University and Care Systems Partnership: Researcher-in-Residence

Organisation: University of Plymouth, Torbay and South Devon NHS Foundation Trust, Torbay Council, NHS Devon
Location: Devon 
Populations served: 286,000 people, plus about 100,000 summer visitors

The Researchers-in-Residence programme is an anchor partnership between the University of Plymouth and the Integrated Care System of Devon, which started with Torbay and South Devon NHS Foundation Trust in 2016 with:

• Researchers embedded within an organisation to work alongside teams helping implementation of new models of care into practice

• Long-term funding to support evaluating new care models

• Development of a new funding model between University and NHS anchor organisations

• Testing and developing the researcher in residence model

The two Researchers-in-Residence, Dr Julian Elston and Dr Felix Gradinger, are part of the Community and Primary Care Research Group at the University of Plymouth, supported by the Director of the Plymouth Institute of Health and Care Research (PHIR) Professor Sheena Asthana, and the Deputy Director of the National Institute of Health Research (NIHR) Applied Research Collaboration South West Peninsula (Pen ARC), Professor Richard Byng.

Impact of the programme

The team were co-producing with system-wide stakeholders evaluation and research evidence around personalised care. This included implementation research on horizontal and vertical integration across the system and exploring impact of intermediate care services including social prescribing (link-workers and wellbeing coordinators, as part of multidisciplinary teams in community settings), a model that is currently rolled out in Singapore at an industrial scale.

The programme has been successful in attracting research and evaluation funding commitments to the University and Devon to the total value of £1,373,043, with a £3.25 to £1 return on investment from the perspective of NHS and Local Council matched-funded contributions.

In terms of social prescribing, due to the track record of the Researchers-in-Residence in Torbay, they were commissioned to support the STP social prescribing roll-out across Devon. This is closely aligned with NHSE/I personalised care work nationally, and the Southwest Academic Health Sciences Network’s Institute of Social Prescribing. As an example of national impact, findings from a rapid survey of PCN link-workers and other social prescribers in Devon were used by the National NHSE Lead for Social Prescribing and GP, Sir Michael Dixon for policymakers to allocate additional £3,000 per link-worker, to support infrastructure costs for VCSE employing them. See a blog from the RIR and her experiences of being embedded during the pandemic here: Researcher in Residence under Covid: when the residence is home - University of Plymouth

Over the past six years, the team have engaged with over 200 stakeholders (as active partners, not research subjects) within acute and community services, general practice, the voluntary sector, the CCG and the wider health and social care system (ICS), including patients and the public. They have also inputted into over 250 meetings, forums and events and presented emerging findings to system stakeholders on over 50 occasions. The team has presented at 8 regional and 8 international conferences, and disseminated findings across the regional footprint (STP, AHSN, CCGs, Healthwatch) as well as nationally (NHS-E Personalised Care Team/Evidence Unit, HALN, NHS Futures Collaboration Platform etc).

Coastal ‘Zoo’ events: there have been 15 events during the period that have showcased the work and impact of the enhanced intermediate care team in Coastal locality, based on the evidence from the research and in collaboration with frontline staff. These have been attended by politicians (Jeremy Hunt, Secretary for State at the time), health and social care leaders (NHS England, NHS Improvement and Monitor), senior managers, GPs and practitioners from across ICS Devon, Isle of Wight and Sussex, Chris Whitty’s team, and repeat visits from delegations from Singapore (most recent online conference with frontline staff presenting in November 22).

Reports have been provided to the organisation throughout the period of the project. These have been shared at Board level, at regional level and at the international conferences. Ten academic, peer-reviewed papers have resulted from the work, building a unique, contextually-rich, and internationally-relevant evidence base for integrated care, which has been scarce in the literature and raising the profile of this unique academia-practice partnership nationally and internationally.

Academic outputs won several accolades, with the paper on embedded research impact highlighted as ‘Editor’s Choice’, and the most recent social prescribing article recognised as ‘Outstanding Paper’ in the 2021 Emerald Literati Awards. The team is most proud of their evidence securing ongoing commissioning to the umbrella partnership of 23 Voluntary, Community and Social Enterprise (VCSE) partners, and helping one of them winning ‘The Queen's Award for Voluntary Service’ in 2021.

How the programme was delivered

The use of embedded researchers or Researchers-in-Residence is a relatively new approach to applied care systems research, with a national NIHR study led by Professor Martin Marshall reporting recently (see recent NIHR alert, from 09.11.22).

The Researcher-in-Residence model was initially funded by a local charitable funder for three-years, recognising that evaluating the impact of any care model would take longer than a year. The NHS Trust has continued to support the RiR model, recognising the returns and continuing need to evaluate and iterate the findings of the care model as more evidence emerges. The University of Plymouth’s have matched this level funding by waiving salary costs for the two Professors and the Full Economic Costing (FEC) of the University research, that is normally applied to all funding applications at 100% of salary costs. This is the first time this has been done, as far as we are aware with an NHS organisation.

At the core of the approach lies a matched-funding model, i.e. the simple but hard principle of pooling resources and expertise for mutual benefit to all stakeholders (analogue to the principle of the delivery of integrated services). Pooling ensures buy-in, helping to overcome access issues and align expectations.

What is the future of this programme?

The RiR model offers a valuable and cost-beneficial approach to growing and developing evaluation and research capacity within the Peninsula health and social care system.

Developing and applying research into practice is recognised as a significant, on-going challenge for academia and the NHS, and local authorities. The RiR model has shown to be effective to both contribute to an evidence base for complex, multifactorial inventions (integrated care model), alongside a cost-effective model of how to achieve this (the Researchers-in-Residence model), with subsequent spin-off research benefits and national impacts.

We argue, therefore, that this approach offers a potentially sustainable impactful, relevant and rigorous approach to research, evaluation, and improvement.

The significant investment that has been made in the building of relationships and networks over the past six years offers a unique repository of organisational memory, knowledge and experience. This is valuable to the Universities of Plymouth and Exeter and the host organisation, as well as the wider Integrated Care System of Devon.

We are currently working on at least six projects to continue with this mutually beneficial partnership through matched-funded sources with a particular focus on:

• The New Hospital Programme (NHP). The University, led by Professor Sheena Asthana, has already begun a process of consultation around NHP, by holding a series of workshops comprising academics and NHS staff to discuss effective health service design, hospital design (with an emphasis on how to support sustainability, well-being, and productivity) and digital infrastructure.

• Continued, dedicated evaluations of specific service innovations and national policy priorities, e.g. nationally mandated programmes like the Population Health Management, Enhanced Health in Care Homes (EHCH), and PCNs through a range of local funding mechanisms.

• Distribution of dedicated projects to include wider ICS/PCN footprint; including voluntary sector and social care (based on current, externally funded projects like National Institute of Health and Care Research).

Advice for others doing similar work

Our key messages are:

• Understanding of what research and evaluation can answer and the time-frame required. Learning is a reflective process based on implementation and evaluation, and won’t provide quick answers.

• It takes time to implement change, and even longer to evaluate its impact. We have mainly evaluated transactional change focusing on delivery of service elements of the care model. However, analysing transformational change i.e. changing culture to service management and delivery takes persistence, and therefore takes longer to do. It is more challenging to evaluate and requires clear frameworks, training and support against which the changes can be judged.

• Timing: commitment from the team implementing a new service or intervention to an evaluation at the outset and their engagement in designing and delivering it will result in more robust findings and meaningful learning.

• Access: identifying and working with service champions and going where the energy is more likely to result in completed evaluations. We have seen this to be most effective when working with clinical champions, frontline staff, and middle managers.

• Mixed method approach: evaluating integrated care will more likely than not require quantitative and qualitative data to undertake a rounded assessment of its impact on service users, care-givers and staff. Evaluation is likely to require additional data collection, some of which could be part of routine service improvement i.e. patient experience.

• Analytical capacity: Despite an interest and desire to engage in evaluation, lack of organisational capacity and capability to retrieve, link and analyse data is preventing organisational learning in its basic form.

• Service user and care-givers voice (in their many forms) do not appear to drive service improvement or inform learning systematically. Engaging service users can provide motivation not only to change delivery but also in a way that will improve the experience and care of users.

• Role of the Researcher-in-Residence. The role needs to be agnostic to the system, and it is important this is supervised by senior academics one step removed. The Researchers can act as a bridge between academia and organisations and draw in resources through networks and relationships. Partly co-locating them with teams enables relationship building.

• Sharing difficult messages needs to be managed carefully to avoid risk of disengagement.

• Critical mass is important. The advantage of having two senior researchers with complementary skill-sets has been extremely beneficial both providing ongoing resilience to the service and different perspectives to bring to research and evaluation.

As per existing research evidence working with early adopters and champions is crucial for this and to do so at every level. This programme benefitted hugely from a Senior Manager and Quality Improvement Lead brave enough for much needed disruptive leadership who went the extra mile, and also from champions at every level of the organisation from members of the public, to frontline teams and Senior Leadership (bottom up, middle out and top down). It also required academics to learn a whole new set of skills so learning is always mutual.

For more information about the programme, contact Dr Felix Gradinger at felix.gradinger@nhs.net