‘Improving health and wellbeing through Research’ Preston Football Club 17 th October 2014

1. ‘Improving health and wellbeing through • Research’ • Preston Football Club • 17th October 2014 Improving health and wellbeing through research – October 2014

2. #LCFTresearch @Lancashirecare

3. Professor Heather • Tierney-Moore • Chief Executive • Event Welcome Improving health and wellbeing through research – October 2014

4. Dr Heather • Iles-Smith • Research & Innovation Lead • “Improving health and wellbeing through research – LCFT strategy refresh” Theme: Research Successes Improving health and wellbeing through research – October 2014

5. Overview • National picture • Local picture • Research strategy • Objectives • Current research • Challenges

6. Why we do research NHS Constitution - To develop new medicines, medical devices, therapies and clinical services - To facilitate access to new medicines/devices /therapies for LCFT Service Users - To add to the evidence base - To embed evidence based practice within LCFT services

7. National Picture • Transformations of NIHR Research Networks- 25 to 15 nationally • Clinical Specialities 6 Divisions • NW Coast Clinical Research Network (NWC CRN) • includes Liverpool, Merseyside, Lancashire & South Cumbria • Division 1- Cancer • Division 2- Diabetes, stroke, cardiovascular disease • Division 3- Children, reproductive health and childbirth • Division 4- Dementias and neurodegeneration (DeNDRoN), mental health • Division 5- Primary care, Ageing, Health services research, dental health, Public health, Muscoskeletal disorders • Division 6- Anaesthesia and pain management, critical care

8. Local Picture • Overall LCFT has a balanced research portfolio- grant based and NIHR portfolio research • Lack of equilibrium between mental health and community services and between professions • Clinical academic researchers • 6 in mental health (all medical) • 0 in community services • 0 joint appointments for Nurses, Allied Healthcare Professionals, Pharmacists or Psychologists • Contribution to the NIHR portfolio (2012/13) • 24% mental health • 76% community services

9. Local Picture- Performance

10. Research strategy Vision To improve the health and wellbeing of patients and service users within Lancashire Care Foundation Trust (LCFT) through embedding research and evidence based practice in clinical services

11. Research Strategy Objectives Main objectives:- Objective 1: Increase access to research for our patients and service users Objective 2: Increase research capacity building within the Trust particularly within the Community Services Objective 3: Increase research culture of the organisation and embed research within each of LCFT Clinical Networks Objective 4: Increase service user/carer involvement in the research process Global enabler Establish financial security for LCFT research activity

12. Current Research • TechCare- Dr Husain, Consultant Psychiatrist, Senior Lecturer • A mobile assessment / therapy for Psychosis • An intervention for clients within the early Intervention service. • Randomized, double-blind Placebo-Controlled, Trial of Gantenerumab in Patients with Mild Alzheimer’s Disease- Dr S Karim, Consultant Psychiatrist Older adults • To reduce or slow down amyloid plaque build up (one cause of Alzheimers) • May improve cognition and function in early Alzheimers

13. Current Research • Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial- Professor Max Marshall, Medical Director • The Lancet, May 2013 (381:9878:1634-1641) • C-GLOVES. An evaluation of the effectiveness of compression gloves in arthritis: a feasibility study- Jenny Welsby, Specialist OT, Rheumatology Department • Occupational therapy study investigating the use of pressure gloves in rheumatoid arthritis.

14. Challenges • Development fit for purpose Clinical Research Facility • Financial stability • Maintaining/growing grant income • Increasing industry studies • Capacity building • focussing on nurses, AHP’s, pharmacists and psychologists • Fellowship applications

15. Thank You for listening….. Web page:- http://www.lancashirecare.nhs.uk/about-us/Research-Innovation.php Please contact us at:- Heather.iles-smith@lancashirecare.nhs.uk R&I@lancashirecare.nhs.uk

16. Professor • Jenny Shaw • Clinical Director for Specialist Services & R&D Director • Mental Health Screening in Police Custody In England: Developing a screening tool and referral pathway Theme: Research Successes Improving health and wellbeing through research – October 2014

17. Mental Health Screening in Police Custody in England:developing a screening tool and referral pathway From the inside out: Healthcare in custody and the criminal justice system

18. Detecting mental illness in Police Custody • Higher rates of mental health problems amongst people in contact with the criminal justice system • Prevalence amongst police detainees • estimates vary • 2%-20% of police detainees have mental health issues (Bradley 2009) • Early identification of mental ill health is a current UK Government priority

19. Policy Priority • Early intervention • Liaison and Diversion • Increasing access

20. The Problem • Mental health screening procedure is not sufficiently robust • identifying the ‘known knowns’ • Non mental health trained personnel • Whose job? • Inconsistent mental healthcare services in custody • Lack of 24 hour cover

21. Research Team Dr. Jane Senior University of Manchester Miss. Heather Noga Lancashire Care NHS Foundation Trust Prof. Jenny Shaw Lancashire Care NHS Foundation Trust / University of Manchester Miss. Susan Tighe Lancashire Care NHS Foundation Trust Dr. Elizabeth Walsh University of Leeds This presentationoutlines independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (PB-PG-0808-17154). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

22. Aims/Objectives • Oct 2010 – Sept 2013 • Aims • Improve current practices in police custody • Develop a referral decision tool • Objectives • Identify and critique current procedures • Develop a mental health referral tool • Develop accompanying training and implementation package

23. Method • Participants • Mental Health Professionals • Police Officers • Service Users

24. Method

25. Results • Agreement that a screening tool should be; • short, simple language • questions mixed with free text observations • current issues • mental health, risk of suicide / self-harm • sensitive • facilitate dialogue

26. CMHS “In a custody environment it would need to be shorter and simplified- detention officers would have difficulties” “Not relevant for custody, too complicated and vague” “The questions don’t really get to the core of the problems and would miss people with severe mental health issues”

27. PriSnQuest “It is brief, therefore quick to complete and less likely to be overlooked or cut short” “Simple and straight forward” “Questions are clear, specific, easy to understand and likely to get the answers that they are looking for”

29. PolQuest • 14 Item Screening Questionnaire • Administer in 5 minutes • All Adult Detainees • Corresponds to a referral pathway

30. Scoring

31. Scoring

32. Referral Pathway

33. Training and Implementation • Implementation Manual • ‘How to’ practical guidance

34. Impact • Screens everyone in custody • Clear referral process • Early identification • Economic use of services • Provides standardisation of care

35. Future Directions Feasibility Study • Implement in real life-one custody suite • Identify issues in application • Design full scale trial

36. Thank you Jenny.shaw@lancashirecare.nhs.uk

37. Dr Waquas Waheed • Consultant Psychiatrist • “Partners 2” Theme: Research Successes Improving health and wellbeing through research – October 2014

38. PARTNERS 2 Development and Pilot Trial of Primary Care Based Collaborative Care for People with Serious Mental Illness

39. Overview of the Purpose of the PARTNERS2 Programme Grant We aim to help primary care and community based mental health services work more closely together. • Develop a system of collaborative care based in GP surgeries where service users are seen regularly by a mental health worker who acts both as overall co-ordinator (supporting individuals to access other services and activities) and therapist. • At the end of the 5 year Programme, we will know if collaborative care for people with schizophrenia and bipolar disorder in England is likely to work.

40. Work stream 1: Assessment of local care pathways and current services for people with severe mental illness Work stream 2: Development of a core outcome set for use in mental health trials involving people with schizophrenia or bipolar disorder in a community based setting. Work stream 3: Development of the system of collaborative care.

41. Developing the grant application 1: Reilly S, Planner C, Hann M, Reeves D, Nazareth I, Lester H. The role of primary care in service provision for people with severe mental illness in the United Kingdom. PLoS One. 2012;7(5):e36468. 2: Reilly S, Planner C, Gask L, Hann M, Knowles S, Druss B, Lester H. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev. 2013 Nov 4;11:CD009531.

42. Building the team Experts in Collaborative care Primary care Schizophrenia and Bipolar disorder Qualitative researchers Trial Methodologists Health economics Biostatistics Service users International partners

43. Contact details: Dr. Waquas Waheed, Consultant adult psychiatrist at Lancashire Care NHS Foundation Trust and North West Hub Lead. 01772 773 515, waquas.waheed@lancashirecare.nhs.uk Maria Cox, PARTNERS 2 Research Assistant at Lancashire Care NHS Foundation Trust, Lantern Centre, Vicarage Lane, Fulwood, Preston, PR2 8DW. 07943 092217, maria.cox@lancashirecare.nhs.uk Jill Barlow, Research Studies Officer, Liverpool Science Park, Innovation Centre 1, 131 Mount Pleasant, Liverpool, L3 5TF. 07818 521 738, jill.barlow@nihr.ac.uk Or Visit: www.birmingham.ac.uk/partners2

44. Dr Lizzy MacPhie • Consultant Rheumatologist • “Finding Time for Research in a Busy Rheumatology Department” Theme: Developing Clinical Research Improving health and wellbeing through research – October 2014

45. Finding Time for Research in a Busy Rheumatology Department Lizzy MacPhie Rheumatology Department Minerva Health Centre Preston

46. Overview • The Rheumatology Service • The challenges & solutions • PPI • Portfolios studies

47. Rheumatology Service • Transferred to community in Sep 2010 • Based at the Minerva Health Centre • Complete service redesign • 0.6 WTE consultant at transfer • 3 WTE consultants now in post

48. Service Developments • Weekly MDT & lunchtime educational meetings • Pathway days to inform service development • Regular patient support group meetings • Launch of website

49. Challenge 1Limited Research Experience • Historically patients considered for clinical trials all sent to Wrightington • No engagement with portfolio studies • No engagement with CLRN • Consultants little academic experience

50. Solution • Networking • Met with CLRN (Prof Goodacre) • Introduced to CLRN nurses • Spoke to Rheumatology colleagues “The Alliance”