best research for best health · overview 4. i) overview of the excellent applied health research...

NIHR Collaborations for Leadership in Applied Health Research and Care Application Form Application reference: CLAHRC-2013-10025 1

COLLABORATIONS FOR LEADERSHIP IN APPLIED HEALTH RESEARCH AND CARE

APPLICATION FORM

DETAILS OF THE PROPOSED COLLABORATION

1. Host Organisation

Proposed Host Organisation: Cambridgeshire and Peterborough NHS Foundation Trust Elizabeth House Fulbourn Hospital Cambridge CB21 5EF Host Organisation lead for this application:

Dr Chess Denman Medical Director Address as above [email protected] 01223 726789 Name, job title and address of the individual who is authorising this application on behalf of the Host Organisation (e.g. NHS Trust Chief Executive):

Dr Attila Vegh Chief Executive Address as above Address as above [email protected]

Proposed Director

Prof Peter B. Jones Head of Department Psychiatry Hon consultant psychiatrist, CPFT Director, NIHR CLAHRC CP CLAHRC Office Douglas House 18b Trumpington Road Cambridge CB2 8AH [email protected] 01223 336961

mailto:[email protected]




Organisations within the proposed NIHR CLAHRC

Cambridge Biomedical Research Centre Cambridgeshire Community Services NHS Trust Cambridgeshire and Peterborough CCG Cambridgeshire and Peterborough NHS Foundation Trust Cambridgeshire County Council – Children, Families and Adults Services Cambridge University Hospital NHS Foundation Trust Eastern Academic Health Science Network Health Education East of England (HEEoE previously known as EoE LETB ) Norfolk and Suffolk Dementia Alliance Norfolk and Suffolk NHS Foundation Trust Norfolk Clinical Academy for Dementia Public Health England Knowledge and Intelligence East Rescon Ltd University of Cambridge - Department of Psychiatry, Institute of Public Health, Engineering Design Centre (EDC), Judge Business School (JBS). University of East Anglia: Faculty of Medicine and Health Sciences University of Hertfordshire - Centre for Research in Primary and Community Care

ABSTRACT

2.

NIHR CLAHRC East evolves from the CLAHRC for Cambridgeshire & Peterborough. It will focus world-class applied health research onto the priorities of the Eastern AHSN, accelerate innovation and act as a national resource. Reaching throughout the East of England, the new, extended collaboration harnesses strengths in the Universities of East Anglia, Cambridge and Hertfordshire; it aims at international impact. NIHR CLAHRC East focuses on improving the health and wellbeing of vulnerable people in complex health systems while retaining a population health view. Research themes concern: enduring disability and disadvantage; dementia, frailty and end-of-life care; patient safety; health economics and patient and public involvement. These are alloyed with knowledge management, a public health skills collaboration, industry engagement and research capacity development. Partner organisations committing matched funding include the full gamut of those planning, commissioning and delivering health and social care, as well as industry. Through on-going prioritisation and peer-review, NIHR funds will be used to support applied health researchers and fund high quality priority research projects, to develop strong, region-wide applications to NIHR and other national funding bodies, and to align other NIHR investments in the region. This will ensure high quality research, maximise value and support the CLAHRC East legacy.

THEMES

3.

Research Themes Theme Leader

Dementia, frailty and end of life care Professor Carol Brayne

Enduring disabilities and disadvantage Professor Tony Holland

Patient safety Professor John Clarkson

Patient and public involvement research Dr Fiona Poland

Health economics research Dr Garry Barton


OVERVIEW

4.

i) Overview of the excellent applied health research

The NIHR CLAHRC for Cambridgeshire and Peterborough (CLAHRC CP) has focused its research on people with mental health problems, intellectual (learning) disabilities, acquired brain injury, dementia, and care for those approaching the end of life. Examples of excellent applied health research undertaken by investigators involved in CLAHRC CP include:

The MRC CFAS study, a longitudinal population and service based research on cognitive decline and dementia has informed current health and social care policy to address the rapidly increasing incidence and prevalence of dementia in the ageing population of the UK (Brayne & colleagues). The results of this study have been used as evidence in public discourse and many national and international policy documents including the highly influential report: ‘Dementia UK: The full report’ (report to the Alzheimer’s Society by Kings College London and the London School of Economics, 2007). This report was largely responsible for raising the policy profile and leading to the development of the National Dementia Strategy. CFAS also contributed to the understanding of the complexity of cognitive impairment as well as the relationship between illness and disability which has greatly enhanced our knowledge on late-life dementia.

Analysis of routine outcomes data on 39,000 people treated in IAPT services in the East of England provided evidence that the cost per session exceeds previously reported estimates, but the cost of treatment is only marginally higher. The study also provides a framework to estimate costs using financial data. The application of this costing framework to IAPT services can also highlight differences which may indicate possible areas for improvement, such as better outcomes for patients and potential efficiency gains. For example, different ways of delivering care may potentially achieve savings via increased treatment volume, for example with over-the-telephone or group-based therapy (Jones & colleagues).

Equipping Youth to Help One Another Programme (EQUIP): Group psychological treatments for offenders with LD normally focus on a particular illegal act (fire-setting, sex-offending etc.), meaning that some offenders are in a number of different groups with overlapping content, while others do not receive group treatment because there are not sufficient numbers with convictions for the same offence. Langdon (UEA) has adapted and piloted (with men with LD) an established intervention for young offenders that aims to prevent further offending by developing moral reasoning and behaviour in groups with a mixture of offences. The clinical benefits have led to a definitive RCT with health economic analysis set in secure and high-secure NHS and independent hospitals, some of the most challenging settings in which to research the needs of vulnerable people.

Analysis using engineering design principles applied to patient safety led to a system-wide design approach to tackling patient safety in NHS blood transfusion services. This has had national (http://www.designcouncil.org.uk) and international impact (Clarkson & colleagues).

Empirical neuro-rehabilitation research and Cochrane reviews (Pomeroy and colleagues) underpin clinical stroke guidelines in Canada (2010) and support those of New Zealand (2010), the Philippines (2011), Scotland (2010), Australia (2010) and the European Stroke Organisation (2011). The Canadian guideline (2010) is reported to save $628m, lead to a 26 % drop in the number of acute care days in hospital, a 13-per-cent decline in residential care days, and a 15 per cent fall in stroke deaths in hospital (Canadian stroke network, 29/05/12 news release).

Barton (proposed theme lead of health economics research) had 11 economic research papers referenced in the National Institute for Health and Clinical Excellence (NICE) Technology Assessment Report (TAR) on Cochlear implants. This TAR informed associated NICE guidance (TA166: Hearing impairment - cochlear implants: guidance), which was issued in January 2009.

ii) Overview of the track record of, and strengths in, implementing health research

The East of England has an excellent track record in implementing health research. Examples include the rapid and successful implementation of NICE guidance CG68 for stroke and Quality Standard Q2, and the early adoption by of the CRASH-II trial results in local A&E departments, work undertaken in partnership with Pen-CLAHRC. Strong partnerships between researchers, NHS services and commissioners support co-production and pull-through, something CLAHRC-CP has fostered through its Fellowship programme, with 33 Fellows recruited over the last 3 years. For example:

Promotion of safe innovation through the supply chain using a systems design approach has changed the role that the purchasing functions currently play in safe clinical practice. This research made a significant contribution to the ‘Purchasing for Safety’ project with results published on the PaSA website. Trusts in England and Scotland have subsequently changed their purchasing systems

http://www.designcouncil.org.uk)/Documents/Documents/Publications/Health/Design%20for%20Patient%20Safety_Design_Council.pdf


(Clarkson & colleagues).

Goodyer and colleagues’ ‘Transfer of Care at 17’ research study suggested that transition into adult life may be compromised by poor mental health, particularly in the Young people in Care (YPiC) group where poor mental health is often accompanied by other potent negative factors. This research has changed the way our local authority partners think about the mental health of young people in their care; as a result, the Goodyer team developed a training programme for foster carers to recognise mental health problems in children in their care. This has been implemented through our Local Authority partners.

The study on IAPT data in the East of England by (Jones & colleagues) described in (i) above, found that all clinical outcomes improved regardless of whether the therapy was delivered over the tele-phone or face to face, except for people with more severe illness where face to face was found to be superior. On the back of these findings the East of England SHA initially devised an educational package for therapy over the telephone. This was then adopted and developed by a national volun-tary sector organisation, RELATE, that has have rolled-out the education nationally. In the East of England it is estimated that the use of tele-therapy has increased by some 20% as a result of the im-plementation of this research.

iii) Up to five specific examples of effective translation.

Research on the decision making capacity of people with learning disability has been translated first into amendments in service configurations and approaches to accommodate their wishes regarding care It was then pulled through into a national policy and legal framework and incorporated into the drafting of the 2005 Mental Capacity Act, legislation that affects an increasing proportion of the population as the prevalence of dementia rises (Holland).

Research supported by the Wellcome Trust, MRC, the Department of Health, a NIHR PGfAR and CLAHRC CP (Kirkbride & Jones) systematically reviewed the evidence on the incidence and prevalence of all psychotic disorders (including schizophrenia and affective psychotic disorders) in England in the last 60 years, looking at the effect of socio-demographic factors such as age, sex, ethnicity, migration, place of birth and upbringing. This was synthesised with data from major epidemiological studies, underpinning the development of a software modelling tool to predict the annual expected number of people who will develop psychosis in any area of the UK. www.PsyMaptic.uk enables commissioners to accurately plan mental health services for their populations and is currently influencing commissioning decisions, particularly in inner cities.

The Prevention of Abuse and Neglect of Older Adults programme (PANICOA)is led by health researchers at the University of East Anglia in collaboration with care providers in the East and North West of England, and the University of Manchester. They studied the relationship between the experience of older people in care homes and the infrastructure, management, skill mix, numbers of staff, training and resident population characteristics in the homes. Key discoveries included definition of the way organisational factors can interact in ways that lead to good care becoming unstable sometimes leading to mistreatment; organisational factors prevent ‘good’ people from providing good care. Quality assurance processes now take account of organisational dynamics in care homes.

Brayne and colleagues in CLAHRC CP investigated alternatives to anti-psychotic drugs for patients with dementia through a meta-review of findings from 30 systematic reviews of the effectiveness of non-pharmacological alternatives to antipsychotic drugs for managing behavioural and psychological symptoms. This included data from over a thousand unique studies and identified 19 types of non-pharmacological interventions that are effective. The final report was presented to the DH and Professor Alistair Burns, national Clinical Director for Dementia. The findings have been adopted by several Clinical Commissioning Groups, including our own, and have been translated into the training curricula for residential care staff.

Baron-Cohen and colleagues produced the Autism Spectrum Quotient (AQ) in 2001. This self-report 50-item questionnaire to screen for autism spectrum conditions in adults was one of the first measures of the autistic spectrum, was widely adopted in research as a dimensional measure of au-tistic traits, and has been translated into at least a dozen languages. It was followed by parent-report adolescent version, and a child version. To adapt it for clinical use, a short (10-item) version was cre-ated for GPs and other front line professionals. Also known as ‘red flags’ for autism the AQ-10 was recommended by NICE in its Guidance for clinical care for adults with autism and is now widely used within the NHS to screen for those who need a full diagnostic assessment.

http://www.psymaptic.uk/


STRATEGY

5.

i) Our themes and the fit with the overall strategy. CLAHRC East evolves from CLAHRC CP; at its core will be a new academic partnership between the Universities of Cambridge (UoC), East Anglia (UEA) and Hertfordshire (UoH), as well as a wider collaboration of partners ranging from NHS provider Trusts, local authorities, CCGs, Public Health England (PHE), third sector organisations and SMEs. The far larger, regional, footprint encompasses a more complete and complex health and social care economy and harnesses the research power of the 3 universities. We believe that this wide collaboration of organisations will enhance our ability to undertake a more ambitious applied health research programme, and further will allow us to be a highly productive strategic partner of the Eastern Academic Health Sciences Network (EAHSN). We have developed the research themes and research infrastructure of CLAHRC East to support, the EAHSN clinical priorities of 1) Dementia and mental health, 2) Long term conditions and 3) Patient safety.

Our overarching ambition is to undertake world-class applied health research using NIHR funds as a multiplier to develop top quality proposals that can be funded through other sources to answer questions relevant to our partners, thus providing evidence that has regional as well as national and international impact. Through this step-change and the strategy outlined below, CLAHRC East will provide the infrastructure for the East of England to become a national resource for applied health research well beyond the current funding round. Our themes for research and implementation are described below and in the organogram (see Section 12).

Dementia, frailty and end-of-life care. Led by Professor Carol Brayne (UoC), this theme continues highly successful applied health research involving established collaborations between universities, commissioners and provider organisations. The overall aim of this theme is to develop the evidence base that will support the efficient delivery of safe, timely and coordinated patient-centred services to the older population transitioning to the fourth age of life and at the end of life. The theme also covers key EAHSN priorities regarding these ubiquitous concerns, and incorporates Dr Stephen Barclay’s work on EoL (end of life) care across diagnostic groups and the life course.

Patient and public involvement research. Led by Dr Fiona Poland (UEA), this theme will focus not only on implementation of current best practice but also on applied research that defines and develops optimal approaches to PPI in applied health research, implementation science and the process of innovation.

Enduring disabilities and disadvantage. Led by Professor Tony Holland (UoC), this theme involving children, young people, and adults ‘at risk’ of mental and physical health inequalities develops the inter-disciplinary applied research in learning (intellectual) disabilities in the universities and strong connections with health commissioners and providers and social care commissioners in the East of England. The theme includes research projects on developing monitoring for seizures in people with epilepsy and learning disabilities, specialist community teams for people with learning disabilities, the implementation of findings relating to early screening and diagnosis for autism spectrum conditions and the mental health needs of young people, including those in local authority care.

Health economics research. Led by Dr Garry Barton (UEA), this work cuts across all themes and is closely linked with the EAHSN. the theme is will provide technical support to the research themes of CLAHRC East as well as exploring methodological developments and undertaking applied research in health economics.

Patient safety. Led by Professor John Clarkson, Engineering Design Centre (UoC) and incorporating the Judge Business School (Professor Stefan Scholtes), this theme brings design principles into complex health and social care systems with many immediate applications, particularly in the light of the Francis Report. The work cuts across all themes in the CLAHRC and maps directly onto the patient safety clinical priority of the EAHSN where the engineers have already been closely involved in the design approaches to improving patient safety in several foundation trusts in the region.

CLAHRC East Core - Research Infrastructure: The CLAHRC Core is the central infrastructure function of CLAHRC East that supports the research and includes cross-cutting specialist population health expertise, knowledge management coordination, capacity development and strategic management of research funds. The Public Health Skills Collaboration (PHSC) is a collaboration between public health consultants, academic public health, and the Public Health England Knowledge and Intelligence Team (KIT) East. The PHSC builds on the successful public health theme of CLAHRC CP that has provided commissioners and researchers with advice on research-based service evaluation and population health. The PHSC will support high quality systematic reviews with international impact, data modelling and evaluation of complex interventions, and will provide research support the EAHSN’s ‘implementation of innovation’ role. Knowledge management (KM) is also a key area where applied health research in the CLAHRC overlaps with the aims of the EAHSN. Profs Barrett and Oborn in the Judge Business School research organisational factors in KM, with evidence supporting the EAHSN in their task of innovation, adoption and spread across the network. Capacity development is led by Professor Catherine Sackley (UEA) and will involve a strong alliance with HEIs, provider organisations within the EAHSN, and HEEoE. Industry engagement will be co-ordinated through the CLAHRC Core; we shall assess all our projects in terms of opportunities for industrial partnerships and translation, and facilitate involvement of industry in co-production of research questions and implementation.


Our regional coverage in CLAHRC East opens our collaboration to the richest life-sciences industry concentration outside the USA. We have already developed a range of industry collaborations, particularly with SMEs. We shall work closely with the Small Business Research Initiative hosted by the EAHSN.

ii) Our specific objectives in the short (1-2 years), medium (2-3 years) and long term (4-5 years) are designed to achieve our overall aim to improve patient care, health outcomes and wellbeing. We will do this through the execution of high-quality applied health research on questions that matter to the partners and the nation, the efficient implementation of results and through increasing the capacity for these activities beyond the life of CLAHRC East. We shall improve the engagement of industry in health and social care, and will ensure legacy.

August 2013 to January 2014 as the new NHS & social care landscape settles: (1) Establishing CLAHRC East Management Board; further engagement of partners and establishment of CLAHRC East Research Prioritisation Committee (see section 12 Leadership and Management arrangements); further meeting CLAHRC East stakeholder group. This work in Q4 2013 is essential as new NHS, social care and public health landscape settles allowing priority projects to be agreed for 2014. (2) Establishment of Local-Global principle within the CLAHRC: answered ambitiously, the most important local questions will have widespread impact. (3) Completion of applied health research projects in CLAHRC CP; dissemination and implementation with partners. (4) Developing more effective mechanisms for PPI in a new, larger, CLAHRC. (5) Enhancing industrial links and partnerships with EAHSN. (6) Prioritisation process round one and preparation for new research & implementation work in Year 1. (7) Continued engagement of EAHSN Board and partners. (8) Recruit to CLAHRC Fellowship scheme and PhDs and establishment of project plan with HEEoE for Psychiatry and Primary Care Applied Health Research Apprenticeship Scheme (PPCAHRAS; see Section 15 Capacity Development). (9) Objective end-2013: clear work plans for priority projects agreed within the partnership with resources in place to deliver, Key Performance Indicators (KPIs) identified, set within our KPI tool (a database tool developed for CLAHRC CP that links project milestones to Key Performance Indicators). Establishment of go-no go decisions end year one; Gantt chart agreed. (10) Development Grant Scheme (DGS; see iii, below) – agree projects leading to large-scale funding applications to other schemes.

1-2 years: (1) Begin new research programme agreed in previous quarter, including DGS. (2) Implementation of work from CLAHRC CP with new partners and matched funding, including industry. (3) Clear project management and review arrangements within themes and local partnerships, brought to CLAHRC East Research Prioritisation Committee with oversight by CLAHRC East Management Board; regular meeting cycle for governance structure. (4) Applications for additional external funding arising from Development Grant Scheme submitted during Qs4-6. (5) Establishing PPI as a theme for research as well as an embedded activity. (6) CLAHRC Fellowship Scheme and PPCAHRAS review at one year; revise plans for years 2-3; Gantt chart review. (7) Project management review for research projects including go-no go decisions. (8) First projects reporting with implementation plans under way with matched funding. (9) Research prioritisation review mechanisms continue and planning for new projects in latter half of CLAHRC East cycle. (10) Development of a CLAHRC Social Care Fellowship in collaboration with the Local Authority Social Services.

2-3 years: (1) Review and management, as for years 2-3. (2) Stakeholder engagement maintained with continued review of organisational changes within the EAHSN partners; CLAHRC East partnerships trimmed, accordingly with review of matched funding. (3) New projects funded through other mechanisms arising from DGS now underway; multiplier effect of CLAHRC East now demonstrable. (4) Second round of DGS in place Qs 6-9. (5) New priority projects coming on stream, including those arising directly from first phase research. (6) Continue working with other NIHR institutions in our region, and with industry. (7) Review and continuation of capacity development plans including the CLAHRC East Fellowship Scheme and PPCAHRAS. (8) Implementation plans reviewed. (9) KPIs for legacy agreed within CLAHRC East and EAHSN.

4-5 years: (1) Completion of applied health research projects; implementation. (2) Legacy planning. (3) Multiplier effect of CLAHRC East DGS should be clear with more, high quality applications for applied health research from within the HEI and NHS/Social Care partners arising within the collaboration and beyond. (4) Impact of Fellowship Schemes and PPCAHRAS visible through increased translation and evidence-based decommissioning. (5) Mature industrial links with collaborations routine beyond CLAHRC East. (6) Increasing ability and activity of other NIHR investments regarding T2 translation through CLAHRC East. (7) Research design principles and research-led innovation into the NHS and social care culture should be embedded within organisations, within the corporate memory and in the shape of researcher practitioners and managers who are sympathetic to innovation and research.

iii) Our strategy for CLAHRC East is designed to meet our objective of improving patient care, health outcomes and wellbeing through the execution of high quality applied health research on questions that matter to the partners and to the nation, the efficient implementation of results, and through increasing the capacity for these activities beyond the life of CLAHRC East. We see the CLAHRC as a catalyst for change and NIHR funding as a multiplier leveraging other resources, including external funding and the workforce. The step change comes from more, high-quality applied health projects in our enhanced collaboration yielding evidence consumed by a more sophisticated, informed workforce that is also amenable to supporting research.

Key aspects to our strategy include: Broadening our geographical coverage through aligning with the Eastern AHSN. We have aligned with the Eastern AHSN strategy and its partner organisations, and are


working jointly with the Universities of Cambridge, East Anglia and Hertfordshire; we shall continue to build innovative collaborations with the Engineering Design Centre (now focused on patient safety) and the Judge Business School. Partnership working and co-production, including PPI. We have learned in CLAHRC CP the value of consensus between those who need to use new knowledge and those who produce it, including the determining of research questions. Engagement of research consumers throughout the research process greatly facilitates later implementation and engenders “pull-through”. An example of this has been our work on telephone-based psychotherapy in IAPT. We align internationally excellent researchers with influential service and policy partners. Developing a process for continuing priority setting with partners. For co-production to be effective the strategy must be flexible, especially in the current dynamic system of health and social care, and the ability to react adroitly, producing high quality applied health research in a timely fashion. We have learned from CLAHRC CP that some of our greatest impacts have arisen from work we did not plan in our original application. Thus, we want the ability to be reactive to new types of questions co-produced by the partners; this involves methodological as well as topic flexibility. Use of NIHR funding for fewer, larger, high-quality projects with regional, national and international significance. We shall use our NIHR funding for a development grant scheme in order to support early or pilot work and the creation of excellent, ambitious applications to other funding schemes (e.g. NIHR PGfAR or HTA, MRC; industry, other partners); we aim to create a multiplier effect. Creating a legacy of high quality infrastructure, enhancing current research capacity and building new, sustainable research teams that collaborate with a workforce eager for evidence within a new culture of innovation that includes PPI. Developing capacity for applied health research. We shall further develop our CLAHRC Fellowship scheme, already regional, and forge a close alliance with HEEoE for a variety of schemes including a Psychiatry and Primary Care Applied Health Research Apprenticeship Scheme (PPCAHRAS; see Section 15 capacity development). Aligning with other NIHR investments e.g. Cambridge Biomedical Research Centre (BRC) to maximise value for money and increase translation from T1 across the T2 gap. Adopting an assertive approach to engaging and collaborating with industry. Our regional coverage in NIHR CLAHRC East opens our collaboration to the richest life-sciences industry concentration outside the USA. We have already developed a range of industry collaborations, particularly with SMEs. We shall work closely with the EAHSN on this matter, exploiting their long-standing experience and the fact that they now host the Small Business Research Initiative. Leadership and clarity of purpose. Our experience in CLAHRC CP and our new, strong collaboration allow us to execute our strategy and achieve our ambitions.

iv) Our strategy for the applied health research is focused on excellence, ambition and co-production. A continuing process of prioritisation within the collaboration and external peer-review will determine our projects. Our focus is on quality; we want excellent research with high impact, and an increased proportion of randomised designs. We also want to be flexible and adaptive, and tightly performance managed so we are not committing funds to five-year programmes of research from the outset. This is why we the CLAHRC Core will retain research funds to be distributed later in the course of the CLAHRC. We propose a Research Prioritisation Committee that will meet periodically (including in Qs 3&4 2013) and judge proposals according to the following criteria: Is the project applied health research? (health-impact by 3-5 years; implementation to be funded through matched resources); Originality (and evidence of prior systematic review); Is this research on the implementation process? Is there an identified customer, regionally nationally or internationally that wants the research and will pull-through the results into practice or policy? Have they committed matched funding? Is there an industrial partner? Is there PPI or is there scope for PPI (unless it is a PPI research project)? Does the project exploit the CLAHRC's geographical spread? To what extent is the project collaborative between HEIs or EAHSN partners? Are the methods scientifically appropriate and has there been peer-review? Will the results have an impact beyond the region? What are the research costs? Is the project suitable for the Development Grant Scheme and submission to other funding agencies for a large-scale study? Does the project assess value (including health economic) and, itself, represent value for money? Projects to be supported will be peer reviewed in collaboration with other NIHR CLAHRCs and other experts.

We have described how we shall align with other NIHR investments especially the BRC and Biomedical Research Unit (BRU) and identify emerging findings that may be suitable for applied health research, including modelling the implications for health systems and economics. We shall also drive our industrial links and continue to work with other NIHR CLAHRCs where possible.

v) Our strategy for translating applied health research into benefits for patients has several facets and builds upon our research strategy. Our close partnership with the EAHSN and its’ clinical priority groups defines our principal delivery vehicle; this can be multiplied through working with other NIHR CLAHRCs and AHSNs, with co-production and matched funding driving implementation. Looking back to T1, we shall work with the Cambridge BRC to “spot winners” and facilitate modelling and translation, as above. Looking forward to T2, we hope our ambition for excellence and relevance in aspects of health care that present ubiquitous challenges will mean people look to CLAHRC East for answers. Our capacity development will also increase the “absorptive capacity” in our regional workforce for evidence and new knowledge, as well as facilitating co-production and collaboration by working as boundary spanners, innovation champions, research-service practitioners and knowledge brokers.


vi) We have clear and complementary aims and objectives for CLAHRC East and the EAHSN for translating research and learning into practice. The leadership team in the Eastern AHSN, current CLAHRC CP and the proposed CLAHRC East contain common members who have been working closely together since the call for AHSNs in 2012. We were the blueprint for the EASHSN knowledge management strategy and links continue with this application and we welcome the requirement for alignment. Representatives of NHS organisations throughout the East of England and the three HEIs have worked on this NIHR CLAHRC application and the common purpose is underlined by the matched funding from the EAHSN. We see the EAHSN not only as the primary customer and delivery vehicle for CLAHRC East applied health research; it is our main implementation arm and we are their R&D division. Plans for CLAHRC East were adumbrated to build upon the strengths of CLAHRC CP and to align immediately with key areas of the EAHSN strategy, notably patient safety, dementia (as an initial priority within mental health) and knowledge management. Moreover, our strategy for capacity development, project review and prioritisation, working with regional research strengths at the T1 gap and the development grant scheme, mean that we can evolve and align more fully with the nascent EAHSN. The outline plans for CLAHRC East were presented to and agreed by the EAHSN Shadow Board in February 2013. Thereafter, there has been close liaison with the EAHSN executive team. The proposed Director for CLAHRC East is a member of the EAHSN Board, and there will be reciprocal membership of CLAHRC East Management Board by EAHSN partner organisations. These include those that have pledged matched funding already, and those we hope to engage over the lifespan of CLAHRC East, sharing a knowledge management strategy with the EAHSN through the East of England Public Health Skills Collaborative. We describe our joint approach to industry engagement in Section 13.

vii) Future complementarity and co-working with the EAHSN so as to deliver improved outcomes for patients and the NHS permeates our strategy from conception to the end of Year 5 and beyond. We explain elsewhere the need for communication and stakeholder involvement, the continued review and prioritisation of themes and projects to ensure that CLAHRC East evolves with the EAHSN. We aim to embrace a wider range of chronic diseases and other threats to mental well-being in terms of research (particularly using our DGS) and implementation, attracting a broader range of partners over the 5 years of CLAHRC East and beyond (see Section 9). That said, our initial research themes are of immediate relevance to all the EAHSN partners. We are paying particular attention to a leadership programme for CCG MH leadership we host, so as to ensure robust evidence based service change in the medium to long-term.

viii) Success of NIHR CLAHRC East will be evaluated through measures of research process, impact on policy and practice, service redesign, capacity development and the achievement of our aim to improve health outcomes and wellbeing. We have previously developed an online software tool to record KPIs as part of our performance management of CLAHRC CP research, and this tool has been adopted by other NIHR CLAHRCs and attracted interest from NOCRI. We shall continue to use this method to monitor our progress in CLAHRC East, particularly the numbers of large, high quality applied health research projects underway in the partnership, catalysed by NIHR funding. We shall follow their publications and impact on commissioning decisions, service change and economic benefit. We will share our knowledge management strategy with the EAHSN with the aim of having a standardised system of measuring and monitoring routine health outcomes within primary and secondary care, and we have experience of their use in observational designs for assessment of clinical and cost-effectiveness. The public health impact of our work will be tracked through our collaborations with Public Health England KIT East and local authority partners. Capacity development will be assessed with provider partners and in collaboration with the HEEoE.

5.2 NIHR CLAHRC East will disseminate results beyond the applying collaboration. Our objective is to undertake research in the East of England, exploiting a remarkable population and service laboratory, that is of relevance not only to our EAHSN partners but that is also of national and often global interest; the ‘Local-Global’ principle. We shall work closely with other AHSNs, NIHR CLAHRCs and national policy levers. The foundation of our research based on co-production of research questions of local and wider interest, answered through internationally relevant research is the engine of dissemination, fuelled by the national network of NIHR CLAHRCs and AHSNs, increasing the capacity for diffusion, adoption and spread. We have already, in CLAHRC CP, worked effectively with the DH and other national bodies in setting our research agenda (e.g. work on the incidence of psychosis) such that the audience for the work exists at a national level.

5.3 NIHR CLAHRC East will become a national resource within our themes. We already have international strengths in our applied research themes that support service development at a national level. We have deliberately crafted these themes to play to our strengths, address conceptually difficult questions that are of wide relevance (e.g. decisions with people who lack capacity or who are at the end of life). Through exploitation of the regional population and the health and social care economy, engendering a culture of curiosity, evaluation, evidence production and use, our collaboration will become the ‘go-to’ resource for evidence relevant to whole system change, novel, high quality research and the skills required to support population health. Our alignment of existing resources (HEIs, NIHR investments and those of other funders), clarity over the Local-Global principle, ambition for excellence and the intention to leave a strong legacy will support our ambitions.


SPECIFIC THEMES

6. Specific theme details for 5 themes submitted:

Dementia, frailty and end of life care

Enduring disabilities and disadvantage

Patient safety

Patient and public involvement research

Health economics research

STRATEGIC PARTNERSHIPS

7.

The track record of organisations within NIHR CLAHRC East working collaboratively: Our current proposal to NIHR for CLAHRC East radically expands our collaboration to include organisations with which we have close collaborations already, and includes new players eager to engage. CLAHRC East will align with the Eastern AHSN and spread our academic leadership to include both the University of Cambridge, and the University of East Anglia with links to other HEIs in the region, notably the University of Hertfordshire and HEEoE. This will allow us to make East Anglia an engine of applied health research focused on the needs of those who implement research findings, and ensuring a legacy beyond the lifetime of CLAHRC East.

In Cambridge we retain the present partners in health and social care: the Clinical School, Engineering and the Judge Business School. We include the major acute trust, CUHT, as well as Cambridgeshire CCG, one of the largest in England. We have a key aim of aligning with the NIHR Cambridge BRC and the NIHR Dementia BRU, accelerating translation of research from T1 across the T2 gap. With the crucial addition of UEA and the regional footprint, we now include strengths in health economics, academic nursing (enhanced by the pledge of a new Chair in nursing in Cambridge), PPI research, disability, and capacity development with UEA hosting the NIHR clinical academic capacity development programme. The main developments in the current proposal are:

• Close alignment with the Eastern AHSN leading to an increased sophistication in the collaboration, focus on NHS priorities and greater geographical reach.

• The bid led by two Academic Health Science Systems: Cambridge University Health Partners and University of East Anglia Health Partners.

• Established regional partnership between the University of Cambridge and the University of East Anglia in terms of management of clinical academic posts funded through the NHS, and ambition for the region to become a laboratory for applied health research with local-global impact.

• Established inter-disciplinary academic working with providers in each lead site. This includes, in Cambridge, CLAHRC CP partners (CPFT, CUHT, Department of Psychiatry, Cambridge Institute of Public Health, Department of Engineering, Judge Business School, and Cambridgeshire County Council). In Norwich, the UEA Faculty of Medicine and Health Sciences encompasses similarly strong working relationships between interdisciplinary groups including health economics, nursing, OT, physiotherapy, psychiatry (including neuropsychiatry), psychology (clinical, forensic, and neuropsychology), sociology, and statistics.

• There are established research collaborations between UEA and UoC at the level of principal investigators, and between NHS trusts, the latter underpinned by NIHR infrastructure already spanning the region such as the NIHR research networks (e.g. MHRN, PCRN and DeNDRoN) and the three CLRNs; these will all be cemented with the formation of the Local CRN for the East of England.

• CLAHRC East will include as new collaborators, research groups within the region that have established an international reputation in early stage and basic health research that involves strong collaborations (e.g. Wellcome Trust Sanger Institute; NIHR Cambridge BRC), now translated into applied health research as described in our strategy, elsewhere.

We have a strong track record for collaboration in CLAHRC CP. For example: a) our TC17 project (Transfer of Care at 17) was a collaboration between CLAHRC CP, CPFT, Cambridgeshire County Council Children’s Services, Peterborough City Council Children’s Services, NHS Cambridgeshire and NHS Peterborough; b) our research into Improving Access to Psychological Therapies was a collaboration between CLAHRC CP, the East of England Strategic Health Authority and seven local PCTs; c) our project ‘a service design approach to frequent attendance in the emergency department’ was conducted by systems engineers working with Addenbrooke’s Hospital; d) the ‘designing and implementing a youth mental health service’ project arose from work undertaken by CLAHRC Fellows, the Norfolk & Suffolk NHS FT and partner local authorities.

The proposed Eastern Academic Health Science Network is a major partner in CLAHRC East, with the shadow EAHSN board involved in the application process; strong links have been built already with the EAHSN senior team. The proposed Director of CLAHRC East is a board member of the EAHSN. Many of our CLAHRC researchers from both University of Cambridge and the University of East Anglia will also play a key role in the


EAHSN research and innovation agenda, for example Professor John Clarkson who is CLAHRC East’s patient safety theme lead, will be co-lead of the EAHSN’s patient safety theme.

Our future plans to develop the CLAHRC East collaboration involve increasing our engagement with local authority public health, primary care and with clinical commissioning. At the time of application the CCG landscape remains fluid, although some strong CCGs are emerging such as the Cambridgeshire group. In our capacity development we have matched funding (£350k) to support regional CCG mental health leadership development, and would like to extend this to other areas underpinning our collaboration, particularly the frail elderly pathway of care.

Future ability and appetite to work collaboratively with a wider range of partners and stakeholders: Our decision to become region-wide illustrates our appetite to work with a wider range of partners. The relationships that we have built in CLAHRC CP have helped us facilitate collaborative research in the current CLAHRC, and now provide a strong foundation for CLAHRC East on which to build our new research programme. We are now well connected not only with the other parts of the NIHR infrastructure in Cambridge, including research networks, the Cambridge BRC and Dementia BRU, but also outside Cambridge, bringing in the expertise of Norfolk and Norwich and the rest of the East Anglia. We have a variety of partner organisations providing matched funding, ensuring co-production of research questions and pull-through of results into innovations in care. Individually and collectively through the EAHSN, our partners are a powerful delivery system. We have a clear strategy to work with industry, collaborating with the EAHSN, and see this as a key aim for the future. We are currently strengthening collaborations with a number of new (post-April 2013) organisations that we shall describe at interview, if we are successful at this stage of the application.

The expertise and intended roles of the proposed strategic partners: The research programme of CLAHRC East will focus on health, disadvantage and disability across the lifespan, addressing key national priorities such as dementia and frailty. This application will bring together the research strengths in the academic departments in the Universities, providing academic rigour and focussing on areas of key importance for public health. The University of Cambridge again brings academic strength in combining three RAE first-in-quality academic departments (Psychiatry, Public Health and Primary Care, Engineering) with a clinical reputation for the highest standard of applied health research (4 programmes of R&D activity all rated ‘strong’ in the last return). The University of East Anglia brings complementary strengths lacking in CLAHRC CP; these include health economics, applied health research in patient and public involvement (PPI), and research led by nurses and allied health professionals (AHPs). The partnership between these universities is equal; three themes are led by Cambridge and two by UEA. Where a theme is led by one, the co-lead will be from the other university. Representatives of both universities will be on the management team. We have begun working with the University of Hertfordshire and consider its inclusion and that of other HEIs in the region as an essential aspect of CLAHRC East. Our partner organisations include NHS, local authority, PHE KIT East, industry and the voluntary sector. While some of these organisations are young, we are fortunate that key individuals remain in our regional system and we are confident that our work will continue to thrive. We also consider other NIHR CLAHRCs as strategic partners in terms of peer review (we have agreed a process of reciprocal scientific review where appropriate), research (we already collaborate with CLAHRC NDL and plan to work with the UCLP and Oxford CLAHRCs) and implementation (we helped CLAHRC Peninsula implement the CRASH-II results). We see working with other NIHR CLAHRCs and AHSNs as crucial to our ambition for national impact, and will make this a priority following the confirmation of the latter and the current competition for the former.

Evidence of commitment and shared vision between the strategic partners: The key evidence is the co-production of CLAHRC East bid with the EAHSN partners and the CLAHRC East Management Board. The process of planning for CLAHRC East has been through a process of discussion and debate that have first involved the agreement of the strategic aims of the EAHSN and second, discussion as to how CLAHRC East can support these while undertaking world-class research. We have had two regional stakeholder meetings and we believe that our strategic partners are committed to working together in CLAHRC East. Our commitment is demonstrated by the pledging of matched funding and the resource commitment of people and time. Our current thinking is that an EAHSN non-executive director (NED) will chair our CLAHRC East Management Board (see Section 12 on Leadership and Management arrangements). Such close linkages demonstrate our ambition that the shared vision between CLAHRC East and the EAHSN partners should develop over the life of the CLAHRC and beyond into its legacy involving the constituent organisations.


LEADERSHIP

8.

Director

The proposed Director of CLAHRC East is Professor PB Jones (FMedSci; NIHR Senior Investigator). He is Head of the Department of Psychiatry, University of Cambridge (from 2000) and has been the director of CLAHRC CP since 2008, overseeing its inception, implementation and the health impacts that have begun to accrue. He has played a lead role in the national collaboration of NIHR CLAHRCs and has been part of the two of the evaluation projects funded by SDO, being on the advisory board for two of these. Professor Jones’ experience in research management began during a three year secondment to the DH Policy Research Programme (1993-6) where he implemented the mental health research initiative. He has been R&D Director for Nottingham Healthcare NHS Trust (1997-2000), led mental health research in Addenbrooke’s Hospital (2000-2003) and has been director of the NIHR MHRN East Anglia Hub (2005-8). Professor Jones has been a member of the NIHR PGfAR mental health subcommittee since 2008 and now also serves on the main panel; he was a member of the NIHR doctoral training awards panel 2009-2011 and has also served on Wellcome Trust and MRC boards. He has had programmatic research support from all these bodies. Professor Jones is an epidemiologist and clinical psychiatrist, with research impacts at the interface between these domains including RCTs and observational studies ranging from those involving health services to epidemiological studies of risk accumulation in birth cohort designs. His c.v. demonstrates how this range of work has led to health impact. Professor Jones has been a NED on a NHS Trust, is a member of the board of Cambridge University Health Partners and represented the University of Cambridge in the development of the Eastern Academic Health Sciences Network; he will sit on the EAHSN board.

Theme Leads

Professor Carol Brayne (NIHR Senior Investigator) is Professor of Public Health Medicine in Department of Public Health and Primary Care in the University of Cambridge and Lead of the Old Age theme in CLAHRC CP. She is a medically qualified epidemiologist and public health academic. Since the mid-1980s her main research area has been longitudinal studies of older people following changes over time in cognition, dementia natural history and associated features with a public health perspective. She is lead principal investigator in the group of MRC CFAS Studies which have informed and will continue to inform national policy and scientific understanding of dementia in whole populations. She has been responsible for training programmes in epidemiology and public health for under and postgraduates since the early 1990s. She is Director of the Cambridge Institute of Public Health at the University of Cambridge.

Professor Tony Holland (FMedSci; NIHR Senior Investigator) is the Health Foundation Chair in the Psychiatry of Learning Disabilities at the University of Cambridge, and LD & acquired brain injury theme lead in the CLAHRC CP. He will lead the enduring disabilities and disadvantage theme in the proposed CLAHRC East. He heads the interdisciplinary Cambridge Intellectual & Developmental Disabilities Research Group (CIDDRG). This group’s research studies in the behavioural and psychiatric risks associated with specific neurodevelopmental syndromes (e.g. Prader-Willi Syndrome); the clinico- legal interface, including offending by people with learning disabilities, decision-making, and adult safeguarding; epilepsy, as it affects people with learning disabilities and advocacy, social inclusion and citizenship. In CLAHRC CP the work is specifically concerned with the needs of adults with learning disabilities and those with acquired brain injury. He is President of the UK Prader-Willi Syndrome Association; psychiatric adviser to the Down Syndrome Association and a Trustee of Hft (a national social care provider for people with learning disabilities). His research has contributed to the development of the 2005 Mental Capacity Act, and he remains closely involved in the Government’s response to the abuse of adults with LD at Winterbourne View.

Professor John Clarkson (FREng) leads the University of Cambridge Engineering Design Centre (EDC) and leads the design theme in CLAHRC CP; this is evolving into the patient safety theme in the current application. His research interests are in the general area of engineering design, particularly the development of design methodologies in process management, change management, healthcare design and inclusive design. His group is particularly focused on systems modelling approaches to the design of safe healthcare delivery and already works on aspects of patient safety with a number of regional partners contributing to the proposed CLAHRC East.

Professor Catherine Sackley (NIHR Senior Investigator) is Professor of Physiotherapy Research in the Faculty of Medicine and Health Sciences at the University of East Anglia and will lead capacity development which lies within the CLAHRC Core function. She is a physiotherapist and her research focuses on the problems experienced by older people and people with neurological disease living in the community. Her work has informed the practice of occupational therapy and physiotherapy, particularly for the residents of care homes, and covers common daily problems such as incontinence, difficulties with mobility and other activities of daily living. The group has supported clinical therapists allowing them to gain the skills required to evaluate their practice; many have progressed to obtain research degrees. Professor Sackley currently leads the NIHR Clinical Academic Training Programme for Allied Health Professionals, a national initiative hosted by UEA.


Dr Garry Barton is Reader in Health Economics at the University of East Anglia and will lead the health economics research theme in CLAHRC East. His main interests and expertise lie in application and development of the methods of economic evaluation. This includes, assessing and comparing, the performance of different utility instruments and in estimating the level of uncertainty regarding decisions of cost-effectiveness. He has been influential in mental health and disability research aligned to the proposed themes in the CLAHRC, has been involved in policy work with NICE and sits on the NIHR Research for Patient Benefit Programme (RfPB) London Regional Funding Committee. Dr Barton is also Deputy Director of the East of England Research Design Service (RDS) and will contribute to our overall aim of increasing quality in applications and projects involving health economic and aspects of value in health systems.

Dr Fiona Poland is Senior Lecturer in Health and Society at the University of East Anglia and will lead the patient and public involvement research theme. Dr Poland has a career-long interest in the development of research to enable community-responsive health and social care through developing appropriate research skills, and joint working between academics, practitioners and stakeholders. Her interdisciplinary research includes social care, bridges the voluntary and HE sectors and involves complex randomised designs aiming at finding empirically-based approaches to the involvement of patients and other people in care. Dr Poland has a leading role in the development of research capacity in newer researcher health professions, such as nursing and midwifery, and in applied and interdisciplinary health research. She has been co-convenor of national symposium on “Collaborative Research in Inclusive Research” (2006) and has contributed to ESRC and other national funding bodies' initiatives in the area of patient and public involvement. Her expertise in qualitative research combined with experimental research designs is a particularly important contribution to the range of expertise in the proposed CLAHRC East.

The proposed CLAHRC East also includes international applied health researchers such as Professor Martin Roland (CBE FMedSci NIHR Senior Investigator), Professor of Health Services Research at the University of Cambridge. In 1994 Professor Roland established and subsequently became Director of the National Primary Care Research and Development Centre. Between 2006 and 2009, he was also Director of the NIHR School for Primary Care Research, a collaboration between the five leading departments of primary care in England. In 2010 the University established the Cambridge Centre for Health Services Research as a formal collaboration between the University and RAND Europe.

Professor Ian Goodyer FMedSci, UoC Professor of Child & Adolescent Psychiatry with expertise bi-directional translational research at the “T1-T2 valley” and Professor Simon Baron-Cohen FBA, Director of the Autism Research Centre; will lead projects including young people in the enduring disabilities and& disadvantage theme.

Professor John O’Brien NIHR Senior Investigator, recently moved from Newcastle to become Professor of Old Age Psychiatry in Cambridge. Professor O’Brien is also the National Dementia Lead for the Dementias and Neurodegenerative Disease Research Network (DeNDRoN); he undertakes clinical studies in dementia, including trials of pharmacological and non-pharmacological management.

Professor Claire Goodman is Professor of Health Care Research at the Centre for Research in Primary and Community Care at the University of Hertfordshire. She brings to the Dementia, Frailty and End-of-Life care theme her expertise in older people, care homes, primary care nursing, and the care of people with long term conditions including towards the end-of-life. There are also strong health researchers in our partner organisations and involved through collaborations with other NIHR CLAHRCs.

Professor Stefan Scholtes is the Dennis Gillings Professor of Health Service Management in the Judge Business School (JBS); Professor Michael Barrett is Professor of Information Systems & Innovation Studies at the JBS and Professor Eivor Oborn is Professor of Health Care Management at the Warwick Business School, a Research Fellow at the JBS and, with Michael Barrett, a Co-Lead of the Judge Business School implementation theme of the CLAHRC CP.

The new Professor of Nursing at the University of Cambridge will be aligned with the CLAHRC through matched funding and will collaborate with other nursing researchers such as Professor Val Lattimer, Head of School and lead nursing researcher at the University of East Anglia.


DEPLOYMENT OF RESOURCES

9.

Justification for resources: Our overall strategy in CLAHRC East will be to use NIHR funds, wherever possible, as a multiplier through their use in triggering and developing applications for external funding from other schemes. This is aligned with our ambition to undertake research, funded through CLAHRC East and other sources, that is useful to our partners, particularly those in the EAHSN, whilst having national and international reach. We believe we have already begun to achieve this in CLAHRC CP.

Research themes

We are going to use 100% our NIHR funding for research and capacity building and 90% of the matched funding for implementation. Details of this deployment are in the submitted spreadsheets. In summary, the deployment of the NIHR resources is similar across the themes in that the majority are for staff costs deployed to undertake applied health research including research on implementation, and costs associated with capacity development. We recognise that insufficient “middle management” is often a rate limiting step in research teams, so we have allocated a post-doctoral (or equivalent) researcher to support each theme lead. We have then allocated an initial tranche of research costs (1 to 2/3 years), following a prioritisation process of draft proposals submitted by researchers and research partners. This allocation will be ratified and/or revised by a Research Prioritisation Committee in Q3 2013 should our application be successful, so as to ensure our work remains topical and relevant (see Section 5 on strategy). The majority of research staff included in the application have specific roles within each of the themes to work both individually and across projects and themes thereby contributing to the whole programme of work. As with CLAHRC CP, the majority of CLAHRC East work will be recruiting participants from mental health services and those with other long-term conditions. This requires high levels of skill and time involving both quantitative and qualitative interviews with patients, carers and support workers; these interviews can be lengthy and time consuming. We have requested positions for key members of research, nursing and administrative staff to support this. Non-pay costs have been minimised whilst ensuring there is adequate provision to travel both across the region and further afield for the purposes of the programme.

Research infrastructure and the CLAHRC East Core

We are keeping our central management costs low, though we are designing more active prioritisation and project management procedures in CLAHRC East that will sit within the CLAHRC East Core infrastructure. As before, we have a part-time CLAHRC Director (Professor Peter Jones), a CLAHRC manager (Angela Browne) and CLAHRC administrator (Lea Wood), both full-time. There will be two part-time CLAHRC Deputy Directors (Professor Cath Sackley and Dr Christine Hill). The additional Deputy (compared with one Deputy in CLAHRC CP) is in recognition of our regional spread, our new, key relationship with UEA, and the central role of population health within CLAHRC East. For clarity, these CLAHRC East Core infrastructure costs have been put into a separate spreadsheet. Note, funding for new research is not currently allocated to themes in years 3-5, being shown in the Core budget. This helps performance management of projects and themes, accountability, our ability to be reactive and to drive up the quality of our applied health research. In addition CLAHRC East Core will support capacity development for applied health research, as well as knowledge management within CLAHRC East. The Public Health Skills Collaboration (as discussed above in Section 5(i)), is part of the Core, though largely supported by matched funds This will provide the umbrella for evaluation projects such as the Children’s IAPT evaluation. These costs are also included in the spreadsheet, together with modest governance costs to support the Research Prioritisation Committee and the CLAHRC East Management Board. This structure in CLAHRC East will ensure quality and good value for money.

Financial contribution from partners and use of matched funding: Financial contribution from partners and use of matched funding: The organisations that are stakeholders within the collaboration are stated in Section 1 of the application form. These organisations have already confirmed matched funding (letters included in the application) or have pledged matched funding. Our matched funding will be used, almost exclusively, for implementation; the relevant amounts are in the spreadsheets of the theme costs. Some of this supports specific projects of particular value to partners, while some is for the whole programme including capacity development. The majority is for implementation. Research funding already awarded to individuals is being used where the work being undertaken as part of this collaboration, acts as a direct extension or augmentation of their award. In essence, funds from NIHR will support applied health research, implementation research, development grants to support piloting for high quality research proposals to be submitted elsewhere, and capacity development. In our capacity development we have matched funding (£350k) to support CCG mental health leadership development. We attach letters confirming £15 million and pledging matched funding from CPFT (our host), Norfolk & Suffolk NHS Foundation Trust (this matched funding includes support from the Dementia Alliance and the Dementia Academy), the Eastern Academic Health Science Network (which includes Cambridge University Hospital Trust), Cambridgeshire County Council, the University of Cambridge, the University of East Anglia: Faculty of Medicine and Health Sciences, Public Health England Knowledge and intelligence East; MacMillan Cancer and Rescon Ltd from the 3rd sector. This has been a difficult economic and organisational climate in which to expect partners to commit but there is now real momentum; commitments will continue to accrue beyond the deadline for application. At the time of application, the


confirmed matched funding amounts to £15 million and up to £10 million in the pipeline, across the five year plan of the programme. It is important to note that we have strong support from the EAHSN, our principal delivery vehicle for implementation, and Dr Robert Winter, the interim accountable officer for the EAHSN, has provided a letter committing matched funding once the licence is granted for what is, in effect, a joint programme of work (see Section 5 Strategy).

Building on DH/NIHR resources and other funding schemes: We have stated in our strategy that we intend to use our CLAHRC East funds as a multiplier. We intend to retain the flexibility within CLAHRC East to promote the development of the highest quality research proposals for applications for funding through schemes (NIHR, industry and otherwise) elsewhere. We have metrics to support and monitor the success of this approach and to provide support through our Development Grant Scheme (see Section 5 Strategy). We want CLAHRC East to be undertaking locally relevant research that has global reach. We also intend to work with the Cambridge BRC and Dementia BRU where there is great potential synergy and interest in aligning work at the T1 and T2 translational gaps, promoting pull-through. Early economic and systems modelling of the effects of novel interventions and technologies; use of MRSA GWAS is an example. CLAHRC East will work closely with the emerging Local Comprehensive Local Research Network, building on the collaborations between the existing infrastructure and CLAHRC CP where the links between Norwich and Cambridge have worked well.

Relative priority of the themes: The themes included in this application are all of key importance to the partners in this application, and the amount of NIHR funding requested is the amount required to deliver the programme of work. We have prioritised the work within each theme so that not all the projects start in 2014, some start in 2015 or 2016 but the projects that we would like to start in 2014, have equal priority. In terms of research themes, we have designed CLAHRC East in a way that builds upon our strengths; so we retain the mental health focus of CLAHRC CP and retain our innovative links with engineers and the business school. The ageing population, cognitive failure and frailty are central to the service response to chronic disease; and mental health problems, learning disabilities and brain injuries are, themselves, chronic disorders. Mental health and behavioural change are central to the management of all long-term conditions. Patient safety runs through all that services do. Thus, we have designed a set of themes that dovetail with the aims of the EAHSN.

Funding scenarios: an award of 50% would probably undermine the collaboration given the levels of matched funding already pledged and the design. Nevertheless, in this situation we would aim to do many fewer things, but retain the quality and ambition of those few projects; we would run a reduced CLAHRC Fellowship Scheme but would not have the ability to accommodate all aspects of our capacity development plans such as the Psychiatry and Primary Care Applied Health Research Apprenticeship Scheme. It would also be extremely difficult to achieve the new partnerships between universities and the truly regional impact. Overall, we estimate that with 50% funding we would deliver about 25% of what we plan with 100%, with much of the central effort being consumed with redundancies and HR impacts, but we would be guided by our partners and CLAHRC East Management Board as to where we focused our research efforts. Funding of 90% of that applied would be managed by our prioritisation group overseen by the CLAHRC East Management Board, with input from EAHSN partners. Our strategy of allocating funds to priority projects put forward in the application that last for only two to three years, depending on their science, would allow us to stagger and complete the initial programme of research. However, there would be an overall loss of more than 10% of the overall impact including implementation and capacity development, as argued for the 50% scenario.

An award of 110% or greater represents a truly exciting prospect for the East of England, the NIHR and other research investments in the region. It is in accord with the matched funding commitments from our partners in the EAHSN and the region, and would allow us to make the East of England the go-to place for research and innovation nationally. Just as argued for the lower funding scenarios, we believe that 110% of funding would result in a larger multiple of output and impact across the gamut of our work, from research to implementation, capacity development and legacy. The ambition to create a regional applied health laboratory with synergy between the universities and remarkable bioscience industry cluster would be supported; our strategy of using NIHR funds as a multiplier lends itself to this, as do the tight, project-by-project prioritisation and management processes that we propose. In addition to increasing volume in each theme, we would explore the development of an additional applied research theme in metabolic medicine and cardiovascular disease. This speaks to two EAHSN clinical priorities, to our population health approach, and to the needs of those with severe mental illness and learning disability who experience significant premature mortality from cardiovascular disease; there are a variety of reasons for this, some preventable. This area of applied health research would exploits the potential for T1 through T2 translation available in NIHR and private industrial investments in the East of England as well as research strengths in the HEIs; it also builds on our experience of the current CLAHRC and spreads our experience in work at the T2 gap. We believe our expertise in behavioural medicine is ideal to complement a programme of applied health research in this domain. Furthermore, the extra funding would enable CLAHRC East to attract more matched funding from partners across the region, building on the momentum built within CLAHRC CP and during the application for CLAHRC East.


EXTERNAL GRANT FUNDING

10.

Details of external grant funding amounting to £91.6 million are included in the worksheet in the submission.

RESEARCH PUBLICATIONS

11. Attached as per instructions.


LEADERSHIP AND MANAGEMENT ARRANGEMENTS

12.

The proposed structure of CLAHRC East is set out in the organogram below.

i) Director and theme leads

CLAHRC East has a wider regional footprint than its predecessor CLAHRC CP. There are two main centres, one in Cambridge and one in Norwich. CLAHRC East Director, Professor Peter Jones, will be based in Cambridge, as are theme leads Professor Carol Brayne, Professor Tony Holland and Professor John Clarkson. Two of the theme leads are based in Norwich at the University of East Anglia - Dr Fiona Poland and Dr Garry Barton. The CLAHRC Director is supported by two deputy directors, Professor Catherine Sackley (Norwich) and Dr Christine Hill (Cambridge); and the CLAHRC Manager, Ms Angela Browne (Cambridge & Norwich). The CLAHRC Director will have control of the NIHR and matched funding. Financial control will be managed on a day to day basis by Angela Browne together with the finance department of the host trust and in close liaison with University finance units. This has worked well in CLAHRC CP.

The theme leads and CLAHRC East Core will form the CLAHRC Executive Committee, meeting every 3 months and chaired by the CLAHRC East Director. The Executive Committee will:

report to the CLAHRC Management Board through the Director;

be responsible for the delivery by the CLAHRC of its objectives;

proactively monitor the progress of the Programmes of Work;

ensure that all partners are regularly informed of CLAHRC activities

Coordinate reporting to NIHR

The Management Executive Group (Director, 2 deputy directors and CLAHRC Manager) will meet on a weekly basis to discuss operational and financial management issues. The Management Executive Group is a much smaller group; in CLAHRC CP this structure was found to be the most effective way of remaining


responsive and flexible in dealing with any issues that arose.

ii) CLAHRC East Management Board

The CLAHRC East Management Board is the main governing body of CLAHRC East and is responsible for financial scrutiny and the overall strategy of the CLAHRC. The Management Board provides high level input to the CLAHRC’s strategic and business plan and will meet twice a year. The chairperson will be identified through advertisement and appointment by the main HEI partners, host trust, Director and NIHR (if appropriate) but the position would suit a NED of the EAHSN Board. Current plans for proposed committee members are:

• CEO Host Trust. • Chair/Deputy Chair of the Eastern Academic Health Science Network. • A CCG representative from the East of England (CEO level). • A Local Authority representative from the East of England (CEO level). • A service executive of SME from the East of England. • Centre Director, Public Health England (Cambridgeshire, Norfolk and Essex). • Service User/PPI Representatives. • HealthWatch representative from the East of England (CEO level). • Head of Children, Families and Adults Services: Cambridgeshire County Council. • Regius Professor of Physic, University of Cambridge (Clinical School).

• Executive Dean of the UEA Faculty of Medicine and Health Sciences.

CLAHRC East has a large number of stakeholders (many of whom have provided matched funding). We plan to include these organisations by holding a stakeholder event prior to the Management Board meetings, akin to a shareholders’ meeting in a public company; all stakeholders, partners and matched funders will be able to propose items for discussion, and participate in an open and transparent meeting with the CLAHRC Executive prior to the Management Board meeting. In this way, the CLAHRC East stakeholders will have an opportunity to be involved in the CLAHRC East strategy.

iii) External advisory or oversight groups

The Research Prioritisation Committee

This committee will be responsible for:

Oversight of the research methodologies used in CLAHRC projects.

Provision of advice to the theme leads, in particular on academic quality.

Oversight of the adoption of future projects to ensure continued high academic standards in parallel with alignment with partner priorities.

Coordinating external peer review with NIHR CLAHRCs.

Regular review of projects already underway.

The committee will meet every 3 months in the first year of the new CLAHRC. The committee will comprise of:

CLAHRC Director and deputy directors.

Responsible Officer for the EAHSN.

CLAHRC Board PPI representative.

Health economist.

Statistician.

CLAHRC Manager in attendance. The Independent Scientific Advisory Board

The Independent Scientific Board shall have the following responsibilities:

Oversight of the research methodologies used in the Programme of Work.

Provision of advice to the Director on the Programme of Work, in particular on its academic quality.

Oversight of the adoption of future research or implementation themes by the CLAHRC CP with the aim of ensuring continued high academic standards.

iv) Relationship and relevance and reporting to the EAHSN

The Chair/deputy Chair of the Eastern Academic Health Science Network (or a NED) will be a member of CLAHRC East Management Board and a board member will also be on the Research Prioritisation Committee. The Director of the CLAHRC is a member of the EAHSN Board. The CLAHRC Director will report progress to the EAHSN Board at its meetings in addition to reporting to the host trust and to NIHR.


WORKING WITH INDUSTRY AND THE NIHR

13. (i) Track record, capacity, ambition and strategy for working with industry and private sector

CLAHRC East will continue to build on the collaborations and working partnerships that CLAHRC CP has both developed and enjoyed over the past five years. Examples of such collaborations include:

• The engagement of the Judge Business School with technology companies on the development of social media tools and their use in chronic health management.

• A collaboration between the adult theme and the company Ultrasis plc who have allowed them free ac-cess to the computerised Cognitive Behavioural Therapy (cCBT) programme 'Beating the Blues’. The col-laborative study is investigating the feasibility, acceptability and effectiveness of this tool as a treatment for depression and anxiety following a stroke.

• A collaboration between the CLAHRC CP adolescent theme and small businesses via the Arts Picture-house Cambs Film Consortium - SimplySonicStudios, Spellbound Animation and foster agencies established to develop a film for foster carer training. In addition, the potential for an e-learning version of the aforementioned foster carer training and an ‘app’ for care leavers are being developed.

• The old age theme has established potential partnerships with private sector partners on development

work towards exercise programmes for people with dementia and emergency and urgent care studies.

• The Autism Research Centre (ARC) has worked with Changing Media Development Ltd to distribute the DVD ‘The Transporters’ to families with a child with autism. Changing Media Development Ltd was a new small business created by the inventors of the DVD; the company won the tender for distribution from the Department of Culture, Media and Sport. The ARC is also working with a computer-game developing company called Compedia and this research-industry partnership won an EU grant to develop online computer games to teach children with autism to recognise emotions.

• CLAHRC CP also facilitated an event around introducing prospective quality assurance techniques to mental health services which brought together a cross section of industry with the CLAHRCs and explored the role of systems modelling and simulation in enhancing healthcare research implementation. Such ex-amples show how CLAHRC CP has paved the way for CLAHRC East to make further progress with indus-try, the private sector and small businesses for research and implementation.

CLAHRC East will engage with a geographical region that contains the richest life-sciences cluster outside of the USA, presenting unrivalled opportunities and responsibilities to succeed in terms of working with industry. The East of England hosts seven of the top UK 15 companies including Microsoft and Glaxo-Smith-Kline, strengthened further with the proposed move to Cambridge by Astra Zeneca.

Norwich has a growing research park and the University of East Anglia has well established relationships with industry partners (including Regen Therapeutics, GE Healthcare) as well as offering Health Economics Consulting (HEC) which has regional, national and international links with the pharmaceutical and medical devices industries and businesses undertaking various commercial projects. HEC has a track-record in assessing the potential for new products selected by UK and EU markets and for specific patient groups. They advise a diverse range of technology companies regarding NICE HTA submissions as well as advising small to medium enterprises in past rounds of the SBRI (Small Business Research Initiative) competition. By putting firms in touch with NHS provider organisations and CCGs, HEC can assist local NHS entities in meeting their CQUIN incentives. In the wider context of industry and innovation, the co-production of health and wealth at a more macro-level is an important element to assess. At UEA, HEC works with Professor Marc Suhrcke and colleagues, who are engaged in research on the relationship between health and wealth and vice versa. HEC can keep this robust and relevant literature under review and help disseminate appropriate new knowledge rapidly. Professor Richard Fordham, Director of HEC will be working within the health economics theme of CLAHRC East.

CLAHRC East industry strategy is ambitious in terms of developing new collaborations whilst continuing to foster those already established relationships. For example Ultrasis http://www.ultrasis.com/ has been in discussions with Professor Peter Jones (CLAHRC CP Director) in relation to a potential project within IAPT psychological treatment services involving an RCT of telephone-based and computer aided CBT, together with the development of a telephone-based risk assessment system which would be developed as part of CLAHRC East. In the enduring disabilities and disadvantage theme, Dr Howard Ring is collaborating with Rescon (a research, development and consulting company with a focus on solving complex biomedical systems problems relating to human performance), to develop hardware, software and analytic strategies to improve seizure monitoring in people with learning disability and epilepsy and support diagnosis and management and evaluate the impact of interventions.

CLAHRC East will further develop the potential of assistive technologies in discussions with industry partners through the dementia, frailty and end of life care theme and the enduring disabilities and/or disadvantage theme. The ATTILA study, for which Dr Chris Fox and Professor John O’Brien are PIs, previous work on the use of call alarms by the oldest old, who fall, has led to a collaboration that is being developed with French firm Vigilio Telemedical (manufacturers of automatic detector Vigi’Fall), and a preliminary approach from a

http://www.ultrasis.com/


Cambridge small business, Advanced Balance Systems.

Good collaborations between the University of Hertfordshire and care home providers, particularly with the main local provider Quantum, mean research partners have already been identified for CLAHRC East.

The EAHSN has a strong strategy for industry engagement with which CLAHRC East will align, and CLAHRC East will be a key member of the EAHSN’s Innovation/Industry Council which will bring together the different health, social care, research, academic and industry communities within the region ensuring a grouping of strategic leaders who can bring governance and oversight to the wealth creation and industry engagement activity. The Innovation/Industry Council will build framework agreements across the region to ensure fair and equitable engagement across all communities. There will also be opportunities to thread CLAHRC involvement into the EAHSN Clinical Priorities groups where the EAHSN will also seek to thread industry colleagues in order to achieve co-production. CLAHRC East is also in discussion with the EAHSN regarding additional elements which could involve evidence building assessments for SMEs and med-tech companies. This will link in directly with the HEC collaboration with the SBRI.

Our strategy will be to introduce a rigorous project selection process, including external peer review, in order to ensure that all proposed theme projects demonstrate how working with industry can influence and benefit patient outcomes. This is highly dependent on an interactive partnership with industry which CLAHRC East will seek to achieve through a close alignment with the EAHSN engagement with strategy. CLAHRC East will both propose and respond to key areas of national and local importance with the aim of informing policy and making a difference to patients within 3-5 years. The EAHSN will assist with the acceleration of disseminating the knowledge generated through such collaborations.

Strategic input on Industry will come at CLAHRC East Management Board level where the intention is to engage with industry leads and experts from the region as well as ensuring expert industry liaison at theme level. This will enable priority-led projects to flourish and to build capacity for applied health research and implementation to be embedded into working practice. Capacity development will be enhanced by the CLAHRC Fellowship scheme which will encourage cross organisation working and we will invite applications for Fellowships from industry to work alongside health and social care partners. CLAHRC East aims to leave a legacy that includes an established infrastructure for a collaborative working relationship between industry, academic and health and social care partners within the region.

(ii) Track record of, and forward strategy for, linking with other NIHR-funded Infrastructure

CLAHRC East will have a strong linkage with other NIHR funded infrastructure both within the region and nationally due to the relationships and collaborations already developed by CLAHRC CP, for example CLAHRC CP has actively collaborated with the local Cambridge Biomedical Research Centre (BRC) and Dementia Biomedical Research Unit (BRU), as well as with local topic specific and comprehensive local research networks:

In the Cambridge BRC, there are explicit links between the mental health research programme and the pull-through of these findings through CLAHRC CP.

The evaluation and implementation theme of the Cambridge BRC, is led by Professor Carol Brayne, the current CLAHRC CP old age theme lead (and CLAHRC East lead for dementia, frailty and end of life care theme). There is also an established partnership between CLAHRC CP and the Cambridge BRC in the development of a population-based dementia register, which was initiated by CLAHRC CP is now part of the dementia research informatics support programme of the BRC, (which also links with the CLAHRC CP end of life care register project that is currently being explored). Professor Carol Brayne also leads on public health and population-based research in the Cambridge BRC. Cambridge University recently recruited a Professor of Old Age Psychiatry, Professor John O’Brien, in order to take advantage of the enormous potential for translational research in neurodegenerative disease presented by the array of NIHR investment, and Professor O’Brien will be part of the dementia, frailty and end of life care theme of CLAHRC East.

CLAHRC CP’s adolescent theme has had useful collaborations for reverse translation with the NIHR BRC through the ROOTs project including medical genetic developments, the physical and nutritional collaborations with the MRC Environmental Epidemiology Unit and a commercial collaboration with Cambridge Cognition and their computerised assessments.

CLAHRC East will also benefit from the expertise of the Clinical Trials Units in Cambridge and Norwich, which will support the CLAHRC’s applied health research activity, and intends to work with the NIHR Healthcare Technology Co-operative which specialises in brain injury regarding the disability theme.

CLAHRC CP has been very successful in establishing relationships and working in collaboration with other NIHR CLAHRCs. In CLAHRC East we intend to develop these further and have had detailed discussions with geographically contiguous CLAHRCs including Nottingham and the new applicants in Oxford and UCLP where there are many points of potential collaboration. Examples of our collaborations with other CLAHRCs and the SDO support programme (to be taken on by UUK) include:

As a result of a learning event for CLAHRCs involved in mental health hosted by our CLAHRC, a specialist depression service and trial was set up in collaboration with CLAHRC NDL. This trial was


also supported by the NIHR East Anglia Mental Health Research Network (MHRN).

The Judge Business School has worked with CLAHRC LNR on the challenges related to the commissioning process as well as working with the Health Services Research Network, NIHR CLAHRCs and the Health Foundation collaborating to develop a briefing report on the challenges of mobilising knowledge.

Working with NIHR Clinical Research Networks (NIHR CRNs) has been part of CLAHRC CP’s agenda and will continue to be so for CLAHRC East. Examples of collaboration include:

Support from the Primary Care Research Network for recruitment into end of life care studies and to the autism screening study (child and adolescent theme).

The provision of GCP training for CLAHRC researchers by the West Anglia CLRN.

DeNDRoN East Anglia’s involvement with the old age theme of CLAHRC CP which will continue through into CLAHRC East’s dementia, frailty and end of Life care theme.

CLAHRC East PIs have a wealth of experience of working with NIHR CRNs for example

Professor Claire Goodman, Professor of Health Care Research at the University of Hertfordshire has played a key role in the DeNDRoN initiative to develop research in care homes; EnRICH (Enabling Re-search In Care Homes) and along with Dr Chris Fox (director for DeNDRoN Eastern Region) and Pro-fessor Carol Brayne is a member of the DeNDRoN National Primary care clinical studies group.

Researchers from CLAHRC CP adult and child and adolescent themes, who have gone on to develop research applications for national funding (RfPB/ HTA), have also worked with the East of England (EoE) Research Design Service (RDS). Links with the EoE RDS will be further strengthened as part of CLAHRC East as one of our theme leads (Dr Garry Barton) is also Deputy Director of the EoE RDS.

Dr Stephen Barclay, CLAHRC CP, is a member of the NIHR Research for Patient Benefit East of England Regional Advisory. Dr Barclay also takes a national role in supporting the development of the NHS End of Life Care Strategy and NICE Quality Standards for EoL care.

CLAHRC East will work collaboratively to ensure plans for closer links with the topic specific and comprehensive local research networks are followed alongside and in line with the EAHSN strategy; in practical terms this will be through shared resources, for instance the streamlining of Research and Development processes, the streamlining of PPI resources including training and events along with the maintenance of joined up research project databases. Local and regional collaboration will ensure increased knowledge transfer and collaboration on what and how to research and implement the local and national priorities. This joint approach in the region is intended to continue with the new structure of the NIHR Local Clinical Research Networks due in April 2014, to offer a unified NIHR infrastructure to support every stage of the research cycle for both commercial and non-commercial research and implementation.


PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT

14.

All NIHR-funded research is required to demonstrate good quality PPI and to have a clear pathway to demonstrate its impact. This has been shown to have a strong relationship to the production of more relevant, feasible and acceptable evidenced interventions and research designs. We have had a number of major developments in CLAHRC CP such as the development of effective means to include people with learning disabilities in the research process in a meaningful way, particularly through the Service Users Advisory Group (SUAG). CLAHRC East proposes to support a step-change in the strategy for public and patient involvement, not only involving patients (service users), their carers, and the wider public in our research, but now researching and developing the best ways to achieve PPI in applied health research, implementation and innovation. The aim of our PPI research theme (see theme details) is to define best practice and to ensure a legacy of PPI in applied health research, nationally.

Thus, in CLAHRC East we have made PPI a cross-cutting research theme in order to include investigate PPI at all stages of the research process, from design to implementation, to evaluate its impact and set new standards for PPI practice. The implementation of our proposed programme of research and activity will enable more strongly conceptualised and evidenced effective contribution of PPI to diverse health care research and interventions. The comprehensive and innovative nature of the planned CLAHRC-programme will provide an unusually-focused, well-contextualised and innovative body of PPI-enabling knowledge and practice to be developed to inform NHS research and practice more widely. The formal research programme will be led by Dr Fiona Poland, Senior Lecturer in Health and Society and Participation Research Lead, University of East Anglia. More details on the research programme are contained in the specific theme details for the PPI theme which are attached to this application.

In summary, the goal of understanding PPI in research will enhance the relevance, quality of experience and impact of NHS research for patients. In the context of CLAHRC East, our core strategic principles for PPI are for it to be “embedded, comprehensive and active” in each CLAHRC project and for this to be further developed and conceptualised over the duration of CLAHRC East.

This will be achieved by an overall strategy with the following objectives:

PPI initiatives being clearly recognised as an important CLAHRC East Key Performance Indicator (KPI) and used to evaluate each project.

All CLAHRC projects will be encouraged to identify 5% resources to support project-specific PPI.

A PPI plan will be linked to each project, theme and overarching Programme.

Plans should demonstrate commitment to including diverse populations throughout the research and implementation process to dissemination.

Links between PPI stakeholders and initiatives at local and regional levels of CLAHRC East will be encouraged, to support active learning and collaboration.

PPI co-ordinators will be identified for each theme and will report back team efforts to a PPI committee, reviewing project teams progress in actively identifying and engaging in PPI.

The PPI theme organisation and projects will provide an evaluative and supportive role across CLAHRC East and coordinate resources for PPI training, consensus and implementation.

Information about CLAHRC East related PPI activities, experiences, training outputs and projects will be posted on the CLAHRC East website, displayed using social media and sent to PPI members and CLAHRC East re-search teams and partners. Over the duration of the CLAHRC we will regularly hold events which share devel-oping knowledge of issues, strategies and resources with stakeholder groups. We will seek publications on findings from individual projects and also the implementation study of the programme itself in high impact aca-demic and practitioner journals. The process and projects should allow for outputs to be selectively produced and published annually from eighteen months from CLAHRC-start to the CLAHRC-end.


CAPACITY DEVELOPMENT

15.

(i) strategies, objectives and plans for applied health research capacity development

We would like CLAHRC East to leave a legacy in East Anglia NHS and Social Care where the use of research evidence becomes an everyday occurrence, where all clinical and non clinical staff are able to scrutinise and question the way things are done, and welcome innovation, ensuring more rapid diffusion and adoption of evidenced based best practice. In order to achieve this legacy, we are making capacity development a major objective within CLAHRC East, building upon what we have learned from our successful CLAHRC Fellowship Programme over the last 3 years of the current CLAHRC (see (iv)). Capacity development in CLAHRC East will be led by Professor Cath Sackley (UEA), who also leads the East Anglia NIHR Clinical Academic Training Programme for nurses, midwives and allied health professionals (CAT) programme. In addition to our Fellowship Programme (see iv), there will be new initiatives:

a) We plan to increase the scope of our training to include more nurses and allied health professionals (AHPs) for example:

We would like to extend and formalise the ‘ground-up’ strategy adopted in the Adult theme of CLAHRC CP, of appointing practitioner researchers who were involved in all aspects of the research theme while remaining embedded in their clinical services. This has been a very rewarding experience for the individuals involved and extremely effective both in ensuring that the research reflects clinical issues, and in the implementation of the findings. We envisage these posts will be initially open to AHPs and psychologists working in the EDD theme this may be extended to other themes.

We would like to optimise the opportunities brought about by the NIHR Clinical Academic Training (CAT) programme for nurses and AHPs. We will provide ring-fenced places on the CLAHRC Fellowship programme and extend the NIHR /Chief Nursing Officer ‘interns’ programme which is already successful in the region. In 2010, the Report of the UKCRC Subcommittee for Nurses in Clinical Research (Workforce) made recommendations regarding the implementation of a clear career pathway for nurses involved in clinical research. Several successful ‘internships’ (both CATS and locally funded) followed and have resulted in successful applications for the CATS Clinical Research Masters, and a further 24 fully funded CATS Clinical Research Masters training places will be available in 2014-15. We plan to offer CLAHRC East nursing and AHP interns placements within successful applied clinical research projects. These will be based in a variety of settings where interventions take place, including patient’s homes, care homes and acute care. Increasing capacity across care settings and agencies (NHS, social care, private care) is important as the ability to successfully conduct research is dependent on an understanding of the setting. The use of ongoing projects to provide experience also brings clinical gains as the interns learn to use best-practice intervention protocols and patient reported outcome measures.

We are discussing with the County Council plans for social workers and occupational therapists to have research training within a new CLAHRC Social Care Fellowship. The everyday mental and physical health needs of people with dementia, or those with enduring disabilities and/or disadvantages, such as people with learning disabilities or ‘looked after’ children are often met, not by health care practitioners, but by social care staff. Traditionally, as the NIHR has recognised in the development of its School of Social Care Research (SSCR), carers have had very limited access to research and their practice is often guided by intuition, experience, and anecdote. Drawing on our experience of the current CLAHRC, and responding to requests by our Local Authority partners, we would like to develop Fellowships aimed at developing an evidence-base for social care. We anticipate that this will be based on the model of the current CLAHRC Fellowships but with a content that focuses particularly on the critical appraisal of relevant literature, and an evidence-based evaluation of interventions. These Fellows will be front-line managers (locality team managers in LD services, children’s centre managers) who can influence the culture within their service.

b) We have had discussions with the Eastern Academic Health Science Network, and the HEEoE for the East of England (Health Education East) to develop joint training, educational and leadership fellowships; for example:

We know that there are particular problems with recruitment to Psychiatry and Primary Care, disciplines upon which CLAHRC implementation depends. We therefore propose an innovative Psychiatry and Primary Care Applied Health Research Apprenticeship Scheme (PPCAHRAS) which will include a research placement and apprenticeship similar to our Fellowship, as well as an educational component, and will span a spectrum of short courses through to Fellowship and research placement.

We will expand the model of reciprocal clinical/research rotations currently funded by UEA and local Trusts.

c) In addition, we are totally committed to the goals of Athena SWAN as is apparent from the leadership of the


current CLAHRC and the proposed CLAHRC East, by the number of women senior researchers and young leaders we have. We intend to develop a strategy to further promote women in applied health research, alongside our general policies on equity and diversity.

(ii) Collaboration’s track record of research capacity development

If we are successful in this application, then we plan to continue with our successful CLAHRC Fellowship programme and would recruit 15 new Fellows to start in January 2014. Our CLAHRC Fellowship programme provided an opportunity to increase capacity for applied health research in the NHS and social care, laying the foundations for developing a culture of collaboration between the academic and service delivery sectors. The Fellowship is aimed at clinicians, health and social care practitioners, and non-clinician managers, who would like to work at the interface of research and practice, to develop an understanding of the research environment, and to develop skills in research methodology, service redesign and change management. The focus within the Fellowship programme is on local applied research and evaluation projects, building local capacity for evidence-informed practice, and facilitating networking across health and social care. 33 Fellowships have been awarded since 2011; our Fellows have come from a wide range of backgrounds: Consultant Psychiatrists, NHS managers, Consultant Clinical Psychologists, Neuropsychologists, Occupational Therapists, General Practitioners, Registered Nurses; they have come from across the East of England (Bedfordshire, Cambridgeshire, Norfolk and Great Yarmouth).

(iii) Clinical and non clinical professions to be developed

Our proposals as described above concentrate in the main on clinicians – physicians, nurses, midwives and allied health professionals. Although the CLAHRC CP Fellowship has been open to non clinicians, we have had limited success in attracting non clinical staff to our Fellowship. We believe that we should focus on developing a short taught course for non-clinical staff which would focus around systems-based service redesign and knowledge management. The Engineering Design Centre has proposed a short course that would be based on teaching non-clinical health managers about system approaches to health service design, and managing the risk and resilience of services, and we would add a basic introduction to research, knowledge production and appraisal. The aim would be to develop managers who have an awareness of evidence based policy and practice and how to apply formal systems thinking to problem solving.

(iv) Attributes of the research training environment and high quality experience

The CLAHRC Fellows programme has been developed over the last 3 years and we will use this as a springboard to develop the CLAHRC East capacity development initiatives described above. We be-lieve that the combination of an educational component, doing a research project under the supervision of an experienced PI, and an action learning set to share experiences, and problem solve, is a high quality experience. However, some potential Fellows may be unable to give the time that this requires, and so we will look to developing different models to deliver the same high quality experience to people with different needs and goals. The aim remains the same, that is to develop skills that can be applied in the workplace to effect real change that ultimately brings about improvements in service delivery. Key themes would remain knowledge production or research based evidence, research methodology, change management and systems theory applied to healthcare.

Mentorship and leadership: The University of Hertfordshire host the national NIHR and Chief Nursing Officer (CNO) Mentorship for Health Research Training Fellows scheme which was launched in 2012. The function is to support nurses, midwives, allied health professionals and healthcare scientists who wish to follow a clinical academic career and support these health professionals to progress, nationally and internationally. The scheme also provides leadership training and several of the ‘mentors’ are based at UEL and Hertfordshire. In addition, there are innovative local initiatives and mentoring schemes many of which are the result of successful RCF joint applications between HEI and Trusts. The skills of the UoH in this area will complement and support our capacity development strategy and will add to the high quality experience of the training environment.

We will build in a quality assurance process starting with an evaluation of the CLAHRC CP Fellows programme, and ensure that we have a suitable process for evaluating CLAHRC East capacity devel-opment initiatives with an annual review of the educational curriculum.

(v) Applied health research careers

In addition to the Fellows and Masters the CLAHRC will also host MPhil and PhD students. We hope to use mixed models of funding, both internally funded and also funded through NIHR and charity funders. The region houses many post-holders of successful post-doctoral and senior scientist awards and individualised mentorship will be provided to those identified as suitable candidates.


EXPLOITING INTELLECTUAL PROPERTY

16.

All major HEI and NHS partners in CLAHRC East have policies for exploiting IP and experience in collaborative ventures. CLAHRC East will seek to ensure that the host trust and all partner organisations are in a position to identify and exploit any innovation and associated intellectual property that they generate and that all intellectual property is managed efficiently and effectively and in the shared interests of the NIHR and all collaborators. CLAHRC East partners include the universities and other local education enterprises, EAHSN, health and social care organisations as well as industry.

CLAHRC East will ensure that a Collaboration Agreement and/or Memorandum of Understanding exists between the host Trust and other partner organisations whereby lead project managers responsible for managing the protection and exploitation of specific CLAHRC East related intellectual property will be identified for each partner and current intellectual property policies will be followed. This will include any establishment of spin-out companies and any income generated from the commercialisation of intellectual assets. Cambridgeshire and Peterborough Foundation Trust (the host trust) take to ensure that any intellectual property arising in the organisation is managed according to the Framework and Guidance on the Management of Intellectual Property in the NHS and Section 5 of the Health and Social Care Act 2001.

CLAHRC East through the Management Board and theme leads will work with partner organisations to ensure the use of reasonable endeavours to exploit any intellectual property via formation of a new company, licensing or other agreements. The Lead Project Manager for intellectual property for each partner organisation shall have full responsibility for; determining ownership of intellectual property: determining whether identified intellectual property should be protected; determining what type of protection is sought, if any; arranging such protection; determining the best route to market for any intellectual property; negotiating and concluding suitable agreements to promote commercialisation of the intellectual property: receiving any revenues and sharing revenues between the Parties as appropriate. Where any discrepancy arises on the matter will be referred to CLAHRC East Management Board for decision.

CLAHRC East will ensure that NIHR is informed of any results or intellectual property whether patentable or not plus any potential publications prior to publication in line with the 28 day rule and will adhere to the guidelines and policy set out by NIHR.


DECLARATIONS AND SIGNATURES

17. A declaration signed by specified representatives of the applicant NHS Trust/Provider of NHS ser-vices fully endorsing the application for an NIHR CLAHRC award and that appropriate support will be provided to the NIHR CLAHRC should the application for funding be successful. Declaration by the NHS Trust/Provider of NHS services of compliance with all NIHR research manage-ment initiatives including uptake of NIHR Research Support Services and use of model research agreements/contracts. Declaration by the relevant Academic Health Science Network Board or other appropriate nascent AHSN governance structure, that there is full endorsement of the application for a NIHR CLAHRC award and that there is agreement with the proposed research/implementation Themes proposed. Declaration that matched funding (to at least the level requested by NIHR) from HEI, NHS or other col-laborators is approved by the contributing organisation and the local AHSN Board or other appropriate nascent AHSN governance structure. Please print this page, have it authorised and return it by post by 20 May 2013 to the address stated at the bottom of this form.

The NHS Trust fully endorse the application for an NIHR CLAHRC award and assert that appropriate support will be provided to the NIHR CLAHRC should the application for funding be successful. The NHS Trust Collaboration will comply with all NIHR research management initiatives, including uptake of NIHR Research Support Services and use of model research agreements/contracts. Signature …………………………………….. Date: ……………………… (NHS Trust Chief Executive)

The Academic Health Science Network Board or other appropriate nascent AHSN governance struc-ture, fully endorse the application for an NIHR CLAHRC award and agree with the proposed re-search/implementation Themes proposed. The Academic Health Science Network Board or other appropriate nascent AHSN governance structure, approve matched funding (to at least the level requested by NIHR) for HEI, NHS or other collaborators. Signature …………………………………….. Date: ……………………… (AHSN Director)

I confirm that I have checked the financial details of application (Reference: CLAHRC-2013-10025) and that this NHS organisation is prepared to carry out this research at the stated cost and to administer the awards if made. The staff salary quoted are correct and in accordance with the normal practice of this institution.

Signature …………………………………….. Date: ……………………… (NHS Chief Finance Officer)