership between universities, NHS Trusts, and the voluntary sector.

Each application received was reviewed and scored by 3 independent reviewers and a member of the public, and the outcomes were discussed at a Funding Selection Committee Discussion, comprising 6 representatives from across GM Higher Education Institutions, a PPIE expert, 2 members of the public, and a representative from the Greater Manchester Integrated Care Partnership.

The call proved very competitive, with the Selection Committee only able to recommend a small number of applications received for funding, and having to make tough choices on which applications were able to be selected. The high quality of applications meant that it was only those scored at the very highest level, that were able to be funded on this occasion.

Professor Matt Sutton, MAHSC Applied Health and Care Research Group Chair, Professor of Health Economics, University of Manchester, and NIHR ARC-GM Deputy Director, shared his reflections on the process:

“To receive such a response to the call demonstrates the clear demand there is in conducting applied health and care research that considers the specific health needs of the Greater Manchester area and seeks to generate impact and benefits to people, communities, patients and carers. The level of high-quality, collaborative, and cross-discipline applications received is a testament to the work that is being undertaken, and seeking to be undertaken, across Greater Manchester”.

Paul Lynch, Director of Strategy and Planning, NHS Greater Manchester Integrated Care Partnership, shared his hopes for the funded research:

“The applications selected for funding demonstrated alignment with the Greater Manchester Integrated Care Partnership strategy 2022-2028 and Greater Manchester’s 5-year Joint Forward Plan. By supporting research in this way, we have a unique opportunity to drive research and innovation to meet the diverse needs of our citizens and communities”.

Further information on the projects selected for funding will be shared at a future date.

Published 25th March 2024

Sharing virtual wards RES evidence base to influence system-wide change

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After recognising the strength and value in the Virtual Wards Rapid Evidence Synthesis (RES), Professor Emma Vardy, Deputy Lead for the Ageing Theme at NIHR ARC Greater Manchester (NIHR ARC-GM) and Consultant Geriatrician at the Northern Care Alliance NHS Foundation Trust, worked with lead author Dr Gill Norman to write an academic paper based on the RES findings. The RES has since been published/cited by a number of credible journals and academic sources in acknowledgement of its timely deep dive of the evolving model of care. In this blog, Emma discusses the importance of sharing evidence widely to inform service development and delivery.

Timely insights

The Virtual Wards RES provided incredibly useful information at a time when Virtual Wards were evolving within the healthcare system. From a clinical perspective having a clear understanding of the evidence base is helpful for service development.

The questions the RES set out to answer were specifically framed around healthcare delivery and service development – things that were relevant within the healthcare system at that time. That’s where the RES has the potential to influence healthcare systems.

What made this RES stand out was its comprehensiveness and its focus on considering what the clinical questions might be. There wasn’t anything like this and timely publication is key which is where the rapid nature of RES is invaluable. If people are going to start acting soon, they may as well be doing the right thing.

I felt very strongly that the value of this work should be shared wider so that colleagues beyond Greater Manchester had the opportunity to learn from the work of the NIHR ARC-GM RES team.

Sharing the evidence

I knew we needed to get the message out and share the evidence with other people. An initial opportunity to share the RES outcomes came about through the British Geriatric Society (BGS) which was developing a position statement to outline the issues around Virtual Wards and care of older people. In my mind, the RES aligned perfectly with this, so I pitched the idea of including a section on research and evidence based on the RES, which they welcomed and the statement was published in August 2022.

Gill and I then worked together to tease out more information from the RES evidence around the theme of Virtual Wards in relation to frailty and older people to create an academic paper that would be publishable and accessible to clinicians. Dr Paula Bennett provided a valuable operational point of view from her experience of stepping up Virtual Wards across Greater Manchester.

To bring the RES outcomes to a clinical audience took a lot of reworking and enhancement of the manuscript so it was helpful to have authorship that included both academics and clinicians.

Defining Virtual Wards

An important element of the paper was defining what a Virtual Ward was. At that time there were services that had been called Hospital at Home, and Virtual Wards was a new term coming through NHS England. I knew that there was some confusion amongst healthcare professionals, so we took the opportunity to clearly define what each term meant and any overlap between the two at the start of the paper.

The final journal article for Age and Ageing, which was published in 2023, was very well received by both academic and clinical peers.

The strength of the paper was also further recognised by the BGS when it was selected as one of 26 ‘exemplar’ open access papers to be published as part of a collection for the BGS Autumn Conference.

The proof, as they say, is in the pudding as the Age and Ageing Virtual Wards paper has a high altmetric score and has been widely cited, which is a testament to the robustness of the research and the value of its rapidity to help guide clinical teams.

Download the Virtual Wards RES at: https://arc-gm.nihr.ac.uk/rapid-evidence-synthesis

Living in the North of England increases risk of death from alcohol, drugs and suicide

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People living in the North of England and in coastal areas are more likely to die from ‘death of despair’, according to new research.

The new analysis shows that between 2019 and 2021, 46,200 people lost their lives due to Death of Despair in England – the equivalent of 42 people every day.

However, in the North East of England more than twice as many people lost their lives due to Deaths of Despair compared to London.

Deaths of Despair is a collective term for deaths from alcohol, drugs and suicide, which tend to occur much more frequently in socially deprived communities.

The study, led by academics from Health Equity North (HEN), the University of Manchester and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) examined local authority data to identify geographical trends and risk factors that contribute to these kind of deaths.

The analysis found that northern regions and coastal areas of England are experiencing a much higher burden of mortality from these avoidable causes.

Out of the 20 local authority areas that experience the highest rates of Deaths of Despair, 16 are in the North, and all of the top 10 areas are in the North.

Conversely, none of the 20 local authorities with the lowest rates of Deaths of Despair are in the North.

The analysis also looked at associated factors that predict the risk of these kinds of deaths; living in the North was the strongest predictor. Local authorities with higher proportions of unemployment, white British ethnicity, people living alone, economic inactivity, employment in elementary occupations, and people living in urban areas had higher rates of Deaths of Despair.

The study found that:

On average, 14.8 per 100,000 more people die from Deaths of Despair in the North compared to the rest of England
Even after accounting for multiple social and economic factors, living in the North of England was associated with a 5.8 per 100,000 increase in Deaths of Despair rate
More than twice as many people died from Deaths of Despair in the North East of England than they did in London (54.7 per 100,000 and 25.1 per 100,000 respectively)
The highest rate of Deaths of Despair in England (at local authority level) is in Blackpool – almost 2.5 times the national average
Three areas in England, all in the North, experienced more than double the average Deaths of Despair – Blackpool (83.8 in 100,000 deaths), Middlesbrough (71.6 per 100,000 deaths) and Hartlepool (70.5 per 100,000 deaths)
Alcohol-specific deaths made up almost half of Deaths of Despair in England, accounting for 44.1% of all such deaths
Deaths of Despair accounted for 2.9% of all deaths in England
Deaths of Despair were highest among people aged 45-54 (55 per 100,000)
Deaths of Despair accounted for 2 in 5 deaths in people aged 25-29 (41.1% of all deaths)
Coastal local authorities had a significantly higher average Deaths of Despair rate than inland local authorities (41.6 per 100,000 compared to 31.5 per 100,000)

The study is believed to be the first of its kind to explore geographical patterning and contributing causes of deaths of despair in England.

The researchers are calling on government to prioritise preventative policies which address the longstanding inequalities across England, with fair funding allocation distributed according to need.

Christine Camacho, lead author and PhD Fellow NIHR ARC-GM, said:

“Our study shows that some of the risk factors of deaths of despair have a more pronounced impact in the North of England, where inequalities in health and wealth are persistent and have widened during recent decades."

"As well as specific public health interventions to prevent deaths from drugs, alcohol and suicide, we need to move further and faster with Levelling Up in England to tackle the underlying inequalities which are leading people to die from despair.”

Dr Luke Munford, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at the University of Manchester, said:

“Time and time again, we see research exposing regional inequity with the North of England often being hit the hardest. Unsurprisingly, the findings of this study further highlight the persistent health inequalities in northern regions. This can’t be ignored – it is not acceptable that more than twice as many people in some deprived communities in the North are dying due to deaths of this nature.

“This research provides policymakers with a novel insight into the associated social factors of deaths of despair, which can help when developing comprehensive strategies that not only target specific risk factors but also consider the intricate relationships among these causes, contributing to more effective prevention and intervention efforts.”

Read the full academic paper published in Social Science and Medicine Journal here – the paper includes a supplement with the Death of Despair rates for all local authorities in England.

Published 15/03/2024

The toll of ‘Deaths of Despair’ in England

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In 2015, a phenomenon coined as ‘Deaths of Despair’ (DoD) emerged in the US, highlighting an alarming increase in mortality due to drugs, alcohol, and suicides, particularly among white men without a college education.

In this Policy@Manchester blog, Christine Camacho (ARC-GM PhD Fellow) and Dr Luke Munford (ARC-GM Deputy Lead for Economic Sustainabilty) explore the spatial patterning of these deaths in England, where an estimated 46,200 lives were lost to Deaths of Despair between 2019 and 2021. They identified stark geographical inequalities.

The study emphasized that Deaths of Despair are not inevitable – but a consequence of inequitable resource distribution.

On average, areas in the North have considerably higher rates of DoD; areas with high unemployment rates, high proportions of White British ethnicity, and urban areas were associated with an elevated DoD risk.
Blackpool had the highest rate of DoD of any local authority, while the North East had the highest regional rate – the lowest rate of DoD was in London.
Preventative policies may require geographical tailoring – devolution policies may offer the potential to deliver locally tailored solutions.
However, national policies to redress imbalances in access to economic opportunities, the labour market, and housing are also needed.

You can access the full blog from the Policy@Manchester site here

Published 15th March 2024

Joining the dots: assessing the roll out of social prescribing link workers in primary care

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Social prescribing is the referral of patients to non-clinical treatments – often for mental health needs and long-term health conditions.

In 2019, the NHS Long Term Plan embedded the role of link workers to coordinate and refer patients from Primary Care Networks. But are the right areas getting the support they need – and how sustainable is social prescribing for both primary care and VCSE organisations?

In this blog from Policy@Manchester, Paul Wilson (ARC-GM Lead for Implementaion Science) discusses the rollout of the link worker programme, and what is needed from policymakers to ensure the longevity of social prescribing.

Referrals are made through GPs to link workers, who connect patients in primary care with sources of support within the community.
Research has found fewer link workers in areas with the highest need – generally urban and deprived communities of lower socio-economic status.
Public health policymakers at local, national, and regional levels must ensure link worker recruitment is targeted where it can have the greatest impact.
There is also a need to comprehensively map, fund, and integrate VCSE organisations into primary care, to ensure the sustainability of social prescribing.

You can access the full blog from the Policy@Manchester site here

Published 14th March 2024

Constant mental maths and difficult decisions – new research highlights how fuel poverty affects mental health

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How does fuel poverty damage mental health? Reviewing the scientific research.

A study led by Natalie Bennett from the NIHR ARC North East and North Cumbria, and Sam Khavandi from ARC Greater Manchester has explored how fuel poverty can affect mental health.

In this blog, they share their findings...

We are living through a ‘cost of living crisis’, where everyday essentials become too expensive for many people. Growing numbers of people are finding that they are not able to afford the energy they need to do things like heat their homes, turn on the washing machine, cook their food or to shower. We call this ‘fuel poverty’.

We know there are three key drivers of fuel poverty: low income, poor energy efficiency in the home, and high energy prices.

Renters (both social and private), and vulnerable groups such as the elderly, families with children and those with disabilities and chronic conditions are particularly at risk of falling into fuel poverty and at additional risk from its health impacts.

When we think about fuel poverty, and how it feels to live in a cold home, the impacts to physical health are perhaps the most immediately obvious. This includes things like worsening chronic conditions like arthritis, and severe and tragically sometimes even deadly impacts to the lungs from chronic exposure to mould.

However, in addition to these serious physical health impacts, there are a myriad of less often considered, yet arguably more widely experienced and still detrimental ways that living in fuel poverty impacts mental health. Though research on the mental health impacts of fuel poverty is growing, there has not yet been an evaluation of what we know on the topic to date.

Our research

We have been working to collate the research to date demonstrating these impacts to mental health, so we can understand:

What has been studied to date?

Are there gaps in what we know?

What kinds of explanations are given for how fuel poverty impacts mental health?

We searched the global literature base for studies on the association between fuel poverty and mental health, including both quantitative and qualitative studies. We found 48 studies, over half of which studied the UK.

Our findings

Our search revealed links to mental health in four key areas:

Home environment – including thermal discomfort and ‘spatial shrink’, where people heat and use fewer rooms in their home.

Behaviour – including poorer sleep and diet, reduced recreational activities and extreme planning of the use of heat and appliances.

Social – including stigma, social withdrawal, deterioration of household relationships and an eroded sense of home.

Economic – including constant mental maths and evaluation of the costs of appliances, debt and money worries and difficult decision making.

We worked with groups at Edberts House community centre in Gateshead and a steering group with the ARC Greater Manchester public involvement panel, including representation from their young people’s group, to inform our understanding of the lived experience of fuel poverty and to sense check our findings.

Our discussions with these groups were important in helping us to reflect on our findings and in helping us to communicate the findings of the research.

As part of this work, we developed a graphic visualising the pathways discussed by the studies in our review, which was directly informed by the public contributors.

(Illustration by Jenny Leonard Art)

What’s next?

We will publish an academic journal article from this research which we hope will help highlight the issue to researchers and policy makers.

We hope that the review will encourage further research on the topic, in order to ultimately help us to understand what can be done to both reduce fuel poverty and lessen its detrimental impact on mental health.

To find out more about this work, contact:

Natalie Bennett (formerly Newcastle University) at n.c.bennett@sheffield.ac.uk

Sam Khavandi, Manchester University at sam.khavandi@manchester.ac.uk

published 14th Feb 2024

How Rapid Evidence Synthesis helped to inform Virtual Wards in Greater Manchester

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A Rapid Evidence Synthesis (RES) led by researchers at NIHR ARC-GM played a pivotal role in shaping the delivery and implementation of Virtual Wards across Greater Manchester.

In 2022 experts from NIHR ARC-GM’s undertook a RES to inform the Greater Manchester Virtual Wards model of care, which aims provide hospital-level care to patients at home.

Virtual Wards deliver a combination of remote monitoring and face-to-face treatment in the person’s home.

The model of care was mobilised at pace during the pandemic and, ahead of wider implementation across Greater Manchester, partners within the system wanted to quickly review available evidence to help inform the process.

NIHR ARC-GM’s framework for a rapid approach to evidence synthesis allowed researchers to provide findings in a timely manner, therefore providing invaluable insights within a short timeframe.

The RES, which was delivered within 6 weeks, found that there was consistent low to moderate certainty evidence that clinical outcomes, including mortality and readmission, for patients treated in hospital at home are probably as good or better than those treated as inpatients.

Other findings included:

Evidence on cost-effectiveness in unclear
There is insufficient evidence on the cost implications for patients and carers
Consistent evidence that barriers and facilitators exist at the organisational, clinical and patient/carer levels. Identified patient-level barriers are likely to have equity implications.

The RES findings were published in a journal article in Age & Ageing which focused on Virtual Wards and implications for the care of older people. It was also the basis of the evidence section of the British Geriatrics Society’s position statement on Virtual Wards and hospital at home for older people.

Dr Gill Norman, who was the Lead Author of the RES, said:

“The RES provided our partners across the Greater Manchester system with reliable evidence gathered using robust techniques within short timeframes. Not only did the RES answer questions around clinical and cost effectiveness, it also identified gaps in research that could be explored further.”

Dr Paula Bennett, RN (Adult) RN (Child) Chief Nurse Health Innovation Manchester who was involved in the Virtual Wards RES from the start, added:

“With a large-scaled transformation project of this nature, it was imperative that we looked at existing evidence to shape and design our services. The RES approach allowed us to explore the literature and research available in a matter of weeks and helped to answer key questions about the benefits and impacts of this model of care, as well as the disadvantages. It played an important role in shaping our thinking of what we needed to do as a system.”

The Virtual Wards RES was delivered in collaboration with partners from across the GM health and care system. Over the next few weeks, we will be publishing a series of blogs from key contributors to the process.

The first blog, from Dr Gill Norman, has been published this week here: https://arc-gm.nihr.ac.uk/news/blog/BLOG-Virtual-Ward-RES

published 8th Febuary 2024

Virtual Wards RES shows value of evidence synthesis for large scale transformation programmes

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When partners across the Greater Manchester health system were tasked with implementing Virtual Wards across the region in 2022, experts within NIHR ARC-GM’s Evaluation Theme were commissioned by Health Innovation Manchester to undertake a Rapid Evidence Synthesis (RES) to inform the process. In the first in a series of blogs from leading figures across the health and care system involved in Virtual Wards, ARC-GM’s Dr Gill Norman offers an insight into the RES process, the outcomes, and the widespread impact of the work regionally and nationally.

The process

Our Rapid Evidence Synthesis framework has been developed to enable evidence to inform decisions around how, or if, to implement innovations in Greater Manchester. It is real-time evidence briefing that is designed to be done very quickly within the commissioning decision-making process.

We use systematic review principles and toolkits, but it is very much stripped back to produce something that can be timely enough to fit that process.

The Virtual Wards RES represented something of step change in the types of innovations we were evaluating using the RES process. We had originally focussed on single innovations, such as an app for mental health conditions. However, we've expanded to cover wider remits and Virtual Wards was the first broader programme of work that we undertook a RES for.

This project was also different because it's part of a national programme, which meant it was always going to be rolled out in some form in Greater Manchester. We were undertaking the RES to inform the implementation and then the evaluation, rather than the decision whether or not to implement it.

Defining the focus

To deliver a RES we need to first identify a set of specific answerable questions that form the focus of the evidence gathering. We worked with colleagues from Health Innovation Manchester to really drill down to what they needed to know to inform implementation.

It became clear at this stage that we were going to do the RES purely using existing evidence synthesis because there was enough evidence at that level. We had six questions to start with, which is more than we’d normally have. Typically, we would have two or three questions for a RES. But we really wanted to explore the experiences of people involved and how different types of wards might work. So, in this instance, it was right to have more questions to cover the key areas, which centred on the effectiveness and safety of Virtual Wards, patient and carer experience, barriers and facilitators, and cost-effectiveness.

What the RES told us

What became clear as I started the RES was that there is extensive literature on the ‘hospital at home’ model - which is about providing hospital level care in the home - and that well established evidence base was going to do a lot of the work of informing the RES. This was particularly relevant because Virtual Wards are mostly being used for older people with frailty and people with multiple comorbidities. In other words - people for whom hands-on care is an important component of hospital level care at home. So Virtual Wards may have a lot of virtual components, but are going to look a lot more like a ‘hospital at home’ model for many of the people who go into that treatment path because of the nature of those people's needs.

The RES showed, broadly speaking, that Virtual Wards are about as good, or possibly a little better, most of the time for most people. The approach was safe and it wasn't producing worse outcomes. However, economically speaking, the evidence around cost-effectiveness was poor.

There was some interesting evidence around what does and doesn't make for effective delivery of Virtual Wards or ‘hospital at home’ in terms of care structures at an organisational level which I hoped would be helpful to guiding implementation.

A glaring gap which made me sit up and think was the experience of the people who are caring for their relatives at home. Instead of their loved one going into hospital and being cared for there, even with the best care possible, they are themselves providing a lot of care at home. The implications of that weren’t very well explored in a lot of the literature.

For example, many of the economic studies excluded out-of-pocket costs to the patient and their carers, which could include unpaid time off work or heating their home to a standard that is acceptable for a hospital inpatient. They also excluded non-financial costs, such as the emotional burden and the risk of burnout which are hard to capture in economics.

For some carers, the model can be a good thing as it gives them the ability to stay close, to be able to communicate and to not have the problem where an elderly person goes into hospital and becomes isolated from their main source of support. But reports coming through from primary studies in qualitative reviews suggested that some people may be really struggling. This highlighted that the impact on carers needs further exploration.

Other interesting findings that came out were around patient selection. People are often selected for care in Virtual Wards or ‘hospital at home’ groups based on certain factors, such as whether they live close enough to the hospital for teams to visit them and what their home set-up is - do they have an appropriate space or somebody living with them who can look after them at home? All of this makes sense, but if admission is governed by those factors, it can have impacts on health equity because they can intersect with financial or socioeconomic status, and other equity-related factors. So, more work is also needed to explore the equity implications of hospital level care at home.

The next steps

The RES was used by Health Innovation Manchester to shape the delivery and evaluation of Virtual Wards, and it identified gaps in research around this model of care for further exploration. It has also fed into wider work and discussions beyond our region. In addition, it was the basis of the evidence section of the British Geriatrics Society’s position statement on virtual wards and hospital at home for older people.

Following completion of the RES, I worked closely with Professor Emma Vardy and Paula Bennett to submit a journal article for Age and Ageing focusing on virtual wards and implications for the care of older people, which was published earlier this year.

More recently, the work has informed a full systematic review of the components of virtual wards and what contribution they're making to effectiveness, which has now been submitted for publication – watch this space.

Dr Gill Norman, Research Fellow at NIHR ARC-GM:

"The next in our RES virtual wards blog series comes from Dr Paula Bennett, in which she explores the impact of the RES from her perspective as the Chief Nurse for Health Innovation Manchester who supported the Greater Manchester Virtual Wards Approach and Group."

Download the Virtual Wards RES at: https://arc-gm.nihr.ac.uk/rapid-evidence-synthesis

Transgender, non-binary, and gender diverse people more likely to have a long-term mental health condition, first England-wide study suggests

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Study of 1.5 million people in England, including nearly 8,000 transgender people, finds a higher proportion of transgender people report having a long-term mental health condition than cisgender people.

Additionally, those with a gender identity other than cisgender male or cisgender female were more likely to report their mental health needs were unmet at their last general practice appointment.

Authors call for the NHS to become more gender-inclusive, including by introducing better training for health-care professionals to improve their ability to meet the mental health needs of trans, non-binary, and gender diverse patients.

The risk of having a long-term mental health condition in England is roughly one in six for transgender men and women (16.4% and 15.9% respectively) and one in ten for cisgender men and women (8.8% and 12.0%), suggests the first nationally representative analysis published in The Lancet Public Health journal.

The study, funded by by the Department of Health and Social Care (DHSC) and the National institute for Health and Care Research (NIHR) as part of a mental health research initiative awarded to NIHR Applied Research Collaboration Greater Manchester (ARC-GM) designed to tackle the disparity between regional needs and mental health research activity, finds that the risk of reporting a mental health condition was even higher for some gender minority groups, reaching almost one in two (47.2%) for non-binary transgender individuals.

Previous evidence suggests a higher risk of some mental health conditions, such as depression and anxiety, amongst transgender, non-binary, and gender diverse patients compared with patients with male or female cisgender identities. However, these findings are from small studies focused on specific groups, such as students or patients seeking gender affirming healthcare, which are not generalisable to the full population.

Dr Luke Munford, Senior Lecturer in Health Economics at The University of Manchester and Deputy Lead for Economic Sustainability at NIHR ARC-GM says

“Trans, non-binary and gender diverse people across England face widespread discrimination, leading to stressful social interactions and feelings of unacceptance, increasing the risk of poor mental health. Additionally, gender dysphoria – a sense of unease due to a mismatch between a person’s biological sex and their gender identity – may increase the risk of poor mental health amongst some trans, non-binary, and gender diverse people, especially when combined with very long waiting times for NHS gender identity clinics.”

The study combined data from the 2021 and 2022 waves of the English GP Patient Survey, which in 2021 introduced more answer choices to questions on gender identity. Out of 1,520,457 people who responded to the survey:

7,994 (0.7%) were transgender,
1,499,852 (98.3%) were cisgender, and
12,611 (1.0%) preferred not to say.

Importantly, 2,600 (0.3%) non-binary people and 2,277 (0.2%) people who chose to self-describe their gender responded to the survey, allowing the researchers to look at outcomes for these groups who are rarely represented in health statistics.

After controlling for age, the researchers found all transgender patients and cisgender non-binary patients had a higher risk of reporting a long-term mental health condition than cisgender men and women

The highest risk was for transgender non-binary patients, of whom one in two reported having a long-term mental health condition (47.2%).
For transgender men and women and for cisgender non-binary patients, the risk was roughly one in six (16.4%, 15.9% and 15.8% respectively)
The risk for cisgender men and women was the lowest at one in ten (8.8% and 12.0%).

The survey did not ask for details of the mental health condition, but previous research has indicated common mental health conditions such as anxiety and depression, as well as eating disorders, self-harm and suicidality are more common amongst transgender, non-binary, and gender diverse groups, whereas severe mental illnesses such as schizophrenia or bipolar disorder are thought to occur at rates similar to those in the binary cisgender population. [1]

Alongside investigating the frequency of mental health conditions, the researchers also looked at how well people’s mental health needs were met at recent general practice appointments. Out of those who reported that their mental health needs were relevant to their last appointment, approximately one in six cisgender men and cisgender women reported their mental health needs were unmet (15.6% and 15.9% respectively), lower than all other gender identity groups which ranged between one in five (20.0%) and one in four (28.6%).

Dr Ruth Watkinson, Research Fellow at The University of Manchester and lead author on the study, says

“Poor communication from health-care professionals and inadequate staff-patient relationships may explain why trans, non-binary, and gender diverse patients were more likely to report their mental health needs were not met at recent general practice appointments. Changes are urgently needed for the NHS to become a more supportive service to transgender, non-binary, and gender diverse patients, including improved recording of gender across health-care records systems and staff training to ensure health-care professionals meet the mental health needs of all patients, whatever their gender,”

Jack Tielemans from The Proud Trust and a co-author of the paper adds,

“Empowering young LGBT+ people to be proud of who they are through youth groups, mentoring programmes and societal support, alongside inclusive healthcare, are important in tackling the higher risk of mental health conditions amongst trans, non-binary, and gender diverse young people.”

The authors note several limitations of their study, including that pooling data from two survey years may mean some participants were resampled in consecutive years leading to biased estimates. Additionally, the clinical language in the survey (long-term mental health condition) and that it relied on self-reporting, may have influenced which patients report a mental health condition. A small proportion of people responded “prefer not to say” to gender-related questions in the survey.

The authors suggest there may be numerous reasons for this choice ranging from privacy concerns to patients feeling there was no suitable response for them. There was a high prevalence of unmet mental health need amongst this group which authors say highlights the importance of including this response option, and of further research to understand the make-up and needs of this patient group.

The full paper can be accessed from here:

Watkinson R, Linfield A, Tielemans J, Francetic I, Munford L. (2024). Gender-related self-reported mental health inequalities in primary care in England: Cross-sectional analysis using the GP Patient Survey. Lancet Public Health

[1] Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgender Health 2022; 23: S1–259.

published 31/1/2024

Scoping Review Highlights Impact of COVID-19 on Social Care and Workforce

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A recent scoping review led by researchers from The University of Manchester and funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), in the British Journal of Social Work, explores the evidence around the repercussions of the COVID-19 pandemic on social care and social work in the United Kingdom.

Out of ninety-seven articles retrieved, the final analysis from thirty-nine articles outlines the psychological impact among professionals in the sector from December 2019 to May 2023.

Before the COVID-19 pandemic, concerns about staffing levels and high workloads within the social care sector were widespread. This scoping review highlights the increasing challenges faced during the pandemic, particularly related to:

the working environment
recruitment
retention
insufficient support for management

The review argues that the COVID-19 pandemic intensified existing difficulties, placing further strains on an under resourced social care system and the social care workforce to deliver services.

The scoping review also suggests the importance of comprehensive strategies to address the psychological well-being of social care professionals, improved support for management and the development and establishment of a coherent pathway for future planning.

The findings derived from the evidence, call for a holistic approach to ensure the resilience and effectiveness of the social care workforce in the living with COVID era.

Read the paper in full:

Owens J, Young A, Allen R, Pearson A, Cartney P et al., The Impact of COVID-19 on Social Care and Social Work in the UK: A Scoping Review, The British Journal of Social Work. 2023.

Read more about the SECURE Study

Published: 31/01/2024

Webinar to reveal ‘alarming’ number of young people in mental health wards far from home

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The “stark shortage” of hospital beds on teenage mental health wards in the UK will be the focus of an upcoming online event.

Clinicians and people affected by mental health problems are invited to hear the results of a national study that has identified a shortage of hospital beds on general adolescent psychiatric wards, forcing hundreds of teenagers to travel miles or wait weeks until being admitted.

Taking place on Thursday, March 21, between 12.30pm and 1.45pm, the free-to-attend webinar will explore how the study’s results will impact future research, clinical practice and service development.

The ‘Far Away from Home’ study was a collaboration between five National Institute for Health and Care Research (NIHR) Applied Research Collaborations (ARCs) – East Midlands, East of England, Greater Manchester, Oxford & Thames Valley and West Midlands.

Senior author Professor Kapil Sayal, from the University of Nottingham, said:

“The study examined the scale, impact and costs of admissions of under 18s to mental health units at distance from their home to a different NHS region, or to adult wards, and I am deeply concerned about the stark shortage of hospital beds.

“This webinar presents an opportunity for young people, parents, researchers, clinicians, service managers and commissioners of mental health services to hear the findings from the ‘Far Away from Home’ study and discuss ideas for future research, clinical practice and service development.”

During the online event, researchers will present national data on the frequency, clinical characteristics and outcomes of 290 admissions collected over a 13-month period, including follow-up data.

In addition, they will present findings from interviews with young people, parents and healthcare professionals on the impact of these admissions.

Co-author Dr Josephine Holland, from the University of Nottingham, said:

“Young people are waiting a long time for a mental health bed, something which those who have assessed them feel they need as a matter of emergency.

“This forces them to wait in places which are not quite right for a young person experiencing a mental health crisis.”

The study was funded by the NIHR ARC East Midlands. The organisation funds vital work to tackle the region’s health and care priorities by speeding up the adoption of research onto the frontline of health and social care. It puts in place evidence-based innovations which seek to drive up standards of care and save time and money.

NIHR ARC East Midlands is hosted by Nottinghamshire Healthcare NHS Foundation Trust and works in collaboration with the Health Innovation East Midlands. It has bases at the University of Leicester and the University of Nottingham.

To attend the webinar, book your place here: https://www.ticketsource.co.uk/arc-east-midlands/t-vvkpoxe

ARC-GM publishes new paper on the role of clinical pharmacists in general practice

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A recent paper published in the British Journal of General Practice examines the decision-making processes of pharmacists in general practice and the impact of funding and employment models on these decisions.

General practices are struggling with unmanageable workload and workforce shortages. Bringing in non-medical professionals to support General Practitioners (GPs) and fill gaps in provision is often seen as part of the solution. As the variety of roles working in general practice expands, deciding who should do what work becomes more complex.

In the study, led by researchers funded by the National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester (ARC-GM), the team interviewed forty-one pharmacists, GPs and other staff working at general practices in England and compared experiences of two different general practice pharmacist funding and employment models.

The research team found there to be four common factors that influenced the negotiation of the GP pharmacist role:

role ambiguity;
competing demands and priorities;
potential for (in)appropriate utilisation of clinical skills; and
level of general practice control over the role.

The research team also found that the employment and/or funding model for the GP pharmacist can affect role negotiation and lead to unintended consequences, such as the inappropriate utilisation of non-medical professionals’ skills.

NIHR ARC-GM funded researcher and lead author, Dr Fay Bradley, commented:

“The study sheds more light on the introduction of pharmacists into general practice and reveals that new general practice roles are not well-defined and tend to develop and evolve through local practice-level negotiation. However, several factors can influence the success of these negotiations and ultimately affect the contribution new roles can make to patient care.”

The NHS in England offers general practices funding to help employ a range of new roles; currently, primary care networks can claim reimbursement for the salaries of 17 new roles through the Additional Roles Reimbursement Scheme. These findings have wider applicability for the introduction of other non-medical roles into general practice.

Read the full publication here.

Published 25/01/2024

Two ARC-GM Related Papers Featured in The British Geriatrics Society Themed Collection on Age and Ageing

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The British Geriatrics Society Age and Ageing medical journal recognises the importance of evidence synthesis in research and actively supports this method as an effective and objective means of keeping up to date with the latest evidence in older adult care. Their recent themed collection, features important evidence synthesis papers from the journal published in recent years addressing various topics related to health and social care for older individuals.

From the broad range of publications available, the journal has chosen to feature two studies linked to the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) reflecting the significance of NIHR ARC-GM’s work in this area.

A rapid evidence synthesis (RES) of Virtual Wards (a virtual ward uses the systems and staffing of a hospital ward while enabling the patient to get the care they need where they live), led by Dr Gill Norman, evaluated this service using international evidence to inform local Greater Manchester work.

Researchers searched databases to address clinical and cost-effectiveness, barriers and facilitators for staff, patient or carer experience for virtual wards, hospital at home or remote monitoring alternatives to inpatient care. The data indicates that outcomes such as mortality and admissions to residential care are probably as good or better with hospital-at-home compared to traditional hospital care. However, uncertainties exist regarding cost-effectiveness, and there is insufficient evidence on the financial impact for patients and caregivers.

Dr Gill Norman commented:

"We were pleased to see the Virtual Wards rapid evidence synthesis featured in this collection, and the level of interest in it. It's based on work to support evidence-based decision making within Greater Manchester but this paper has helped us contribute to the national conversation around virtual wards. Use of existing evidence syntheses in this kind of work supports timely decision-making for safe and effective care, avoids research waste and helps with planning future work."

More information about NIHR ARC-GM’s approach to Rapid Evidence Synthesis (RES), and a downloadable version of the Virtual Ward RES is available here.

Read the paper in full:

Norman G,Bennett P,, Vardy E., Virtual wards: a rapid evidence synthesis and implications for the care of older people, Age and Ageing, Volume 52, Issue 1, January 2023, afac319, https://doi.org/10.1093/ageing/afac319

Another important contribution to the collection is a systematic review and meta-analysis of instruments addressing concerns about falling in older individuals and those at an elevated risk of falls. The research team looked at 58 studies focussing on four measurement tools, findings suggest that there is evidence for excellent measurement properties of all four.

Lead author on this paper, Dr Lisa McGarrigle said:

"We are very pleased to see our review on measures of concerns about falling included in this collection. The review exemplifies how evidence on the reliability and validity of assessment tools can be synthesised to guide best practice. Findings from this review were used to inform the recently published World Guidelines for Falls Prevention in Older Adults, also published in Age and Ageing."

Read the paper in full:

McGarrigle L, Yang Y, Lasrado R, Gittins M, Todd C., A systematic review and meta-analysis of the measurement properties of concerns-about-falling instruments in older people and people at increased risk of falls, Age and Ageing, Volume 52, Issue 5, May 2023, afad055, https://doi.org/10.1093/ageing/afad055

The full British Geriatrics Society Evidence Synthesis for Older Adults, An Age and Ageing themed collection can be accessed here:

https://academic.oup.com/ageing/pages/evidence-synthesis

Published: 19/12/2023

Signpost to Health Study: Targeting Pre-frail Older Adults with Physical Activity Intervention

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A new paper published in BMC Geriatrics reports on initial intervention development targeting pre-frail older adults. The Signpost to Health study, led by Dr Annemarie Money in the Healthy Ageing theme of the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), is a behaviour change intervention aimed at pre-frail older adults, which would signpost them to group-based physical activity classes known to be effective for delaying or slowing frailty.

Frailty is a medical condition common in older adults characterised by diminished strength and reduced physiologic function in which individuals are more vulnerable to multiple adverse health outcomes. Pre-frailty is an intermediate stage associated with some minor health outcomes. However, the main risk is progression toward moderate/severe frailty. Evidence shows physical activity interventions to be effective in slowing or modifying the progression of frailty.

In-depth qualitative work with key stakeholders who would be involved in the intervention (older adults and a range of health and exercise professionals) were undertaken. The research aimed to explore the practicality of taking forward such an intervention and identifying uncertainties to be explored in the feasibility stage.

Nine key themes were identified, with key issues related to physical activity messaging, the use of the term ‘frail’, how to identify and recruit pre-frail older adults, and the acceptability of behaviour change techniques being proposed.

Lead author Dr Annemarie Money (Research Fellow, University of Manchester and NIHR ARC-GM) said:

“There was overwhelming support for a proactive approach to addressing issues around frailty and pre-frailty. Given that a large proportion of older adults are estimated to be pre-frail, interventions aimed at this group have the potential to support healthy ageing, positively impacting on frailty outcomes and providing wider population health benefits. Efforts to secure funding to continue to develop and feasibility test this intervention are ongoing”.

Read the paper in full here.

Published 19/12/2023

The Mental Health Navigators (MHN) Evaluation Research Team Wins 'Dialogue and Change' award for their patient and public involvement and engagement work

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An NIHR ARC Yorkshire and Humber led research team based at the University of York, that evaluated Wakefield District Housing’s Mental Health Navigator scheme has been awarded the ‘Dialogue and Change’ award from Investing in Children for their outstanding patient and public involvement (PPI) work.

The independent award recognises projects that demonstrate meaningful dialogue where people with lived experience work together with researchers to make real improvements, leading to positive changes.

The Mental Health Navigators (MHN) Evaluation is evaluating the impact and implementation of the Wakefield District Housing (WDH) MHN scheme, assessing the outcomes for tenants and factors which enable successful implementation of the scheme.

WDH is a large social housing provider, covering Wakefield and a wider area across the North of England, and its MHN scheme aims to support those experiencing mental health difficulties to stay in safe and secure housing and improve their wellbeing. This study aims to share the lessons learnt from the evaluation to enable further roll of the MHN scheme and thus support more people who are experiencing mental health difficulties and resulting vulnerabilities.

More infornation about the MHN evaluation is available from here

The team spoke with people who have had mental health issues and lived in social housing. They asked for their thoughts and suggestions throughout the research project, who explained they felt like ‘they were equal partners in the research, not just used for their stories.’

The people they spoke to said the researchers really listened to their ideas and made changes based on what they said. For example, the researchers made their consent forms and information sheets easier to understand after getting feedback. They also changed their interview questions to be more supportive to participants.

“Often you get the feeling that you’re just being ticked off in a box. It often felt like we were being pimped out by people to just go out and do a presentation and that’s it. They’d design a presentation for you and you’d go off and be the face of it, even though you had no say in it. They didn’t actually want our opinion, because that might be contrary to what they believe. And eventually I got a bit ticked off with it, I didn’t just want to be a ticked box. This is proper involvement, proper PPI. Here the involvement is so much more inclusive.”

“Do I think they’re worthy [of the award]? Yeah, I do. And it’s on a personal level because of how they’ve involved me; how they’ve listened to me; when they’ve said they’re going to do something, that they’ll go away and do it. I feel that I’ve been invested in, I’ve been heard. My opinions have been listened to and been acted on.”

“For me, getting involved in this research, it's been liberating for me. I've got a use. I've got a purpose. I'm not just on the scrap heap, it feels like it's brought me back to life.”

The assessor concluded that the PPIE members were included on equal terms to academics and professionals. Their diverse perspectives and understanding of service users' needs led to important contributions that may have otherwise been overlooked.

The participants who were listened to said it was an empowering experience. They want other research projects to work in the same way. By fostering open communication and genuinely valuing PPI input, the research team created an empowering experience that satisfied key criteria of recovery models.

The research team behind the evaluation is led by Dr Sarah Blower at University of York, with collaborators from the University of Newcastle, The University of Manchester, ourselves at NIHR ARC Greater Manchester and NIHR ARC North East and North Cumbria.

The MHN evalution is funded via the NIHR ARC National Priority Consortium - Health and Care Inequalities led by NIHR ARC North East and North Cumbria.

published 4th December 2023

Sharing Adam’s Story at Eccles Sixth Form College on World Mental Health Day 2023

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On World Mental Health Day 2023, we went to Eccles Sixth Form College in Greater Manchester and engaged in a meaningful exploration of mental health through the lens of Adam’s Story. Presented to 100 students, the interactive film created a space for genuine discussions and reflections.

Featuring an 18-year-old in the film resonated strongly with students. “I like how they’ve used an 18-year-old…we’re all around this age.” Students also shared their ideas for how Adam’s family could support themselves and each other better, and reflected on how Adam’s key worker could do things differently.

You can access the full blog from the Made by Mortals website here...

Northern ARCs soar at prestigious regional research conference held at airport

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In a sky-high collaboration, the National Institute for Health and Social Care’s Northern Applied Research Collaborations (ARCs) of Greater Manchester, North East and North Cumbria, North West Coast, and Yorkshire and Humber joined forces for a two-day conference showcasing the pinnacle of life sciences and key medical technology advancements across Northern England.

The Great North Research Conference for the Life Sciences and Medical Technology Industries, organised by NIHR Clinical Research Network of North East and North Cumbria, was set against the backdrop of the iconic Concorde Conference Centre at Manchester Airport on 21st and 22nd November and attracted professionals, experts and enthusiasts from across the UK, offering educational and interactive presentations - as well as tours of Concorde!

Key note speakers included former Health Minister Lord O'Shaughnessy, while Professor Alistair Hall shared insights into reports, advancements and latest developments in the life sciences industry from across the NIHR infrastructure.

The ARC teams, representing North West Coast (ARC NWC), Greater Manchester (ARC GM), North East and North Cumbria (ARC NENC) and Yorkshire and Humber (ARC YH) managed a dedicated stall at the event providing attendees with a glimpse into their innovative regional and national projects to reduce health inequalities and how their work is aligned with national health and social care priorities.

Day one's breakout sessions navigated diversity, equity, and inclusion featuring Xoli Belgrave from Parexel, decentralized trials with NIHR National Patient Recruitment Centres and collaborative strategies in the north by Oliver Buckley Mellor from the Association of the British Pharmaceutical Industry (ABPI).

Day two's sessions took flight with Phil Brown from the Association of British HealthTech Industries (ABHI) on regulation and Dr. Ian Newington from NIHR Central Commissioning Facility discussing funding opportunities.

Sian Cunningham, Communications Officer for ARC NWC, said:

“The Northern ARCs collaborated today to inspire the audience and convinced them of the value of investing in research in the North, outlined the innovation taking place and its impact which is benefitting organisations, service users and communities. This event has shown the advantage of ARCs working together in collaboration and uniting to demonstrate the pioneering research in the North of the country.”

published 29/11/2023

£40,000 funding awards available for Applied Health and Care research projects

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The Manchester Academic Health Science Centre (MAHSC) Applied Health and Care Research Group, a joint initiative between MAHSC and the NIHR Applied Research Collaboration Greater Manchester (ARC-GM), are offering the opportunity to apply for awards to fund cross-discipline, multi-institution, research-led projects that have potential to generate health and social care impact and benefits to people and communities, patients, and carers.

The projects should focus on topics allied to applied health and care and consider the specific health needs of the Greater Manchester area, with a view to ongoing impact, publications, and potential for securing definitive funding. Multiple awards are available for up to £20,000-£40,000 per project.

The Principle Investigator and team must be working in a university or NHS organisation in the Greater Manchester area.

Projects should align with the Greater Manchester Integrated Care Partnership strategy 2022-2028 and Greater Manchester’s 5-year Joint Forward Plan.

For guidance, the 6 missions of the Greater Manchester Integrated Care Partnership are as follows:

The recovery of NHS and care services
Strengthening our Communities
Increasing prosperity
Prevention and early detection
Supporting our Workforce and Carers
Achieving financial sustainability

The full Greater Manchester Integrated Care Partnership Strategy, Improving health and care in Greater Manchester, 2023-2028, can be viewed here, with the Greater Manchester Integrated Care Partnership Joint Forward Plan available here.

Professor Matt Sutton, MAHSC Applied Health and Care Research Group Chair, Professor of Health Economics at the University of Manchester, and NIHR ARC-GM Deputy Director, said:

“This is an exciting opportunity to develop research studies that have the potential to generate health and social care impact and benefits to people and communities, patients, and carers. We look forward to receiving applications that help to address the key challenges facing the Greater Manchester health and social care system.”

Projects are encouraged to tackle health and social care inequalities, including but not limited to, the inclusion of under-served groups in research. It is important that projects include a named sponsor from the local health and care system, demonstrate Public and Community Involvement (PPIE), and (representation/inclusion) of voluntary sector partners is encouraged.

The awards may fund staff salaries, project running costs, and equipment essential to the study/project, and the grant duration is for 1 year. Awards cannot cover research overhead costs.

Applications can be submitted to MAHSC@healthinnovationmanchester.com, with a closing date of 26th January 2024 and a decision will be made on funding awards by February 2024.

More information on the application process can be found on the application form below.

Application Form

NHS England Funds Extension of ICS Research Engagement Network Programme

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The Public Involvement and Engagement leads from the National Institute for Health and Care Research (NIHR) infrastructure across Greater Manchester are thrilled to announce the securing of funding from NHS England, to continue the Integrated Care Systems (ICS) Research Engagement Network (REN) Programme until March 2024.

The project focuses on establishing a community-led research network that actively listens and responds to the health and priorities of diverse communities across Greater Manchester, fostering inclusivity in research.

Built on insights gained from the initial phase, the programme has identified key areas of focus. Feedback from research and Voluntary, Community, Faith and Social Enterprise (VCFSE) partners emphasised the need for a respectful research charter to guide collaborative partnership working.

Additionally, the importance of community connectors, a skills/knowledge exchange between the VCFSE sector and researchers, and the potential for a VCFSE-led community research hub were highlighted.

The three primary objectives of the program are as follows:

To increase the opportunity for more people to get involved in research by improving how researchers engage with diverse communities about specific projects.
To create an infrastructure to sustain long-term reciprocal relationships that build trust between communities and researchers.
To gain a better understanding of who is getting involved in research by developing a system for monitoring participation.

Sue Wood, Head of NIHR Applied Research Collaboration, commented:

“If we are to put the voices of those most at need at the heart of research that tackles inequalities in health and care, we need to build trust and sustainable relationships with our most vulnerable communities. Only in working in partnership with the VCFSE sector and the Integrated Cares System will research organisations begin to create the networks essential to breaking down the barriers to inclusive research.”

What we have done so far:

We held an online seminars and face-to-face event, engaging participants from research and VCSE organisations. Small group discussions explored themes such as a respectful charter for research, community connectors, VCFSE-led research hubs, and skills exchange.
Started the mapping of community connectors across Greater Manchester with the assistance of research and VCFSE networks.
Developing a draft Respectful Research Charter for review by VCFSE Leadership.

This initiative aims to make research more inclusive and impactful, fostering collaboration between research organisations, the voluntary sector, and community voices to support healthcare planning and delivery within Greater Manchester.

If you or your organisation works with Community Connectors (trusted people within the community who engage and involve local residents in research) we would like to hear from you. Please email: Emily.howlett@mft.nhs.uk

Find out more...

Published 16/11/2023

New publication highlights the perspectives of younger adults living with type 2 diabetes in Greater Manchester

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A new paper published in BMJ Open has shed light on the challenges and perspectives of younger adults living with type 2 diabetes in Greater Manchester.

The Prioritising Action on Diabetes in Greater Manchester work, led by Prof. Peter Bower (Professor of Health Services Research at The University of Manchester and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) Lead for Evaluation), was undertaken as part of the Novo Nordisk funded Cities Changing Diabetes Programme.

The mixed method study, of participants with type 2 diabetes aged between 18 and 40, explored the barriers to and opportunities for successful diabetes prevention; diagnosis, care and management; and overall health and wellbeing.

The researchers identified five different perspectives on living as a younger adult with type 2 diabetes, characterised as:

stressed and calamity coping;
financially disadvantaged and poorly supported;
well-intentioned but not succeeding;
withdrawn and worried;
young and stigmatised.

The study builds on earlier research in the wider project which showed that adults under the age of 40 are under-diagnosed in the care record. The research involved collecting data from participants across Greater Manchester using a survey, and then inviting them to take part in an interview or focus group to understand their perspectives in more detail.

It found that people aged 18 to 40 years shared some common experiences, but required different solutions to their problems. It also showed that there are five identifiable sub-groups of younger adults living with type 2 diabetes in the region.

Lead author Dr Sarah Croke, Research Associate at The University of Manchester and part of the NIHR ARC-GM Evaluation Theme, said:

“Our research identified some particular challenges for younger adults living with type 2 diabetes in Greater Manchester, especially for those with work, children and family commitments. We also found significant differences in the preference for support, access to information and ability to follow self-management advice. People living with diabetes in this age group want to be healthy and may benefit from improved, tailored support to help them avoid, delay onset or live better with type 2 diabetes.”

A full report summarising the breadth of research undertaken throughout the Cities Changing Diabetes in Greater Manchester project can be found here.

Cities Changing Diabetes is a commitment to drive action against type 2 diabetes and obesity in cities globally, it is a global public-private partnership programme that aims to address the systemic issues underlying the rise in obesity and type 2 diabetes and aims to reduce health inequity.

Since the launch of Cities Changing Diabetes in 2014, the global programme has grown to more than 40 cities.

New framework for a rapid approach to evidence synthesis

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Researchers have developed a new framework to streamline the evidence gathering process when assessing the effectiveness of healthcare innovations.

Health and social care organisations face the challenge of providing a high-quality service whilst operating with limited resources, so the implementation of effective and safe innovations, such as new treatments, tests, or improved working methods, is essential.

Innovations can have negative as well as positive effects or may make no difference. Evaluating their effectiveness and safety requires synthesising existing evidence, which can often be time-consuming and complex.

In response to this challenge, researchers from the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) and the University of Manchester have developed a new framework for a Rapid Evidence Synthesis (RES) approach.

Unlike a full systematic review, RES serves as a more streamlined and quicker alternative; it draws on evidence synthesis methods including the GRADE Evidence to Decision framework to provide rapid assessments of the existing evidence thereby maximising utility in a real-time decision-making context for healthcare innovations.

A recent paper published in Systematic Reviews outlines the RES approach.

Dr Gill Norman, Research Fellow at The University of Manchester and NIHR ARC-GM commented:

“RES uses evidence briefing methods in a transparent approach to supporting decision-making around innovation adoption, implementation and evaluation. It’s specifically designed for situations where directly relevant evidence may be limited - precisely because innovations are novel. It’s a systematic, pragmatic and flexible way to identify and assess evidence for quality and relevance in a short timescale and it allows us to provide “good-enough” answers.”

The RES approach has been integrated into the decision-making processes of the Greater Manchester AHSN, as part of Health Innovation Manchester (HinM). ARC-GM researchers provide RES support to a range of Greater Manchester health and social care providers and commissioners to support their decision-making.

Dave Boulger, Associate Director for Population Health at NHS Greater Manchester Integrated Care, describes how the NIHR ARC-GM team are providing RES support to help inform the Greater Manchester 5-year Alcohol Strategy,

“Preventing alcohol-related harm is a highly complex task and at NHS GM we are committed to producing an evidence-based strategy and action plan in order to maximise the level of impact that we have.

Working with the team to undertake a series of Rapid Evidence Syntheses will contribute towards us achieving that ambition by shining a spotlight on the most effective approaches to intervention, and the gaps that exist within the evidence base, against which we might want to undertake more detailed research.

The team have been really positive and supportive, the production of the RES was very timely, and the quality of the work that has been produced has been professional and incredibly helpful.”

The researchers emphasise that their approach is not a substitute for a systematic review, but rather a method to assess the quality and relevance of evidence for effectiveness and safety of innovations more rapidly.

Many completed RES reports by the research team are freely available for download on the ARC-GM website:

https://arc-gm.nihr.ac.uk/rapid-evidence-synthesis

Read the paper in full:

Norman, G., Wilson, P., Dumville, J. et al. Rapid evidence synthesis to enable innovation and adoption in health and social care. Systematic Reviews 11, 250 (2022). https://doi.org/10.1186/s13643-022-02106-z

Published: 24/10/2023

New Study Shows Widening Socioeconomic Inequalities in Flu Vaccine Uptake during COVID-19 Pandemic.

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A new study published in PLOS medicine, from researchers at the University of Manchester and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) finds that socioeconomic inequalities in annual seasonal influenza (flu) vaccine uptake widened significantly during the COVID-19 pandemic.

The study utilised electronic health records from Greater Manchester (2015/16 to 2021/22), focussing on three age groups eligible for the NHS flu vaccination:

preschool children (ages 2 to 3 years),
primary school children (ages 4 to 9 years), and
older adults (age 65 years and above).

Key findings of the study include:

Among older adults, the gap in flu vaccine uptake between the least and most income-deprived areas doubled over the seven flu seasons, with approximately 80% of this increase occurring during the COVID-19 pandemic.
Among preschool children, the uptake gap increased in 2020/21 before decreasing in 2021/22.
Among primary school children, inequalities increased in both COVID-19 pandemic years,
Despite an overall increase in vaccine uptake during the pandemic, larger increases occurred in less deprived areas, leading to wider inequalities across all age groups.

The study's lead author, Dr Ruth Watkinson, commented these findings:

“The COVID-19 pandemic caused major disruption to routine healthcare services, making it harder for some people to get their flu vaccine. There was also a big increase in misinformation about vaccination, which may have put some people off taking up the flu vaccine. It’s really important that we work to address these factors and reduce vaccine uptake inequalities.”

The researchers believe that the widening socioeconomic inequalities in flu vaccine uptake during the COVID-19 pandemic may exacerbate disparities in flu-related morbidity and mortality.

This study underscores the need for public health officials and policymakers to address these disparities and ensure that vaccines are accessible to all, especially during public health crises like the COVID-19 pandemic. Further research is required to better understand the underlying causes and develop strategies to mitigate these inequalities in vaccine uptake.

Read the paper in full here:

Watkinson RE, Williams R, Gillibrand S, Munford L, Sutton M (2023) Evaluating socioeconomic inequalities in influenza vaccine uptake during the COVID-19 pandemic: A cohort study in Greater Manchester, England. PLOS Medicine

Published 03/10/2023

Involvement in Research Through Participatory Arts: 'Hidden LIVE – Adam's Story'

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A new paper, published in Child Adolescent Mental Health explores the use of participatory arts to create a theatre production titled "Hidden LIVE - Adam's Story."

In recent years, participatory arts have gained recognition for involving the public in various forms of creative expression, such as film, music, photography, and theatre. This approach has shown potential value in public and patient participation in health and care research by allowing individuals to creatively express their perspectives and experiences related to health conditions, treatments, and services. Participatory arts can also offer a platform for healthcare professionals to reflect on their practice.

"Hidden LIVE – Adam's story", which was first performed in May 2022, addresses the mental health challenges faced by young people. It combines a pre-recorded podcast narrating a fictional young person's story with a live monologue from a Child and Adolescent Mental Health Service (CAMHS) caseworker's perspective. The aim of the production was to raise awareness, and to encourage discussions about solutions related to youth mental health.

An interactive workshop followed the performance, enabling attendees to share their experiences and brainstorm ways to enhance the well-being of young individuals dealing with mental health issues.

"Hidden LIVE – Adam's story" was co-produced with 10 young individuals aged 17 to 24 from Greater Manchester with personal or supportive experiences related to their mental health. They collaborated with an arts-based company Made by Mortals and health researchers from National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) across eight online workshops to develop the production, focussing on the challenging transition from CAMHS to adult mental health services. Together, they shaped the character, script, recording, and soundtrack.

In the creation of "Hidden LIVE – Adam's story", co-production principles played a pivotal role in promoting collaboration, equity, and shared responsibility among team members. Young participants were treated as true collaborators, one of the young people, Ashgan, 21, talks about their experience working on this project here.

Dr Andrew Grundy (Lived Experience Researcher) and author of the paper commented:

"This paper defines and then evidences co-production principles put into practice in this theatre production. It will benefit anyone working in the participatory arts, and in involvement activities, showing what it might mean to work towards co-production principles. We’ve now worked with some of the young people on the team to develop an evaluation questionnaire to formally capture the impacts of the performance on attendees."

Using co-production principles in health and care and research can guide public involvement in participatory arts and improve engagement. The participatory arts are effective in addressing mental health issues by empowering service users and healthcare professionals but more research is needed to understand the benefits and challenges, both for young participants and attendees, and to formally evaluate such projects.

Watch a video abstract of this paper here:

Read the paper in full here:

Grundy AC, Hine P, McAvoy A, Lovell K. (2023). Hidden LIVE – Adam’s story: a mental health theatre production as an example of participatory principles and practices. Journal of Child and Adolescent Mental Health

Published 03/10/2023

New funding secured to continue research on support strategies for parents of children with obsessive-compulsive disorder

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Researchers from The University of Manchester, the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), The University of Liverpool, and several charity an clinical experts, have secured an extra £150k of funding from the NIHR to continue their work on reducing the burden and distress experienced by parents and carers of children with Obsessive-Compulsive Disorder (OCD).

In the initial NIHR funded CO-ASSIST study, the research team looked at published evidence and spoke to parents and carers of children with OCD and professionals to understand parent support needs.

Through workshops with parents and professionals, the study found that the most helpful solution would be to develop an online platform containing co-produced parent-informed resources and information to help parents and carers that are supporting a child with OCD.

Watch this short animation explaining the CO-ASSIST Findings:

As part of the new study, which is hosted by Greater Manchester Mental Health NHS Foundation Trust, the team will work with parents/carers to co-design a prototype of the intervention and will work closely with a panel of 8-10 parents/carers to plan research to test the new platform. The research team will also work with community groups and relevant organisations to make sure the platform is accessible to parents from ethnic minorities and refugee communities.

For more information and to keep up to date with this programme please access the ‘Development of a programme to reduce burden and distress in parents and carers of children with OCD’ pages here:

https://arc-gm.nihr.ac.uk/projects/Developing-a-programme-to-reduce-burden-and-distress-in-parents-carers-of-children-with-OCD

Published 09/10/2023

‘Hidden: Adam’s Story’ Interactive Film Launch - World Mental Health Day 10th October 2023

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We are pleased to announce that on World Mental Health Day, 10th October 2023, we will be launching a new and free, online interactive film.

The ‘Hidden: Adam’s Story’ film and resource have been developed to support discussions around mental health for young people, through exploring young people's mental health issues from the perspective of a young person affected by mental health illness, whilst also looking into the impacts on their siblings, mothers and keyworkers.

The film includes an interactive discussion on the barriers faced by the characters, and how we can help overcome these. The film's aim is to strengthen communication and relationships between young people, their families and those who support them.

Back in September 2021, the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), Made by Mortals and the NIHR Greater Manchester Patient Safety Research Collaboration (GM PSRC) embarked on a project with 10 young individuals (aged 16 to 18) from across Greater Manchester to collaborate on a podcast where they created a character reflecting their own personal experiences.

The podcast then transformed into an immersive live show, Hidden LIVE.

One of the young people who co-produced the podcast and video resource, Sadia Mir, commented:

“When I think back to the start of the project, I remember being very nervous. I did not feel like as young people would actually be listened to and that I would not be talking about my involvement in the project at all. I was very wrong!

The project from the start made me feel included and heard, and 'Adam's Story' is a project I fondly talk about as an achievement and a piece of my own story. I have talked about Adam's Story to friends, family, future employers and cited it as good practice in my everyday work. I'm proud of our achievement - one that truly listened to, and was developed by us young people.”

The free, film and resource are accessible to anyone interested in young people's mental health, including families, young people, mental health/health and social care professionals, teachers, youth group leaders, charities with a Mental Health focus, schools and colleges.

When you sign up to this event, you will receive:

The link to watch ‘Hidden: Adam's Story’ in advance of World Mental Health Day - Tuesday 10th October.
A PDF guide to the interactive workshop within Hidden: Adam's Story. The film is led by a presenter who guides you through discussion questions informed by Adam's story.
A list of signposting information where support can be found for individuals affected by mental health illness.

Professor Karina Lovell, ARC-GM Mental Health Theme Lead commented:

"This amazing film highlights the real barriers that young people face in mental health difficulties. The co-production with young people and our partnership with Made by Mortals has made the film a reflective piece for all.”

Watch the trailer here:

Sign up for access to a new interactive film, Hidden: Adam's Story here.

Published 22/09/2023

"Take a walk in someone else's shoes." Participatory Arts for informing health research.

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A recent research paper published in Research Involvement and Engagement, sheds light on the potential of storytelling and persona creation in offering unique insights into how these creative methods can bridge the gap between academic institutions, healthcare facilities, and communities while promoting trust and empathy.

Co-created arts-based methods for participation in research, like storytelling and creative expression, allow individuals to share their perspectives, human experiences and emotions, they are increasingly seen as valuable ways to involve the public and patients in healthcare research and services.

This research led by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), draws upon on number of research projects that used participatory arts with community members, to gain valuable insights into the respective research proejcts:

One of these, "Hidden: Adam's Story “focuses on Mental Health Awareness for young people. This audio-podcast series was created collaboratively with, Made by Mortals, and involved Individuals with lived experience taking on leadership roles to share their insights, creativity, and to gather knowledge. The planning for the podcast series drew on the participant’s imagination and life experiences to create characters and scenarios, with each episode featuring characters of diverse backgrounds and health conditions, designed to represent qualities shared by the creators.

"Hidden: Adam's Story," has been used in a number of ways, one of these being as a public and patient involvement and engagement (PPIE) tool to inform health research, another being as a training tool for healthcare professionals in hospital settings.

The research team also relied on participatory approaches in the use of a character and story to explore young adults' attitudes towards COVID-19 vaccines, which provided valuable insights into future vaccination strategies.

ARC-GM Research Associate and Author of this paper, Stephanie Gillibrand, commented:

"Using participatory approaches such as these re-imagines the ways in which we can communicate peoples' voice, experiences and ultimately how we may be able to include these in the overall research process. It highlights the importance of championing these approaches to diversify the voices that get heard in a way which promotes ownership over these narratives."

Involving those with lived experiences, particularly from groups who are traditionally excluded in research, helps to shift power dynamics, and may aid in trust and relationship building between institutions and communities in a way that encourages empathy within creative methods to aid health research and healthcare processes.

By involving individuals with lived experience of health conditions, these initiatives empower participants and users to "take a walk in someone else's shoes."

Read the paper in full here.

Published 22/09/2023

Ill-health and deprivation: How we can address health inequalities in left behind neighbourhoods

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We have long known that the health of people living in deprived areas is worse than the national average. But this raises important questions, such as how big is the gap? Is it narrowing or growing over time? Are some deprived places worse off than others? And how do health inequalities affect economic performance?

In this article, from Policy@Manchester's Power in Place publication, Dr Luke Munford our NIHR Applied Research Collaboration Greater Manchester (ARC-GM) Deputy Lead for Economic Sustainability, looks at those disparities in greater detail.

Men and women living in left behind neighbourhoods live, respectively, 3.7 years and 3 years fewer than average. This gap in life expectancy has been widening.
Tackling these health disparities will not only improve the lives of millions of citizens, it will also bring significant savings to the taxpayer.
The Levelling Up strategy must include a strand on reducing spatial health disparities through targeting multiple neighbourhood, community and healthcare factors.

You can access the full blog from the Policy@Manchester site here

PPIE Award for Valued Panel Member

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Members of the NIHR ARC-GM and Health Innovation Manchester Public and Community Involvement and Engagement Panel (PCIE), bring a range of skills, knowledge and lived experience to research themes.

One member, Manoj Mistry, has served as a valued member of the panel since 2017. His invaluable contributions have extended to various research projects and teachings across the University of Manchester Faculty’s PPIE Forum, Manchester Academy for Healthcare Scientist Education (MAHSE), Doubleday Centre, and Primary Care Research in Manchester Engagement Resource (PRIMER) patient groups.

Manoj won the Individual Public Contributor category at the 2023 Social responsibility in The University of Manchester Faculty of Biology, Medicine and Health ‘Outstanding Contribution to PPIE’ awards.

Manoj commented:

“I was pleased and delighted to go be given this award. It would not have been possible without some of the outstanding individuals at The University of Manchester that I have worked with over the last 12 years".

NIHR ARC-GM and Health Innovation Manchester would like to congratulate Manoj on this award, and on the valuable insights that he has contributed to vital work since joining the Public and Community Involvement and Engagement Panel (PCIE).

The University of Manchester has published a blog displaying the inspirational and outstanding commitment to Patient and Public Involvement and Engagement (PPIE).

You can access the full blog about Manoj’s award win here.

Find out more about our Public and Community Involvement and Engagement Panel here.

Economics for policy & practice: Showcasing economists in NIHR ARCs & PRUs

Event: Event

Date: 13th June 2024

Time: 09:30 - 16:00

'Economics for policy & practice: Showcasing economists in NIHR ARCs & PRUs' will offer an opportunity for economists working in NIHR Applied Research Collaborations (ARCs) and Policy Research Units (PRUs) to join together as we showcase the highlights of work done to date, as well as ongoing and upcoming plans.

We'll be welcoming key local policy and decision-makers and national NHS England colleagues, as well as researchers from all NIHR ARCs and PRUs.

This free event is located in central Manchester and includes lunch and refreshments.

New paper proposes 7-step method for evaluating commercial health apps.

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A recent publication in BMJ Open by researchers from the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) and the University of Manchester unveiled a new 7-step method and supporting framework for evaluating commercial smartphone health apps.

There are many smartphone health apps on the market already used by patients, the public and healthcare professionals; however, existing published reviews primarily focus on apps developed and used by researchers, overlooking the evaluation of commercial mobile health (mHealth) apps.

This work, which aimed to address the lack of consistent methods for conducting systematic reviews of mHealth apps, used case studies of existing reviews conducted by the research team in addition to reviews published in key medical informatics journals to provide guidelines for future evaluations.

The research team introduced the novel TECH approach to develop review questions and the eligibility criteria, which considers the Target user, Evaluation focus, Connectedness and the Health domain.

The research paper outlines seven key steps for conducting rigorous health app reviews:

writing a research question or aims,
conducting scoping searches and developing the protocol,
determining the eligibility criteria using the TECH framework,
conducting the final search and screening of health apps,
data extraction,
quality, functionality and other assessments, and
analysis and synthesis of findings.

The next step is to develop reporting guidelines for systematic health app reviews.

Norina Gasteiger, ARC-GM funded PhD fellow, lead author on this paper, and the recent winner of the 2023 Postgraduate Research Student of the Year Award for the School of Health Sciences at The University of Manchester commented:

“This work has been a collaborative effort, with involvement by digital health researchers and academics at the University of Manchester who are experts in conducting health app and systemic literature reviews. We are excited to be progressing the method and ensuring that future app reviews are performed in a standardised and reliable manner. We hope our work will guide best practice and demystify the process.”

Read the paper in full: https://bmjopen.bmj.com/content/13/6/e073283

Published: 26/06/2023

Improving outcomes through collaborative research – the successes in Greater Manchester

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We are celebrating our fourth year in operation by sharing our successes, ambitions and achievements in a new impact report.

Since the inception of the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), we have cultivated strong partnerships with the NHS, councils, patients and the public, the third sector, industry and universities across the region. We have created a platform and network for discussions and relationships between the universities, academics, heath and care systems, local authorities and VCSE sectors to enable research to be undertaken that is aligned to the priorities and needs of local areas.

During this time, we have also played a leading role in leveraging around £23 million in additional research funding into Greater Manchester, collaborating with more than 120 organisations, in over 100 research projects.

ARC-GM is one of 15 NIHR funded regional ARCs across England; created to support health and care research that meets the needs of local people and healthcare systems in Greater Manchester.

We are launching - ‘Our Story So Far’ - to showcase some of the impactful work that ARC-GM has carried out and our vision for the future. Some of our successes include:

Co-developing research with parents and carers of children with obsessive-compulsive disorder (OCD). The project helped parents to make sense of OCD and dispel misconceptions, supported families to develop a shared understanding of the condition and provided opportunities for parents to be heard by people who understand.
Highlighting the issues that affect the local population including published research on the impact of COVID-19, building a fairer future for children and overcoming health inequalities in ‘left behind’ neighbourhoods. These evidence-based reports have been shared with the Government and are supported by MPs and policy makers.
Supporting the development of the next generation of researchers, offering PhD studentships, Pre-doctoral Fellowships and Research Internships to health and care professions, service users and carers, university undergraduates. 27 Research Interns have spent time with the ARC-GM team, enhancing their research knowledge and skills through first-hand, supervised experience.
A study of inequalities in the uptake of the COVID-19 vaccine, particularly in those most at-risk on contracting the virus. This allowed ARC-GM to explore sensitive issues that may not have otherwise come up, including the existing mistrust amongst some marginalised groups stemming from racism and experiences of culturally insensitive healthcare.
Co-producing “Adam’s Story” with local young people – an audience immersive multi-media theatre experience which allows viewers to put a mask on and become ‘Adam’, a young man facing a mental health crisis, and understand the challenges Adam faces. The piece was made in partnership with local theatre production company Made by Mortals to help raise awareness young people’s mental health and creating opportunities for important conversations. More information about Adam’s Story is available on YouTube https://youtu.be/Z48rPHGkHas

Prof. Dame Nicky Cullum, ARC-GM Director, said:

“ARCs are in a unique and important position within communities, in that the research they do is responsive to local needs and priorities. It’s important that ARCs are locally focused because there is no ‘one size fits all’ approach; every area is different to the next – particularly in the North. What makes our ARC in Greater Manchester stand out is the relationships we’ve made, to co-produce, design and deliver research that provides answers to important local questions, to support the health and wellbeing of people in our area.”

Mark Fisher, Chief Executive at NHS Greater Manchester Integrated Care, said:

“Research and innovation is vital to ensuring we, as an Integrated Care system, remain at the forefront of improving population health outcomes. Our partnership with ARC-GM is both long-standing and successful. It is essential we can continue to work together to meet the many challenges we are facing to ensure we deliver the very best for our residents.”

Further details of the work and successes of the ARC are available to view in the full report:

NIHR ARC-GM: Our Story So Far

Published 7th June 2023

Northern regions received £21m less from flagship ‘levelling up’ fund

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New analysis of the government’s Community Renewal Fund (CRF) allocation has found that the North missed out on funding to the tune of £21 million.

The CRF, which was a cornerstone of the government’s ‘Levelling Up’ agenda, was established to address regional inequalities through investment in place-based initiatives.

However, the findings of a new study suggest that the current method for CRF allocation runs the risk of widening existing inequalities rather than ‘levelling up’.

Academics from Health Equity North (HEN), The University of Manchester and ourselves at the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) examined the allocation of the first round of the CRF across English regions, and whether more economically deprived regions are getting a proportionate share of the pot.

They found that:

Nationally, there was no significant correlation between regional economic resilience and funding allocations.
All regions in the North of England received less than their expected share of the flagship ‘levelling up’ fund.
The least resilient region in England – the North East – received £13.4 million less.
By contrast, the South West was awarded £9.9 million more than their expected share.

To support CRF allocation, the government developed a way to measure economic resilience, which covered productivity, skills, unemployment, population density, and household income. These were selected to identify places with poor economic performance, which would be less able to resist and recover from shocks.

The CRF allocation process involved multiple stages, with the economic resilience index being used at the outset to identify 100 priority places. There are more than 10 steps from the identification of priority places to CRF bid approval, with the final decision made by the Secretary of State for the Department of Levelling up, Housing and Communities.

The analysis by the resaechers, used the UK government’s methodology to construct a regional economic resilience index to generate a ‘fair share’ funding allocation and compared these to the actual allocation.

The average resilience score in England was 46.0, ranging from 28.5 in the North East to 65.6 in London.

Dr Luke Munford, ARC-GM Deputy Lead for Economic Sustainability, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at the University of Manchester, said:

“There are deep-rooted, persistent regional inequalities in health and wealth across England. People in the North live shorter lives and have higher rates of bad health, disability and economic inactivity. These inequalities have widened during recent decades and will continue to do so without effective policies put in place by government.

“While investment like the Community Renewal Fund is very welcome, the methodology for distribution of the funding doesn’t add up and has the potential to further widen the North-South divide.

“Despite committing to targeting people and places most in need, our research shows the imbalance that remains when it comes to investing in areas that face worse inequalities.

“To mitigate this risk, there needs to be allocation of funding at a regional level, based on an objective measure of need and involving local leaders in decision making.”

Christine Camacho, ARC-GM PhD Fellow and Public Health Registrar, said:

“The ‘levelling up’ agenda offers an opportunity to address the longstanding inequalities in England, but our findings clearly show that there was no significant correlation between regional economic resilience and CRF funding allocations.

“A transparent approach for the distribution of funding to regions based on need is essential. Economic resilience is only one part of the story. A multidimensional index of community resilience could be used to assess place-based disparities.”

The full paper has been published in Regional Studies, Regional Science and is avaiable available below:

Camacho C, Webb R.T, Bower P & Munford L., (2023) Levelling up or widening the gap? An analysis of community renewal fund allocation in English regions using an economic resilience index. Regional Studies, Regional Science 10:1, 496-505

published 23rd May 2023

Growing divide in regional health inequalities exposed

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A new report has found a worrying pattern of lower life expectancy, higher infant mortality and worse health and wellbeing in the North of England.

Health Equity North: 2023 provides a snapshot of the health issues facing the North and adds to a growing body of evidence highlighting the urgent need to address regional health inequalities and improve productivity in the North.

The report (available here) marks the launch of Health Equity North (HEN), a new virtual institute focused on place-based solutions to public health problems and health inequalities across the North of England.

The institute’s academic directors analysed the latest available data on life expectancy, infant mortality rates and self-assessed health, disability, and unpaid care, and the findings have exposed the worsening health divide between the North and the rest of England.

The North does significantly worse in all these areas, which also impacts productivity with above average rates of economic inactivity due to ill health or disability.

The key findings include:

People born in the North can expect to live at least one year less than the English average.
The North East of England has the lowest life expectancy - around three years less than the best performing regions
Across the North there is an average of 4 deaths per 1,000 live births compared to 3 deaths per 1,000 live births in London and the South East - this equated to an extra 144 infant deaths in the North in 2021
Of the 72 local authorities in the North of England, 52 (72%) have lower levels of very good or good health than the national average
The North has higher rates of bad/very bad health with 6.9% of people in the North East, 6.4% in North West, and 5.9% in Yorkshire and the Humber reporting bad/very bad health - compared to the English average of 5.3%
The North has the highest rates of people who report that their day-to-day activities are limited a lot by a disability: North East (9.8%), North West (9.1%), Yorkshire and the Humber (8.2%) – compared to the English average of 7.5%
The five local authorities with the highest levels of people who report a disability limits their day-to-day actives a lot are located in the North: Knowsley (North West; 13%), Liverpool (North West; 12.7%), Blackpool (North West; 12%), Manchester (North West; 11.4%), and Hartlepool (North East; 11.3%)
The North has higher rates of economic inactivity due to ill health or disability: 5.7% in the North East, 5.3% in the North West, 4.7% in Yorkshire and the Humber – compared to the English average of 4.1%
The top five local authorities with the highest levels of economic inactivity due to long-term sickness or disability are in the North
More people in the North state that they provide unpaid care - in the North East 10.1%, the North West 9.7%, and Yorkshire and the Humber is 9.3%, compared to the English average of 8.9%

HEN brings together leading academics who have a unique understanding of their regional communities enabling the creation of research and policy solutions of local benefit. The institute will produce annual updates of health in the North to help and challenge local and national policy makers in their efforts to reduce regional inequalities.

The institute directors were joined by leading health and policy experts from across the North of England at the HEN launch event in Leeds on April 19, 2023, where they discussed the findings of the new report and HEN’s mission to tackle inequalities in the northern regions.

Dr Luke Munford, HEN Academic Director, ARC-GM Deputy Lead for Economic Sustainability, Health Economist from the University of Manchester, and co-author of the report, said:

“Health Equity North’s first health status report adds further weight to the growing list of evidence laying bare the ingrained health divide across the country. The northern regions have faced worse health outcomes for many years and with the added challenges posed in the wake of the pandemic and the current cost of living crisis, things look set to continue on a downward spiral.

However, a joined up approach to tackle these inequalities at local and national level would help to rebalance regional health inequity.”

Professor Clare Bambra, HEN Academic Director, ARC North East and North Cumbria Lead for Inequalities and Marginalsed communities, Professor of Public Health at Newcastle University, and co-author of the report, said:

“Health Equity North is committed to fighting health inequity through research, policy impact, and public health improvement. Our first report clearly shows that health inequalities in the North of England aren’t going away. They are getting worse and they will continue to do so without urgent action to ensure people living in the North have the same life chances as those in the rest of England.”

The report authors have made a series of recommendations to help improve health and productivity in the North:

Local government, Integrated Care Systems and combined mayoral authorities should work with researchers to identify areas of greatest health need within their authorities where they can most effectively implement evidence-based policies to tackle the social determinants of health.
Central government should commit to policies and interventions to improve health across the North and take a cross-governmental approach, across the Department for Levelling Up Housing and Communities, the Department of Health and Social Care, Department for Work and Pensions and the Department for Science Innovation and Technology.
Long-term increases in public health funding to local authorities and the Integrated Care Systems in the North need to be made and ring-fenced and achievements reported to Parliament.
Prioritise the development of an integrated, national health inequalities strategy with an explicit focus on addressing the social determinants of health:

reducing poverty
improving housing
increasing energy security
creating better jobs
improving early child development and education
creating healthy and sustainable places in which to live and work
improving efforts at prevention

Research funders should give increased priority to research that helps to address health inequalities including a place-based focus on prevention.
Provide universal access to occupational health for the country’s workforce with a specific focus on increasing access and supporting employers in areas with the worst health outcomes.
Increase NHS and local authority resources and service provision for mental health in the North. Increase the existing NHS health inequalities weighting within the NHS funding formula.
Embed Equality Impact Assessments in all policy processes relating to socioeconomic deprivation at national, regional, and local levels.
Integrated Care Systems should commission more health promotion, condition management and prevention services that promote the health and wellbeing of the workforce in the North.
Local public health and health inequalities budgets in the NHS should be safeguarded so that action to relieve acute NHS backlogs does not undermine efforts to tackle the root causes of ill-health and boost health resilience.

To find out more about Health Equity North and to read the full report, visit:

www.healthequitynorth.co.uk

Pubished 15th May 2023

Levelling up or widening the gap?

blog

There are deep-rooted regional inequalities in health and wealth across England. ‘Levelling Up’ is the UK Government’s flagship policy to redress these inequalities through additional investment, with the Community Renewal Fund (CRF) one strand of this funding.

In this Policy@Manchester blog, Christine Camacho (ARC-GM PhD student and Public Health Registrar) and Dr Luke Munford (ARC-GM Deputy Lead for Economic Sustainability and Health Economist from the University of Manchester) examine the allocation of the first round of the CRF across English regions, and whether more economically deprived regions are getting a proportionate share of the pot.

Based on an economic resilience index, Northern regions received £21 million less than their expected share of the first round of the CRF.
Nationally, there was no significant correlation between regional economic resilience and funding allocations.
As such, the current allocation method may widen, rather than reduce, regional disparities – and jeopardise the levelling up agenda.

People living in the North of England have an average life expectancy 2 years lower than the rest of the country, and a £4 per-person-per-hour gap in economic productivity. These inequalities are persistent and have widened during recent decades. Existing geographical divides were exacerbated by austerity, and feelings of being ‘left behind’ are considered to have contributed to a reshaping of the UK’s political landscape, including spurring the Conservative Party to propose a regional development policy of ‘Levelling Up’ as a centrepiece of their successful 2019 election manifesto...

You can read the fhe full blog from the Policy@Manchester website here.

New PhD studentship opportunity: October 2023 start

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In collaboration with the NIHR Greater Manchester Patient Safety Research Collaboration, we are pleased to be able to offer a funded PhD studentship at The University of Manchester on “Social Workers’ Implementation of National Guidelines with Looked-After Children Who Self-Harm.”

This mixed methods PhD will first explore current social work practice, including if/how current guidelines are used to guide practice. It will then use the behaviour change wheel [1] and stakeholder involvement [2] to develop an intervention to support social workers’ management of self-harm among looked-after children.

Entry Criteria:

Applicants are expected to hold a minimum upper second-class undergraduate honours degree (or equivalent) in Psychology or cognate discipline.

A Masters degree in a relevant subject and/or experience in relation to social work and/or self-harm is desirable.

Funding:

Studentship funding is for a duration of three years to commence in October 2023 and covers UK tuition fees and a stipend.

However, due to funding restrictions the studentship is only open to UK nationals.

How to apply:

More information about this PhD opportunity and details of how to apply are available from the Find A PhD website:

https://www.findaphd.com/phds/project/social-workers-implementation-of-national-guidelines-with-looked-after-children-who-self-harm/?p156964

published 28th March 2023

How NIHR ARCs rose to the challenge of COVID-19

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A national publication highlighting how National Institute for Health and Care Research Applied Research Collaborations (NIHR ARCs) rose to the challenge of COVID-19 launched pn Thursday 23rd March, the third anniversary of the first UK lockdown.

Vital work from across the ARCs in response to the pandemic is showcased in NIHR ARCs: Supporting the fight against COVID-19 (PDF), including ARC Grester Manchester projects.

The publication brings together case studies demonstrating how ARCs pivoted their research programmes in response to the pandemic. It showcases work across a range of themes including children and young people, care homes, equality and diversity, end of life care and workforce planning.

Three projects from ARC Greater Mancheste are included in this new publication:

Informing public policy on health data sharing through Citizens’ Juries (on page 11)
COVID-19: Health and Care Inequalities in the North of England (on page 18)
Exploring Inequalities and Community Experiences of the COVID-19 Vaccination Programme in Greater Manchester (on page 39)

Bringing these projects together shows how ARCs were able to pivot their research in response to the pandemic, thanks to their funding from NIHR. ARCs’ expertise in data modelling, multiple long-term conditions, mental health and social care, alongside their ability to build and sustain collaborations placed them in a unique position to support the COVID-19 effort.

The publication was led by NIHR ARC East Midlands, with communications support from NIHR ARC West. In the foreword, the ARC Directors write:

“In 2020, we made rapid changes to our research programmes across the ARCs, to inform policy and practice, improve health and care, and deliver national-level impact in this rapidly changing landscape.

“Our expertise in data modelling, multiple long-term conditions, mental health and social care alongside our ability to build and sustain collaborations across the NHS, social care, the voluntary sector and industry, has placed us in a unique position. We have been able to contribute to the efforts to understand the virus and its impact on communities, locally, nationally and globally.

“This publication outlines our response as ARCs, both collectively and individually, to this challenge. It showcases the part we have played in supporting the health and care sector and patients, public and communities. We are proud of our part in lending our expertise to understanding the disease and assisting the global effort to contain it, improving outcomes and saving lives.”

Professor Lucy Chappell, Chief Executive of the NIHR and the Department of Health and Social Care’s Chief Scientific Advisor, said:

“This impressive report sets out how that effort was provided, extending across many different themes, specialisms, and areas of the country. It illustrates how researchers, working together to tackle a common cause, can have such an important impact for patients and the public.”

Download NIHR ARCs: Supporting the fight against COVID-19 (PDF).

To keep up to date with the latest funding opportunities, events and projects, from across the country, join the ARC email newsletter and follow @NIHRARCs on Twitter.

Social Work Week: An interview with Professor of Social Work, Alys Young.

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This year’s social work week runs from Monday 20 to Friday 24 March with the aim to bring people together to learn, connect, and influence change.

Watch Prof Michelle Briggs, our ARC-GM Capacity Building Theme Lead, talk to Prof Alys Young, Professor of Social Work at The University of Manchester.

This short interview covers Alys’ career pathway, her experiences of supporting a social worker as part of our ARC-GM research internship programme, and Alys’ advice for people thinking about a career in social care research.

Find out more about social work week here: https://www.socialworkengland.org.uk/

Read more about our social care focussed research here: https://arc-gm.nihr.ac.uk/social-care

Published 21/03/2023

Applications are now open for ARC Greater Manchester’s Pre-doctoral Fellowship Programme

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Each year since the inception of ARC-GM, we have offered professionals from the health and care system in Greater Manchester the opportunity to spend time with researchers to develop a competitive PhD proposal. By contributing up to £20,000 in backfill per Fellowship, plus a £2,000 training budget, ARC-GM aims to develop research capacity across a range of disciplines. Previous Fellows include those from Social Work, Nursing, Speech and Language Therapy, Physiotherapy and Dietetics.

Capacity Building Programme Manager, Ross Atkinson, commented:

“Not only are we seeing an increase in the number of people applying to our Fellowships, but we are attracting interest from a wide range of professional backgrounds – not just in the NHS. We are particularly keen to receive applications from those working in Local Authorities and other organisations where research is perhaps less prominent to see how we can support. This week is Social Work Week – social work is one area we are looking to make a difference.”

Laura McGarrigle, Clinical Specialist Physiotherapist and ARC-GM Pre-doctoral Fellow, shared her experience:

“I had a project plan in place, had made contact with potential supervisors and an awareness of what future self-development was required. Having been successful in gaining a pre-doctoral fellowship position, I have found I have more self-confidence when it comes to engaging with opportunities that arise and accepting the challenges head on!"

Guidance for applicants, a link to the online application form and information about previous years’ Pre-doctoral Fellows can be found on the ARC-GM website here.

Published 20/03/2023

Declining mental health, Long COVID and preventable deaths – how the COVID-19 pandemic hit the North harder

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A group of leading academics have today (Monday 13th March) released a book that details how people in the North of England suffered significant inequalities compared to their Southern counterparts during the COVID-19 pandemic.

Northern Exposure, written by Professor Clare Bambra and Dr Natalie Bennett of Newcastle University and Dr Luke Munford and Sam Khavandi of the University of Manchester and NIHR Applied Research Collaboration (ARC) Greater Manchester, builds on reports the authors produced with the Northern Health Science Alliance (NHSA) over the course of the pandemic. These showed the devastating impact of regional inequalities on how severely COVID-19 hit the region.

It reveals how:

Around 2,500 deaths could have been prevented if ‘Levelling Up’ of the North had occurred pre-pandemic.
The average COVID-19 mortality rate during the first 13 months of the pandemic was 17% higher in the North - an additional 29.4 more deaths per 100,000 people.
Rates of long COVID are 30% higher in the North than in the rest of the country.
Hospital pressure was 10% greater in the North, and experienced larger reductions in elective, inpatient, emergency inpatient and outpatient procedures.
People from minority ethnic backgrounds, women and younger people experienced greater declines in mental health during the pandemic. People in these groups in the North had worse mental health scores than those in the rest of England

The book also details how, in addition to the severe health impacts, the pandemic also took a toll on economic outcomes. On average, those living in the North experienced:

A 20% higher rise of levels in unemployment compared to the rest of England
An additional 6 weeks in the harshest levels of lockdown
A drop in wages during the pandemic compared to elsewhere in the country

Professor Bambra, lead for Inequalities and Marginalised Communities at the NIHR ARC North East and North Cumbria, has been instructed as an independent expert witness to module 1 (which examines the UK’s pandemic preparedness and resilience) of the COVID-19 Independent Public Inquiry, chaired by Baroness Heather Hallett. She will do this alongside Professor Michael Marmot, Institute of Health Equity. She said:

“Emerging from the COVID-19 pandemic and entering further challenging times, our book highlights the urgent need for policies that support the building of a stronger, healthier, and more equal country – for everyone.”

Co-author Dr Luke Munford, Deputy Lead for Economic Sustainability at NIHR ARC Greater Manchester, said:

“Before the COVID-19 pandemic, England was a deeply unequal country. Individual circumstances, including where you live, led to different outcomes in key domains of people’s lives, including their health and wealth. We found that more deprived areas in the North experienced greater COVID-19 mortality than equally deprived areas in the rest of the country. In particular, the effects of deprivation on health are made worse when an area is in a region which already has higher deprivation levels.”

Hannah Davies, health inequalities lead for the NHSA, wrote the foreword for the book. She said:

“Understanding where the North of England fits into the rejuvenation of the country is vital. The economic arguments for improving the health of the most deprived communities in the UK are clearly and dramatically shown. The North’s relatively poor physical and mental health meant it suffered under the pandemic for longer and it hit harder. Nowhere has it been illustrated more clearly that health is wealth – and that is a lesson we must take into the future.

“Unless action is taken to rectify this, there is likely to be a long-term health legacy from the COVID-19 crisis – with health inequalities increasing into the future. To avoid a long shadow of COVID-19 hanging over the future of the North, we need to act to reduce the North-South divide.”

Northern Exposure is published by Policy Press, an imprint of Bristol University Press and is available to view at https://library.oapen.org/handle/20.500.12657/61395

Putting the voices of those most in need at the heart of research to tackle health and care inequalities. A blog by Sue Wood.

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The recent commitments from Northern Leaders at the Convention of the North, highlights that tackling health and care inequalities is a key priority for the North of England and Greater Manchester, with a need to find real solutions to the challenges of levelling up the North with other areas of England and uniting the North to unlock its potential. A series of recent reports shines a spotlight on the disproportionate impact that the COVID-19 pandemic has had on the health and care inequalities that are deeply entrenched within the North of England.[1][2][3][4][5]

Research has a vital role to play in improving health and care for all, getting to the root causes of health and care inequalities and the needs of diverse communities, providing the evidence of what works to address these unfair and avoidable differences. However, we also know that those most vulnerable in our communities are disproportionately affected yet under represented in research studies.

Never has it been more important to do research ‘with’ not ‘for’ or ‘about’ the people, it is designed to help with health and care policy needing to be driven by the experiences of communities.

You do not have to look too hard to find plenty of references to ‘a strong sense of community’ across the localities and neighbourhoods of Greater Manchester. However, the experiences of our diverse communities vary and valuing their differences is crucial to involve and engage with all communities, especially marginalised and those that are seldom heard. If we are to create equal involvement opportunities for all we need to understand the value and needs of these communities and create better ways of enabling their voices to be heard.

The Greater Manchester Public and Community Involvement Engagement Forum was set up in March 2020 with a vision of being a safe space for those with a passion to improve the way research organisations work together with colleagues from the Voluntary, Charity and Social Enterprise (VCSE) sector and members of the public, bringing people together to share best practices, opportunities and to form connections of mutual benefit.

From the Forum has grown some exciting and innovative partnerships but also a growing recognition that there is much more that needs to be done to build trust and sustain mutually beneficial relationships between research organisations and the communities of Greater Manchester to ensure that the research we do is truly representative of our diverse population.

In March 2022 National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) and the NIHR Greater Manchester Patient Translational Research Centre (GM PSTRC), with VCSE colleagues held a workshop showcasing some of the research that had taken place during the pandemic to spotlight the inequalities faced by the communities of Greater Manchester and uncover the potential for health and care research to make a difference for the future.

The vibrant discussion in the room helped to highlight some of the challenges we face and need to urgently address to ensure those communities most in need can engage with researchers and be part of the discussion about their needs.

The key messages from the workshop were:

The allocation of resources are key to tackling inequalities - the VCSE sector need resources and investment to support communities trapped in poverty. More needs to be done by larger organisations to reach out and make resources available to smaller groups and upskill community groups to work together.
Effective partnerships need time and recognition of organisational strengths – partnerships that are built on shared values and evident through trusted interactions can create long-term relationships. The VCSE sector has extensive expertise in working on the ground with people facing the greatest needs and research organisations have much to learn from them on effective and culturally sensitive approaches.
Communication in accessible formats is needed – research needs to be accessible and understandable for everyone. There is lack of awareness about the research being undertaken in communities with poorly designed resources that are not accessible due to the language used or the format in which the are delivered.
To understand and tackle inequalities researchers need to go to the heart of communities – culturally appropriate events/workshops are needed to engage with communities in a meaningful way with communities part of the design of the process. Together we need to particularly acknowledge and understand variation within regions and local areas to understand how inequalities are impacting neighbourhoods. Capturing the full extent of this diversity will help finds solutions that work for the whole community.

A full report from the workshop is available here.

The research organisations in Greater Manchester have committed to work together to strengthen the way we work to create sustainable networks with VCSE colleagues and community groups that have mutual benefit and will support the participation of those currently mostly excluded from taking part in health and care research.

To support this, Greater Manchester has been awarded funding by NHS England to further develop understanding of how research engagement networks within Integrated Care Systems can be created, enhanced and sustained. Information on this programme is available here.

The aim being to:-

Co-produce improved approaches for creative engagement and communication in partnership with VCSE organisations to build trust with communities currently more excluded from research.
Develop an improved network wide system for monitoring and evaluating diverse and inclusive involvement and participation in research within specific areas and communities in our region where inequalities are most evident.

Only in working together will we be able to put the voices of those most in need at the heart of our research to tackle health and care inequalities.

[1] The Parallel Pandemic: Covid19 and Mental Health

[2] Overcoming Health Inequalities in Left Behind Neighbourhoods

[3] Child of the North

[4] COVID-19 in the Northern Powerhouse

[5] A Year of COVID-19 in the North

The 2022 NIHR ARC-GM Student Showcase

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ARC-GM PhD Students, Pre-doctoral Fellows and Interns presented their achievements at last year’s Student and Intern Showcase. Staff and colleagues from our partner trusts came together on 29th November 2022 in a remote session to celebrate the learning and impact of their training with ARC-GM.

ARC-GM aims to support and fund health and social care professionals from NHS and care partner organisations, who want to develop their research skills, ideas and initiatives. The team is committed to supporting the development of outstanding researchers wishing to conduct applied research that has the potential to deliver an impact on patients, public and policy regionally and nationally.

The event was well attended by academics across the ARC-GM portfolio and colleagues from partner health and care organisations; we were delighted that so many of our students were able to take part and showcase their impressive achievements.

Prof. Michelle Briggs, Lead for Training and Development at ARC-GM said:

“It was fantastic to hear the ARC-GM Interns, Pre-doctoral and PhD Fellows present about their research journeys. I’m impressed at the progress and impact they have all made; they should be proud of their accomplishments. Over the next few months I’m really looking forward to learning more about how the Interns and Pre-doctoral Fellows, in particular, build on their new research skills as part of their clinical practice with their associated health and care providers.”

PhD Student, Mia Bennion commented on the day:

“It was great to hear about everyone's research projects, particularly people's reflections on their experiences throughout the research process. It's clear there's so much valuable work that's taking place. I'm so grateful to have received a prize for my presentation at the showcase!”

Prizes were awarded for the following categories:

PhD Student presentation

Mia Bennion (click here to view Mia’s presentation)

Pre-doctoral Fellow poster

Elizabeth Walkden (click here to view Elizabeth’s poster)

Research Internship poster

Laura McGarrigle (click here to view Laura’s presentation)

All of the posters and presentations from our 2022 showcase can be viewed here.

You can find out about all our training and development work and opportunities from here.

Published 03/03/2022

NHS programme linked to 20% reduction in risk of Diabetes

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An NHS behaviour-change programme has been linked to a significant reduction in the risk of developing Type 2 Diabetes Mellitus in adults with raised blood sugars.

The analysis, carried out by University of Manchester researchers shows that when controlling for the characteristics of participants, the risk of Diabetes progression was 20% lower in people with pre-diabetes referred to the NHS Diabetes Prevention Programme (NDPP) when compared to similar patients not referred to NDPP.

The study, funded by the National Institue for Health and Care Research (NIHR) Health and Social Care Delivery Research, and hosted by Northern Care Alliance NHS Foundation Trust, is published today in the journal PLoS Medicine (28/02/23).

The NHS Healthier You Diabetes Prevention Programme in England is offered to non-diabetic adults with raised blood sugars – or pre-diabetes - providing exercise and dietary advice to help reduce people’s risk of developing the disease.

Across the 2,209 GP practices for which the researchers had data, over 700,000 people were identified with pre-diabetes and around 100,000 had a code in their health records indicating they were referred to the programme.18,470 patients referred to NDPP were matched to 51,331 similar patients not referred to NDPP.

The probability of converting to Type 2 Diabetes at 36 months after referral was 12.7% for those referred to the NDPP and 15.4% for those not referred to the NDPP. Using a figure of 1000 people referred to NDPP and 1000 not referred to NDPP, by 36 months after referral, the team calculate they would expect 127 conversions to Type 2 diabetes in the group referred to the programme and 154 in the group not referred.

The mechanism for the difference is likely to be through weight reduction, with previous work showing that people who attended the NHS DPP were associated with a significant reduction in weight - the key factor in reducing risk - of 2.3 kg on average.

In addition, prior work also showed levels of HbA1c - the average blood sugar levels for the previous two to three months - reduced by a significant 1.26 mmol/mol.

Most of previous trial results have shown that weight loss is the key factor in reducing risk of the disease; increased BMI was also a key factor.

Dr Rathi Ravindrarajah from The University of Manchester and NIHR Applied Research Collaboration Greater Manchester (ARC-GM) said:

“Our findings show that the NDPP appears to be successful in reducing the progression from non-diabetic hyperglycaemia to Type 2 Diabetes. Even though we were only able to examine referral to the programme, rather than attendance or completion, it still showed a significant reduction in risk of 20%. That suggests the decision to implement programme quickly and at scale in England was the right one, and as the results are reproducible, it also supports the continuation of similar programmes to Northern Ireland, Scotland and Wales.”

Professor Evangelos Kontopantelis from The University Manchester and NIHR ARC-GM said:

“Type 2 diabetes is a major public health concern which has been rising globally, with over 3 million people in the UK currently diagnosed with it. Previous studies have shown that both lifestyle modifications through diet and physical activity and medication can prevent progression to this condition. This study is good news for the Healthier You Diabetes Prevention Programme which we show beyond doubt is a powerful way to protect your health.”

Health and Social Care Secretary Steve Barclay said:

“The NHS Diabetes Prevention Programme has seen promising results with a 20% reduction of risk to those taking part developing Type 2 Diabetes, empowering people suffering with pre-diabetes to take control of their own health. Type 2 Diabetes costs the NHS around £10 billion a year, but this evidence-based programme is an example of how we can help people make lifestyle changes to prevent the disease progressing, whilst ensuring value for the taxpayer.”

NHS national clinical director for diabetes and obesity, Professor Jonathan Valabhji, said:

“This important study is further evidence that the NHS is preventing type 2 diabetes and helping hundreds of thousands of people across England to lead healthier lives. We completed roll out of the NHS Diabetes Prevention Programme in 2018, and now over 1.2m people have been offered support with lifestyle changes including better quality nutrition, weight loss, and increased physical activity, which this study shows is preventing development of this life-changing condition. You can easily check your risk through the Diabetes UK ‘Know Your Risk’ tool.”

The paper Referral to the NHS Diabetes Prevention Programme and conversion from non-diabetic hyperglycaemia to type-2 diabetes mellitus in England: a matched cohort analysis is available:

Ravindrarajah R, Sutton M, Reeves D, Cotterill S, Mcmanus E, et al. (2023) Referral to the NHS Diabetes Prevention Programme and conversion from nondiabetic hyperglycaemia to type 2 diabetes mellitus in England: A matched cohort analysis. PLOS Medicine

published 28/02/23

Care Home Workers’ Views on Augmented Reality and Virtual Reality Hand Hygiene Training

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New research on exploring Care Home Workers’ Views on Augmented Reality and Virtual Reality Hand Hygiene Training has been published in Health & Social Care in the Community.

Led by Norina Gasteiger, as part of her National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) funded PhD study at The University of Manchester, this qualitative realist study interviewed 25 care home staff from 6 different care homes, to look at how, and in what contexts care home workers think augmented reality and virtual reality training delivered via smartphone apps might work in promoting hand hygiene practice. The team were also interested in exploring how the training could be implemented and maintained in the future.

The study found that care home staff:

All agreed that novice carers would especially benefit from augmented reality or virtual reality hand hygiene training.
Believed that feedback and reminding, repeated practice, and interactive learning could be triggered by augmented reality and virtual reality training.
Expected that the training could help to improve their hand hygiene technique and awareness about how infections spread.
Emphasised that hand hygiene interventions may not work for everyone equally and are context-dependent.

Care home staff also highlighted differences between care homes and learners, regarding policies on further training/development, preferences, and comfort with technology.

Norina Gasteiger, lead author, comments:

“This work highlights an opportunity for using augmented and virtual reality technologies for hand hygiene training in care homes.

Carers and managers gave us important insights on how the training could be implemented and what it is about the technologies that might make them effective as training tools. In the next step of the project, we will work closely with care home managers to decide which technology best suits their care home and to test the feasibility of the training.”

The full paper in Health & Social Care in the Community, is open access and freely available:

Gasteiger, N., van der Veer, SN., Wilson, P. & Dowding, D. Exploring care home workers' views on augmented reality and virtual reality hand hygiene training: A realist interview study. Health & Social Care in the Community. (2023)

Cross-ARC National Health Economics Showcase Event

Event: Event

Date: 14th March 2023

Time: 09:00-16:00

Hosted by NIHR ARC Yorkshire and Humber in partnership with ARC Greater Manchester, this national event will bring together Health Economic themes to showcase their projects and research, share and exchange good practice and promote cross ARC working.

The event will cover a range of topics, including the use of routine data, challenges using economic evidence with local decision makers and capturing outcomes for cross sectorial working.

The event is free to attend.

We welcome attendees from:

ARC Health Economic themes
Health Economists working within other ARC themes
Wider ARC partners

The event will be held at the University of Sheffield. The joining instructions for the event, along with the final programme, will be sent out closer to the event.

If you have any questions about this event, please get in touch with NIHR ARC Health Economics theme: arc_heee@sheffield.ac.uk

ARC-GM Internal Seminar Series: Mental Health Theme

Event: Seminar

Date: 08th March 2023

Time: 12.00-1.00pm

Overview of the Mental Health Theme, Karina Lovell.
Presentations on current research – details TBC

A new rapid review finds that a number of interventions may reduce hospital outpatient no-shows

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Outpatient no-shows have important implications for costs and the quality of care in the NHS. In 2019/2020, there were over five million outpatient no-shows across the NHS in the United Kingdom, with an estimated annual cost as high as £750 million.

Predictive models could be used to identify scheduled appointments that are at high risk of no-show. Healthcare staff could then intervene in a targeted manner, to reduce the risk that these appointments will be missed.

Researchers from the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) and The University of Manchester have undertaken a review of interventions aiming to reduce outpatient no-shows by using predictive models. The researchers examined the effectiveness of these interventions, as well as the associated costs, acceptability to staff and patients, and effect on health inequities.

The review found that several promising interventions can be used in combination with predictive models. Specifically, predictive model-based reminders and predictive model-based patient navigator phone calls are probably effective at reducing no-shows. However, it is uncertain whether predictive model-based overbooking is effective.

Additionally, the researchers concluded that more evidence is needed regarding the cost-effectiveness, acceptability, and equity of all identified interventions.

Dr Theodora Oikonomidi, Research Associate at the University of Manchester and NIHR ARC-GM, who led the review,

“this review is timely, as an increasing number of health care organisations turn to using predictive models to manage outpatient appointments, in hopes that this technology will help to manage the appointment backlog created due to the COVID-19 pandemic.”

The full findings of this work have been published in Journal of the American Medical Informatics Association:

Predictive model-based interventions to reduce outpatient no-shows: a rapid systematic review | Journal of the American Medical Informatics Association | Oxford Academic (oup.com)

NIHR ARC-GM are also working in collaboration with Manchester University NHS Foundation Trust as they implement an integrated and innovative Electronic Patient Record (EPR) solution called Hive.

We are looking to describe how a predictive model within Hive that supports the identification of patients who are likely to not attend their outpatient appointment can be used to help staff manage outpatient no-shows in the trust. More information about this research can be found here.

published 11/01/2023

Digital Health Inequities Seminar Series:Equity-Focused Implementation of Virtual Primary Health Care: Key Insights and Future Directions from Canada

Event: Seminar

Date: 08th February 2023

Time: 1-2pm

Dr Jay Shaw & Simone Shahid (UofT) - Equity-Focused Implementation of Virtual Primary Health Care: Key Insights and Future Directions from Canada.

A monthly seminar on topics relevant to digital health inequities held every second Wednesday of the month.

Please contact digital-inequities@manchester.ac.uk if you would like to receive seminar details.

Novartis UK launch Implementation Science video series

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NIHR ARC-GM Lead for Implementation Science and University of Manchester Senior Lecturer, Paul Wilson shares the screen with experts on Implementation Science from across the healthcare landscape.

This includes Dr Samantha Dixon (Global Head of Implementation Science at Novartis), Dr Tracey Vell MBE (Medical Executive at GMHSCP and Medical Director at Health Innovation Manchester), and Piers Ricketts (Chief Executive of the Eastern Academic Health Science Network).

Over the course of five episodes, the expert panel will seek to bring the concept of Implementation Science to life, through real-world insight. We delve into the details of this approach, the key components required for success and the essential need for a collaborative and partnership-based approach, which sees local systems (including health, social care and public services) working together.

Paul Wilson (NIHR ARC-GM Implmentation Science Lead and University of Manchester Senior Lecturer),

“It was a pleasure to be involved with these panel discussions from experts across the health and care system, to discuss the importance and application of implementation science to aid the systematic uptake of evidence-based products, practices and polices into routine clinical practice.”

Episode One: Implementation Science… What is it?

Episode Two: Implementation Science... What does the science say?

Episode Three: Implementation Science... What role can industry play

Episode Four: Implementation Science... Systemic solutions for the future

Episode Five: Implementation Science... How it works in practice

The video series can be accessed from the Novartis UK dedicated Implementation Science web pages

“I don’t do anything”: It’s time to place more emphasis on strength training in later life

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Since 2011, the UK Chief Medical Officers’ (CMOs) guidelines on physical activity have included strength recommendations. However, there is limited evidence that these recommendations are getting through to those who need them.

In this Policy@Mancester blog, Dr Ashley Gluchowski, from our NIHR ARC-GM Healthy Ageing team, outlines how older adults are engaging with the guidelines, and whether more can be done by public health officials and local authorities to remove barriers to activity.

Less than half of 50 – 74-year-olds in England are meeting the strength recommendations.
There is a lack of detail and options in the CMOs’ guidance around what constitutes strength training, and how intensely it should occur
Older adults also report a lack of ability-appropriate classes, as well as a lack of strength training encouragement from healthcare professionals

One in three older adults in the UK are classed as inactive, while one in six deaths are linked to physical inactivity. As our population ages – with 25% expected to be over 65 by 2050 – the impact of inactivity on older people’s health, social and mental wellbeing, and quality of life will increase, as will the burden placed on healthcare systems...

You can access the full blog from the Policy@Manchester site here.

published 28th November 2022

New research highlights the unequal impact that deprivation has on COVID-19 deaths in the North of England

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New evidence just published in the leading scientific journal Health and Place has found that while COVID-19 death rates were consistently higher in areas of socioeconomic disadvantage across the country, they were even higher in deprived areas of the North.

The research shows that those living in the most deprived communities in the North of England shouldered the greatest burden from COVID-19.

There was evidence of an association between COVID-19 deaths and area-level deprivation – but the impacts of deprivation on deaths was higher in the North: the researchers call this the ‘deprivation amplification’.

The most deprived local areas in the North had 14.5% more deaths per 10,000 than those in equally deprived areas in the rest of England.

This latest research was jointly undertaken by Dr Luke Munford and Sam Khavandi from the University of Manchester and ourselves the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), and Professor Clare Bambra from Newcastle University and NIHR ARC North East and North Cumbria.

Lead author on the study, Dr Luke Munford, Senior Lecturer of Economics from the University of Manchester and NIHR ARC-GM Deputy Lead for Economic Sustainability, said:

“Our research provides clear evidence that those living in the most deprived communities in the North of England shouldered the greatest burden from COVID-19.”

Co-author Prof. Clare Bambra, Inequalities Lead for the NIHR Applied Research Collaboration (ARC) North East and North Cumbria added:

“Our research shows that COVID-19 is an unequal pandemic. People in the most deprived communities in the North have been most impacted with higher deaths. The government’s Levelling Up agenda needs to be revitalised if it is to reduce regional health inequalities.”

Commenting on the research, Hannah Davies of the Northern Health Sciences Alliance stated:

“This alarming and important research shows just how important the levelling up agenda is if we are to tackle the deep inequalities which undermine the fabric of our society.

“The government must take place-based action to improve health outcomes otherwise we risk undermining the health and wealth of the whole country.”

The findings add to a growing body of evidence of an unequal pandemic resulting from inequalities that are caused by the social factors that influence health – including housing conditions, employment and access to good-quality health care.

Across the country, COVID-19 exacerbated existing health inequalities, with the brunt of deaths experienced in socially disadvantaged communities. Reducing these inequalities requires long-term national action.

The COVID-19 pandemic took place against a backdrop of social and economic inequalities.

The authors’ previous research had already identified significant regional inequalities with high rates of COVID-19 deaths in the north regions.

However, this new research shows that there was an amplification of the effects of deprivation on COVID-19 deaths in the most deprived areas of the North.

Read the full research paper:

Munford L, Khavandi A, Bambra C., (2022). COVID-19 and deprivation amplification: An ecological study of geographical inequalities in mortality in England. Health & Pace. Vol 78.

More about the study:

Researchers analysed official data of COVID-19 death rates from March 2020 to April 2021 by local area (Middle Super Output Areas - MSOAs) to understand the relationship between deprivation, region and COVID-19 mortality rates.

They found that across England, the most deprived 20% of local areas had higher mortality than the least deprived (44.1% more COVID-19 deaths/10,000). However, the most deprived local areas in the North (Yorkshire and Humber, North West and North East) fared worse than equally deprived areas in the rest of England (14.5% more deaths/10,000 in the Northern deprived areas).

There was evidence of an association between COVID-19 deaths and area-level deprivation – but the impacts of deprivation on deaths was higher in the North: the researchers call this the ‘deprivation amplification’.

Understanding the relationship between COVID-19 mortality rates and deprivation is complex.

Deprivation is affected by wider social determinants of health such as housing, working conditions, unemployment, healthcare access etc. This can cause higher exposure to the virus, for example people in low-income jobs are less amenable to remote working so employees were less able to benefit from local lockdown restrictions and working from home. Self-isolation is also harder in overcrowded housing and densely populated areas. In addition, people living in more deprived areas of the North have higher clinical risk factors (such as underlying health conditions like heart disease or diabetes)

Further information:

This research was carried out as part of the Health Inequalities national priority topic area of the NIHR Applied Research Collaborations (ARC) and was led by NIHR ARC Greater Manchester and ARC North East and North Cumbria.

Find out more here: Inequalities and marginalised communities - ARC (nihr.ac.uk)

Published 22nd November 2022

Health inequalities and regional productivity

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The health of those living in the north is worse than those living in the south, and this inequality is reflected in the comparative economic performance as well. The regional inequality in economic performance is prominent throughout the United Kingdom. In this blog, Dr Luke Munford (NIHR ARC-GM Deputy Lead for Economic Sustainability) and Professor Clare Bambra explore the links between health inequalities and economic inequalities across the UK.

They also consider the impact that the COVID-19 pandemic has had on health and economic performance. Considering an array of variables, they suggest investing in place-based public health, a more holistic approach to improve outcomes in the labour market and promoting health and prevention services across care systems.

Health is an important pre-requisite for economic performance, and therefore, a stronger focus on health must be adopted in order to ‘Level Up’.
The north experiences lower levels of economic activity rates, implying higher rates of unemployment and economic inactivity.
Over the last 50 years, over 1.5 million northerners died earlier than if they had experienced the same lifetime health chances as those in the rest of England.
The central government can focus on mitigating health inequalities by investing in place-based public health, improving labour market participation and job retention, increasing NHS funding in the north, implanting an inclusive, green industrial strategy, and developing health promotion and prevention services.

The renewed effort to ‘Level Up’ England is essential, as there are deep-rooted and persistent regional inequalities. People living in the north of England typically perform less well than those living in the rest of England on many important metrics...

You can access the full blog from the Policy@Manchester site here.

Published 18th November 2022

COVID-19 lockdown was associated with fewer physically active older adults, a recent paper shows

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Researchers from NIHR ARC-GM and The University of Manchester have published a paper in BMC Public Health which identifies that the proportion of older adults realising the recommended levels of physical activity decreased from 43% in September 2020 to 33% in January 2021 during the third COVID-19 lockdown

The impact of COVID-19 lockdown on physical activity trends and changes in exercise patterns project, as part of NIHR ARC-GM Healthy Ageing and Economic Sustainability themes, used a sample of 3,660 older adults (aged ≥ 65) who took part in the UK Household Longitudinal Study’s annual and COVID-19 studies.

The researchers examined trends in the proportion of older individuals who were physically active both before and after the government-imposed lockdown in March 2020.

Activity levels remained about the same as pre-pandemic during the first lockdown, but there was a decline in activity between September 2020 and January 2021 with those least active before the beginning of the COVID-19 pandemic becoming more active and those more active became less during the second lockdown.

Jack Elliott, Research Associate in our Economic Sustainability Theme, who led the analysis, said:

"The long-term risks to older adults' health outcomes resulting from lockdown-related inactivity are concerning. To counteract these risks, government officials, health experts, and media professionals need to encourage the uptake of physical activity. In particular, the promotion of activities with reduced risk of COVID-19 infection, such as home workouts, should be targeted at those particularly vulnerable to infection or those wanting to take extra precautions."

The research team concluded that whilst the restrictions helped control the spread of COVID-19, they have also likely had adverse effects on population health including deconditioning from reduced activity levels. Resources are required to promote the uptake of physical activity and help older adults regain pre-pandemic activity levels to counteract the potential long-term health effects.

Dr Luke Munford, Deputy Lead of our Economic Sustainability theme, who also co-authored the paper, commented:

“We know that it is really important to keep people physically active as it has been shown to improve quality of life and mental well-being. We show here that the lockdowns associated with the pandemic led to reductions in levels of physical activity and we need urgent action to reverse these trends.”

Read the paper in full: Elliott, J., Munford, L., Ahmed, S. et al. The impact of COVID-19 lockdowns on physical activity amongst older adults: evidence from longitudinal data in the UK. BMC Public Health 22, 1802 (2022).

Published 18/10/22

New funding to strengthen regional infrastructure for public involvement in research in Greater Manchester

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The Public Involvement leads from the National Institute for Health and Care Research (NIHR) infrastructure across Greater Manchester have successfully been awarded £10k from NIHR to support, learn from and strengthen regional infrastructure for involvement, engagement, and participation in health and care research.

The proposal has been co-developed with members of the Greater Manchester VCSE Leadership Group, which represents the Voluntary, Community and Social Enterprise (VCSE) sector across Greater Manchester. The work is being progressed by the Greater Manchester VCSE Population Health Group, which is co-chaired by Charles Kwaku-Odoi of Caribbean & African Health Network (CAHN), as a first point of contact.

This builds on previous engagement with the Greater Manchester Centre for Voluntary Organisation (GMCVO), Healthwatch Manchester and Macc (Manchester Community Central).

The £10,000 funding will be devoted to strengthening strategic and operational relationships for patient and public involvement between the Greater Manchester VCSE sector and the NIHR research infrastructure.

Dr. Bella Starling (Director of Vocal)

"Greater Manchester is a vibrant and varied region, rich in community life, heritage, science and culture. It's vital that we work together across all these sectors to produce the best health research, most relevant to the needs of our population”.

There will be a focus on co-creating a programme of partnership approaches based on the needs of Greater Manchester communities, to maximise collaboration across health and social care research activity. All parts of the local infrastructure will be coming together to map and learn from existing areas of good practice, strengthening existing and forming new relationships and networks.

The new funding from NIHR, will help to provide a platform to bring together the Greater Manchester VCSE sector and the local NIHR public involvement and engagement infrastructure co-create an action plan to cement better partnership working between Greater Manchester health and care research teams and VCSE organisations.

Charles Kwaku-Odoi, (Chief Officer of CAHN)

“The Greater Manchester VCSE Leadership Group which represents over 17,000 organisations across the region is delighted to be collaborating with academic partners to ensure that the lived experience of local people influence and shape research now and in the future. The excellent world-leading research undertaken in Greater Manchester must benefit local residents, and that is why there is overwhelming support for this co-produced collaboration”.

Prof. Caroline Sanders, (ARC-GM Lead for Patient & Community Involvement and Engagement and Professor of Medical Sociology at The University of Manchester),

“The VCSE sector has been especially pro-active in tackling new challenges and worsening health inequalities during the COVID-19 pandemic. This funding enables us to strengthen our partnerships and shared goals, especially to address health inequalities going forward with community voices at the heart of research and action.”

More information about all of the Greater Manchester NIHR Public Involvement & Engagement infrastructure can be accessed from the websites below.:

Published 12th October 2022

NIHR ARC Implementation Workshop 4

Event: Workshop

Date: 16th January 2023

Time: 14:00-16:00

This workshop will be hosted by Caroline Watkins from ARC North West Coast

Facilitating implementation through implementation research is one of the core functions of the ARCs. Implementation leads across the ARCs welcome the opportunity for informed discussions among those involved in implementation practice, research and funding around some key issues that would benefit from a coherent approach. To that end, we are organising a series of linked two-hour virtual roundtable events later this year. Each one will involve two short presentations to stimulate discussion, leading to the development of recommendations which will be collated from all four events to inform future ARC plans and strategies.

Study links devolution in Greater Manchester to modest improvement in life expectancy

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The devolution deal which granted Greater Manchester increased control over a range of public services, including health and social care, has been linked to a positive impact on life expectancy in a study by University of Manchester researchers.

The Health Foundation funded study also showed the benefits linked to devolution on life expectancy were felt in the most deprived local authorities where there was poorer health, suggesting a narrowing of inequality.

The study, published in The Lancet Public Health (showed that between 2014/16 and 2017/19):

Life expectancy was 0.2 years higher in Greater Manchester compared to a comparable control group from the rest of England. The change in Greater Manchester was 2·2 times larger than the average change in life expectancy over the same period.

The change persisted throughout the period after the devolution deal and was larger for men (0.34 years) than for women (0·06 years).

Statistically significant increases in life expectancy were observed in eight out of the ten local authorities in Greater Manchester, with the exceptions of Rochdale (decrease) and Oldham (no change).

In the short-term, life expectancy remained constant in Greater Manchester but declined in comparable areas in England. In the longer-term, life expectancy increased at a faster rate in Greater Manchester than in the rest of the country.

Improvements in life expectancy were larger in the local authorities with the worst levels of income deprivation and lowest life expectancy prior to devolution, when compared to areas with equally high deprivation and low life expectancy in the rest of England.

The improvements, say the researchers, may have been a result of a combination of changes in response to the devolution deals in the region, including the health and social care devolution agreement, the devolution of powers over wider determinants of health (such as housing, employment, transport, adult education, policing, and economic development), and the election of a Greater Manchester mayor.

The study, which is the first of first kind, estimated the impact of devolution on the population stratified by sex, local authority, income deprivation, and life expectancy compared to the rest of England, excluding London.

The researchers used local authority data on life expectancy at birth published by the Office for National Statistics between 2006 and 2019 to calculate the relationship.

Lead author Dr Philip Britteon Research Fellow at The University of Manchester said:

“We provide the first robust evidence on the impact of devolution in England on population health, focusing on changes occurring in Greater Manchester.

“The study shows modest improvements in life expectancy in Greater Manchester compared to comparable areas in the rest of the country from the introduction of devolution until the start of the COVID-19 pandemic in 2020, using a robust statistical method.

“This finding may have been driven by combination of changes in response to the health and social care devolution agreement, the devolution of powers over wider public services, the election of a new mayor, or earlier steps to improve population health prior to devolution.

"The findings support the suggestion that devolved systems are able to more closely identify and address the needs of local populations. However, further research is required to understand the mechanisms behind the estimated effect.”

Co-author Professor Matt Sutton from The University of Manchester and Deputy Director of the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) said:

“In Greater Manchester many more people die younger than in most other parts of the UK; many others suffer more from serious diseases.

“However, this study has shown that devolution in Greater Manchester could improve things for the better.”

Following devolution, the Greater Manchester Health and Social Care Partnership (GMHSCP) - now part of NHS Greater Manchester Integrated Care)was established to set strategy and oversee its delivery, including the delivery of Taking Charge, the region’s five year plan.

And also part of the health and social care devolution settlement, NHS England granted the region control of its share of the national sustainability and transformation fund.

The GMHSCP policy priorities also formed components of The Greater Manchester Strategy; a plan produced by Greater Manchester Combined Authority on behalf of Greater Manchester partners, to transform and integrate public services within the conurbation.

Co-author Dr Yiu-Shing Lau from The University of Manchester said:

“These findings may provide clues to the potential success or failure of Integrated Care Systems in England.

“However, there are key differences that should be considered when drawing comparisons between the setup of the GMHSCP and the organisation of Integrated Care Systems outlined in the Health and Care Act 2022.

“Similar improvements in population health may not be replicated in Integrated Care Systems without a comprehensive representation of councils on their board.

“The success of future devolution reforms may therefore depend on other factors beyond the types and strength of powers devolved to a health system, including the extent to which health and wider public services are aligned.

“Future research will seek to further investigate the findings of the study by evaluating the impact of devolution on a range of outcome measures and investigating the activities in Greater Manchester that may have contributed to the observed change in life expectancy”

The full paper, The Impact of Devolution on Health: A Synthetic Control Analysis of Greater Manchester in England, published in The Lancet Public Health is available here.

Published 29th Sep 2022

2022/23 Internship Programme Applications now open!

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The NIHR ARC-GM is pleased to announce that our 2022/23 Internship Programme is now open for applications.

The NIHR ARC-GM Internship Programme provides health and social care professionals in Greater Manchester the opportunity to spend 30 days over a 4-9 month period with our research teams. The programme presents a fantastic opportunity to gain insights into research, enhance existing skills and develop new ones.

Prof. Michelle Briggs, (Clinical Professor of Nursing at The University of Manchester and Manchester University NHS Foundation Trust, and Clinical NIHR ARC-GM Capacity Building Lead) said:

“Our Internship Programme provides a supported experience working alongside NIHR ARC-GM researchers; it also benefits from the established relationships that NIHR ARC-GM has with all the universities in Greater Manchester and the wider organisations committed to encouraging confidence and competence in research.

The Internship Programme provides a firm foundation for health and social care professionals who are interested in developing an academic career combined with working in the health and care environment.“

The programme is based at The University of Manchester. It has been designed to be flexible and inclusive; applicants from diverse backgrounds, social care and public health disciplines are particularly encouraged to apply.

Laura McGarrigle, who completed the Internship Programme in 2021/22 and is now undertaking a Pre-doctoral Fellowship with NIHR ARC-GM, commented:

“I would highly recommend this internship to anyone in the department keen to develop their research skills and ideas. I feel much more confident, competent and able to see how I can keep going with the path of research alongside a clinical career.”

You can read more about the experiences of the 2021/22 cohort of interns from here

Online Question & Answer Sessions for applicants:

5th October at 12:00 & 31st October at 13:00 (Email: arc-gm@nihr.ac.uk to book on)

Deadline for applications:

11th November at 5pm

Start date:

January 2023

Further information about the internships and details of how to apply are available here.

Published 26/09/2022

Free immersive show comes to Stockport and Salford raising awareness of challenges faced by young people struggling with their mental health

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After a successful first performance at the Royal Northern College of Music, an immersive show that aims to highlight the challenges faced by young people who struggle with their mental health is going on tour across the North West.

The new dates are Wednesday 19 October at The Forum Theatre in Romiley, Stockport, and Thursday 10 November at The Lowry Theatre, Salford, and further performances will follow in early 2023.

The performance has been created by two National Institute for Health and Care Research (NIHR) centres, ourselves at ARC-GM, and the Greater Manchester Patient Safety Translational Research Centre (GM PSTRC).

Ten young people from diverse backgrounds worked with researchers and not-for-profit organisation Made by Mortals to create a performance that encourages audience members to walk in the shoes of a fictional character, Adam. They recorded a podcast which is combined with a live performance to create the show.

Adam is 18 years old and transitioning from children’s mental health services to adults. Immersive sound and live action combine to give a real sense of what it’s like to be Adam. Audience members are encouraged to wear an eye mask to heighten the experience. A trailer has been created to give an insight into what it’s like to attend a performance - https://arc-gm.nihr.ac.uk/hidden-live.

One of the young people involved in the performance, said

“All of us involved have different ethnicities, ages, genders, and backgrounds. It really helped when we were creating the characters, and all of the details around their lives, because we all had such a range of experiences from our real lives that we could draw on due to the differences in our cultures and unique backgrounds. For example, we decided on the name Adam as it was ethnically ambiguous, so anyone could listen to the podcast and relate to it, because we didn’t want anyone to feel limited and as though it couldn’t be applied to them.”

An actor plays the part of Adam’s mental health support worker, Shaun. He helps to guide the audience through the story and suggests they remove their eye masks at key points during the performance. Shaun speaks about his experiences of working with Adam. The script for this was created by working alongside parents and carers with lived experience of mental health services. Shaun speaks about his relationship with Adam, the support he is able to offer and how that is changing now that Adam has turned 18.

Prof. Karina Lovell, lead for Mental Health at ARC-GM and Professor of Mental Health at the University of Manchester, said:

“We believe the podcast that’s been created with young people and Made by Mortals gives an accurate portrayal of the challenges faced by young people struggling with their mental health. It’s a powerful performance and we hope it makes a difference to not only the people who come along to the live performance, but to those who read the resource we’ll be creating on the day.”

Shaun also highlights how the music, which was co-created by the young people involved, reflected the story. This included an eclectic mix of instrumentation representing the cultural heritage of the young co-creators, and Adam’s dialogue being transformed into beautifully lyrical melodies performed live by a violinist.

Paul Hine, Director at Made by Mortals, said:

“Coproduction is at the heart of this project and it’s this that helps us to create a sense of what it’s really like for young people struggling with their mental health. We are keen for as many people as possible to experience the performance and encourage anyone interested to register for tickets.”

The performance will be followed by an interactive session where audience members are encouraged to ask questions about the show to encourage discussion.

One of the researchers, Dr Leah Quinlivan, who leads mental health research at the GM PSTRC, said:

“An important theme of our work is mental health and this includes developing interventions for adults as well as young people. We are therefore, delighted to be involved in this project, as it has the ability to reach a diverse audience and make a difference to young people struggling with their mental health.”

Further information and details of how to book tickets for the upcoming performances at The Forum Theatre in Romiley, and The Lowry in Salford can be found here - https://arc-gm.nihr.ac.uk/hidden-live

Published 26/09/2022

Study suggests A&E staff give lower priority to patients from deprived areas

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Healthcare professionals may be unconsciously assigning lower clinical priority to patients from poorer areas compared to patients who live in more affluent areas, a study of English Accident and Emergency (A&E) departments by The University of Manchester and ourselves, as the National Institute of Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) has suggested.

The findings, published in the Journal of Health Economics are the first to show evidence of income-related inequalities in access to timely and appropriate emergency care in England.

Using national data on patients arriving by ambulance at all major English A&E departments during 2016/17, the researchers compared waiting times, treatments, and health outcomes for patients.

They found that patients from more deprived areas waited longer to receive treatment, and received less complex treatment than those from more affluent areas, even when presenting with the same health conditions and at the same hospital.

Though the inequalities in waits were small for an individual patient (2.2% increase in waiting time for the start of treatment), the differences were systematic and represent a substantial amount of delay at the population level.

Patients from deprived areas were also less likely to be admitted to hospital (2% less) and less likely to be referred on for follow-up care (7% less).

Previous research has found patients from more deprived areas also wait longer for planned operations such as knee replacements despite having the same level of need for treatment, but this is the first study to look at waiting times for emergency care.

The observed inequalities were present even when A&E departments were less crowded, indicating that inequalities aren’t concentrated in periods when staff are under greater time pressure. It is possible, say the researchers, that unconscious bias is the reason that lower priority is given to patients from deprived areas.

Waiting times are likely to be more important in an A&E setting, where the severity of conditions may have very serious health consequences for patients, and prioritisation decisions must be made quickly. This pressure may also lead to higher fear of litigation, which could subconsciously affect how doctors interact with some patients.

Patients from the most deprived areas, who are more likely to have underlying health conditions, accounted for more than twice as many attendances as those from the least deprived areas, and were equally or more severe on arrival, despite being younger on average.

But inequalities in timely and appropriate care in A&E may also exacerbate these existing health inequalities, with patients from the most deprived areas almost 6% more likely to attend A&E again within 7 days and almost 5% more likely to die within 30 days, compared to the least deprived.

Lead author Dr Alex Turner from The University of Manchester said:

“Our results suggest the NHS principle of “equal access for equal need” is not being upheld in English Emergency Departments.

“Adding to evidence from previous studies that patients from more deprived areas wait longer for planned operations, we find these patients also wait longer for care in A&E where extended waits are more likely to have severe consequences for health”

“And though the magnitudes of inequalities are smaller in an A&E setting than in planned care, we also found patients from deprived areas were substantially more likely to choose to leave without treatment while waiting in A&E.

“Not only do patients from more deprived areas receive less timely care, they also receive different care, with physicians less likely to provide these patients with complex care within the A&E and less likely to refer them for subsequent care.”

Co-author Dr Ruth Watkinson from The University of Manchester and our own NIHR Applied Research Collaboration Greater Manchester (ARC-GM) Economic Sustainabiluty team

“We find evidence that suggests patient-staff interactions, and particularly unconscious bias towards patients from deprived areas, may contribute to unfair inequalities in A&E. Policies designed to improve these interactions should be prioritised.

“Inequalities in mortality following A&E attendance suggest the healthcare system may be exacerbating already-entrenched inequalities.

“Addressing this is especially important given reducing health inequalities is a key priority for the NHS.”

The full findings are avilable from the Journal of Health Economics:

Turner AJ, Francetic I, Watkinson R, Gillibrand S & Sutton M., Socioeconomic inequality in access to timely and appropriate care in emergency departments. Journal of Health Economics. (2022) Volume 85

This news story was published 22/08/2022

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During the COVID-19 pandemic, there have been concerns regarding potential bias in pulse oximetry measurements for people with high levels of skin pigmentation. In November 2021 the UK Health Secretary ordered a review into racial bias in medical devices including pulse oximeters.

Researchers from the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) and The University of Manchester have undertaken a review to investigate the accuracy of pulse oximetry in measuring blood oxygen saturations by levels of skin pigmentation. The review found that, compared with the gold standard measure for blood oxygen saturation, hospital-based pulse oximetry may overestimate oxygen saturation by around 1% (on average) in people with high levels of skin pigmentation and people whose ethnicity is reported as Black/African American.

This review included all of the available evidence up to December 2021.

Dr Chunhu Shi, Research Fellow at The University of Manchester and NIHR ARC-GM Evaluation Theme, led this review:

Our estimate of the average bias of 1% in people with high levels of skin pigmentation is new knowledge. This estimate, for the first time, reflects how large the extent of the bias would be in pulse oximetry measurements for people with high levels of skin pigmentation.

The findings from this work have substantial implications. The overestimation identified at threshold values for diagnosis of hypoxaemia could lead to clinically important hypoxaemia remaining undetected and untreated.

For example, when using 92% as the threshold of diagnosing hypoxaemia, clinicians could consider a pulse oximetry reading of 93% as normal for a patient with high levels of skin pigmentation if the overestimate is disregarded. However, when the overestimate of 1% for this level of skin pigmentation is considered, the patient’s true oxygen saturation could be around 92% and suggest a possible hypoxaemia.

Despite the clinical implications of the overestimation, the bias estimates met internationally recommended thresholds and UK standards. We considered that the currently recommended thresholds may need re-evaluation, and the use of more conservative criterion may have merit.

Our findings support calls for the use of better calibrating algorithms within oximeter device software to address possible measurement bias. This review results offer some insights into the possible amount of bias to consider

.

The full findings of this work have been published in the BMC Medicine:

Shi C. Goodall M. Dumville J. Hill J. Norman G.Hamer O et al. The effects of skin pigmentation on the accuracy of pulse oximetry in measuring oxygen saturation: a systematic review and meta-analysis. BMC Medicine. (2022) 20:267

This review has been funded by the NIHR ARC-GM and ARC North West Coast and supported by NIHR, and the Accelerated Access Collaborative at NHS England and NHS Improvement.

New funding for Dementia research within ARC Greater Manchester from NIHR in collaboration with the Alzheimer’s Society

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ARC Greater Manchester is offering three career development awards for dementia research, as part of a national NIHR initiative to support promising early career researchers in dementia and to build up their number and skills across the NIHR family.

The ARC funding, provided by NIHR in collaboration with Alzheimer’s Society, is supporting a cohort of post-doctoral health and care researchers toward independence, developing their skills to establish their own research projects, programmes and ultimately groups.

Prof. John Keady, Professor of Older Peoples Mental Health at the University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, said:

“It is a great honour to be part of this NIHR Applied Research Collaborations and Alzheimer’s Society initiative aimed at strengthening post-doctoral health and care research in dementia. Our specific Fellowship will span health and social care and look to build a lasting legacy in creative practices that values and promotes the contribution of people living with dementia in Greater Manchester and beyond.”

We are offering career development awards for the following projects:

Project 1: Everyday aesthetics and the intersection of arts and health. This fellowship project will use a participatory approach to develop, deliver, and evaluate an individually tailored, multi-arts social intervention with people with dementia living at home. With its ‘at-home,’ community focus, this project will provide new forms of sensory and embodied knowledge and understanding and will look to measure the arts-informed engagement at multiple time-points across the trajectory of the social intervention.

Project 2: Digital technologies for falls prevention for people with dementia. The Keep On Keep Up (KOKU) digital exercise programme supports older people to engage with simple, effective, evidence-based falls prevention exercises. KOKU is currently being modified for people with dementia and has been successfully tested with four care providers to enable people living at home with regular support visits to remain independent. This fellowship project will build on this work with intervention modification and a feasibility RCT.

Project 3: Dementia and palliative/end-of-life care. This study will build on on-going work by the EMBED-Care study team by exploring the potential for more integrated models of end-of-life care and knowledge exchange between hospices, health and care services and local authorities within Greater Manchester. This will comprise: i) a systematic review of research on integrated models of end-of-life care; ii) a mapping exercise to explore different types of integrated models of; and iii) qualitative interviews with key stakeholders in Greater Manchester.

Prof. Chris Todd, Professor of Primary Care and Community Health at The University of Manchester, Director of the NIHR Older People and Frailty Policy Research Unit, and our ARC-GM Lead for Healthy Ageing, said:

“I am delighted that we are hosting these Fellowships. They will help us achieve our goal of enabling people living with dementia to live longer, healthier, more fulfilling and socially connected lives in safe environments. They will also help us to train the future research leaders in this important and all too often overlooked area”.

Dr Emma Vardy, Consultant Geriatrician at The Northern Care Alliance NHS Foundation Trust, Honorary Senior Lecturer at The University of Manchester and our ARC-GM Deputy Lead for Healthy Ageing, said:

“People with dementia were particularly affected by the COVID-19 pandemic including the effects of isolation, deconditioning and hence increased risks of falls. Falls prevention has been identified as a priority for the health and social care system in Greater Manchester and so we are particularly pleased that one of the fellowships will focus on using digital technologies to prevent falls in people with dementia, ensuring that people with dementia will not miss out on potential benefits that these technologies may offer”.

Information about all the awards available across the ARCs is available on the ARC Wessex website.

Published 12th August 2022

NIHR ARC Implementation Workshop Series Workshop 3 - Bringing organisation science into implementation science

Event: Workshop

Date: 10th October 2022

Time: 14:00 - 16:00

This workshop will be hosted by Graeme Currie from ARC West Midlands

Facilitating implementation through implementation research is one of the core functions of the ARCs. Implementation leads across the ARCs welcome the opportunity for informed discussions among those involved in implementation practice, research and funding around some key issues that would benefit from a coherent approach. To that end, we are organising a series of linked two-hour virtual roundtable events later this year. Each one will involve two short presentations to stimulate discussion, leading to the development of recommendations which will be collated from all four events to inform future ARC plans and strategies.

NIHR Applied Research Collaborations (ARCs) Implementation Workshop Series Workshop 1 - Maximising the Impact of NIHR funded research

Event: Workshop

Date: 19th September 2022

Time: 14:00-16:00

This workshop will be hosted by Paul Wilson from ARC Greater Manchester.

Facilitating implementation through implementation research is one of the core functions of the ARCs. Implementation leads across the ARCs welcome the opportunity for informed discussions among those involved in implementation practice, research and funding around some key issues that would benefit from a coherent approach. To that end, we are organising a series of linked two-hour virtual roundtable events later this year. Each one will involve two short presentations to stimulate discussion, leading to the development of recommendations which will be collated from all four events to inform future ARC plans and strategies.

£2bn cost of mental ill health in the North of England

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A report out today by the Northern Health Science Alliance (NHSA), ourselves NIHR ARC Greater Manchester and other northern ARCs, shows that a parallel pandemic of mental ill health has hit the North of England with a £2bn cost to the country at the same time as the COVID-19 pandemic.

Mental health in England was hit badly over the course of the pandemic. But people in the North performed significantly worse in their mental health outcomes compared to those in the rest of the country.

People in the North under 35 were more likely to have developed a psychiatric disorder over the course of the pandemic, an increase of 2.5% compared to a reduction of 1.3% in rest of England.

There was a 12% increase in the numbers of anti-depressants prescribed during the pandemic in the North. During the pandemic, people living in the North were prescribed more anti-depressants proportionately than those in the rest of England (5.3 compared to 4.3).

Before the-pandemic, people from ethnic minorities and those from a white British background had similar mental health scores, Over the pandemic people from ethnic minorities had a larger fall in their average mental health (1.63 points compared to 0.87) and this was greater for those of an ethnic minority in the North (a fall of 2.34 compared to 1.45 for the rest of England).

Women from ethnic minorities in the North had the worst mental health in the country. Their mental health scores fell by 10% at the start of the pandemic and their scores were 4% lower throughout the pandemic.

Mental health fell equally in the North and the rest of the country during the pandemic (5% decrease), but it recovered more quickly in the rest of the country (to 1.3% decrease) than in the North (2% decrease).

The report conservatively estimates the reductions in mental health in the North during the two years of the pandemic have cost the UK economy £2bn in lost economic productivity. This is £2bn more which has been lost than if the North had suffered the same mental health outcomes as the rest of the country.

The gap between the lowest and highest earners increased during the pandemic and remains large.

Report co-author Clare Bambra, Professor of Public Health at Newcastle University, said:

“These findings reiterate that the pandemic has been very unequal. People in our most deprived communities have suffered most, in terms of death rates, dying younger and in on going ill-health such as long covid. These health inequalities reflect long-term inequalities in the social determinants of health, how we live, work and age.”

Dr Luke Munford, from our NIHR ARC Greater Manchester Economic Sustaiability theme, who also co-authored the report, said:

“Our mental health is important for us as individuals but is also important to our society. We have shown, again, that the pandemic was not equal – people in the North of England fared worse. We need to act urgently to address this or these unfair inequalities will grow and as already hard hit individuals and us as a society will unfairly suffer.”

The report urges that more needs to be done to address inequalities in mental health in the North, if ‘levelling up’ is to be achieved.

Among its key recommendations, the report’s authors are calling for an increase in NHS and local authority resources and service provision for mental health in the North, along with an increase to the existing NHS health inequalities weighting within the NHS funding formula.

Hannah Davies, Health Inequalities Lead at the NHSA and report co-author, said:

“Increased deprivation in the North of England has added to a decline in mental health in the North of England over the course of the pandemic.

“The reasons for this are many: increased time spent in lockdowns, the type of work people in the North do but the driving factor is poverty.

“To reverse these outcomes immediate action should be taken to provide funds to mental health suppliers proportionate to the need in those areas and measure to reduce deprivation – particularly as the cost of living crisis tightens its grip further on the most vulnerable.”

The report is backed by the NHSA’s mental health trust members: Rotherham Doncaster and South Humber NHS Foundation Trust and Tees, Esk and Wear Valley NHS Foundation Trust.

Kathryn Singh, Chief Executive of RDaSH, said:

“Our work at RDaSH is rooted in our communities and our teams have huge experience of how much impact COVID-19 has had on the mental health of those communities – the parallel pandemic. Our experience on the ground is very much borne out by the findings of report, where levels of deprivation were already high, and where the pandemic has exacerbated all the trends that were already in place.

“But I think we are in a good position to support the vital recommendations of this report, and I’m hopeful we can play our part in the innovation and vital investment needed into mental health in communities across the North, so that they can play their full part in the UK’s economy.”

Brent Kilmurray, Chief Executive of TEWV, said:

“During the pandemic we saw not only an increase in demand for our services, but an increase in acuity – with people presenting to us with more severe mental health conditions.

“We provide services in some areas of very high deprivation, and we’re working with partners from all sectors across our region to find new ways to support these communities with their mental health. Community mental health transformation is hugely important and will help to provide more joined-up care, taking a person-centred approach to find new ways to support people with mental health issues.

"We know the impact that COVID-19 has had on people’s mental health and if you feel your mental health is being affected, please seek help and support as soon as possible.”

Read a copy the ‘Parallel Pandemic’ report here

With great power: Taking responsibility for integrated care

blog

July 2022 sees the formal establishment of the Integrated Care Systems (ICSs) created by the Health and Care Act 2022. These bodies will integrate health and social care in England, with the aim of providing more joined-up services tailored to local needs.

However, questions remain about how ICSs will function at place-level, particularly in terms of decision making and accountability at place level. In a new blog with Policy@ Mancster, one of our NIHR ARC-GM PhD Fellows, Melissa Surgey (@MelissaSurgey) outlines how ICSs will interact with pre-existing bodies, where the gaps are in the legislation, and how policymakers in Government and the NHS can start to fill them in...

You can access the full blog from the Policy@Manchester site here

Developing new ways of providing support to parents and carers of children with obsessive-compulsive disorder: Findings from the CO-ASSIST study

news

Obsessive-compulsive disorder (OCD) is a severe and debilitating emotional disorder that often begins in childhood.

The effect of obsessions and compulsions are not only distressing for the child experiencing them, but also for the child’s parents and carers.

Without adequate support, the role of caring for children and young people can pose a significant burden to parents and carers.

The CO-ASSIST study was funded by the National Institute for Health and Care Research (NIHR) Research for Patient Benefit (RfPB) and supported by the Applied Research Collaboration Greater Manchester (NIHR ARC-GM). The project was hosted by Greater Manchester Mental Health NHS Foundation Trust and was led by Dr Rebecca Pedley, Research Fellow at the University of Manchester, NIHR ARC-GM Mental Health Team.

The project was carried out with consultation from two national charities, OCD UK and Anxiety UK. Speaking of the project, CEO of OCD UK, Ashley Fulwood, who has been involved in planning the project from its early stages, commented:

“We now know that OCD can have a devastating impact on individuals with OCD, including children. But loved ones, especially parents of children and adolescents with OCD are often left feeling powerless to help their child. Which is why the team at OCD-UK were fully support of this important piece of research”

During the project, researchers spoke to parents and carers of children with OCD and professionals to get a detailed understanding of parents’ support needs and preferences. Drawing on these findings, a series of interactive workshops with parents and professionals were used to identify and reach consensus on new ways to support parents and carers of children living with the condition.

Debbie Robinson, a parent with lived experience and co-researcher commented on her role within the project:

“Working as a co-researcher on this project has been a tremendously rewarding and at times gut -wrenching experience for me as a parent of a child with OCD. To give so many parents a voice to be heard and acted upon was my motivation and has been such a worthwhile job. The findings have validated so many experiences and hopefully will lead to real change in the way that OCD is perceived, and families are supported in their hugely difficult role as carers.”

The study found that the most feasible and helpful solution was an online platform containing parent and carer informed information and resources.

Once developed, the platform will help equip parents and carers to support their child, make sense of OCD and develop a shared understanding of OCD within the family. It will also help parents to consider their self-care and provide opportunities for parents to be heard.

The team have been keen to share the findings from the project with families affected by OCD and members of the public, creating an animation, a podcast and a written summary.

The animation was narrated by Ian Puleston-Davies, patron of OCD UK charity and well-known for his TV acting roles including Coronation Street and The Teacher. Discussing the importance of the project, Ian commented:

“Take it from me, it’s exhausting being a parent of a child suffering from OCD. They really do need all the help they can get. And to know you are not alone, whether you are that parent, or that child who suffers, is so incredibly important. As a patron of OCD UK, I am always looking for an opportunity to shout about OCD from the rooftops…”

The team are now working on a grant application to seek funding to develop and test the online platform.

You can view the animation and podcast, and read more about CO-ASSIST here:

https://bit.ly/3MWRdLf

Published 5th May 2022

Hidden LIVE: Adam's Story

Event: Event

Date: 11th May 2022

Time: 13:30-15:00

for Hidden LIVE is an immersive performance that will challenge you to encounter life as a young person struggling with their mental health. This multi-media theatre piece uses imagination and experiences of ‘real people’ and asks you to question what you can do to help.

This performance is taking place during Mental Health Awareness week 2022. The event is free and open to anyone. Access support is available, please contact Karon Mee karon.mee@manchester.ac.uk for more details.

Stop. Read. Hidden. adjective. Kept out of sight, concealed. Breathe. Think.

Hidden LIVE is an immersive performance that challenges audiences to walk in the shoes of a young person struggling with mental health.

“In a few moments you will enter an avatar and become Adam. Adam’s life will become your responsibility. You will have the controls. You have the headset. Help him survive, strive even”.

Adam has just turned 18. Mum is now even more in the dark. Sean, Adam’s key worker, feels like a failure. Adam wants to be referred to adult services, will they take him?

This multi-media theatre piece uses the imaginations and experiences of ‘real people’ and asks you to question what you can do to help. “I was told we didn’t do home visits when I first came to the job, but I stood my ground and did it anyway”.

Helping to improve the health and care of patients and the public.

About us

Health Inequalities

Public Health

Social Care

COVID-19

Twitter

NIHR

Highlights

Sign up for access to a new interactive film, Hidden: Adam's Story here.

Helping to improve the health and care of patients and the public.

About us

Health Inequalities

Public Health

Social Care

COVID-19

Twitter

NIHR

Highlights

S﻿ign up for access to a new interactive film, Hidden: Adam's Story here.

Sign up for access to a new interactive film, Hidden: Adam's Story here.