Working in partnership

As part of our civic mission, Plymouth Institute of Health and Care Research (PIHR) is committed to working with the local and regional community, always reflecting not just what we are good at, but what we are good for. We can and should make a positive impact on our local area and be a force for change, in part by connecting our research to non-academic stakeholders so that it informs decisions about public policy and professional practice. To understand how we achieve this its important to recognise who our key stakeholders are and how we work with them.

Our stakeholders and how we work with them

Patients and the public

We undertake consultative and collaborative research with patients and the public, recognising that, as the ultimate users of both our research and the health services that our research informs, they are the most intensely affected by the work we do. Their active involvement is not just a right. It ensures relevance.

PIHR has been spearheading innovative approaches to Patient and Public Involvement (PPI), particularly through the use of digital technologies.

How we work with patients and the public

We use conventional and innovative methods in engaging the public in our research. We have built networks and collaborations with patient representative groups such as local MS Society Branches and COPD and Parkinson’s disease support groups. We have explored the potential of including under-served groups in priority setting (Nasser, Quinn, Callaghan) and in health services and clinical research through the development of virtual panels (Neill, Holt).

We work on how to reflect uncertainty in the evidence base, one of the challenges in communication between scientists and the public (Nasser, Hanks); and use immersive and futuristic scenarios to engage the public in complex scientific concepts (Nasser) in collaboration with the Transtechnology Research Group and SEADS network. The latter has also been used as an educational intervention in other interdisciplinary settings like the International Space University Space Studies programme.

Communities

As many health-related problems affecting people are linked to their experiences within families, communities and society, we are committed to understanding and acting upon wider determinants of health, which necessitates inter-sectoral working in place. Examples include our work – often with the support of local voluntary agencies - with some of the most socio-economically deprived communities in the country; and our growing contribution to understanding core-periphery patterns in socio-economic disadvantage and related health risk factors.

How we work with communities

We are committed to working with the most disadvantaged communities, in part to give them a voice in research that is often dominated by more ‘professional’ voices. 

The Centre for Health Technology’s UKRI-funded Pop-Up (Jones, Willis, Asthana), a University-led partnership in the heart of one of the most socioeconomically deprived areas of the country, provided opportunities for residents to explore digital technology and eHealth solutions. We have also introduced and evaluated the use of simple technological devices to reduce social isolation in care homes (Jones) and to promote intergeneration connection (Jones, Willis, Asthana, Chatterjee, Warren, Reyes, Krizaj, Gaudi).

The Peninsula Dental Social Enterprise (PDSE), listed as one of the top 100 social enterprise companies in the country, (Witton, Paisi) is a not-for-profit organisation developed by the Peninsula Dental School. It works closely with local communities, partner agencies, NHS Commissioners, local authorities and national dental bodies to improve oral health and reduce inequalities through education, community engagement, training and treatment. It uses evidence-based approaches to improve access to dental care for all, particularly those excluded from mainstream dentistry. PDSE has developed a community clinic which treats people experiencing homelessness, individuals using drug and alcohol services, as well as vulnerable women at risk of having multiple children removed from their care free of charge. It has won numerous prizes for its work. Further work is underway to broaden access to care to more groups experiencing social exclusion.

In our Community and Primary Care Research group (CPCRG) (Byng, Taylor, Thompson, Callaghan, Quinn) our NIHR funded trials (worth over £6m) have sought to examine the effects of support for improving healthy lifestyles and wellbeing in Plymouth (and other sites) with an aim to addressing health inequalities. We have focused recruitment in Plymouth on the most deprived areas of the city and tailored the respective interventions for those with complex needs who would not normally be involved in research studies. For example, in the e-coachER trial we worked with Plymouth City Council to subsidise the GP exercise referral scheme only for participants coming from practices in the most deprived areas of the city. The STRENGTHEN and ENGAGER studies focused on supporting those with experience of the criminal justice system, and the TARs study recruited smokers who predominantly came from disadvantaged communities. Focusing on these communities has enabled not only stronger links but also greater generalisability from the research findings.

A new collaboration between PIHR (Hickson), Dartmoor Community Kitchen Hub, Torbay and South Devon Trust and the University of Exeter are working to deliver high quality nutritious hot meal delivery to vulnerable older members of the community.

We work with many local charities and community groups such as Plymouth Community Homes, Well-Connected and Millfields Inspired who help us work with schools in the most deprived areas of Plymouth (Joshi). We run an annual SoapBox science Plymouth to promote women in science. This allows them to talk to the public about their research in a friendly and easy way.

Our health and care partners

Our local hospitals are among our most important partners because they are the link to building research capacity within the health and social care system, providing a test-bed for the discovery work that PIHR undertakes and providing a means by which we can translate our findings into accessible treatments and care. In turn, one of the most important services that we offer our local hospitals is the building of research skills so that research can be undertaken that is locally relevant and user-informed.

Health and care professionals are creative problem solvers, who are involved in advancing practice and able to improve clinical outcomes. Healthcare research within nursing, midwifery and allied health professions is emerging and enhancing opportunities can enable this group to maximise their potential in transforming healthcare.

South West Clinical Schools is a collaboration between the University and five NHS hospitals in the South West of England. The initiative encourages nurses, midwives and allied health professionals to look at their practice, challenge current thinking, try out new ideas and work out ways to measure what they're doing.

Supported by academics from the School of Nursing and Midwifery and the School of Health Professions, the main objectives of the Clinical Schools are to: develop capacity and capability for clinical research, evidence-based practice and quality improvement activity; support the nursing, midwifery and allied health professions' leadership within the hospitals; and embed a clear clinical academic career pathway to assist the transition from undergraduate student through newly registered health professional to research leadership roles located within clinical settings.

Our research support and research activities are conducted through the Innovations in Patient Care and Quality (ImPACT) research group.

The South West Clinical Schools support a wide range of activities such as:

  • the Alumni Clinical Research Grant Scheme
  • funded scholarships (supported by Charitable Funds)
  • pre-doctoral, doctoral and post-doctoral colleagues conducting clinical research
  • masters students undertaking Clinical School targeted dissertations
  • hosting international visitors and visiting scholars
  • developing research active interest groups and accredited clinical academic wards and departments, developing and delivering researcher development programmes and seminars with clinicians to support evidence-based-practice
  • the dissemination of research findings, including publication support
  • the centre for ‘novice to expert’ researcher mentorship scheme
  • research grant sourcing and application support and submission, complementing existing resources including the hospital’s Research and Development Departments and Libraries.

The research that has flowed from these collaborations is wide-ranging - from the organisational aspects of care (e.g. workforce, safety and quality of care) to the impact of specific interventions on outcomes for patients. Examples include:

  • A multi-centred feasibility RCT for Children with Cerebral Palsy (ACCEPT) which compares a novel fun intervention aimed at improving walking and balance, with usual physiotherapy care (Rapson).
  • A cluster randomised controlled feasibility study of a nurse-led, holistic assessment and care planning intervention for older people living with frailty in primary care (HAPPI) (Lyndon).
  • We have undertaken several studies evaluating whether the introduction of continuous pressure monitoring, coupled with patient and carer education helps pressure ulcer risk to be self-managed by patients.
  • With clinical staff at Somerset NHS Foundation Trust, we are developing and testing a comfort intervention for cancer patients receiving radiotherapy (CIRT).
  • Research projects at Plymouth University Hospitals NHS Trust include the evaluation of health related quality of life outcomes and the prevalence of post-traumatic stress disorder in survivors of critical care (Tantam).
  • Exploring patients’ and healthcare professionals’ experiences of patient‐witnessed resuscitation (Fiori)
  • Developing and testing a Patient Reported Measure for Emergency Department patients aged 65 and over (PREM-ED 65+) (Graham)
  • Evaluating the impact of peer assisted learning among undergraduate nursing students in the clinical environment (Carey).

Other local partners

Good health and well-being is not something that can be achieved by the health system alone. The Health Creation Alliance suggests that medical healthcare only contributes about 20% to our health outcomes and there is a need for work to be done with people, patients and communities in the ‘80% zone’. 

We support the Alliance’s vision of remodelling our systems for health creation by working with other local partners – public health, the police, education, housing, social services and wider economic regeneration activities. We also support its principles of listening to communities, helping to build connections and focusing on their strengths to find new bottom-up solutions.

Who do we work with?

We work with a wide range of local partners, reflecting our philosophy that good health and well-being is not something that can be achieved by the health system alone. Our local authorities, which house both public health and social care are key partners. Plymouth City Council is a member of our Plymouth Health Innovation Alliance.

Public health
PIHR and public health staff have worked collaboratively on numerous public health related research projects, including mental health (Byng) and behavioural change trials (Taylor); and evaluations of social prescribing across the Peninsula (Husk, Byng, Elston, Gradinger, Hazeldine, Westlake, Asthana). 

The Plymouth Public Health Forum was setup as a collaboration between the University of Plymouth and Plymouth City Council to forge links between public health workers engaged in the region. Quinn, Byng and Asthana are currently involved in a joint NIHR project aimed at addressing barriers, activating facilitators and identifying opportunities to produce integrated solutions for public health research in Plymouth. 

With Cornwall Public Health, we are exploring nature-based interventions for people with Autism (Featherstone, Husk, Asthana) with a view to shaping both local and national practice.

We have also explored the use of arts-based methods, e.g. in our film ‘Food on the margins in Plymouth’ (Pettinger).

Social care
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. 

Using our research in residence model, we have undertaken extensive research into organisational integration and new care models in South Devon and Torbay (Elston, Gradinger, Byng, Asthana), in which social care staff are core members of joined up, multi-disciplinary services. We are also exploring methods of developing social care research capacity by training social workers to carry out research and supporting them through embedded teams in their own social care organisations (Welbourne, Sheaff, Byng, Elston, Gradinger, Asthana).

Other local authority services
Housing and wider economic regeneration plays a key role in shaping health inequalities. 

PIHR (Asthana, Jones) is a stakeholder of the proposed Plymouth Cavell Centre, a community health and wellbeing hub that will not only join health and social care services along with voluntary and community groups, providing a holistic offer to the local population to address the wider determinants of ill health. The range of activities and services provided at the centre will support, and act as a catalyst for, the city’s regeneration programme. 

PIHR members (Elston, Gradinger) have been similarly involved in developing and communicating the vision for health hubs in Torbay and South Devon, and are contributing to the UK Knowledge Mobilisation Forum, a national network of embedded local authority researchers with FUSE (The Centre for Translational Research for Public Health) .

Criminal justice
Led by Richard Byng, the Mental Health Group is working alongside a range of criminal justice agencies and stakeholders to e.g. 

  • shape and define services to better fit the needs of ex-offenders, such as Street Triage and the Neighbourhood Liaison and Diversion intervention
  • services that aim to divert people away from the Criminal Justice System (Callaghan, Hazeldine)
  • develop ways of organising care for men with common mental health problems as they approach being released from prison (Byng, Callaghan, Quinn, Rybczynska-Bunt). 

Parsons has been working with LandWorks, a rural land-based resettlement scheme that works with men released on temporary licence and community sentences to research the benefits of preparing, cooking and sharing ‘good’ food with others as a tool for health, well-being, social inclusion and community resilience. 

Research in the School of Law, Criminology and Government (vulnerability, criminalisation and inequality) also intersects well with our focus on a highly vulnerable population, in terms of all life changes, including health and builds on partnerships (Devon and Cornwall Police, Office of the Police and Crime Commissioner (OPCC) Devon and Cornwall, Devon Rape Crisis, Cornwall Rape and Sexual Abuse Centre (CRASAC)) across the Peninsula.

Education
Because education predicts employment, income and access to material resources as well as psychosocial well-being (and related stress-induced immune changes) and health behaviours, it is arguably the single most important modifiable social determinant of health. 

There is growing evidence of coastal disadvantage with respect to children and young people. Rates of participation in higher education are poor along the coastal fringe, while rates of hospitalisation for self-harm, alcohol and substance use are high. Gibson and Asthana have been mapping these patterns, e.g. for the 2021 Chief Medical Officer’s Report; while Passy works with local schools to explore the practice implications for getting a fair deal for students in coastal areas.

Peninsula Medical Foundation (PMF)
PIHR has a strong relationship with PMF, an independent charity fundraising through work with individuals, communities, businesses, trusts and foundations. Their generous support has enabled PMF to raise almost £4 million since 2002. PMF is motivated by a belief in high-quality basic research and channels the majority of its funding into the Medical School.

Working with businesses

From licensing and co-development of novel technologies with industry to working with SMEs to grow the region’s digital health sector and establishment of spin-out companies to commercialise University IP, PIHR researchers are working with businesses and driving commercialisation of our research, innovation and expertise to deliver real-World impact and economic benefit.

Health Technology
PIHR brings together health and technology expertise from across the University to drive the development, evaluation and implementation of innovative technologies, products, services and approaches to transform health and social care and create an economy of wellbeing. 

This is a core mission for the Centre for Health Technology and the South West Interdisciplinary Technology Consortium for Health and care (SWITCH) Ecosystem. Part of the European Connected Health Alliance and linked to the wider Digital Health Ecosystem Network, SWITCH seeks to incubate, accelerate, embed and export innovative technology solutions in health and care. It provides a single front door for industry, researchers and investors looking for partners, infrastructure and expertise, acting as the go-to innovation enabler for service users, funders and local businesses. 

For example, the eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC) project offers a range of services to local businesses, from academic support to boost innovation, funding support for the development of eHealth innovations, work-based internships, access to a digital and eHealth test bed to access to the EPICentre, our new innovation lab and business facilities.

Plymouth Health Innovation Alliance
The Plymouth Health Innovation Alliance (PHIA) is an interdisciplinary, cross-sector partnership dedicated to developing the profile of and maximising opportunities for health-related research, innovation, knowledge exchange, research and development led business growth and inward investment in Plymouth and the South West region. Centred on Plymouth’s Health Innovation Campus and co-ordinated by the University of Plymouth, the partnership brings together Plymouth City Council, University Hospitals Plymouth NHS Trust, South West Academic Health Science Network, Plymouth Science Park, businesses, health and care organisations, public sector bodies and the third sector, to enhance collaboration and put the region on the health innovation map.

Plymouth Health Innovation Campus
Plymouth Health Innovation Campus is the central component of the City's health research, innovation and economy activity, taking advantage of the existing geographical co-location of many of the City's health innovation assets and expertise that encompass Plymouth Science Park, University Hospitals Plymouth NHS Trust, Plymouth Medical and Technology Park. The Campus utilises the South West's clinical workforce and cross-sector skills base to develop health innovation and enterprise capacity.

Agri-tech
The launch of PIHR is taking us into new collaborations with the Plymouth Faculty of Science and Engineering, including its Agri-Tech unit. The Speciality Crops team is working to validate the cosmetic and pharmaceutical benefits of a range of seaweeds and coastal plants provided by Cornish SMEs, using 3D printing, cell culture and molecular techniques. 

We are also excited by exploring the potential of agri-tech to promote a healthier human microbiome, which has been linked to a range of disease outcomes (e.g. cancer, obesity, Parkinson's, multiple sclerosis and women's health). Recent UKRI Strategic Priorities Funding will see food systems transformation research (led by Pettinger ) focusing on co-production of healthy and sustainable diets for disadvantaged communities.

Commercial activity

Commercialisation of PIHR’s research, innovation and expertise includes activities from spin-out companies developing patent protected innovations and technologies, to utilising our expertise and capabilities for provision of commercial services.

Our local NHS Trust

University Hospitals Plymouth NHS Trust

University Hospitals Plymouth NHS Trust (UHP) is the largest acute Trust in the South West Peninsula, delivering a full range of general hospital services to 270 000 people living in south and west Devon and Cornwall.

Together with Livewell Southwest, an independent social enterprise UHP is an anchor institution in a local integrated care system with almost 10 000 staff. This partnership serves a diverse population with a wide variation in health and life expectancy, within which there are pockets of deprivation. For example, the life expectancy gap between those living in the most and least deprived areas of Plymouth is 4.4 years. 

 Accordingly the mission statement of the partnership`s “People First” program is:

“To support our local and regional population to lead healthier lives and, when the time comes, to support them in dying with dignity in the place of their choosing with their loved ones”

Derriford Hospital including The Royal Eye Infirmary (REI) is also the specialist centre for more than 1.5 million people across Devon and Cornwall , offering the widest range of hospital-based services in the South West Peninsula. Services include emergency, maternity, paediatrics and a full range of diagnostic, medical and surgical sub-specialties as well as many regional specialist services such as the south west peninsula cardiothoracic services, transplant services including kidneys and stem cells, specialist neurosurgical services including interventional radiology (thrombectomy for stroke) ; hepatobiliary and upper GI surgery. It is the major trauma centre for the region.

As host to the South West Medical Defence Group in a city with a strong military tradition, UHP hosts a tri-service staff of 200+ military doctors, nurses and allied health professionals fully integrated within the hospital workplace.

The Trust has a thriving postgraduate medical centre, training multiprofessional staff in clinical skills, simulation, human factors and ergonomics, and hosts the Plymouth Radiology Academy, the only purpose-built Radiology Academy in the world.

Research, development and innovation employs almost 100 people, delivering a portfolio of 550 clinical trials annum (~ 50 commercial) and with access to a comprehensive range of support services: endoscopy, imaging, pathology and combined labs, pharmacy and aseptics. The purpose built Lind centre for clinical research provides a six bed ward facility with capacity for overnight stay, hot lab and genetically modified compound level two capability.

In 2020/21 this capacity and capability, along with our strategy to embed research as part of core business within clinical services allowed UHP to be amongst the leading sites in the UK for COVID -19 trials. Looking forward into 2021/22, R&D, in collaboration with primary care networks in the locality and with NIHR clinical Research Network South West will launch the Mayflower Mobile Research Unit - broadening our trials and research offer to investigators and underserved communities.