Health services research

The COVID-19 pandemic has posed multiple challenges to the provision of health services. Researchers in the Community and Primary Care Research Group have been undertaking a number of research projects in this area. Dr Sarah Rybczynska-Bunt and Professor Richard Byng have been leading the Plymouth site of the ESRC funded ‘Remote by Default’ COVID-19 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.

Led by Professor Jenny Freeman, staff from the University’s Rehabilitation 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.

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 Rob Witton and Dr Ian Mills investigated the experience of dental staff providing urgent care during the pandemic. Their findings suggested that Dentistry needs to be effectively integrated into wider healthcare infrastructures to improve communication and patient care.

Dr Edward Meinhert has secured funding from the NIHR (Artificial Intelligence in Health and Care Awards) to undertake real world testing of an artificial intelligence-enabled app (Wysa) as an early intervention and support tool in the mental health referral care pathway. According to Edward: “Mental health conditions place a large burden on individuals, healthcare systems, and the economy – and this has only been exacerbated by the COVID-19 pandemic. Waiting times and unmet need are of serious concern, so this project is taking a step to do something about it”.

There is debate regarding the role that inequalities in health care make to overall health inequalities, compared to disparities in sectors such as education, housing and income support. However, inequalities in the use of health care threaten the core NHS principle of health care equity (equal opportunity of access to health care for people with equal needs) and tend to conflict with the public’s understanding of what is ‘fair’. Our research looks at the role that health care inequalities plays in health inequalities, compared to sectors such as education, housing and income support.

Inequalities in the utilisation of cardiovascular care and mental health services have been an important focus of Asthana and Gibson’s research, in part through the use of the use of synthetic estimation techniques (within a Bayesian analytical framework) to develop prevalence estimates. This work has informed their research on formula funding for public services and a growing concern about the interlinked and complex problems driving service need in coastal areas.

As we can increasingly expect to interact with our health services through digital technologies, problems of digital exclusion (Asthana) are becoming an important focus of our research. The ‘Remote by Default’ COVID-19 project, funded through the ESRC, is examining digital communications between patients and primary care practices (and is led by Professor Trisha Greenhalgh from the University of Oxford). Working closely with ‘deep-end’ practices that service highly deprived populations, Rybczynska-Bunt and Byng are leading the Plymouth site which will focus on the impact of remote by default on individuals living in poverty or with complex needs.

In addition to the above some of our members are undertaking research on inequalities faced by specific communities. Dr Andrew Jolly, Lecturer in Social Work, has been undertaking a number of studies on inequalities and disadvantages faced by migrant households, such as the risks of food security amongst undocumented migrants and the implications of social workers of families having no recourse to public funds. 

Researchers in the Community and Primary Care Research Group have been undertaking a range of studies examining community extension of primary and secondary health care services with a view to improving public health. This includes the NIHR’s Public Health Research Programme funded STRENGTHEN project, led by Professor Adrian Taylor which assessed whether additional support via Health Trainers was effective in improving the health behaviours and wellbeing of people receiving community supervision. Similarly the group also led the national study NIHR funded TARS study to investigate whether Health Trainer support was better at helping people quit smoking for longer, compared to existing support, while the e-coachER assessed the effectiveness of the GP Exercise Referral Scheme.

Led by Professor Jonathan Pinkney and Dr Dawn Swancutt, with co-applicants Dr Sarah Baldrey, Professor Adrian Taylor and Professor Richard Byng, the NIHR funded PROGROUP study is examining the evidence base for specialist multidisciplinary (‘Tier 3’) services for obesity, and specifically whether a group-based behavioural intervention can be an effective model of care for these services.

Further details can be found on the group’s public health webpage.  

Social Prescribing is designed to support the non-clinical needs of people who may need support with their mental health, who are lonely or isolated and who have long-term conditions or complex social needs that affect their wellbeing. It tends to comprise both a pathway through which individuals experience services (including, for example, self-referral, a referrer and link worker) and a set of activities or interventions (e.g. nature-based, art based, debt and housing advice)

We have considerable research expertise in social prescribing and host the NIHR-funded academic collaborative for the National Academy for Social Prescribing (Husk, Elston, Carder-Glbert, Cartwright). Husk is currently leading on a project, funded by NIHR and MRC, in collaboration with the University of Sheffield, to investigate how social prescribing might be broadened and offered outside the NHS.

(Husk, Elston, Gradinger, Hazeldine, Byng, Asthana)

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 (Sheena Asthana), architecture (Bob Brown) and primary care (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 (Nasser).