• The Digital House of Care: information solutions for integrated care

      Muirhead, Andrew; Howard, Brenda; Ward, Derek; University of Derby (Emerald, 2016-10-17)
      Purpose – The purpose of this paper is to describe the development of a digital tool in an English county striving towards a vision of integrated information that is used to underpin an increasingly integrated future of health and social care delivery. Design/methodology/approach – It discusses the policy context nationally, the origins and implementation of the initiative, the authors’ experiences and viewpoint highlighting key challenges and learning, as well as examples of new work undertaken. Findings – In all, 12 health and care organisations have participated in this project. The ability for local commissioners and providers of services to now understand “flow” both between and within services at a granular level is unique. Costs are modest, and the opportunities for refining and better targeting as well as validating services are significant, thus demonstrating a return on investment. Key learning includes how organisational development was equally as important as the implementation of innovative new software, that change management from grass roots to strategic leaders is vital, and that the whole system is greater than the sum of its otherwise in-silo parts. Practical implications – Data linkage initiatives, whether local, regional or national in scale, need to be programme managed. A robust governance and accountability framework must be in place to realise the benefits of such as a solution, and IT infrastructure is paramount. Social implications – Organisational development, collaborative as well as distributed leadership, and managing a change in culture towards health and care information is critical in order to create a supportive environment that fosters learning across organisational boundaries. Originality/value – This paper draws on the recent experience of achieving large-scale data integration across the boundaries of health and social care, to help plan and commission services more effectively. This rich, multi-agency intelligence has already begun to change the way in which the system considers service planning, and learning from this county’s approach may assist others considering similar initiatives.
    • Digital interventions to promote self-management in people with osteoarthritis: systematic review and meta-analysis - Study protocol

      Safari, Reza; Jackson, Jessica; Dhadda, Buk; Watkins, Merryl; Sheffield, David; Anthony, Denis; Ward, Derek; University of Derby; NHS Southern Derbyshire; Lincolnshire County Council (National Health Service (NHS), 2018-05-11)
      The proposed research is a systematic review and meta-analysis of available randomised controlled trials of digital interventions to promote self-management in people with osteoarthritis. The effects of self-management programs, on patient outcomes such as pain, disability, function and quality of life will be analysed in direct pairwise meta-analysis. The health service outcomes and cost effectiveness data will also be extracted if reported in the papers and will be synthesised narratively.
    • Exploring the long-term influence of the family nurse partnership on the lives of young mothers

      Woodward, Amelia; Ward, Derek; Jackson, Jessica; University of Derby (Oxford University Press, 2017-10-20)
      Background The Family Nurse Partnership (FNP) is an intensive nurse led home-visiting programme for first-time mothers under 19 years old and their babies, run by the English Government. This small qualitative study is part of a larger study which examined the key outcomes of the programme in one UK location. Few studies have explored the experiences of young mothers after graduating from the FNP. The aim of this study was to explore mother’s own experiences of the programme and particularly how the FNP programme has had an impact upon parents and their children post-graduation from the programme. Methods Data was collected using face to face, semi-structured interviews with a purposeful sample of 12 mothers who had graduated from the FNP programme. Mothers were asked about their experience of the programme and their subsequent life-course. The interviews were recorded and then transcribed verbatim. Analysis of the data was conducted using a constant comparative approach. Results The mothers who had participated in the FNP program were very positive about their experiences and talked about the continued impact the programme has had on their lives. Themes emerging from the data included the importance of the supportive nature of the relationship with the family nurse and how participating in the FNP had increased their self-confidence and has empowered them to make positive changes in their lives. Conclusions The interviews found that mothers valued the intervention and it had a long-term impact on the mothers. In addition ways in which the FNP intervention has influenced the lives of clients and their families, that are not routinely measured by the programme were identified. Researchers are now working with the programme providers to support its development of a more flexible intervention model of parenting support so that the beneficial effects of the programme can reach more vulnerable parents. Key messages: •Mothers value the FNP intervention and continue to benefit from the programme after it has finished •Further development and evolution of the model is being undertaken which aims to reach more parents and should be researched.
    • Oral nutritional supplements in care homes and the community: Nutrition review and staff education.

      Giles, David; Lewis, Rachel; Ward, Derek; University of Derby (University of Derby, 2018-03-29)
      The University of Derby’s Health and Social Care Research Centre has been commissioned to support the delivery of Southern Derbyshire CCG’s review of oral nutritional supplements (ONS) and education of care home staff. Southern Derbyshire currently spends £1,409,099 on ONS prescribing (SH3-OT26 PID, 2016). While the efficacy of the use of ONS in malnourished patients is well understood (Agarwal, Miller, Yaxley, & Isenring, 2013), their use may not always be appropriate and other methods such as food fortification may result in either equal or better outcomes for considerably lower cost (Baldwin & Weekes, 2012). A successful pilot in five care homes by Southern Derbyshire CCG achieved cost savings of £183,203.33, along with the associated benefits of increased dietetic support to those residents who required input. On this basis, building on the pilot work, the present programme of work was conceived. Broadly, the project aimed to: (a) improve the nutritional state of residents in 112 care homes and at home; and (b) reduce spend on ONS prescribing. This was divided into two work streams: (1) evaluating the efficacy of a training programme on the identification, prevention and treatment of malnutrition, through a “Food First” approach including MUST training; and (2) the assessment, review and support of GP practices with patients prescribed ONS within their own home. This report provides an overview of the work done by the dietetics team up until the end of February 2018. The analysis of the dataset provides context for the recommendations presented.
    • The role and value of medicines management work packages 1 & 2

      Giles, David; Lewis, Rachel; Ward, Derek; University of Derby (Southern Derbyshire County Council, 2017-07-28)
      Work Package 1 presents the findings and recommendations from the analysis of Southern Derbyshire’s Medicine Management “Work Log” SharePoint data set. The report provides an overview of the work done by the Medicine Management team. The current form and function of the SharePoint data set are also discussed. The analysis of the dataset (Annex Document) provide context for the recommendations presented, which are based on six case studies selected by Southern Derbyshire Medicines Management team. Work package 2 presents the findings and recommendations from our evaluation of the project to embed Clinical Pharmacists in Patient Facing roles within the ‘Belper Five’ group of practices. This element of the report continues to explore the value of medicines management from the viewpoint of the expanded role of the patient facing Clinical Pharmacists within a general practice setting.
    • Synthesis of UK evidence based recommendations for adult obesity prevention and treatment for service improvement and implementation

      Bird, Lydia; Cross-Bardell, Laura; Ward, Derek; Kai, Joe; University of Derby (Academic Health Science Network, 2015-09)
      This is a synthesis of UK evidence-based recommendations for adult obesity prevention and treatment services, produced by the Why Weight East Midlands AHSN team. It is intended as a ‘user-friendly’ summary of existing multiple sets of, often overlapping, guidance from the National Institute for Health and Care Excellence (NICE), Public Health England (PHE) and other sources. This work has been produced in response to consultation with Local Authority, CCG and other public health stakeholders in the East Midlands in 2014-15, many of whom are newly tasked with commissioning, delivering and evaluating public health services in their localities. The aim of this synthesis is to help inform and facilitate service improvement, and the implementation of interventions based on best available evidence or practice. Links to sources and original references are provided in Appendix 1 for users to access further detail. A Why Weight Checklist has also been developed as part of this synthesis (Appendix 2). This is intended to enable users to easily assess ‘where they are at’ or may need to be supporting health improvement in their locale.
    • Using behavioural insights to improve the healthiness of children’s packed lunches.

      Jackson, Jessica; Ward, Derek; Giles, David; Bunten, Amanda; Howell-Jones, Rebecca; Burgess-Allen, Jilla; University of Derby; Public Health England (Oxford University Press, 2017-10-20)
      Background Childhood obesity continues to rise in the UK from 9.3% in children aged 4-5 years to 19.8% by age 10-11. Only 1 in 100 school packed lunches meet national recommendations for school meals in England with 82% containing unhealthy snacks and 61% sugar sweetened drinks. Encouraging parents to identify healthier choices could reduce added sugar content and improve the healthiness of school lunches. Methods A cluster randomised controlled trial was implemented in 17 primary schools (8 intervention, 9 control) in England. The intervention comprised of 3 packs of materials delivered to parents who make children lunches (7-11 years). Materials were designed using behavioural-insights to raise awareness of added sugar and offer healthier options. The materials were delivered over a 4-week period in intervention schools. Photographs of the contents of the packed lunches were taken at 3 time points; 1719 pre-intervention, 1745 post-intervention & 1725 at 3 month follow-up. Visible items in each photograph were coded for nutritional content. A parental survey was conducted at post follow up to explore parental knowledge, attitudes and beliefs about healthier packed lunches. Results The coding and analysis is underway and findings will be presented in November. Presented data will describe group differences pre-intervention, post-intervention and follow up from the >5000 lunch boxes for 1) the number lunch boxes that contain surgery food; 2) the average number of sugary food items; 3) the average grams of sugar in lunch boxes; and 4) the proportion of lunch boxes that contain fruit or vegetables. Conclusions This study was funded by Public Health England to explore whether low cost, low intensive interventions can have a significant impact on changing health behaviours. There is a lack of evidence on improving the nutritional quality of packed lunches and if improvements are identified there are potential implications for child health, nutrition and obesity rates. Key messages: •The study aims to ascertain the effectiveness of a behavioural-insight informed intervention in changing the healthiness of packed lunches provided by parents of primary school aged children. •This low cost, low intensity intervention has the potential to improve the healthiness of primary school age children’s diets.
    • Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial

      Bunten, Amanda; Porter, Lucy; Burgess-Allen, Jilla; Howell-Jones, Rebecca; Jackson, Jessica; Ward, Derek; Staples, Vicki; Staples, Paul; Rowthorn, Harriet; Saei, Ayoub; et al. (Elsevier BV, 2020-10-08)
      Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3–6 (age 7–11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier “swap” items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.