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The NIHR Applied Research Collaboration Greater Manchester (ARC-GM) is supporting applied health and care research that responds to, and meets, the needs of local populations and local health and care systems.

 

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The National Institute for Health and Care Research (NIHR) fund, enable and deliver world-leading health and social care research that improves people's health and wellbeing, and promotes economic growth.

The NIHR Applied Research Collaboration Greater Manchester (ARC-GM) supports applied health and care research that responds to, and meets, the needs of local populations and local health and care systems.

We are  one of 15 ARCs across England, part of a £135 million investment by the NIHR to improve the health and care of patients and the public.

Our research activity is  pivotal in finding new and evaluting better ways of preventing illness and delivering care, ensuring that Greater Manchester continues to be at the leading edge of health innovation, applied research, care and treatment.

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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

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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:

 

 

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

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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

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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

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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.

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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

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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:

 

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

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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

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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:

 

 

This news story was published 22/08/2022 

 

 

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Pulse oximeters may overestimate blood oxygen saturation for people with high levels of skin pigmentation in hospital settings compared with gold standard measures

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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:

 

 

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.

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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

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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.

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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.

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£2bn cost of mental ill health in the North of England

news

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

 

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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

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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

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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”.

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