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Research by Community and Health Research Unit (CaHRU) broadly impacted on healthcare provision and care received by patients from ambulance services. The research directly informed policy and was a key factor in improving prehospital care for emergencies by directly influencing care systems, regulators, ambulance services, paramedics, and service users, initially in the East Midlands and subsequently throughout England from 2008 onwards.
The research which aimed to improve quality of ambulance care led to: development of new clinical quality indicators for ambulance services in England; benchmarking of service quality; initiatives to address gaps in care; measurable improvements in managing pain, heart attack, stroke, asthma and diabetes across all English ambulance services. Regulators now use these quality indicators to assess ambulance trusts in England.
National and international policy on the use of competition in health care since 2006 has been strongly influenced by a series of studies conducted at the University of Bristol led by Professor Carol Propper. By providing compelling evidence on how competition affects patient care, these studies have had a major impact on policy design at the highest levels. The research has underpinned a series of political decisions to use competition and choice in the NHS and informed the design of the current regulatory structures to support these policies. Specific decisions influenced by the research relate to the structure of prices, policy on mergers, and policies to promote greater use of choice and competition to benefit patients and taxpayers.
Improving patient experience of health services is a policy priority worldwide. The University of Manchester (UoM) has conducted research on patient experience since 1995, leading to the development of a series of validated measures for assessing patient experience of quality of care in primary care, including access to care and the degree to which services are patient-centred. Our measures have been in routine use in the NHS since 2004, sent to samples of several million patients. The data have been used to provide incentives for the highest quality practices, and to inform policy makers about current care throughout the UK.
Care provided to patients by emergency ambulance services is changing nationally and internationally. For example the proportion of 999 calls in England resulting in conveyance to hospital fell from 68% in 2007-8 to 55% in 2012-3. Professor Snooks of Swansea University and colleagues have collaborated with clinicians, policy makers and academics to identify approaches more cost-effective than routine conveyance to Emergency Departments (EDs) for many patients. International application of Snooks's evidence that telephone advice, decision support and referral pathways are safe and effective has reduced unnecessary attendance at EDs and costs without compromising patient experience, safety or quality of care.
This case study focuses on the research conducted by members of the UoA examining the services offered to service users and carers in secure settings. This includes forensic mental health services and prisons. It has had a significant impact on the development of professional practice in secure settings based on the views, experiences, and needs of service users and carers. It has established service user and carer engagement in research conducted in secure settings. It has also informed service and policy developments in the United Kingdom and internationally.
Work led by Professor Nick Barber at the UCL School of Pharmacy showed that a majority of patients have problems soon after starting a new medicine for a chronic condition, and this led to the development of a post-consultation intervention by pharmacists that was shown to be more effective and cheaper than normal care. This entered Department of Health policy for pharmacy in 2008 and Barber helped design the New Medicines Service that was launched in October 2011. This service is offered by community pharmacists in England and by the end of May 2013 over a million patients had received the service. The intervention increases patient adherence to medication, thus improving quality of care, and reducing cost to the NHS from wastage. It also improves patient safety through better identification and resolution of adverse effects.
Work on better management and identification of Medically Unexplained Symptoms (MUS) has led to the introduction of new treatments in primary care in England through the Improving Access to Psychological Treatment (IAPT) programme as well as having an impact on service planning and commissioning. These approaches have also been implemented into the routine training and practice of General Practitioners (GPs) in parts of Europe. A clinical and economic evaluation of a psychosocial approach to chronic fatigue syndrome using general nurses and development of a cognitive behaviour therapy approach has changed general practice and enhanced the patient experience for those with MUS.
Research carried out by LSHTM to develop and test patient reported outcome measures (PROMs), which measure health outcomes from the patient perspective, has demonstrated the feasibility of routinely collecting such measures before and after elective operations. In 2009, the Labour government mandated that PROMs should be collected on all NHS patients in England undergoing one of four surgical operations, a policy endorsed by the coalition following the 2010 election. This remains the only nationwide programme of its kind worldwide, providing essential data for comparing providers' performance, patient choice and other quality improvement approaches.
Between 2006 and 2008 an evaluation carried out by the University of Sheffield of the National Infarct Angioplasty Pilot showed that primary angioplasty for ST-elevation myocardial infarction (heart attack) is feasible, cost-effective and acceptable to patients and carers. As a direct result, a new national strategy using primary angioplasty was published in the National Service Framework for Coronary Heart Disease. National audit data has since shown the proportion of patients receiving primary angioplasty increasing from 42% to 73% and mortality falling from 10.6% to 8.7%. An impact assessment based on our economic analysis estimated a £294 million net benefit to the NHS.
Beneficiaries of this research are patients in intensive care and healthcare staff. This research has had impacts in two distinct but related areas:
These advances are informed by our synthesis and application of rigorous, innovative methodologies relating to questionnaire development and real-time data collection.