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How was it for you? Reflections on involvement

1 Aug

This edition, we meet Andrew Grundy, who is involved in the Safer Transitions project in our Safer Care Systems and Transitions research theme.

Why did you decide to become involved in the Safer Transitions project?

I accepted an invitation to become involved in the Safer Transitions project because I am a mental health service user with lived experience of mental health service transitions myself; community to inpatient, and back again, on a number of occasions.

I also have research interests this area – my interests are in service user’s experiences of mental health services. My PhD is focussed on service users’ experience of risk assessment and management in an acute setting, which (among other things) involved sitting in and observing ward rounds and discharge meetings.

I wanted to use my lived and learned experience to make a difference in this area of hospitalisation discharge. We know that staff can become so focussed on the process that they lose sight of the person, and service users often feel lost in the system. So I feel it is important to constantly remind people that it is service users and carers who we hope will benefit from the research we do.

How do you think the Greater Manchester PSTRC has benefitted from your involvement? What difference do you feel that you made?

My involvement has focussed on assisting with the design and conduct of a study on the development of a Core Outcome Set for mental health hospitalisation discharge interventions – that is, a fundamental set of outcomes that we hope would be used in all future research into mental health discharge. This involved making the online study information sheet and surveys accessible and acceptable to a lay audience.

I have also been involved in co-producing an intervention to improve the service user experience of hospitalisation discharge. I’ve been involved to bring the service user experience and perspective into consideration when coming up with potential ideas in this area, and I’m excited about the next steps (watch this space!).

How do you feel you have benefitted from your involvement?

I’ve definitely picked up more research understanding and skills, particularly around developing a Core Outcome Set and the Delphi method – the process for producing the Core Outcome Set via an online panel completing various surveys, and then a face-to-face consensus meeting to agree the final outcome set.

I’ve also been able to use some of the most difficult experiences of my life (such as inpatient admissions) to make a difference to the research.

Would you recommend becoming involved in research to other patients/carers/health professionals? If so, why?

I would recommend being involved in the design and conduct of research, particularly if you have first-hand experience of a mental health condition (with all that entails) because you have a form of knowledge and expertise that people with only an academic knowledge-base don’t have.

The same is true if you are a friend or family member supporting someone with a mental health condition – that knowledge and experience is invaluable to academic researchers.

If you’re a health professional, your experience of clinical practice is also really helpful.

You may not feel like an ‘expert’ but clinicians, carers and service users have such a wealth of different kinds of knowledge that can make a real difference throughout the research process.

Artificial Intelligence and decision making – experts discuss results of Citizens’ Juries to inform national guidance

1 Jul

Banner _Citizens Juries workshop image

Is it necessary to give reasons for decisions made using artificial intelligence (AI) software even if the results may not be as accurate? Leading academics and experts believe, with the development of AI advancing, guidance on how it can be used in decision making is needed.

The National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR Greater Manchester PSTRC) and the Information Commissioners Office (ICO) commissioned two citizens’ juries* to investigate AI and decision making. In healthcare, the juries prioritised accuracy over explanation, but in other scenarios** they reached different conclusions; clearly, context matters.

The results were presented and discussed recently at a workshop attended by NHS National Data Guardian, Dame Fiona Caldicott, and chaired by Professor Stephen Campbell, Director of the Greater Manchester PSTRC. More than 50 people from across the country participated, including members of the two juries, NHS executives, academics and researchers working in range of specialisms such as philosophy, computer science and the arts.

Professor Niels Peek, Theme Lead for Safety Informatics at the Greater Manchester PSTRC, said: “Before there is widespread adoption of AI across the NHS it is important to develop guidelines to make sure patient safety is assured. We were keen to work with the ICO on this to help inform the guidance it is writing. We chose to commission two citizens’ juries to find out what the public think about this complex issue.

“It was valuable to reflect on the findings of the juries with a large group of experts during the workshop. We presented the research and invited questions before taking part in table discussions about AI and decision making which helped to give extra weight to our existing findings.”

Kayshani Gibbon, from The Royal College of Art (RSA), also spoke about research it’s due to publish on the ethical use of AI, giving the attendees additional background information.

Dame Fiona Caldicott, NHS National Data Guardian, said: “I welcome this project and the way it has involved a cross-section of the public in these important considerations on AI that will have a major impact on our lives. We have also used the citizens’ jury approach, and have found it’s a valuable way to learn in more depth what members of the public think.”

Ben Bridgewater, CEO at Health Innovation Manchester, attended the event and expressed how important he felt it was to be establishing a position on AI and decision making in the NHS. Ben said: “In Manchester we’re at the forefront of innovation in healthcare so being involved in this research and having the opportunity to comment on the results has been valuable.”

Simon McDougall, Executive Director for Technology and Innovation at the ICO spoke about the wider importance of the research as well as its significance: “Better understanding the public’s views on explaining AI decisions is vital for the ICO and The Alan Turing Institute, who are working with us on this, as we are developing guidance for organisations in this area.”

“The citizens’ juries gave us the opportunity for an in-depth exploration and discussion about the issues arising from AI decision-making and equipped us with a unique and informed public opinion on this complex issue.

“Our research findings, informed by the juries, have recently been published in our interim report.”

The citizens’ juries were run by Dr Malcolm Oswald, Director of Citizens Juries c.i.c. He said: “Bringing together experts from across the country and varying specialisms to discuss AI and explainability was a great opportunity to open up the debate.  These questions on AI will become ever more crucial as it increasingly affects our daily lives. It’s a complicated topic, and these citizens’ juries gave us five days to bring expert evidence and the time for people to work together to reach reasoned recommendations that will inform national policy.”

To find out more about the NIHR Greater Manchester PSTRC visit –  http://www.patientsafety.manchester.ac.uk/ and you can learn more about the breadth of projects Citizens Juries c.i.c. are working on at https://citizensjuries.org/

PhD Fellow Focus: Rebecca Musgrove

1 Jul

by Rebecca Musgrove

Rebecca Musgrove_Photo

Rebecca Musgrove joined the University of Manchester as an NIHR Greater Manchester PSTRC-funded PhD student in January 2019.  As part of the ‘Safety in Marginalised Groups’ theme, she is focusing on the epidemiology (how often and where diseases or healthcare events happen) of suicide and self-harm after discharge from Mental Health inpatient care.  She is particularly interested in the role of primary care and specialist mental health services in protecting against suicide in the period shortly after discharge.  She hopes to use the Clinical Practice Research Datalink (CPRD), a large UK dataset derived from a large network of GP practices, linked with hospital admission, mental health and mortality records to define a cohort.

Prior to taking up the studentship, Rebecca worked as a Senior Analyst with the Mental Health policy team at NHS England.  She used data from the Mental Health Services dataset and other relevant national collections to provide monitoring tools and analysis to support the implementation of the Five Year Forward View for Mental Health and the more recent Long Term Plan.  She holds a Master’s degree in Demography and Health from the London School of Hygiene and Tropical Medicine.  Prior to this Rebecca worked as a trainer and in operational management in community Sexual Health in London and as a Child Protection Manager in war affected communities internationally.

She is passionate about improving health outcomes and reducing premature mortality for people who experience mental ill health and hopes her PhD will provide evidence to support and further develop existing UK policy.  After completing her PhD she hopes to continue working closely with the NHS in a mental health-care research capacity.

Developing a resource to help healthcare professionals implement NICE guidelines for self-harm

1 Jul

by Jessica Leather

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Jessica Leather joined the NIHR Greater Manchester PSTRC Marginalised Groups theme as a PhD Fellow in September 2018. Before coming to the University of Manchester she completed a MSc in Health Psychology at Liverpool John Moores University. Following her masters, she worked as a research assistant for a bowel cancer screening intervention for Black and Asian Minority Ethnic populations in Liverpool. Her main interests lie in behaviour change interventions, particularly involving healthcare professionals as recipients or agents.

Jessica’s PhD focuses on the development of an intervention to aid healthcare professionals in implementing the NICE guidelines for self-harm, supervised by Prof Christopher Armitage, Prof Navneet Kapur and Prof Stephen Campbell. Self-harm is a key risk factor for suicide; approximately half of people who die by suicide have a lifetime history of self-harm. Presentations in primary care for self-harm are a critical setting for healthcare professionals to identify suicide risk and intervene. However, it is unclear:

  1. what is the rate of patients presenting with self-harm
  2. whether healthcare professionals are aware of the guidelines for self-harm, and
  3. which factors may influence whether or not healthcare professionals implement the guidelines.

Therefore, this project aims to understand the experiences of healthcare professionals when encountering patients at risk of self-harm, and develop an intervention to facilitate the implementation of NICE guidelines for self-harm.

Study 1 comprises a representative survey in which healthcare professionals will report how frequently they encounter patients, and how they typically respond when they believe someone is at risk of self-harm. The survey will capture details about any training or tools they have received to aid their assessment and management of self-harm, and whether or not these resources were sufficient. Existing scales will be used to measure specific factors that could be associated with implementing the guidelines, such as a dislike of them, or an over-confidence in clinical judgement. Finally, the survey will use models of behaviour change to identify the issues that need addressing to improve the implementation of the guidelines.

Study 2 comprises of semi-structured telephone interviews in which healthcare professionals will be able to suggest acceptable solutions to the specific barriers they face when trying to implement the guidelines, while expressing whether or not they think an intervention would be useful and feasible for them in their professional role. This work will form the basis for an intervention to facilitate the implementation of NICE guidelines for self-harm by healthcare professionals.

Experts gathered to discuss patient safety at symposium in Manchester

26 Jun
PSTRC Symposium - Dr Aidan Fowler, Prof Stephen Campbell and Dr Richard Preece

l-r: Dr Aidan Fowler (NHS National Director of Patient Safety), Prof Stephen Campbell (Director, NIHR Greater Manchester PSTRC), Richard Preece (Executive Lead Quality, Greater Manchester Health and Social Care Partnership)

A symposium was held by the National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC) in Manchester to discuss some of its areas of research. Experts from Paris and Norway joined NHS National Director of Patient Safety, Dr Aidan Fowler to speak at the event which around 100 academics, researchers, policy makers, and NHS executives attended last month.

The Greater Manchester PSTRC is one of three national NIHR funded patient safety research centres and is based at the University of Manchester. It works in partnership with Salford Royal NHS Foundation Trust. The centre carries out research across four themes which investigate patient safety in primary care and transitions of care. Its work is being adopted by the NHS, making a real difference.

The event gave attendees the opportunity to learn about crucial patient safety issues from experts and panel sessions allowed for meaningful discussion and insight.

The main areas of patient safety covered at the event were Artificial Intelligence and patience safety, transitions of care and patient safety, avoidable harm and patient safety, as well as the unique health and social care infrastructure in Greater Manchester.

Richard Preece, Executive Lead Quality Greater Manchester Health and Social Care Partnership spoke about the Greater Manchester Quality Improvement framework which he published at the end of last year. He highlighted that it is a framework for system safety. Richard, said: “We work in partnership and this involves our universities and research centres such as the Greater Manchester PSTRC, as well as patients and staff, to make care safer and to improve the outcomes and experiences of patients and service users.

“The symposium was a valuable opportunity to hear about some of the research underway and to speak to researchers and decision makers because by working together in this way we can start to improve the care system.”

Professor Anita Burgun from Paris Descartes University and Paris Artificial Intelligence Research Institute delivered a keynote speech on hybrid approaches in AI and its relevance to patient safety. She talked about her recent research looking at the overall prevalence of adverse events reported in social media.

Anita joined a panel, along with the PSTRC’s Theme Lead for Safety Informatics, Professor Neils Peek, Lecturer in Health Informatics at the University of Leeds, Professor David Wong and Professor David Clifton from the Department of Science and Engineering at the University of Oxford who chaired the session. The panel discussed the PSTRCs recent work on AI and patient safety.

The international input continued with Professor Karina Aase, Centre Director for SHARE, Centre for Resilience in Healthcare, University of Stavanger, Norway.  Karina presented some highlights from her research around Quality and Safety in Care Transitions, Expanding our Understanding. Karina spoke about creating common ground, widening the current perspective on care transitions and trying to work out a framework for researching it.

Professor Stephen Campbell, Director of the NIHR Greater Manchester PSTRC, said: “We were delighted that so many experts in patient safety could join us at our first symposium where we were all in agreement that the patient should be at the centre of everything we do. Working together and sharing research will help us to continue to improve patient safety.

“We value the input from all speakers and attendees who asked probing and insightful questions during our panel sessions. The research we undertake is making a tangible difference in the NHS and we are looking forward to seeing more of our research in practice, improving safety for patients.”

Using the Ingenuity Process to address the communication and co-ordination problems in mental health hospital discharge

26 Jun

by Natasha Tyler, (Justin Waring, Nicola Wright, Andrew Grundy, Kyri Gregoriou)

N Tyler PPI event photo1

The Ingenuity Process is a method that encourages innovative responses to specific challenges in society. This process is a proven way of making sure innovation activities are included in our decision-making processes.

The Ingenuity Process requires a clear focus upon defining the problem, identifying multiple solutions and determining the most effective solution. In practice, individuals and organisations tend to neglect these critically important activities in order to cut corners. The Ingenuity Process provides a rigorous framework to ensure that the correct problem or root cause is considered, that a diverse range of potential solutions are generated and that the best solution is highlighted.

We conducted a review of the types of mental health discharge interventions that have been tested in past research and found that very few of these interventions focus on communication and co-ordination of services.

We then asked a group of 93 researchers, service users, families, healthcare professionals and mental health policy makers/decisions makers what the key research priorities are in terms of mental health discharge, what makes a discharge difficult and what might improve it. Thematically, improved co-ordination and communication between services was one of the most common responses. Yet very few interventions to our knowledge have looked specifically at addressing this problem.

We are working with an NHS trust that has two sites, each containing multiple acute mental health inpatient wards. We worked with staff in the trust to map out the key agencies involved in mental health care transitions. Understanding who might be involved with the service user on the way into hospital (admission) and similarly who might be involved on the way out (discharge).

On 17th April 2019, we held an Ingenuity Process event, bringing together these key agencies from health and social care services (police, supported living, homelessness, crisis, liaison, social work, primary care). The staff worked together to:

  1. define the problem
  2. discuss and discover multiple solutions, and
  3. determine the best solution.

As a result we generated lots of ideas about what the problems are and captured the perspectives of different groups. Working in small groups, staff generated lots of interesting ideas about how to solve these problems. The next stage of our research will be deciding upon the best solutions across the groups and how to implement them.

Brexit vs. Mental Health – Considering the mental health needs of the UK Central and Eastern European community

5 Apr

by Aaron Poppleton

AARON POPPLETON_DSC_0570_CEE Mental Health

In the UK, Brexit is the topic of the moment.  Regardless of outcome, the impacts are already being felt across the country. Around two million people from Central and Eastern Europe (CEE) currently live in the UK. As with many ethnic minority groups, there hasn’t been a lot of research looking into their health needs. This is particularly true for mental health and wellbeing – something which Brexit is thought to have made worse. Limited information makes it much harder to deal with challenges such as higher rates of depression, anxiety, alcohol misuse and death through suicide.

Alongside the NIHR Greater Manchester PSTRC’s work with marginalised groups, the UK Central & Eastern European Health Research Forum took place on the 19 February 2019. Researchers and CEE community members were invited to attend from across the UK and Ireland to discuss ways to improve community mental health awareness and research. The day consisted of a series of presentations and small group discussions, with topics including:

  • “Brexit is coming… How can we explore, maintain and strengthen well-being / mental health within the CEE community?”
  •  “Developing strategies for self-harm and suicide prevention in the UK-CEE community”

Attendees shared a wide range of academic and personal experiences, which provided plenty of food for thought.

What’s next?

The day culminated in a whole meeting discussion on “where do we go from here?”. Attendees felt it was important to continue the momentum of the day through creating a formal network of academics with an interest in the mental health and wellbeing of the UK CEE community. It is intended this will happen through a group webpage and online meetings focussed on particular community mental health needs. The mental health of children and adolescents will likely be an early topic for discussion.

The immense value of public and patient involvement was discussed. It is proposed that lessons learned from events and research projects undertaken within the community will be widely shared. We hope to discuss this in a future community event to test and refine these ideas, removing as many barriers as possible to improve mental health and wellbeing.

Finally, a range of wider partners were identified, who will be approached to help with the practicalities of research, and to make support for the Central and Eastern European community a reality.