Sustainable, cost-effective health systems

The COVID-19 pandemic posed multiple challenges to the provision of health services and transformed the way the NHS operates – for the first time people were unable to walk into a GP surgery.

This £750,000 project, funded by the Economic and Social Research Council (ESRC) and led by Professor Trisha Greenhalgh from the University of Oxford, investigates what will be required to scale-up and deliver better remote care. Dr Sarah Rybczynska-Bunt and Professor Richard Byng have been leading the Plymouth site of the project which examines digital communications between patients and primary care practices in light of the need to limit face-to-face appointments.

Byng has also collaborated with other academics in the NIHR ARC South West Peninsula (PenARC), and the Peninsula Clinical Trials Unit (PenCTU) to support the rapid reorganisation of General Practice in response to COVID-19.

At the start of the COVID-19 pandemic, access to all face-to-face dentistry was suspended. Urgent and emergency dental treatment was provided from Urgent Dental Care centres (UDCs) that were rapidly established across the country. Research co-authored by Professor Robert Witton and Dr Ian Mills investigated the experience of dental staff providing urgent care during the pandemic. The findings from their study How can dentistry recover from COVID-19? suggested that Dentistry needs to be effectively integrated into wider healthcare infrastructures to improve communication and patient care.

Medical, nursing and Allied Health Professionals (AHP) are crucial players in the NHS’s commitment to becoming a ‘Net Zero’ NHS. The effective implementation of this goal requires strategic vision and resourcefulness from educators, practitioners and students (future leaders).

The climate emergency is also a health emergency, threatening the core purpose of the NHS, putting at risk the health and wellbeing of patients and communities. Unabated, climate change will disrupt care, affecting patients and the public at every stage of their lives. Visionary change-makers, therefore, are crucial to support current and future NHS green leaders. Dr Clare Pettinger has reviewed sustainable eating for nutrition professionals, working closely with her professional body (the BDA) to champion both pedagogic research and practical policy application via the pioneering One Blue Dot Toolkit. This has led to her co-developing the new Greener AHP hub. She is also working with the Business School on ‘collaborative leadership for sustainability in AHPs’ to develop this work further.

Similarly Dr Daniela Oehring , Associate Professor in Optometry, has been undertaking research around healthcare students' and professionals' attitudes towards sustainability and healthcare. This mixed methods project involves an extensive literature review, written questionnaires of healthcare educators and subsequently, and semi-structured interviews of healthcare professionals, academics, and students. It will consider the key obstacles to professionals and students supporting environmental sustainability, and how these can be overcome.

eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC) is a highly collaborative and interdisciplinary project, initially funded in 2017 by a grant of £2.7 million from the European Regional Development Fund (ERDF) and the South West Academic Health Science Network (AHSN), and received a further £4m to extend the project until 2023.

This programme has focused on the production of truly useful innovations which could improve quality of life and boost wellbeing for many.

We welcome ideas that:

Professor Ray Jones
Professor Arunangsu Chatterjee

Professor Rod Sheaff's research focuses on the relationships between organisational structures, production processes and policy outcomes in the health sector, and in public sector and 'third sector' organisations more widely. He has conducted research in these topics in the UK and a number of other countries (including Germany, Italy, Sweden, Russia, USA).

Current and recent research projects including co-commissioning with third sector organisations, the Patient Safety Collaboration Evaluation Study and Integration and Continuity in Primary Care.

With an ageing population, there is an increase in the number of people living with one or more long-term conditions; health and social care services are coming under increasing pressure. Rising and increasingly complex demand is forcing health and social care services to re-think and re-design the provision of service to assure good quality of care whilst ensuring services remains affordable.

Working with services in Torbay and South Devon, PIHR researchers ( Byng , Elston , Gradinger , Asthana ) have evaluated a range of innovations in integrated health and social care, from enhanced intermediate care services to the use of multi-disciplinary health and wellbeing teams. This work is part of a wider programme of research on Person Centred Coordinated Care, which has involved the development of frameworks to measure experiences and outcomes in multimorbid patients and organisational readiness for integration as well as carrying out a series of service evaluations ( Lloyd ).

There are 13.9 million people with disabilities in the UK, many of whom are physically disabled. The Covid-19 pandemic and subsequent reduction in face-to-face appointments has meant people of all ages have received no rehabilitation with the need growing with recovering Covid-19 patients. In response to the crisis, clinicians have found new ways of working and are rapidly adapting and creating telerehabilitation solutions with little, specific guidance, training or support and resulting variation in approaches.

Led by Professor Jennifer Freeman , staff from the University’s Rehabilitation Research Group and Centre for Health Technology , have developed a toolkit for health and social care practitioners, patients and carers to support the delivery of rehabilitation services via remote methods such as video-based and telephone. The Telerehab project , which is funded by NIHR and UKRI, responded to both the decline in face-to-face input during the COVID-19 period and the need to support those recovering from the disease. The project has created a telerehabilitation toolkit and training package for current and future clinicians.

( Freeman , Buckingham, Marsden , Jones , Kent , Demain , Gunn , Logan ).

We have been working with our trust partners to support key developments in health system design including integrated care, the development of health hubs and the Health Infrastructure Plan (HIP2), now New Hospital Programme. As part of this we organised a series of online consultation sessions with academics and key regional stakeholders, from the NHS and industry. Read our rapid review of key issues for the future and our Green Paper, collating the consultation responses.

We have also engaged in futuristic research about what the health system of the future may look like in 2050; what role hospitals and ‘spoke’ hubs may play in the wide system and how can they best be designed for both sustainability and service quality (in terms of e.g. patient flow and therapeutic landscapes). Take a look at our entry for the Wolfson Economics Prize (the hospital of the future) to explore the interdisciplinary work we have been doing between experts in health policy ( Professor Sheena Asthana ), architecture ( Professor Robert Brown ) and primary care ( Professor Richard Byng ) and medical and quality improvement staff from Torbay and South Devon Foundation Trust (Joanne Watson and Susan Martin). Thanks to architecture MA students Josh Earl, Chrisopher Trigg and Aaron Walkley for the great graphics.

As digital technology is expected to play an important role in the health service of the future, we carry our research reviews, work with digital producers, offer test-bed opportunities and evaluate a wide range of digital projects ( Centre for Health Technology ).

Internationally, we have supported the process of setting priorities for research that is responsive to the needs of health system. This includes a meta-research project that developed new frameworks that informed the work of the World Health Organisation, the Cochrane Priority Setting Methods Group (based at the University of Plymouth) and the EVIR funders forum ( Professor Mona Nasser ).