Introducing

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands

October 2013

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We are delighted to have been awarded funding by National

Institute for Health Research to host a Collaboration for

Leadership in Applied Health Research and Care (CLAHRC) in

the East Midlands. As many of you will know, our bid followed a

considerable period of consultation and embodies the ambitions

of many people and organisations across the six counties of

Leicestershire, Northamptonshire, Rutland, Nottinghamshire,

Derbyshire and Lincolnshire. Our application now forms the

template for the next five years of work to deliver world class

research, health service improvement, better patient outcomes

and improved public health. Working with all our partners,

we will make the East Midlands a healthier place to live.

This handbook provides an overview of our plans, partners and

people. It describes what we have set out to achieve and how

it will be done. We will shortly set out various opportunities

to get involved in the CLAHRC East Midlands programme.

If you would like more information about CLAHRC East

Midlands, please contact Bill O’ Leary on wjo2@le.ac.uk

Professor Kamlesh Khunti

Director of NIHR CLAHRC East Midlands

The East Midlands is a great place to undertake healthcare

research and this is reflected by the decision of the NIHR to

award us CLAHRC funding. With £28 million provided over the

next five years we will be able to carry out world class research

that will focus on the health needs of the people of the region.

For me, however, the most important thing is to make sure that

when the research tells us that things can be done better, that

health outcomes can be improved and that we can add life to

years as well as years to life, then we do something about it.

We will ensure that the lessons learned are put into practice

quickly with a focus on delivering safe, high quality, patient

centred care. I was thrilled when, as Chief Executive of

Nottingham Healthcare, I was asked to host the CLAHRC

East Midlands and to Chair its Governance Board. I am

now even more thrilled that we have the opportunity to do

great things for the health of the people of this region.

We must not waste that opportunity and I am confident that

with the skilled and dedicated teams associated with our

CLAHRC, we will make a real difference for our patients.

Professor Mike Cooke, CBE

Chief Executive

Nottingham Healthcare NHS Trust

Foreword

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What is CLAHRC East Midlands?

Following a successful five year pilot, the National Institute for

Health Research (NIHR) has awarded funding to 13 Collaborations

for Leadership in Applied Health Research and Care (CLAHRCs)

across England. CLAHRC East Midlands is one of these.

CLAHRC East Midlands will improve patient outcomes by

conducting research of local relevance and international

quality. It will build on the substantial achievements of the

CLAHRCs for Leicestershire, Northamptonshire and Rutland

(LNR) and Nottinghamshire, Derbyshire and Lincolnshire

(NDL) in bringing together health providers, commissioners,

patient groups, health and research networks, life science

industries and academic institutions to support the NHS

to meet locally identified priorities. The overarching aim of

CLAHRC East Midlands is to improve health outcomes across

the region. More information on CLAHRCs can be found

at www.nihr.ac.uk/Pages/default.as

DERBYSHIREPOP: 1.02M

NOTTINGHAMSHIREPOP: 1.1M

LEICESTERSHIRE

NORTHAMPTONSHIREPOP: 692,000

LINCOLNSHIREPOP: 713,700

RUTLAND

POP: 980,400

YPOP: 37,400

Y

• ONEOFTHEFASTESTGROWINGREGIONS

• HIGHERRATEOFCHRONICILLNESS

• SOCIO-ECONOMICDIVERSITY

• 17.1%POPULATIONAGED65ANDOVER

• 8.5%OFPOPULATIONFROMETHNICMINORITIES

• LOWERLIFEEXPECTANCYTHANNATIONALAVERAGE

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NIHR CLAHRC East Midlands partners

The host organisation for CLAHRC East Midlands is Nottinghamshire Healthcare NHS Trust

East Midlands

East Midlands Academic Health Sciences NetworkEast Midlands Leadership AcademyEast Midlands Local Education and Training BoardEast Midlands Ambulance Service NHS TrustNHS CB Derbyshire and Nottinghamshire Area TeamNHS CB Leicestershire and Lincolnshire Area Team

Derbyshire

NHS Erewash CCGNHS North Derbyshire CCGNHS Southern Derbyshire CCGChesterfield Royal NHS Foundation TrustDerby Hospitals NHS Foundation TrustDerbyshire Community Health Services NHS TrustDerbyshire Healthcare NHS Foundation TrustNHS Hardwick CCG

Leicestershire and Rutland

University of LeicesterUniversity Hospitals of Leicester NHS TrustNHS East Leicestershire and Rutland CCGNHS Leicester City CCGNHS West Leicestershire CCGLeicestershire Partnership NHS TrustLoughborough UniversityLeicestershire County Council

Lincolnshire

NHS Lincolnshire East CCGNHS Lincolnshire West CCGNHS South Lincolnshire CCGNHS South West Lincolnshire CCGLincolnshire Community Health Services NHS TrustLincolnshire Partnership NHS Foundation TrustUnited Lincolnshire Hospitals NHS TrustUniversity of Lincoln

Northamptonshire

NHS Corby CCGNHS Nene CCGKettering General Hospital NHS Foundation TrustNorthampton General Hospital TrustNorthamptonshire Healthcare NHS Foundation TrustNorthamptonshire County Council

Nottinghamshire

University of NottinghamNottinghamshire Healthcare NHS TrustNHS Mansfield and Ashfield CCGNHS Newark and Sherwood CCGNHS Nottingham City CCGNHS Nottingham North and East CCGNHS Nottingham West CCGNHS Rushcliffe CCGNottingham University Hospitals NHS TrustSherwood Forest Hospitals NHS Foundation TrustInstitute of Mental HealthNottingham City CouncilNottinghamshire County Council

Industry

Baxter Healthcare LtdInHealth LtdMSD LtdNovo NordiskPRIMISQbtechSanofi-Aventis

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NIHR CLAHRC for NDL & LNR: Leading world-class research for the past five years

CLAHRCLNR

CLAHRCNDL

CLAHRCEM

CLAHRC East Midlands will build on the strengths of the two

existing CLAHRCs which bring together a wealth of expertise in the

area of prevention and management of chronic disease, public and

mental health, and implementation and improvement science.

DELIVERED OVER 100 RESEARCH & IMPLEMENTATION

PROJECTS

RECRUITED 30,000 PEOPLE

AS RESEACH PARTICIPANTS

ATTRACTED OVER £20M IN EXTERNAL RESEARCH GRANT

INCOME PUBLISHED OVER 300 PAPERS IN PEER REVIEW

JOURNALS

SUPPORTED 30 PhDs

Over the past five years the two CLAHRCs have: produced a

substantial level of high quality studies, delivered over a 100

research and implementation projects, recruited over 30,000

participants, attracted over £20 million of external research grant

funding, published over 300 papers in peer reviewed journals and

supported over 30 PhDs.

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The five themes of CLAHRC East MidlandsPreventing chronic disease (PCD)

This group will address major issues in preventive medicine and public health. It will build on work already undertaken by CLAHRC LNR and NDL, local Biomedical Research Units (BRU), particularly those focused on cardiovascular, lifestyle and self-management therapies, and other strong research groups in disease prevention. It will address emerging challenges in health commissioning. Specifically, the theme will expand the range and reach of lifestyle therapies to promote self-management and initiatives aimed at the promotion of metabolic health and prevention of chronic disease in specific high risk target groups.

Theme Lead: Kamlesh Khunti is a general practitioner with a proven track record in NHS and academic leader-ship, research, innovation, service redesign. He Co-leads the Diabetes & Metabolic Medicine Research Group at University of Leicester which undertakes research into early identification and interventions in people with diabetes and vascular disease, including black and minority ethnic (BME) populations. He is an advisor to the Department of Health’s (DH) National Screening Committee on Vascular Risk, Chair of the DH-Royal College of General Practitioners (RCGP) Committee on the Classification of Diabetes, Chair of the National Institute for Health and Care Excellence (NICE) Guidelines on Prevention of Diabetes, Clinical Advisor for the Diabetes NICE-led Quality and Outcome Framework (QOF) Panel and Secretary of the Primary Care Study Group of the European Society of Diabetes (EASD).

Managing chronic disease (MCD)

This group will generate new knowledge in the priority area of long term conditions. Theme projects will build on previous work undertaken by CLAHRCs LNR and NDL. The theme will examine decision support tools to enhance the timely and appropriate delivery of treatment in primary care, with a focus on diabetes and chronic kidney disease (CKD). In addition, it will examine specific interventions to empower individuals focusing on chronic obstructive pulmonary disease (COPD) self-management strategies and post-cardiac rehabilitation options. It will also explore the use of technology to support self-management in people with chronic disease.

Theme Lead: Sally Singh has an established track record in pulmonary and cardiac rehabilitation. She has major research awards from the NIHR, the Health Foundation, the Medical Research Council COPD consortium and the British Lung Foundation. Her research has focused on the development of outcome measures, service delivery and, more recently, the use of technology to support individuals with cardiac and respiratory disease. She has contributed to national and international committees including NICE advisory and guidelines groups and has co-chaired the European Respiratory Society and American Thoracic Society Statement on Pulmonary Rehabilitation. Sally has also developed and trialled a web based intervention for cardiac rehabilitation that has since been adopted by the NHS Heart Improvement team. Data collected within this programme has been used to model national savings that would accrue from appropriate adoption of similar services.

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Caring for older people and stroke survivors (COPSS)

This group will deliver applied research to improve the health and wellbeing of older people and those who survive a stroke. Theme projects will emphasise co-production between researchers and research users, including patients and public, with collective preparation for implementation and early patient benefit. The theme will assemble a critical mass of research-interested partners from centres across the East Midlands and build capacity by actively developing new researchers and by encouraging and supporting NHS, academic, patient and industry collaboration to exploit research opportunities.

Theme Lead: John Gladman has a substantial track record with more than 25 years of applied health research in stroke rehabilitation and the care of older people. He currently leads the CLAHRC NDL’s Older People’s Health and Wellbeing theme and the East Midlands Academic Health Science Network’s (EM AHSN) Frail Older People theme. Examples of translation of his research into patient benefit include home based stroke rehabilitation, home and bed based intermediate care, and dementia care in general hospitals.

Enhancing mental health (EMH)

This group will co-produce and implement applied research in common long-term mental health conditions with service users, the EM AHSN and NHS primary and secondary care partner organisations. Research and implementation will inform the assessment and management of these conditions in clinical pathways across the East Midlands and build capacity for future work in this area. Clinical conditions addressed by the theme will include depression, health anxiety, attention deficit and hyperactivity disorder in children and adolescents, and dementia.

Theme Lead: Richard Morriss is an internationally renowned health services researcher in mood disorder and the implementation of research. In CLAHRC NDL he is Director of Research and lead of the Adult Mental Health theme. He chairs the NICE Guideline Development Group for bipolar disorder, holds a NIHR programme grant on bipolar disorder and is the lead of the Mood Disorders theme for the NIHR MindTech Health Technology Co-operative. He has developed a number of interventions that have been internationally or nationally implemented on early warning signs of relapse in bipolar disorder, models of care for depression, training interventions for front-line staff on the assessment and management of people at risk of suicide, and the primary and secondary care assessment and management of medically unexplained symptoms.

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Implementing evidence and improvement (IEI)

This group will undertake rigorous research to increase the knowledge base and to advance the theories and methods for translating and spreading evidence-based innovations into routine clinical practice. This will be achieved by evaluating the range of implementation, improvement and translation strategies used by the CLAHRC East Midlands study teams. Transferable lessons will be identified and shared with collaborators, partner organisations, other healthcare leaders and the health and implementation research communities. The theme will also have a support function, advising study teams on appropriate implementation and knowledge translation strategies.

Theme Lead: Justin Waring has been at the forefront of social science research in the area of service improvement, clinical quality and patient safety for over ten years. Justin’s research centres on the analysis and appraisal of complex service innovations as they are implemented in, and interact with, institutionalised organisational and professional practices, especially those related to managing risk and resilience in healthcare. This has included patient safety improvements, information and Computer Technology (ICT) innovations, service redesign, workforce reconfiguration, new organisational form, care transitions and integration and major service re-configuration. In patient safety, Justin’s research has led to changes in reporting and learning systems, including improvements in hospital-based reporting systems, that have informed the work of the National Patient Safety Agency (NPSA) and Royal Colleges. In service re-design and improvement, Justin’s research has supported the local translation and adoption of business and management practices into healthcare settings. More recently, Justin has worked with local service leaders, including CCGs and NHS executives to appraise and redesign discharge pathways to promote the safety of patient care transitions. Justin also consulted and contributed to the Quality Workstream of Lord Darzi’s Next Stage Review, working with the former Chief Medical Officer and with service leaders from across England.

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CLAHRC East Midlands will provide a wide range of

opportunities for stakeholder engagement and participation

across all of its structures, themes and projects.

This will enable intended end-users of research to shape its

selection, design, delivery, dissemination and implementation.

We will pro actively involve patients as co-producers

of research and implementation to ensure that:

• Studies are relevant to the people who use services

• Outcome measures are easily understood by patients

• How people are recruited to studies is effective,

particularly in under-represented communities

• Research findings are understandable by patients

and distributed widely Research evidence is used to

improve peoples’ lives as quickly as possible

CLAHRC East Midlands will also engage with the wider

public across the region. This will take many forms including

the production of leaflets and posters targeted at a general

audience, organising open information-sharing events and

the use of social, print and broadcast media to promote

CLAHRC East Midlands activities and achievements.

Public Involvement (PI) Programme

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Rachel Munton

Director East Midlands Academic Health Science Network

“I see the roles of the EM AHSN and CLAHRC East Midlands as entirely complementary:

CLAHRC will conduct research and implementation studies, whilst EM AHSN has a clear role

in the application of proven interventions at pace and scale across the East Midlands. We

have mature partnerships in the East Midlands on which our collaborations are built, research

expertise, energy and commitment from our higher education and NHS partners. This is all

about the improvement of health outcomes in the East Midlands, and the CLAHRC/AHSN

partnership will focus relentlessly on this core objective.”

There will be close relationship between CLAHRC East Midlands

and the EM AHSN with both of them working to improve the health

of people in the region. The role of CLAHRC East Midlands will be

to undertake world class applied health research across the five

themes with a focus on long term conditions. The evidence from

their research will be then be translated into practical solutions to

local healthcare challenges and, with the support of NHS and other

stakeholders, implemented across the region.

Working with the East Midlands Academic Health Science Network

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CLAHRC East Midlands Research Priorities

The population of the East Midlands is characterized by ethnic,

cultural and geographic diversity and by large disparities in

economic prosperity and health outcomes between different

communities. The priorities for health providers and commissioners

in the region reflect specific local challenges as well as overarching

national priorities. Health issues, such as the prevalence of smoking,

coronary heart disease, stroke, hypertension, asthma, kidney disease,

diabetes, mental health issues and obesity are examples of universal

health concerns that have particular resonance in areas where rates

are above the national average.

A particular consideration in commissioning and delivering health

care is the varied needs of the sizeable ethnic communities in some

areas. For example, in the 2011 census, only 45% of Leicester’s

population described themselves as white British.

Prevalence of Long Term Conditions (LTC) in East Midlands

(19 CCG in Leicestershire, Nottinghamshire, Lincolnshire,

Derbyshire and Northamptonshire).

0% 10% 15%

EAST MIDLANDSENGLAND 2011/12*

Coronary Heart Disease

Stroke/TIA

Hypertension

COPD

Mental Health

Dementia

Diabetes Mellitus

Depression

Chronic Kidney Disease

Obesity

* QOF data. Source: NHS Commissioning Board CCG Information Packs 2013-14.

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Contributions from Matched Funding

NHSTrusts£6m

NHSClinicalCommissioningGroups£4.3m

LocalAuthorities£500k• LocalEducationand

TrainingBoard

LeadUniversities£5.7m

OtherUniversities£225k

Industryandcommercial£1.2m

EastMidlandsAcademicHealthSciencesNetwork£525k

TOTAL£18,417,404

We have generated over £18 million of matched human and

financial resources from our partner organisations whose willingness

to invest heavily demonstrates a strong commitment around projects

of local priority and national importance. This includes support from

our academic partners, local trusts, Clinical Commissioning Groups,

East Midlands Academic Health Science Network, life-science

industry and East Midlands Local Education and Training Boards.

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CLAHRC EM Themes

Our proposal is based on five inter-related themes with projects

led by world-class researchers. The proposed programme

has been confirmed through extensive consultation with our

partners and the public. The first phase projects have been

reviewed by the NIHR Research Design Service East Midlands,

researchers and representatives of the patient groups.

Proposed projects underpin local plans to support prevention

and help people manage their long term conditions. Our

proposal is aligned with the NHS outcomes framework and

the NHS public health and adult social care frameworks.

APPLIED HEALTH THEMES WILL INVOLVE BOTH

RESEARCH AND IMPLEMENTATION

CENTRALSERVICES,MANAGEMENT,ADMINISTRATION,COMMUNICATIONS,PUBLICANDPATIENTENGAGEMENT

PREVENTINGCHRONICDISEASE

(Prof Kamlesh Khunti)

MANAGINGCHRONICDISEASE

(Prof Sally Singh)

CARINGFOROLDERPEOPLEAND

STROKESURVIVORS(Prof John Gladman)

ENHANCINGMENTALHEALTH(Prof Richard Morriss)

IMPLEMENTINGEVIDENCEANDIMPROVEMENT(Prof Justin Waring )

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CLAHRC EM Governance Structure

Our proposal is underpinned by a strong governance and

management structure with the aim of achieving a sustained legacy

in applied health research of direct benefit of our patients. We have

key representation on the Executive group, chaired by Prof Mike

Cooke, who is a strong supporter of the CLAHRC. The East Midlands Partners’ Council of lay people will ensure the

activities of our CLAHRC reflect the issues of greatest concern to

patients and the public and will contribute in the co-production of

research and implementation. The Chair of the Partners’ Council

will also be a member of the CLAHRC Governance Board. Our

scientific committee will be led by an independent Chair.

GOVERNANCEBOARDCEOs, Chairs and COOs of NHS partners, Directors of Public

Health, University Deans, Chair of Partners’ Council, Director of EM AHSN, Representatives from UK CRN Networks and NHS R&D

EXECUTIVEGROUPDirector of CLAHRC EM (Chair), Associate Director and Head of Operations, Theme Leads and Managers, two members of the

Partners’ Council, Representatives of EM AHSN, Representatives from UK CRN Networks and NHS R&D

PARTNERS’COUNCILLay people and patients representing

partner organisations and patient advocacy groups

SCIENTIFICCOMMITTEEIndependent panel of senior

researchers including lay members and industry representation

DIRECTOROFCLAHRCEM

5THEMES

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Strategies for Knowledge Transfer:Embedding Research from CLAHRC EM

Our strategies for knowledge translation will include working with

the Academic Health Science Network, Strategic Clinical Networks

and CLAHRC networks. The award of a CLAHRC East Midlands

will allow us to create an international centre of excellence to

deliver a large volume of high-quality applied health research of

local and national relevance through partner contributions, at

relatively low cost to the NIHR, and build strength and capacity for

world-class research within the East Midlands. Most importantly,

the award would significantly contribute to improving patient care

and ensure “Healthier living for longer” for people with long term

conditions, their families and carers in the East Midlands.

Academic Health Science Network

CLAHRCEMRESEARCH

CENTRES

OTHERCLAHRCs

PATIENTS AND PUBLIC

STRATEGIC CLINICAL NETWORKS

• Cardiovascular• Dementia and

Neurological Conditions

NHS & OTHER HEALTH

PROVIDERS

• CREATEANINTERNATIONALCENTREOFEXCELLENCEINHEALTHRESEARCH

• PRODUCEIMPORTANT,HIGHQUALITYRESEARCHEVIDENCE

• BUILDSTRENGTHANDCAPACITYTOUSERESEARCHEVIDENCETOIMPROVEHEALTHANDHEALTHCARE

WITHIN THE EAST MIDLANDS

CLAHRC East Midlands