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The Public Health cross-cutting research theme works across the NIHR ARC to enable and enrich approaches to research, evaluation and intervention development that maximise the impact of our work on health inequalities. We will prioritise the development and evaluation of interventions to tackle poor health among those at greatest risk and across the whole community, while examining their effect on the differences in health between rich and poor.
Our focus reflects local health patterns, in particular the fact that coastal communities of Kent and Sussex generally experience markedly worse health and wellbeing than other parts of our region. These include high rates of poor mental health and heart and lung conditions.
These challenges predominate in areas relatively isolated by geography, with low economic growth and poor employment opportunities, alongside populations of older people vulnerable to isolation who often moved to coastal communities in retirement. These communities often host significant numbers of refugees and looked after children who have particular health challenges. Smoking and obesity are more common than in more affluent areas.
Working with other NIHR ARC KSS Themes, we also address the needs of older adults with co-morbidity, and younger populations at times of transition, and how these are affected by place and other structural factors.
To produce new interventions and evidence that prevent adverse health outcomes and reduce health inequalities in early, adult and later life.
We will use Theme funding to work closely with other Themes to enhance understanding of health inequalities and how they can be addressed, and to focus on our own four sub-themes:
- Mental and physical health and their interdependence.
- Substance use and its impact on mental health, sexual health and blood borne virus prevention in adolescents and young adults.
- Social prescribing and preventive interventions for the mental and physical health of elderly people living at home or in residential or nursing care settings.
- The physical, mental and sexual health of looked after children/young people and under 25s living separated from primary family/kinship groups.
During the early Covid-19 epidemic, we worked with local authority public health partners and academic colleagues on projects aimed at optimising the pandemic response for key vulnerable populations and sectors.
- Improving information and communication with migrant communities.
- Understanding and responding to the challenges of receiving patients into community care settings during the pandemic.
At the same time, we worked with other Themes to support their ability to address health inequalities at population level, including the Unlocking Data project led by Dr Elizabeth Ford.
Our work on The relationship between mental health, sexual health and blood borne viruses takes the form of a doctoral study.
Looked after children (LAC) are the focus of another doctoral project, The Mental Health and Well-Being needs of Looked after Children in South East England, working closely with the Starting Well theme to draw on the range of expertise in this area across the ARC.
Building on our Covid-19 work with care home and domiciliary care staff, we have worked with the Social Care theme to establish a community of practice. This group is working with us to prioritise place based and health inequalities work in these settings, supported by our Public Advisor Joy Fletcher who has extensive relevant expertise. For additional information please contact Oluwafunmilayo Vaughn or Stuart Jeffery.
We have established a Public Health Community of Practice across Kent Surrey and Sussex, open to practitioners and academic colleagues across the region. This group provides advice support and challenge to our core projects, and enables us to support other themes in focussing on health inequalities and access a wide range of public health advice and input across the whole ARC portfolio.
Discharge to Assess Pathways (D2A)
Does a discharge to assess programme introduced in England meet the quadruple aim of service improvement?
Researchers from the Applied Research Collaboration Kent, Surrey and Sussex (ARC KSS) have published their findings following an evaluation of a local discharge to assess service. Across the country, discharge to assess pathways were given a significant boost in funding during Covid-19, expanding and extending their reach to further improve the appropriateness of long-term care needs following discharge from acute care. The pathway reduces acute length of stay by moving the point of detailed assessment for ongoing care from the acute hospital into the community with the full assessment 4-6 weeks post discharge. This allows for a period of rehabilitation prior to assessment of long term need within a more suitable environment for the assessment to take place.
Along with local recommendations for the service, the evaluation found evidence that the development of the service had met the fourth aim in the ‘quadruple aim’ of service improvement. Quadruple aim builds on the widely used triple aim (‘improving the experience of healthcare’, ‘reducing the cost of provision’ and ‘improving the wider health of the population’) by adding in ‘improving the work life of staff’. Very few papers have explicitly considered quadruple aim as an outcome framework.
Click here to view the publication
This initial evaluation has formed the basis for a wider study that is underway across a variety of places in Kent, Surrey and Sussex. This follow on study is focused on the community elements of the pathway and patient experience. It will make recommendations for good practice that are hoped to help inform other systems across the country.
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