Health services research

There is debate regarding the role that health care inequalities makes to health inequalities, compared to 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’. 

Insofar as differential use of preventive, screening, treatment and rehabilitation services can influence rates of disease, survival and well-being among different groups, inequities in health care may also compound the disadvantages conferred to health status by socio-economic position. This would undermine the second core principle of the NHS: that it should contribute to the reduction of avoidable inequalities in health.

Health services research looks at the role that health care inequalities plays in health inequalities, compared to sectors such as education, housing and income support and is led by the Plymouth Institute of Health and Care Research (PIHR).

Inequalities in health care

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.

Health management and commissioning

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.

Integrated 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).

Social prescribing

We have considerable research expertise in social prescribing and host the NIHR-funded academic collaborative for the National Academy for Social Prescribing. 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) (Husk, Elston, Gradinger, Hazeldine, Byng, Asthana).