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Report to the Meeting of theOxford Health NHS Foundation Trust

Board of Directors

29 March 2018

Research and Development Report

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BOD 38/2018(Agenda item: 11)

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1 Clinical Quality and Care..........................................................................................................................4

2 Networks and Collaborations...................................................................................................................4

2.1 Oxford Academic Health Science Network (OAHSN)........................................................................4

2.2 Dementia Clinical Network Update March 2018..............................................................................6

2.3 Oxford Academic Health Sciences Centre (AHSC).............................................................................7

2.4 Oxford Institute of Nursing, Midwifery and Allied Health Research.................................................7

3 National Institute of Health Research Infrastructure...............................................................................9

3.1 NIHR Collaboration in Leadership in Applied Health Research and Care (CLAHRC) Theme Updates 9

3.2 NIHR Diagnostic Evidence Co-operative (DEC)................................................................................12

3.3 NIHR MedTech and In Vitro Diagnostic Co-operatives (MIC)..........................................................12

3.4 NIHR Oxford cognitive health Clinical Research Facility (CRF)........................................................13

3.5 NIHR Biomedical Research Centre (BRC)........................................................................................16

3.6 NIHR Clinical Research Network (CRN)...........................................................................................18

4 Research Set Up, Management and Governance...................................................................................19

4.1 Pipeline Group Meetings................................................................................................................19

4.2 HRA.................................................................................................................................................19

4.3 Capacity and Capability...................................................................................................................19

4.4 Contracts and Confidentially Disclosure Agreements.....................................................................20

4.5 Costings..........................................................................................................................................20

4.6 Study Data Capture.........................................................................................................................20

4.7 Monitoring and Auditing of Research Projects...............................................................................20

4.8 Studies and Participant Recruitment..............................................................................................20

5 Pharmacy...............................................................................................................................................21

6 Case Records Interactive Search (CRIS)..................................................................................................22

7 Trust Governance and Reporting Mechanisms......................................................................................22

7.1 Reporting and Governance.............................................................................................................22

8 Finance...................................................................................................................................................24

8.1 Income............................................................................................................................................24

8.2 FY18 Performance..........................................................................................................................24

8.3 Collaboration in Leadership in Applied Health Research & Care (CLAHRC)....................................24

8.4 Biomedical Research Centre (BRC).................................................................................................25

8.5 Research Capability Funding (RCF)..................................................................................................26

8.6 NIHR Study Income.........................................................................................................................27

8.7 Clinical Research Facility (CRF)........................................................................................................27

8.8 Subcontracted study income..........................................................................................................27

8.9 DEC \ MIC........................................................................................................................................27

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8.10 Clinical Research Network: Thames Valley and South Midlands (CRN)...........................................27

8.11 Grant Applications..........................................................................................................................28

8.12 Risks - Redundancy Costs................................................................................................................29

8.13 Oxford Academic Health Science Network (OAHSN)......................................................................29

8.14 Summary of Funding Timeframes...................................................................................................29

9 Staffing...................................................................................................................................................29

10 Estates...................................................................................................................................................30

11 Communications....................................................................................................................................30

11.1 Significant Communications...........................................................................................................30

11.2 Additional communications activities:............................................................................................32

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1 Clinical Quality and Care Participation in research produces widespread benefits for patients and, more generally, improvements in quality of care. A Censuswide comsumer poll of 3,000 people in England, commissioned by the NIHR published data in September 2014 saying that 95% of those as responding stated that it is very important that the NHS carries out clinical research, with 85% or people agreeing that they would be very or somewhat willing to take part if they were diagnosed with a medical condition or disease. This accounted for the main factor that was most likely to motivate them into taking part, along with if a friend/family member was taken seriously ill and didn’t have the treatment they needed. The majority of those surveyed said that clinical research takes place within the NHS, Universities and Clinical Trials Units. Oxford health NHS FT has strong links to the University of Oxford, which has been rated as the world’s best university for clinical, pre-clinical and health subjects for the past 5 years (2011- 2016 THE World University Rankings), top ranked in the Research Excellence Framework 2014 for research quality in Psychology, Psychiatry and Neuroscience and third highest University in the areas of mental health and dementia in the RAND report commissioned by NIHR in 2015. In addition Oxford Health NHS Foundation Trust was the top ranked mental health Trust in the Mental Health Highlight Area in the NIHR RAND report

2 Networks and Collaborations

2.1 Oxford Academic Health Science Network (OAHSN)

Currently Oxford Health NHS FT is hosting three Oxford AHSN networks;

Early intervention led by Prof Belinda Lennox and Dr Matthew Broome for the Thames Valley, Matt Williams (Manager)

Anxiety and Depression led by Prof David Clark and Ineke Wolsey (Manager)

Dementia led by Prof Rupert McShane and Fran Butler (Manager)

2.1.1 Oxford AHSN Mental Health

Fran Butler started on 26th February as Senior Programme Manager Mental Health for Oxford AHSN. This new role is to co-develop with local stakeholders a sustainable programme of mental health innovation and improvement and ensuring that Oxford AHSN’s three programmes – Innovation, Improvement and Industry both contribute to mental health and are connected with mental health priorities and planning in the health system.

The AHSN has an 18 month project to evaluate Sleepio, a computerised CBT programme aimed at improving to help people with sleep problems.

Mike Denis, Oxford AHSN’s Director of Information Strategy, has succeeded in securing £1m to continue the Clinical Record Interactive Search (CRIS) system.

2.1.2 Early Intervention in Psychosis (EIP)

Early Intervention in Psychosis Best Practice Meeting: Work continues with successful EIP Best Practice Steering Group meetings. Over this period, guest speakers and topics for discussion have included;

Sleep apnoea and psychosis Making Every Contact Count (MECC) Perinatal Mental Health and Postpartum Psychosis Early Youth Engagement in first episode psychosis (EYE-2) study

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Meetings have been expanded to allow for greater participation in the ‘Best Practice’ section of the meeting from teams’ clinical staff. January 2018’s meeting had over 30 participants; including service users and commissioners from each area within the patch.

Quality Champions’ WebEx Monthly meetings continue to take place to ensure that quality issues and concerns are discussed and shared.

Epic Minds Campaign. This campaign is to raise awareness of EIP services and to encourage clinicians to join EIP services from other disciplines has been developed with involvement from service user volunteers at each stage. The campaign involves the development of a distinctly branded website (due to go live shortly), a suite of publicity materials (collateral includes t-shirts, posters, cards, introductory leaflets, and pop-up banners for use by clients and at health/recruitment events), animated video, and a series of service user films (Epic Stories).

Initial designs of materials were developed with input from service users and circulated to teams for use ‘in the field’. Designs were subsequently amended in readiness for the final print/manufacture run. The campaign has been shared with Rt Hon Norman Lamb MP and received his approval and support.

EIP Peer Reviews. In order to encourage service development and promote cross-border sharing of best practice, a peer review process – based on the principles of Appreciative Enquiry (AE) – was established for teams across the Thames Valley and Wessex. This involved a total of nine EIP teams from the Region.

Two well-evaluated preparatory workshops took place in November in Oxford and in Southampton to ensure all participants, including service users and carers, were prepared and sufficiently skilled to undertake face-to-face visits to teams across the South Central area.

All nine EIP Peer Review visits took place between November and December 2017 according to the schedule (in spite of the occasionally adverse weather conditions). The visits involved a total of 63 interviewees (39 EIP Staff, 9 Team Leads, 8 Service Users, 4 Carers, and 3 Peer Support Workers) and 35 interviewers (18 EIP Staff, 7 Team Leads, 3 Service Users, 2 Carers, 2 Peer Support Workers, and 3 ‘Others’ – including AHSN and NHS England staff). Reports recording the findings from the visit were produced – and circulated to relevant teams in January – to allow for the continuation to the ‘Delivery Phase’ of the project, which is now underway.

The incidence of psychosis is affected by many variables, including social deprivation, population age profile, ethnicity and population density. The Psymaptic psychosis incidence tool uses epidemiological data that uses these variables to predict the number of new cases of psychosis that can be expected in each region each year. Oxford Health NHS Foundation Trust took on 280 new FEP cases in the 12 months before the end of September 2017. This was against a predicted 151 cases and, therefore, 46% higher than anticipated. Milton Keynes and Berkshire took on roughly the anticipated number of new cases in the same time frame.

LiveFit Personal Trainer Pilot Project conducted in Berkshire EIP service (Reading and Slough locations) to meet unmet need; i.e. 50/212 (24%) clients with a BMI >25. Initial findings were presented at Royal College of Psychiatrists International Congress in Edinburgh. All (14) participants consistently reported improvements across several key areas of the QPR post-intervention. Approach and learning is currently being extended into Bracknell and Newbury

Training arranged for clinicians from each team within the AHSN geography. A number of training sessions have been arranged: Positive and Negative Syndrome Scales (34 clinicians trained), Common Assessment of At-Risk Mental States (35 clinicians trained), Autism Diagnostic Interview-Revised Training (10 clinicians trained). Economies of scale achieved through block/joint booking. Trained staff will be better able to deliver a number of the NICE concordant interventions more frequently.

The Early Intervention in Psychosis network will be closing in its current form as of the end of March 2018. Some of its work, such as EIP Best Practice Steering Group meetings will continue without input from the AHSN. The future of the South Region EIP Programme is evolving.

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2.1.3 Anxiety and Depression Network

The focus for the last 6 months has been on 3 projects:

Continuous Performance Improvement of all our IAPT services (Berkshire, Buckinghamshire, Oxfordshire and Milton Keynes) to maintain current high recovery rates (consistently some 5% higher than the national average and requirement). Recovery rates average continue to be held at an average of 56.3% (Q3) and reliable improvement rates have reached 69.4%. The services have already reached the anticipated 10% increase in patient numbers achieving recovery by the end of treatment (from 938 in April 2017 to 1054 in January) despite service disruption for the past 12 months whilst expanding to include Integrated IAPT services. We have had a specific focus on ensuring therapists take Anxiety Disorder Specific Measures (ADSMs) during treatment including at the start and the end of treatment. This drive towards paired ADSMs is important as patients suffering from specific anxiety disorders such as agoraphobia, PTSD and OCD need these specific questions to assess if they have improved or not. The generic measures for depression and anxiety (PHQ9 and GAD7) only address general depression and anxiety. We are pleased to be able to report that % collection of paired ADSMs for patients suffering with specific anxiety disorders is increasing across the region and, with that, a more accurate measure of patients’ true recovery in terms of symptom relief (such as leaving the house, ritualized behaviours etc).

The sub-projects below reflect our focus on relapse prevention work going forward. Durability of Clinical Gains: a long and a short paper with findings have been finalised and are currently with Prof Clark awaiting final sign-off before publication. As reported before, a strong theme from all our patient feedback and consultation work is a need for improved support post discharge, especially in the first 6 months.

Maintaining Therapeutic Gains: This work stream is run by our Patient Forum members and their (staff) PPIEE leads from all services. This survey has been designed to obtain detailed information about exactly what patients think will keep them well after discharge. This information will then enable us to improve post-discharge support and, with that, higher levels of continued well-being and fewer relapses. We anticipate the therapy support app to be an important part of this.

The IAPT therapy support APP: work on this app (with a dual focus, firstly to support patients during and after their therapeutic journey to maintain their therapeutic gains and secondly to conduct a large scale follow up study with thousands of patients uploading clinical scores monthly over a period of a year) is well under way now we have had affirmation of funding from the Oxford CLAHRC for a feasibility study this coming financial year. We have been working on content and functionality with the Patient Forum for the past 6 months and held a well-attended extended stakeholder event held on 21 st February which was focused on important detail on content and functionality. The event was attended by patient representatives, HI therapists, PWPs, data specialists and app developers. The outputs of this consultation exercise will now be collated and fed into the specification (or further consultation). Project group has also been broadened going forward and first meeting planned 21st March.

Health economics evaluation: health care utilisation evaluation of additional, integrated and co-located IAPT services for patients with Long Term Conditions (LTCs) and co-morbid depression and/or anxiety. All Thames Valley IAPT services were successful in being awarded Early Implementer status and funding, as well as national funding for a Thames Valley wide health care utilisation evaluation. We now have preliminary results from cohort 1 patients’ Client Self Service Receipts (CSRIs) from Professor Stuckler showing an average of just under £200 for a six month period across Thames Valley.

2.2 Dementia Clinical Network Update March 2018

Webinars. The AHSN have continued to run our successful dementia network webinars. Over this period, webinar topics have included;

Diabetes and Dementia

Dementia and Driving

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Dementia with Lewy Bodies

People with dementia getting lost

A report produced on the dementia webinars highlights that there have been over 1000 live attendees and about 900 viewings of the recordings. There are over 370 people on our webinar e-mailing list now.

Services for Young People with Dementia The Dementia Clinical Network has continued to support Milton Keynes memory clinic in setting up services for people with young onset dementia. The team in Milton Keynes have run several very well-received social events for people with young onset and their carers. This is spread of an initiative from Berkshire.

Memory Services Accreditation Maureen Cundell from the Oxford Central Memory Clinic has been seconded to the AHSN for two days a week and supported the successful re-accreditation of three of the Trust’s memory clinics against the Royal College of Psychiatry’s MSNAP standards. A fourth is in the process of going through reaccreditation.

Best Practice Network for Post-Diagnostic Support This best practice network no longer has dedicated funding and so has been relying on the goodwill of our Steering Group with members from around the Thames Valley and Milton Keynes. We have developed a programme for a CPD event in March, the main theme of the which is learning from service user and carer experience - what is the most useful thing that those working in Post-diagnostic support can do to support service users and carers.

Best Practice Network for Care homes in-reach teams which support care homes to provide quality care to people living with dementia. Network members share best practice and support each other to take initiatives forward. The teams from around the Thames Valley are running various projects including improving oral care in care homes and introducing dementia champions to care homes. The network ran an event for these teams in December in which team members were able to try out simulation suits for frailty and dementia, and in which they heard about the AHSN’s Patient Safety initiative on Hydration. A further network event will be held in March in which teams will hear about rarer forms of dementia and about the EPIC study.

Driving and dementia The network has been is looking in to the use of telematics in the process of establishing when/whether a person with cognitive impairment should stop driving. The network has been developing a study ‘Driving Behaviour in Older Adults: A Telematics Study’ working with an established cohort study.

The dementia network will be closing as of the end of March 2018. Some of its work such as webinars and the Care homes in -reach team network will be continued within the AHSN, whilst other projects come to a natural close or can continue without the network’s support.

2.3 Oxford Academic Health Sciences Centre (AHSC)

The ASHC will submit a separate report to the Board regarding activity across the four partner organization in Oxford. These reports will be on a biannual basis

2.4 Oxford Institute of Nursing, Midwifery and Allied Health Research

The Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR) is an Oxford Brookes University led partnership between key stakeholders to lead and participate in world class research and evidence-based practice that will produce knowledge to enhance the health and wellbeing of the population of Oxford, Oxfordshire, The Thames Valley, and beyond. They have a particular interest in innovation and best practice at the point of care.

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2.4.1 OxINMAHR members work in close collaboration with staff at Oxford Health, in a range of research, workforce development and practice improvement activities including:

1. PIPOx Project led by Debra Jackson. Active members of this team from Oxford Health NHS Foundation Trust include Sarah Gardner, Gabby Parham, Jill Bailey and Emily Buxton and current final year Mental Health Nursing student, Charlotte Ballard who will be joining Oxford Health NHS Foundation Trust upon graduation (she has been recruited into forensic mental health). This project has generated several publications and is informing a tier 2 RfPB being submitted through Oxford Health NHS Foundation Trust in March 2018.

2. The ‘Enhancing nursing staff resilience’ project involving Cathy Henshall and Debra Jackson, working with Linda Dix and Martyn Smith, and nurses in the forensic mental health environment is well on track and due to commence in March 2018.

3. They are currently nearing completion of data collection for a study called ‘Maternal attitudes to antibiotic use: a community-based study’, being conducted in the OX4 community. In addition to providing important information useful in relation to antibiotic use in primary care, this study forms the basis of Helen Bosley’s (Oxford Health Infection control Matron) PhD, supervised by OxINMAHR members Debra Jackson, Jane Appleton and Cathy Henshall.

4. Funding was awarded by the Sir Halley Stewart Trust in 2017 to support spiritual care activity within Oxford Health (£57,588). This funding has provided Dr Guy Harrison with a 0.5fte project development officer for two years to develop spiritual care strategies to benefit Oxford Health NHS Foundation Trust staff, patients and carers.

5. Debra Jackson, Director of OxINMAHR holds the role of Professor of Nursing at Oxford Health NHS FT, has been invited (and accepted) to be Professor of Nursing for Oxford Healthcare Improvement based at the Warneford Hospital, Oxford Health NHS Foundation Trust.

6. Recently commenced doctoral students include Karen Lascalles and Sarah Gardner, and though early in the projects, are working closely with Helen Walthall, Helen Aveyard, Debra Jackson, and colleagues to further develop their work which will directly benefit patient care at Oxford Health NHS Foundation Trust.

7. Extending clinical research opportunities for non-medical staff includes recent work undertaken by Beatrix Ruckli to include work on the Recovery College and the Occupational Sciences research group; and Charlotte Ballard who has spent time as an INTALECA intern exploring some of the mental health issues associated with avoidable patient harm, and migrant health.

8. Participation of Oxford Health staff in writing retreats hosted by OxINMAHR, including Cathy Henshall, Jane Fossey, Monika Rybecka, Beatrix Ruckli, and Helen Bosley.

9. Increasing the visibility of non-medical research in the Trust through a programme of lectures and seminars conducted by international leaders in community or mental health nursing. These include: Prof Wendy Cross from Monash University Australia and Chair of the Australian College of Mental Health Nurses; Prof Kim Usher from the University of New England, Australia and Editor in Chief, International Journal of Mental Health Nursing; Prof Denise Wilson from Auckland University of Technology, New Zealand whose research focus is on Māori/indigenous health and health service engagement, family violence, cultural responsiveness, and nursing and health workforce development; and, Dr Gillian Murphy from Western Sydney University, Australia, whose research focus is on loss and recovery in childhood parental death and children of parents with chronic mental illness (forthcoming in March 2018).

2.4.2 Projects in development

Collaborative projects are currently in development or under review are:

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1. The Dementia Registry Project, situated in OX4. This team, led by Jo Brooke and Jane Fossey is planning to submit an NIHR Program Grant in 2018.

2. The OX4 Programme led by Debra Jackson and involving numerous colleagues from Oxford Health NHS Foundation Trust, is in development.

3. Tier 2 RfPB being submitted through Oxford Health NHS Foundation Trust in March 2018 involves several staff from the Trust.

4. “ERICA - Stopping Child Maltreatment through Pan-European Multiprofessional Training Programme: Early Child Protection Work with Families at Risk”. Submitted for European Commission funding with Finland leading. In the UK, Jane Appleton and Emma Leaver (Oxford Health NHS Foundation Trust) are supporting this.

5. “A qualitative study to examine the service provider and commissioning factors which facilitate and inhibit effective child protection practice between General Practitioners and Health Visitors”, Jane Appleton is leading this with multiple colleagues from Oxford Health NHS Foundation Trust.

2.4.3 Key Publications

Over the last 12 months there have been over 50 publications, the key ones being:

Bosley, H., Henshall, C., Appleton, J.V. & Jackson, D. (2017) A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children. Journal of Clinical Nursing, DOI: 10.1111/jocn.14073 Trust funding PHD

Jackson, D., Durrant, L., Bishop, E., Walthall, H., Betteridge, R., Gardner, S., Coulton, W., Hutchinson, M., Neville, S., Davidson, P. & Usher, K. (2017) Pain associated with pressure injury: a qualitative study of community-based, home-dwelling individuals. Journal of Advanced Nursing, 73(12), 3061–3069.

Jackson, D., Durrant, L., Bishop, E., Walthall, H., Betteridge, R., Gardener, S., Coulton, W., Hutchinson, M., Neville, S., Davidson, P. & Usher, K. (2017) Health service provision and the use of pressure redistributing devices: Mixed methods study of community dwelling individuals with pressure injuries. Contemporary Nurse, 53(3), 378-389.

Jackson, D., Usher, K., Woods, C., Sayers, J., Kornhaber, R. and Cleary, M. (2017) Safety, Risk and Aggression: Health Professionals Experiences of Caring for People affected by crystal methamphetamine (ICE) when presenting for Emergency Care. International Journal of Mental Health Nursing, 26(5), 437-444.

Jackson, D, Durrant, L.A., Hutchinson, M., Ballard, C.A., Neville, S. & Usher, K. (2017) Living with multiple losses: Insights from patients living with pressure injury. Collegian. https://doi.org/10.1016/j.colegn.2017.10.008

Murphy, G., Peters, K, Wilkes, L. & Jackson, D. (2017). Adult Children of Parents with Mental Illness: Dehumanization of a Parent - She wasn't the wreck in those years that she was to become later, International Journal of Mental Health Nursing, DOI: 10.1111/inm.12409.

Murphy, G., Peters, K., Wilkes, L. & Jackson, D. (2017) Adult Children of Parents with Mental Illness, Navigating Stigma. Child and Family Social Work. 22(1), 330-338.

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https://doi.org/10.1016/j.colegn.2017.10.008

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3 National Institute of Health Research Infrastructure

3.1 NIHR Collaboration in Leadership in Applied Health Research and Care (CLAHRC) Theme Updates

3.1.1 Theme 1

All projects on target to complete by December 31, 2018.

Projects with updates:

Cost of Self Harm Project – Professor Keith Hawton and Dr Apostolos Tsiachristas were invited to present their evidence from this work to the All-party Parliamentary Group (APPG) on Suicide and self-harm. The APPG “found the evidence astonishing and it will forward it to the minister [for health and social care, Jeremy Hunt]”.

An ethnographic study of frail, older patients’ health care journeys through, and experiences of, an Emergency Multidisciplinary Unit – Study written up in report form and executive summary of findings posted on CLAHRC website. Executive summary posted on website for Dunhill Medical Trust (external funders of the study). All authorities and participating trusts notified of findings. Publications in preparation.

Clinical Decision Making in Ambulatory Care; A Case Study of Clinicians providing Ambulatory Emergency Care in Urgent Care Settings in Oxfordshire (EMU) – Dr Sara McKelvie, project lead, approved as a doctoral student in the Department of Primary Care (back dated to October 2016). Given a number of presentations on the project, including Physiotherapy UK conference (systematic review) and NAPCRG conference in Montreal (17-21st Nov).

Patient experience based co-design in early intervention in psychosis services (EBCD in EIP) - Young People's Experience of Psychosis – Project now complete and the summaries are with DIPEx/healthtalk who will be creating the website during Q1, 2018.

All other projects on target.

3.1.2 Theme 2

Two projects at risk of delay, one beyond December 31, 2018. All other projects on target to complete by December 31, 2018

Projects at risk of delay:

CORKA: COmmunity based Rehabilitation after Knee Arthroplasty (HTA funded study, CLAHRC Adopted project [leveraged funding]) – 11 recruiting sites now open (three closed). Recruitment is currently at 608 of 620. Original recruitment end date: 31st August 2017 – extended to December 2017. Potential delay to August 2018

Better Outcomes for Older People with Spinal Trouble (BOOST) RCT HTA funded study, CLAHRC Adopted project [leveraged funding]) – 256 of 332 (77%) predicted participants have been recruited. New recruitment targets agreed with both DMEC & PSC which includes extending recruitment to June 2018. 12 sites open and two in set up. Drafting of first two publications underway (expected January 2018). Risk of delay to 31 March 2020.

Projects on target, with updates:

Self-directed and supervised exercise treatments for rheumatoid arthritis (iSARAH) [for clinicians] – As of 19 December 2017:

o 589 registered users and 276 therapists have completed the training and have provided end-of-training feedback.

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o contacted 86 therapists who expressed their interest to participate in the service evaluation.

o 8 NHS sites have started implementing the SARAH programme, and 14 more sites to start soon.

o Dr Cynthia Srikesavan received the Chartered Society for Physiotherapy’s (CSP) Robert Williams International Award at the Physiotherapy UK 2017 conference for her work on the implementation of the SARAH project.

o Cynthia, along with Dr Esther Williamson also co-authored an article on the CSP website about the SARAH intervention as part of their Clinical update series: http://www.csp.org.uk/frontline/article/clinical-update-rheumatoid-arthritis-hand-exercises.

Self-directed and supervised exercise treatments for rheumatoid arthritis (mySARAH) [for patients] –

o The usability evaluation of the preliminary version of mySARAH in nine volunteers with rheumatoid arthritis to resolve usability issues have been completed. The final version of mySARAH will be available in first week of January 2018.

o Between January and 14 October 2018, the feasibility and acceptability of mySARAH will be evaluated in a proof-of-concept study in up to 12 people with Rheumatoid arthritis.

o The protocol, IRAS form and all supporting documents have been reviewed by the CTRG review. The final version of protocol and supporting documents will be submitted in the first week of January 2018.

Preventing falls and fragility fractures – Paper expected to be submitted Q1, 2018 to Age and Ageing "Do nursing stations within bays of hospital wards reduce the rate of inpatient falls ? – An Interrupted Time Series Analysis from the United Kingdom"

DAPA (Dementia And Physical Activity) extended qualitative study and implementation research (Phase 1 funding extension) – Main report (HTA) in press.

Oxford Pain, Activity and Lifestyle (OPAL) cohort study – Recruitment at 3,459 of 4,000. 29 sites open, 24 sites have completed both baseline mailouts (initial and reminder). Plan to open further sites in Jan/Feb 2018. Year 1 Follow Up has started and response rate currently at 79%.


3.1.3 Theme 3

All projects on target to complete by December 31, 2018

3.1.4 Theme 4

One project at risk of delay, but all projects on target to complete by December 31, 2018.

No significant updates.

3.1.5 Theme 5

All projects on target to complete December 31, 2018

CollabOrative Care Model for Bipolar DisOrder (COMBO) [on target for Dec 2018, but at risk of delay) – Trouble in recruiting GPs/surgeries.

Evaluation of a digital monitoring system in psychiatric inpatient wards to minimise disruption to the patients at night – Project using Oxecam Ltd camera based health monitoring technology (breathing and heart rate monitoring) to reduce the need for sleep disruptions (nursing supportive

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http://www.csp.org.uk/frontline/article/clinical-update-rheumatoid-arthritis-hand-exercises

http://www.csp.org.uk/frontline/article/clinical-update-rheumatoid-arthritis-hand-exercises

http://www.csp.org.uk/news/2017/11/17/physio17-csp-announces-award-winners-2017

http://www.csp.org.uk/news/2017/11/17/physio17-csp-announces-award-winners-2017

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observations) of patients in acute psychiatric wards who may pose a risk to themselves or others. Progress so far:

o Initial workshop with nursing staff and former patients complete

o Project and collaboration approved by all Oxford Health quality and legal teams (issues re data protection and confidentiality addressed).

o Legal agreement formally signed.

o Steering committee established.

o PPI being implemented: how best to inform patients and carers about the system.

OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE) – Widening the number of regions we will recruit in to increase the number of practices involved and number of eligible patients to invite. Our revised target for number of practices to recruit is 100 (up from 39).

o Recruiting centres in Southampton and Cambridge now opened.

o As of the December 15th 2017, 33 practices recruited and 125 patients randomised.

o A further 16 practices have expressed an interest in the trial but not yet been set up.


3.1.6 Theme 6

All projects on target to complete by December 31, 2018

3.1.7 Forward Look and High Profile Developments

CLAHRC Extension: Received confirmation from the NIHR CCF of 9 months pro-rata extension funding (Jan, 2019 to Sept, 2019) on the 9th of January, 2018. Allocation of funding to themes/project currently being finalised by CLAHRC Executive board.

CLAHRC Annual Stakeholder Symposium: Will be held November 2018 at the Saïd Business School. An organising committee comprised of theme representatives has been put together to develop the programme, with admin support from the CLAHRC core team.

3.2 NIHR Diagnostic Evidence Co-operative (DEC)

Operations of the NIHR DEC Oxford concluded on the 31st December 17, with the NIHR Community Healthcare MedTech and In-vitro Diagnostics Co-operative initiating on the 1st January 2018.

3.3 NIHR MedTech and In Vitro Diagnostic Co-operatives (MIC)

The NIHR Community Healthcare MedTech and IVD Co-operative was officially launched on the 10th of January at the Cohen Quadrangle of Exeter College. The launch included short talks from the Medical Director Professor Chris Butler, the theme leads, and the programme Manager for the MIC. The launch concluded with a tea and cake reception.

There have been more than 9 company interactions in the last six months, covering urinary tract infection, multiplex POC diagnostic platforms, sepsis, cardiovascular conditions and decision support in general practice

The DEC/MIC team has published more than 18 peer reviewed papers in the last 6 months

The DEC/MIC team published a paper highlighting the state of the evidence available for point-of-care diagnostic tests: Verbakel JY, Turner PJ, Thompson MJ, et al. Common evidence gaps in point-of-care

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diagnostic test evaluation: a review of horizon scan reports. BMJ Open 2017;7:e015760. doi: 10.1136/bmjopen-2016-015760

The team published a new Horizon Scanning report covering point-of-care testing for H. pylori infection (number 48). The report was developed into a Clinical Intelligence report which was peer reviewed and published in the BJGP: Point-of-care Helicobacter pylori testing: primary care technology update. Brian D Nicholson, Lucy M Abel, Philip J Turner, Christopher P Price, Carl Heneghan, Gail Hayward, Annette Plüddemann. Br J Gen Pract 2017; 67 (665): 576-577. DOI: 10.3399/bjgp17X693881

Innovate UK Small Business Research Initiative Phase II project: The MIC is continuing to support Mologic Ltd in their development of a point-of-care diagnostic test to stratify patients to the most appropriate treatment during acute exacerbations of their condition.

Ongoing studies include the METRIC (MEasuring TempeRature In Children) trial, which is a methods comparison study of different thermometry devices.

Dr Philip Turner, Manager of the MIC gave a public lecture in January entitled ‘Beyond accuracy: Evidence gaps and unintended consequences. Factors influencing utility of point-of-care diagnostic tests’. The lecture was delivered in association with the Department for Continuing Education at the University of Oxford

MIC Deputy Clinical Director Dr Gail Hayward, Dr Philip Turner and Dr Joseph Butler presented a session at the ‘Improving the Physical Healthcare of People with Serious Mental Illness’ workshop which was hosted by Oxford Health on the 26th January. The MIC hosted a workshop session entitled ‘Point of care tests to improve monitoring of physical health in psychosis. Can technology help?’ Point-of-care medical technologies and diagnostics were presented by industry representatives, and the use of technologies was discussed which might improve the management of this vulnerable patient group in the community

Dr Gail Hayward attended and contributed to the NHSE CRP & POC Accelerated Learning Workshop 2018 in London on the 28th February, whilst Dr Philip Turner introduced the Community Healthcare MIC to the members of the BIVDA Point-of-care Working Group at the headquarters of BIVDA in London

3.4 NIHR Oxford cognitive health Clinical Research Facility (CRF)

The CRF is a single managed entity hosted by OUH in partnership with OHFT. The CRF provides a flexible and integrated neuroscience resource that facilitates the efficient and timely conduct of experimental neuroscience including high intensity early phase experimental medicine research and early phase clinical trials. The CRF’s aim is to be fully aligned with the strategies of both the NIHR BRCs based in Oxford to enable, encourage and facilitate high intensity research in neuroscience and to work with principal investigators and commercial partners both established and new to achieve this aim.

The main research areas include; Adult Mental Health Disorders, Dementia and Neurological Conditions.

3.4.1 Outputs

Data submitted for the annual return on activity between 1st April 2016 and 31st March 2017 shows that 32 studies were undertaken and 34 peer-reviewed articles were published where either CRF staff were contributing authors or the research was carried out on the CRF.

The CRF provides specialist clinical research study and trial support for many activities for a range of studies, including both commercial and non-commercial sponsors studies, with a focus on experimental medicine.

Key examples of studies currently active:

A clinical biomarker study of immunological phenotypes associated with monoaminergic anti-depressant response, and the brain and cognitive phenotypes associated with variation in peripheral C-reactive protein (CRP) levels, in patients with major depressive disorder (MDD), BIOmarkers in Depression study (BIOdep). BIOdep is a ‘Wellcome Trust Consortium for

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Neuroimmunology of Mood Disorders and Alzheimer’s Disease’ study, a public-private partnership with collaborations between 7 academic and 4 industry partners looking at the effect of inflammation on Alzheimer’s disease and treatment-resistant depression. We successfully reached target recruitment for Cohort 1 in 2016-17 and are currently recruiting to Cohort 2. Recruitment has been extended to December 2018. The data from cohort 1 will be available later this year for analyses and publication.

Bipolar disorder (BD) has a strong genetic component and calcium signalling is considered to be a key part of its pathophysiology. The Oxford calcium channel antagonist study: exploration of the role L-type calcium channels in cognition and sleep (OxCaMS) is designed to find out more about the short-term effects of a calcium channel blocker called nicardipine. This OH-BRC experimental medicine studycompares the effects of nicardipine and placebo. The results may help to decide whether calcium channel blockers are likely to benefit individuals with mood instability and bipolar disorder. They may also facilitate the search for new medicines that are more effective, safer and easier to tolerate. We are also interested in whether people’s genes influence the effects of calcium channel blockers. The gene we are interested in is CACNA1C which codes for a part of the calcium channel. The study opened in November 2017, with the first participant recruited in December 2017.

The primary objective of the PREVention of dementia by ENvironmental intervention and Therapy (PREVENT) study, funded by the Alzheimer’s Society, is to describe the interaction of Alzheimer’s Disease (AD) risk (based on genetics and family history) and biological markers of AD in middle age. We will do this by comparing high and low AD risk participants in the 40-59 age range in terms of a variety of AD biomarkers. A secondary objective of the study is to establish a trial-ready cohort that will at a later stage be used to test the benefit of an intervention program based on multiple risk factors. The study may result in the identification of intermediary biomarkers of AD risk in middle age and will enable further targeted research in AD. The study is recruiting to target on the CRF, with 57 of 64 participants recruited to date.

The European Prevention of Alzheimer’s Dementia (EPAD) study. EPAD is a research initiative that provides a platform to investigate new treatments that aim to prevent or delay the onset of clinical symptoms in people at risk of developing AD. It involves more than 36 organizations across Europe including universities, pharmaceutical companies and patient organizations and is supported by the European Innovative Medicines Initiative. It is also working closely with other, similar initiatives worldwide, including the US-based Global Alzheimer’s Platform. The EPAD longitudinal cohort study (LCS) will draw on existing national and regional registers of people at risk of developing AD to create a single, pan-European EPAD register of around 24, 000 people. Of these, the 6000 deemed to be at greatest risk of AD will be invited to join an EPAD cohort of ‘at risk’ subjects. This group will undergo a wide range of assessments and imaging over time. The project will select around 1500 people from the cohort to take part in early stage ‘adaptive’ clinical trials of drugs designed to prevent AD. All data collected from the EPAD cohort and trial will be made publicly available for analysis to help researchers everywhere improve their understanding of the early, pre-dementia phase of AD. Ultimately, the hope is that this project will reinvigorate the development of treatments for one of the most challenging diseases facing our ageing societies. EPAD opened to recruitment on the CRF in Jan 2018.

3.4.2 Studies in set up and due to open within the next 6 months include:

Deep and Frequent Phenotyping (DFP) study funded by the Medical Research Council. The DFP study will both track and predict change over time in preclinical AD and healthy controls. It will do this by measuring pathology using a number of different methods (brain imaging, CSF collection, cognition change) over time. We predict the study data will be the largest, openly available dataset on preclinical Alzheimer’s disease thereby providing a rich data source for research into both understanding AD better and informing treatment trials for new drug development

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SINAPPS2 is a MRC funded randomised phase II double-blinded placebo-controlled trial aiming to test efficacy and safety of intravenous immunoglobulin and rituximab versus placebo treatment of antibody-associated psychosis in addition to the current psychiatric standard of care. Approximately 2400 adult patients with acute psychosis will be screened for serum anti-neuronal membrane antibodies in mental health NHS services across England to identify 160 patients with antibody positive psychosis. They will be screened at eight SINAPPS2 sites in acute hospitals in England and about 80 will be randomised 1:1 to receive either intravenous immunoglobulin (IVIG) followed by rituximab or placebo infusions. Study participants will be followed for 12-18 months. The primary outcome is time to remission sustained for six months. The main SINAPPS2 site is Oxford University Hospitals NHS Foundation Trust. However, the IVIG/placebo infusions will be delivered at the CRF. The SINAPPS2 trial will contribute to a limited but growing body of evidence about the role of pathogenic neuronal membrane antibodies in antibody-associated psychosis. It has potential implications for understanding and management of psychosis and it could have a significant impact on the improved health of a group of patients with antibody-associated psychosis.

The RESTAND (Research on Emotional effects of SeroTonin Agonism in Non-medicated Depression) and RESTART (Research on Emotional effects of SeroTonin Agonism in ResistanT depression) studies will investigate the early effects of activating serotonin-4 (5HT4) receptors on emotion processing in depressed patients, to help further our understanding of the mechanisms underlying antidepressant treatment. RESTAND will recruit participants with depression who are unmedicated and RESTART will recruit participants with depression who are on medication but have shown poor response to their current medication. Both will use a double-blind, placebo-controlled, randomised experimental medicine design, with some participants randomly allocated to receive 7 days of a drug which activates 5HT4 receptors called PF-04995274. On the 6th and 7th days, we will measure how participants’ process information such as emotional faces and words using computer based tasks and neuroimaging. If participants who have been given PF-04995274 show positive biases in how they process emotional information at this early stage, this will suggest that activating 5HT4 receptors is a potentially useful mechanism for treating depression. Findings could therefore help guide future antidepressant drug development. Both studies are funded by the Medical Research Council and sponsored by the University of Oxford. They are due to open in Spring 2018 at the CRF.

3.4.3 Occupancy

2016/17 Occupancy (Apr 16 – Mar 17).The occupancy reported in the 2016/17 NIHR annual report was 56% and reflected the three sites which at that time made up the Oxford cognitive health Clinical Research Facility. This was an increase on the 47% reported for 2015/16. The 2016/17 Warneford site occupancy of 59% was a significant increase on the prior year level of 44%.

The year to date occupancy at the Warneford CRF for the period April to December 2017 was 58% which is slightly up on the 57% reported for the same period last year. The predicted full year occupancy is expected to be 61% which is a small increase on the 59% reported last year.

The capacity of the Warneford CRF is reviewed on a monthly basis by the CRF operations team in order to ensure that the unit is used as efficiently as possible.

3.4.4 Renewal of CRF funding

The NIHR Oxford cognitive health CRF was awarded renewal of NIHR funding (3.7M over 5 yrs) commencing April 2017, hosted by OUH. The CRF renewal included resource to expand the facilities at the JRH. The CRF team has been working with the Acute Vascular Imaging Centre (AVIC), Nuffield Dept of Neurosciences, and the OUH Executive Team and R&D Dept to determine the optimal way of achieving this aim. However, as an appropriate location for the CRF expansion at the JRH has not yet been identified, we invited proposals for the subsequent CRF underspend (FY2017-18). These were reviewed by CRF panel members, with the maintenance and development of CRF infrastructure being a primary consideration. This has resulted in a

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number of successful funding applications being approved. We are currently in the process of working with the successful applicants from the CRF competition. We will continue to work with colleagues at OUH to deliver the expanded CRF.

3.4.5 Strategy and Research Objectives

The primary objective is to deliver new therapies tailored to the needs of individual patients by breaking down disciplinary boundaries, taking advantage of scientific, technical and infrastructural capabilities that cut across disorders.

Short-term objectives

Short-term objectives: to build further our capability in translational neuroscience, to facilitate the objectives of OH-BRC, to support the successful CRF competition applicants, to expand facilities at the JRH, to finalise the PPI/E strategy for the CRF.

Medium-term objectives:

To realise plans for purpose built integrated and coordinated neuroscience research and clinical facilities across Oxford. Work has been initiated for a joint University-NHS Masterplan to develop the Warneford as a Brain Health Centre for translational neuroscience. The Masterplan is driving the joint development, the first stage of which is the £4.5 million upgrade of the Oxford Centre for Human Brain Activity, now part of the newly opened Wellcome Centre for Integrative Neuroimaging.

Long-term objective

To deliver an efficient translational pipeline fueled by Oxford’s unrivalled scientific infrastructure and expertise and deploying the very best science to deliver new therapies for patients’ mental, cognitive and neurological disorders.

3.5 NIHR Biomedical Research Centre (BRC)

The successful Oxford Health BRC, a partnership between OHFT and University of Oxford has commenced with funding started in April 2017, £12.8 million over 5 years with 50% of the annual budget being awarded within the first year.

The hub of the new center is at OHFT Warneford Hospital site. The site also houses the University of Oxford’s Department of Psychiatry and its associated research centers and facilities.

The strategy is to bring the best science to the complex problems facing research into mental disorders and dementia with the aim to use digital and other new technologies to produce scalable solutions with global application and transform our discovery science into new treatments and diagnostic tools, delivering precision care that is strongly informed by patient involvement, ethical and economic consideration

3.5.1 Operational Progress

BRC Theme leaders meetings continue on a monthly basis to discuss and optimize budgets and synergies across the themes in order to maximize outputs. Theme leaders are looking at resources aligned to projects for year 2 of the funding.

BRC Steering Committee continues to meet monthly. The committee is responsible for the operational, strategic and scientific direction of the NIHR Oxford Health BRC.

Operational budgets have been set and are issued monthly. These are to be used to form to forecast the year end position, thus allowing for the identification of any cost pressures or underspend. The Trust has received only 50% of the annual budget in the first year and plans are forming to allocate 100% from April 1st 2018

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Governance Structures are established. The newly established Research Management Group (RMG) will receive quarterly reports from the BRC and provide an opportunity for additional strategic collaborations across NIHR infrastructure in Oxford.

Contracting. The NIHR BRC contract has been negotiated and signed. The Trust is awaiting feedback from the NIHR regarding the Framework for Intellectual Property Agreement between the University of Oxford an Oxford Health NHS FT.

Reporting and Metrics. Work is ongoing regarding the mechanisms for data collection for the annual return. A new Data Manager is in post to coordinate this.

Collaborations.

o The NIHR is proposing to create TRC for mental health, with 1 year of funding with the management post being based at the NIHR. A business case has been accepted, and undergoing fine adjustments.

o Work continues to work collaboratively across BRCs nationally

3.5.2 BRC Themes

Adult Mental Health: Innovation in Diagnosis and Treatment (Theme Lead: Professor Paul Harrison)

We have adopted 29 studies, providing logistical or other support of some kind. These studies together represent all relevant activity we are aware of. Our two research managers (Liliana Capitao [50% with experimental medicine theme] and Arne Mould [50% with old age and dementia theme) are both doing a fantastic job. Amongst their other roles, they have set up 10 Standard Operating Procedures (SOPs) to be used by research within the theme, and have a rolling programme of work to extend to additional areas, and keep all SOPs up to date.

We are on budget for 2017-2018, and have begun to set the budget for 2018-19. The latter includes continuing most of the Y1 commitments, and using the increased funding to provide support for five new studies which have been adopted, as well as 50% support for a D.Phil. student, and contributions to the salary of a researcher working on stem cells for bipolar disorder, and for two consultant psychiatrists who are working on BRC-related studies.

We are currently planning our contributions to the joint BRC/CRF open day in May.

Older adults and dementia (Theme Lead: Professor Clare Mackay) –

Our focus has been primarily on the first three of these sub-themes. Within the Pharmacological Interventions sub-theme, the Deep and Frequent Phenotyping (DFP) Study, European Prevention of Alzheimer’s Dementia (EPAD) Study, and PREVENT Dementia study are building trial-ready cohorts for future treatments. Within the non-pharmacological sub-theme, we have published papers examining the effects of mobility1 and sleep2 on brain structure. We have also published a protocol paper outlining the Defining the Impact of improved Sleep on COgnitive function (DISCO) study, which is investigating the impact of a digital Cognitive Behavioural Therapy programme for insomnia on cognitive functioning.3 Finally, within the Public and Patient Involvement sub-theme, we have worked with the PPI theme to survey researchers on their current activities and training needs. We are also running a series of focus groups to develop a strategy to reinvigorate the Friends of Oxford Dementia and Ageing Research (OxDARE) registry of interested research participants.

Precision Psychological Treatments (Theme Lead: Professor Anke Ehlers) –

The theme made further progress with building infrastructure for digital interventions, creating content for specific online treatment programmes and therapist training, randomized controlled trials and analyses of treatment processes.

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After the appointment of a virtual reality (VR) specialist (Dr. Avitor Rovira), the virtual reality laboratory has been equipped to facilitate Freeman’s work on VR in the treatment of paranoia and Stein and Bowes’ work on the effects of bullying. The BRC support was instrumental in Freeman’s successful application for an NIHR i4i Challenge Award (£ 3.9 m).

Recruitment of a web developer for the development of an online platform for psychological treatments has proved difficult. As an interim solution, we have worked with two IT companies to create a generic version of the online treatment programmes developed by Clark and Ehlers in Wellcome Trust funded work. The programmes were adapted to a responsive design so that they work on tablets and smartphones, and the video recording function was improved. The programmes are now ready to be used in new studies of online psychological therapies for posttraumatic stress disorder (PTSD), social anxiety disorder and perinatal anxiety and depression.

Progress has been made with developing and maintaining online training sites for the implementation of effective treatments for anxiety disorders and mindfulness cognitive therapy.

Recruitment has started for a new trial comparing two therapist-assisted online psychological treatments for PTSD (Ehlers). Another RCT investigates the effect of low intensity mindfulness training on student mental health and wellbeing (Kuyken). A further RCT evaluates the efficacy of an online resilience training in the prevention of PTSD and depression in paramedics (Wild). In three RCTs, the relationship between poor sleep and psychotic and PTSD symptoms was investigated (Sheaves et al., Psychological Medicine, 2017, https://doi.org/10.1017/S0033291717003191; Freeman et al., Lancet, 2017, http://dx.doi.org/10.1016/ S2215-0366(17)30328-0; Woodward et al., 2017, http://dx.doi.org/10.1016/j.brat.2017.07.001).

3.5.3 BRC Cross Cutting Themes

Informatics/digital health (Theme Lead: Professor Simon Lovestone)

The theme has been streamlined into three sub-themes – Digital Health, led by Chris Hinds and will continue to support and develop True Colours as a primary Function, Clinical Informatics, Led by Tanya Smith and will drive the use of the Case Records Interactive Search (CRIS) within the research arena and clinical audit within the Trust and Bioinformaitics, led by Prof Caleb Webber.

Neuroimaging and Cognitive Neuroscience (Theme Lead: Professor Kia Nobre)

The theme has been streamlined into sub-themes of Magnetic Resonance Imaging (MRI), Magnetoencephalography (MEG), and Cognition, with the aims of developing standardized assessments, applying assessments across research studies, and translating assessments into clinical settings. Work within this Theme is closely aligned to the recently established Wellcome Centre for Integrative Neuroimaging and the Older Adults and Dementia theme of the BRC, with a number of joint appointments.

MEG is being used to explore synaptic health and network dynamics in a number of disease areas, including Alzheimer’s Disease and Mild Cognitive Impairment with the NTAD study, a collaboration between Oxford, Cambridge, Janssen, Lilly, AstraZeneca and DFP a collaboration between Oxford, Cambridge, Glasgow, London, York. In addition further work is ongoing using MEG in Bipolar Disorder with three projects – COMET, OxLith and OxCAMS.

The theme is also researching cognitive phenotyping with standardised tasks, validated precision tasks and experimental task development

Clinical research infrastructure and experimental medicine (Theme Lead: Professor Catherine Harmer)

We have adopted 29 studies (at the intersection with adult mental health theme) and provide pharmacy, statistical, experimental design, analysis, SOP and CRF support from the budget from

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this theme. We have jointly funded 5 pilot studies on the pathway to fellowship or larger scale funded.

We are within budget for 2017-2018 and our 2018 budget will include an additional staff member - Dr Cassandra Gould van Praag (from 3 April). Cass will provide neuroimaging support for experimental medicine studies particularly focused on analysis support. We are continuing to engage with industry to facilitate experimental medicine studies; our research programme funded from UCB Pharma focused on the use of implicit cognitive biomarkers has started; our experimental medicine probe of stress has been incorporated into J&J novel therapeutics pathway and we are in the planning stages of an Oxford based research programme on glutamatergic novel compounds with J&J.

Patient and Public Involvement and Ethics (Lead: Professor Ilina Singh)

The PPI Strategy for the BRC and CRF has been coproduced with support from the Patients and Research (PAR) group, BRC PPI Liaisons and was sent to the NIHR in December 2017. The feedback was received in February and is being addressed. Sandra Regan the PPI Manager left the Trust at the end of December and the new Manager Claire Murray joined in February. Work is ongoing developing operational plans to deliver the strategy. An ongoing relationship with OUH BRC, specifically the Partnerships for Health, Wealth and Innovation theme, has been established in order to identify links for joint research and to share learning from practical experience across the two BRCs.

Education and Training (Lead: Professor Elizabeth Tunbridge)

The funding for the Education and Training theme fundamentally starts in 2018. A new training coordinator, Tamara Lewin to support the theme has been appointed.

3.6 NIHR Clinical Research Network (CRN)

According to NIHR CRN performance metrics, in FY 2017/18 to date, OHFT is the second highest recruiting trust to the NIHR Mental Health portfolio (after South London and Maudsley NHS FT). This builds on the success seen in FY 2015/16 and FY 2016/17. At the current time Oxford Health has 37 NIHR portfolio studies reporting recruitment activity in FY 2017/18 to date.

Studies cover the following range of conditions: bipolar, (hyper) mania, schizophrenia, MDD and depression, chronic depression, sleep disorders, psychosis, delusions and hearing voices, anxiety, generalised anxiety disorder, PTSD eating disorders, autism, suicide, adolescent mental health in schools, enduring behavioural problems in young children, and staff and carer surveys.

The dementia portfolio includes a wide range of participants; controls without cognitive disorder and those with mild cognitive impairment (MCI), prodromal Alzheimer’s Disease (AD) and mild/moderate AD.

The CRN are proud of their achievement in meeting participant recruitment targets. There are a range of studies, commercial drug trials, non-commercial trials including repurposed medications, tele-care, patient and carer surveys, genetic studies and studies in care homes. The dementia team are supporting recruitment to the European Prevention of AD longitudinal cohort study (EPAD) study.

The dementia team continue to receive high levels of referrals from memory clinic and other older adult clinical staff, in the last 12 months, 460 people were added to the research interested list from memory clinic referrals. An audit of one of the memory clinic referrals over a defined period of time was conducted to see what research activity people referred took part in. The following was found: out of 65 people referred, all of whom were prescreened, 33 were screened in detail and/or received participant information leaflets about studies. 6 people participated in clinical research. That is 1 in 10. The team are very pleased with this outcome, given the rigorous inclusion and exclusion criteria for the majority of studies recruiting. The dementia team are actively working with all memory clinic services across the trust to improve research participation rates.

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Drs Andrew Molodynski and Rohan Vanderputt continue in their respective roles as CRN Mental Health lead and CRN Dementia lead across the Thames Valley region.

4 Research Set Up, Management and Governance

4.1 Pipeline Group Meetings

New processes are being established to streamline a committee approach to setting up studies within the Trust due to the potential increased number of studies as a result of the successful BRC. A Pipeline Group, chaired by Prof Andrea Cipriani, Associate Director of R&D, meets regularly to determine whether studies are of scientific, strategic, patient value and whether there is capacity to undertake the study in the Trust and where the study could take place. It is key that a Principal Investigator (PI) is identified early in the process that can lead the study set up and delivery. The Pipeline Group will establish whether the study is appropriate to be developed in terms of undertaking costings, contract negotiations, capacity and capability (completion of HRA Statement of Activities) as part of the set up process thus enabling a more transparent and collective approach to research to ensure study targets can be met and that there is no overburdening of certain patient populations.

4.2 HRA

Approval is the process for the NHS in England that brings together the assessment of governance and legal compliance, undertaken by dedicated HRA staff, with the independent REC opinion provided through the UK Health Departments’ Research Ethics Service. Since its introduction in April 2016 the changes have been embedded within the Research Support Office HRA Approvals

4.3 Capacity and Capability

One aspect of HRA Approval is ensuring that there is clarity on the resource implications for participating NHS organisations and others delivering research within an NHS care setting.

For non-commercially sponsored studies a Schedule of Events and Statement of Activities forms are used to capture all information around study activities being undertaken at a local level as part of the approvals process.

For commercially sponsored studies a completed NIHR Industry Costing Template and template agreement are used to prior to local NHS approvals to confirm that the sponsor intends to use with host organisations.

The R&D office will work with researchers and sponsors to ensure a swift process of confirming the Trust’s capacity and capability to deliver the study to time and target. The team require that authorisation has been obtained from the appropriate Service Director, responsible for the Directorate where the research activity will take place before Trust Management Approval is provided to the research team.

4.4 Contracts and Confidentially Disclosure Agreements

An agreement between OHFT and OUH to undertake the review of research contracts and contracts Confidentially Disclosure Agreements (CDA) from a legal perspective to ensure the Trust obligations are appropriate is ongoing and working effectively.

Recently concerns were raised regarding the terminology within legal agreements over the liability. The Trust has agreed a preferred approach that no contract or CDA should have unlimited liability without a complete risk assessment. Internal processes, aligned with OUH are ongoing to assess and monitor risk, with agreed internal processes for sign off

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4.5 Costings

The Head of R&D leads the costings process and works closely with research and clinical teams to provide accurate information on the timing and cost of undertaking specific protocol driven activity, including the set up and management of studies to ensure that the studies are run in a cost neutral manner within the NHS.

4.6 Study Data Capture

The Research Support Office received a new database system called Studyline in May 2017. Studyline runs on the OXNET server, a secure NHS server system. The updated database has some new and enhanced functions and will be used to its full potential to provide reports and data on research activity, including recruitment, to ensure a more robust and accurate understanding of research activity taking place within the Trust and surrounding Trusts Studyline has recently been linked with the NIHRs Central Portfolio Management System (CPMS) where data is uploaded overnight.

4.7 Monitoring and Auditing of Research Projects

The R&D Support Team audited four hosted studies in 2017. Three of the studies were selected at random and one study was visited as issues of recruitment prior to capacity and capability were raised. No serious breaches were recorded from the audits but issues were noted across the visits and recommendations put in place.

Further monitoring and auditing will be planned for 2018 when staff return to post from leave.

4.8 Studies and Participant Recruitment

The NIHR publishes league tables on an annual basis for NIHR portfolio adopted studies. There may be slight discrepancies in the data when comparing to internally data capture due to reporting differences and potential lag time.

2014/2015 2015/2016 2016/2017

Number of Studies 40 48 60

Number of Participants 2012 2576 2537

4.8.1 NIHR Metrics and Targets

Performance in initiating (70 Day target) for clinical trials and Performance in Delivering (Time to Target) for commercial clinical trials

4.8.2 Initiating studies

The Trust has fallen from 100% compliance in ensuring clinical trials are opened in a timely fashion and that the first patient is recruited within 70 days of receiving a full application. Due to the small number of studies, generally 10 to 12 studies one or two studies not meeting the target can change the percentage significantly. This is potentially due to difficulties in recruiting to studies on a national level or local issues. The data for studies missing the target is included in the overall metrics for 12 months, therefore will be reflected in the graphs until 2018/2019.

4.8.3 Delivering Time to Target

OHFT has fallen slightly in the compliance for delivering the stated number of participant in the allocated recruitment period for commercial clinical trials. As the number of studies that close in any one metric

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period is small, between 2 and 5 generally as failure of one study to meet the target can have a significant effect.

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5 Pharmacy The pharmacy department is currently supporting the delivery of 12 Clinical trials involving medicines within the trust. Most of these are Clinical Trials of Investigational Medicinal Products. There are a further 6 studies being set up.

Of these, 10 are commercially sponsored studies and 8 are non-commercial. Three of the open studies and two of those in set up are BRC supported studies. The BRC has given the pharmacy department some funds for research support. Therefore at present, pharmacy work done on BRC studies is not being charged for. As the number of BRC studies increases, we may need to review this model of pharmacy service support.

Most of the research medicines are stored at CPSU in Kennington, where they are managed by the pharmacy clinical trials team. In one study, the medicines are stored at the CRF and dispensed directly from there. The pharmacy team are supporting the CRF staff in delivering these activities.

6 Case Records Interactive Search (CRIS) UK CRIS went live in March 2017. Our CRIS data is now attached to CareNotes and will be updated on a weekly basis.

The CRIS Manager (Tanya Smith) who is also the Digital Theme Leader of Ox-CRIS and UK-CRIS for NIHR Oxford Health Biomedical Research Centre supports the Ox-CRIS infrastructure, facilitating users, both within the clinical audit and service enhancement teams in the Trust and researchers in the BRC to use CRIS. She also contributes to the leadership of UK-CRIS as the key contact for the other UK CRIS NHS Trusts. There are currently 11 UK CRIS Trusts and 3 DCRIS Trusts, which together create the CRIS Network. The team will soon include a CRIS Data Administrator who will support new users of CRIS to set up their accounts and projects and also conduct the audits. An additional post is also currently being advertised for a CRIS Academic Support and Data Analyst who will provide support to CRIS researchers in framing their CRIS question and also run complex searches and extract relevant data for users to subsequently analyse.

The Oxford CRIS Oversight Group meetings are held bi-monthly to discuss submitted applications and monitor the audit of CRIS searches. The group is chaired by the Medical Director and Caldicott Guardian

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and is attended by the CRIS Coordinator, Director of IT, Head of Information Governance, Head of R&D, a carer/patient representative, representatives from the trust Clinical Directorates, Trust Audit Team and academic leads from the University.

To date the CRIS Oversight have approved 24 applications, 15 of which were research questions, 2 service evaluation, 7 clinical audit questions and one feasibility application, which has so far consisted of 10 sub searches. We have 14 active CRIS searches and 19 active CRIS users.

We are progressing well will with our natural language processing (NLP) capabilities and further collaborations are also in progress. These will provide the CRIS users with an automatic text reading facility for extracting and bringing into context relevant data from free text fields within CRIS. Agreements have been set up via the research passport system for our collaborators at Manchester University and a data processing contract is now approved with a German academic institution who specialise in text mining, SCAI Fraunhofer, to provide NLP expertise for CRIS free text data. All authorised non Trust staff researchers are provided with a virtual desktop environment, created by the Trust IT department, which restricts both access to the data and prevents the data from being removed from the Trust firewalls. This is now being upgraded to enable faster processing which will benefit our NLP research.

Consent for re-contact is our current focus. A Consent for Re-Contact user group has been set up, led by Simon Lovestone and including members from the directorates, researchers, R&D, IT, IG and a lay representative. The group will finalise the form in CareNotes and establish a suitable process to also include bio resource linked to the electronic medical record (EMR) via CRIS as well as novel participant recruitment of non-patient citizens via NHS, using digital engagement and routine clinical/real world data.

7 Trust Governance and Reporting Mechanisms The Research Management Group (RMG) was established in November 2016 and continues to meet on a monthly basis. It is a stakeholder committee of those involved in research across the geographical coverage of Oxford Health NHS FT and is represented by a number of partners and collaborators across the region including Trust R&D and clinical directorate leads, BRC, CRF, CLAHRC, DEC, CRN, University of Oxford, Oxford University Hospitals NHS Foundation Trust, AHSN and AHSC.

7.1 Reporting and Governance

The RMG is a high level committee established to drive the collaborative research strategy across the Trust. It is responsible for the strategic and scientific direction of the research undertaken with or in partnership with OHFT.

The RMG oversees and monitors the financial position of research where there is involvement of the Trust and receive reports from the Head of R&D Finance which will highlight major areas of expenditure, anticipated changes or impacts on budgets and related funding. In addition it is accountable for the assurances made to the Trust to ensure fulfilment of its responsibilities as a host organisation

The RMG receives information and assurances from the various research activities undertaken in conjunction with OHFT, including dashboard reports on the OHFT BRC, CRF, CLAHRC, DEC, TV&SM CRN, Case Records Interactive Search (CRIS), Research Feasibility, Set-Up, Delivery and Management (including quality assurance), Pharmacy and Research Finance.

A summary of these reports is submitted to the Quality Sub Committee: Effectiveness on a quarterly basis.

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8 Finance

8.1 Income

The Trust receives research funding from various commercial and non-commercial organisations. These funding streams are outlined in the table below along with the FY18 budgeted values.

The NIHR, Department of Health and CRN:TV&SM require the completion of detailed quarterly and annual returns to ensure all funding is used appropriately and within the year awarded. Any unused funding would need to be returned to the relevant funding organisation. Quarterly and annual forecasts are also required by these organisations to demonstrate the need for continued funding

8.2 FY18 Performance

At the end of January 2018 (period 10) the R&D performance was £90k favourable against budget due to a combination of vacancies and higher than expected income generated. The year end position is excepted to be at a similar level.

Note: The deadline for this report meant that the last complete period was period 10. During the next month the FY19 funding and associated budgets will be agreed

8.3 Collaboration in Leadership in Applied Health Research & Care (CLAHRC)

The CLAHRC commenced in January 2014 and following a successful extension application it will now run until September 2019. It is led by Professor Richard Hobbs from the University of Oxford, Department of Primary Care.

The CLAHRC theme budgets were originally allocated in two phases, phase one covered the first 27 months and in 2015 following a mid-term review phase two covered the next 33 months.

Richard Hobbs will be issuing details of the process for applying for extension funding (Jan 2019 to Sep 2019) in the near future with the allocations being agreed during the summer.

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Type FY18 (£k)National Institute for Health Research (NIHR)Collaboration in Leadership in Applied Health Research & Care CLAHRC 2,000Biomedical Research Centre BRC 1,495Research Capability Funding RCF 1,036Study income 846Clinical Research Facility (OUH hosted) CRF 582Subcontracted study income 224Diagnostic Evidence Collaborative DEC 208Total 6,391Other FundingClinical Research Network: Thames Valley & South Midlands (Core Funding) CRN:TV&SM 842Other income (Non-NIHR Grants and studies) 531CRN:TV&SM Network Funding CRN:TV&SM 312Non-NIHR CRF Income 71Total 8,147

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The budgets are detailed below (£k):

Phase 1 Budgets Theme Lead FY14 * FY15 FY16 TotalBetter Management of Psychiatric comorbidities Mike Sharpe 14 161 370 545Health Behavior and Behavioral Interventions Sarah Lamb 38 168 336 542Early Intervention and Service Innovation John Geddes 16 144 318 478Patient Self-Management (Chronic Disease) Richard McManus 46 226 380 652Patient experience and PROMS Ray Fitzpatrick 55 187 346 588Central and Support Costs Richard Hobbs 81 364 250 695Total 250 1,250 2,000 3,500

Note: FY14 reflects 3 months

Phase 2 Budgets & Extension Funding Theme Lead FY17 FY18 FY19 FY20 * TotalService redesign Belinda Lennox 312 204 160 25 701Behavior change (exercise & rehab) Sarah Lamb 267 248 173 25 713PROMS Ray Fitzpatrick 191 229 194 25 639Multi-morbidity Mike Sharpe 123 142 114 25 404Patient self-management Richard McManus 362 407 188 25 982Behavior change (weight & obesity) Susan Jepp 268 180 116 25 589Central and Support Costs Richard Hobbs 477 490 394 179 1,540Unallocated 100 661 671 1,432Total 2,000 2,000 2,000 1,000 7,000

Note: * FY20 reflects 6 months

8.3.1 Performance

The actual expenditure is forecast to be in line with budget for FY18

8.3.2 Matched Funding

A fundamental requirement of the CLAHRC is the need to demonstrate matched funding committed by other organizations linked to CLAHRC activities. This needs to be at least to the same level as the NIHR funding. Identification of this funding is an on-going process involving the senior management team and theme leads.

8.4 Biomedical Research Centre (BRC)

BRC funding commenced in April 2017 and will continue for five years based on the profile below:

£k FY18 FY19 FY20 FY21 FY22 Total

Funding 1,499 2,844 2,848 2,814 2,819 12,824

BRC funding is based on £1m per year per theme. The Oxford Health BRC contains three themes but funding in year one for new BRC’s is limited to 50%. The slight shortfall on £3m per year was due to a national reduction by the NIHR post award.

The annual indicative budgets are set out below (£k), however the actual expenditure will be reviewed regularly to ensure best value for money is being achieved. This may lead to reallocations as and when appropriate. One of the key features of the BRC is that wherever possible individuals are not funded 100% and matched or shared funding is sought.

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Summary Lead FY18 FY19 FY20 F Y21 FY22 Total

BRC Themes Adult Mental Health Paul Harrison 237 458 464 464 464 2,086 Older Adult Mental Health Clare Mackay 326 541 541 541 541 2,490 Psychological Treatments Anke Ehlers 306 504 483 445 439 2,176 Cross-cutting Themes Neuroimaging & cog. neuroscience Kia Nobre 112 288 288 288 288 1,266 Informatics & Digital Simon Lovestone 172 480 476 476 472 2,076 Infrastructure & exp. Medicine Catherine Harmer 159 242 242 242 247 1,132PPI&E Ilina Singh 58 125 145 147 150 625 Training Liz Tunbridge 20 53 55 57 60 245 Core Costs John Geddes 109 153 155 155 158 730 Total 1,499 2,844 2,848 2,814 2,819 12,824

8.4.1 Performance

The actual expenditure is forecast to be in line with budget for FY18

8.5 Research Capability Funding (RCF)

Research active NHS organisations receive RCF to enable them to meet some, or all, of the research-related component of the salary of their researchers and research support staff working on clinical and applied health research, where that component is not already provided by another funding source.

The annual RCF allocation combines a percentage of the NIHR funding received in the previous calendar year with an allowance for each Senior Investigator associated with Trust.

The FY18 RCF allocation was £1.036m, a reduction of £0.009m on FY17 due to a reduction in the infrastructure rate (-£13k) only partially off-set by increased study related RCF (£4k)

The Trust splits its RCF income between that earned by the Trust and Department of Psychiatry and that from the Department of Primary Care, the breakdown and year on year movements are shown in the table below:

FY18 (£k) Department of Psychiatry \ Trust (including CLAHRC)

Department of Primary Care Total

Senior Investigators (SI) Guy Goodwin, John Geddes, Mike Sharpe

Sue Ziebland, David Mant, Trisha Greenhalgh, Andrew

Farmer, Chris ButlerSI related RCF (£75k) £0.225m £0.375m £0.600mStudy funding £0.077m £0.227m

Study related RCF £0.025m £0.074m £0.099mInfrastructure

- CLAHRC- DEC

£2.000m£0.248m

Infrastructure related RCF £0.300m

£0.037m £0.337m

Strategic contribution £0.049m (£0.049m) -Total £0.599m £0.437m £1,036mFY17 £0.740m £0.305m £1,045m

Increase \ (Decrease) on FY16 (£0.141m) £0.132m (£0.009m)

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8.6 NIHR Study Income

The NIHR study income is made up of two awards linked to the Department of Primary Care. These are NIHR program grants awarded to Professor Richard McManus (£518k in FY18) and Professor Andrew Farmer (£327k in FY18). Two recently successful NIHR applications were:

Professor Daniel Freeman (£3,9m) “Immersive virtual reality to transform the lives of patients with psychosis” starting in June (36 months)

Dr. Valeria Frighi (£152k) “Fractures in people with intellectual disabilities: comparison with the general population and development of a fracture risk calculator specific to these patients” starting April 2018 (18 months),

8.7 Clinical Research Facility (CRF)

CRF funding commenced in April 2017 and will continue for five years profiled as follows;

£k FY18 FY19 FY20 FY21 FY22 Total

Funding 740 744 748 751 755 3,738

The award is hosted by OUH but the bulk of the funding is used to support the CRF on the Warneford site. Some funding was planned to be used for the development of CRF facilities at the OUH however due to problems in identifying suitable space the funding was reallocated to three other areas selected as part of a completion in the autumn.

The BRC requirements for experimental medicine has lead to later phase studies being displaced from the Warneford CRF due to lack of capacity. To address this work is taking place to make the ECT suite at the Whiteleaf research ready to undertake clinical research studies. The business case was approved in the autumn and the facility should be available in the near future

8.8 Subcontracted study income

This includes an MRC study in collaboration with Cambridge University and a number of smaller grants

8.9 DEC \ MIC

The DEC lead by Gail Hayward from the Department of Primary Care was extended until December 2017.

The NIHR has replaced DEC’s with MIC’s (Medtech and In vitro diagnostic Co-operative) and the Trust hosted a successful MIC application (£1.24m) from the Department of Primary Care which starts January 2018 and runs for five years.

8.10 Clinical Research Network: Thames Valley and South Midlands (CRN)

The budgeted FY18 funding from the CRN of £842k for core staff and £312k for hosted network staff is shown in the table below along with the forecast year end position.

Division Specialty FY18 Budget(£k)

Forecast(£k)

Variance (£k)

Core AllocationDivision 4 Mental Health 376 348 (28)

Dendron and Neurological disorders (Dendron) 275 198 (77)Division-wide (Division 4) 140 104 (36)

Cross-Divisional Non-Pay, Overheads & Other 51 50 (1)Total 842 700 (142)

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Network staffDivision 4 Mental Health 13 13 -

Dendron and Neurological disorders (Dendron) 13 13 -Division 5 Primary Care 247 229 (18)Cross-Divisional 39 40 1Total 312 295 (17)

The adverse variance on the core allocation is due to vacancies. All staff employed by the Trust and funded by the CRN are now line managed by the R&D senior management team. This will allow greater flexibility and more opportunities for the staff.

8.11 Grant Applications

Grant applications take place on a regular basis submitted by various individuals and to a number of different funding bodies, activity since November 2014 is shown in the table below;

FY15 (Nov-Mar) FY16 FY17 FY18

(Mar-Feb) Total

Outcomes of Grants submittedAwarded 1 11 14 1 27Unsuccessful 14 18 20 3 55Submitted 10 10Work in progress 6 6On-hold \ Withdrawn 1 2 3Total 15 29 35 22 101Funding applicationsNIHR 6 12 8 2 28Health Foundation 2 1 2 5OHSRC 2 1 1 4CSO, Scotland 1 1Research Councils UK (RCUK) 1 1MRC 1 1Sub-contracted 4 14 24 19 61Total 15 29 35 22 101Funding Requested (£k)NIHR 3,295 9,058 22,540 956 35,849The Health Foundation 575 75 106 579 1,335OSRC 14 2 - 5 21CSO, Scotland - 34 - 34Research Councils UK (RCUK) 50 - - 50MRC 149 149Sub-contracted 50 2,536 1,201 509 4,296Total 3,984 11,705 23,997 2,051 41,737Grants AwardedNIHR 2 4 6Health Foundation 1 1 2 4OHSRC 1 1CSO, Scotland 1 1Sub-contracted 6 8 1 15Total 1 11 14 1 27Funding Awarded (£k)NIHR - 5,078 21,770 - 26,848The Health Foundation 75 75 107 - 257OSRC - 2 - - 2

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CSO, Scotland - 34 - - 34Sub-contracted - 1,539 240 109 1,888Total 75 6,728 22,116 109 29,028

8.12 Risks - Redundancy Costs

Where staff are funded from time limited awards there is a potential redundancy risk. This has always been monitored along with HR to identify and mitigate the risk on a case-by-case basis

A cost pressure of approximately £130k has been identified for FY19 due to reduced income in a Dendron cost centre previously managed by the CRN. This will be partially mitigated if commercial study income can be carried forward. This is waiting on a decision from the senior finance team.

8.13 Oxford Academic Health Science Network (OAHSN)

The OASHN is seen as a clinical development rather than research and is reported separately in the finance report to the Board. The Medical Director is the executive lead.

Oxford Health hosts the Dementia, Early Intervention in Mental Health and Anxiety and Depression OAHSN Clinical Networks.

There was a financial pressure of £105k in FY18 due to the Trust agreeing to fund a senior member of the AHSN with no budget identified.

The Anxiety & Depression Network is planning to continue into FY19, having secured additional funding of approximately £100k with the main funders being the CLAHRC and AHSN. The other 2 Networks will close at the end of March 2018.

There is currently a risk of redundancy for one of the Network Managers who is linked to the Early Intervention network. Options are being considered.

8.14 Summary of Funding Timeframes

Infrastructure or Award

Current funding timeframe Renewal/relicensing timeframes

AHSN 2013 to 2018 Anxiety & Depression Network will continue into FY19

CLAHRC Jan 2013 to Sep 2019 Potential call for renewal in mid 2018

DEC Extended until Dec 2017 Replaced by MIC

MIC Jan 2o18 to Dec 2022

CRF April 2017 to March 2022

BRC April 2017 to March 2022

CRN April 2014 to March 2019

9 Staffing A new Patient and Public Involvement (PPI) Manger, Claire Murray has been appointed to support the BRC, CRF and R&D within the Trust and to take on the finalisation of the PPI Strategy and its operationalisation.

The new Data Manager, Donna Scott has joined the team to support the capture and reporting of metrics for the NIHR including the annual returns for the BRC and CRF and to look for opportunities within the Department for the use of data collected

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The R&D Finance team has expanded to include Bona Patel to support the team as the role of the finance team increases.

A number of staff from pharmacy, the R&D Office and two research assistants are currently on or expected to be on maternity leave over the coming months. There are current difficulties in recruiting to clinical trials pharmacy team following two unsuccessful rounds of advertising and interviewing.

The Research Support Manager left the Trust in September. A member of the Team, Francesca Hatton is currently acting up as the role is redefined to address the changing needs of the department.

The pharmacy team currently consists of three part time pharmacists (one lead and two clinical trial pharmacists) and two technician posts. They have recently welcomed Ioana Fodor (clinical trials pharmacist) back from maternity leave.

The dementia nursing and research assistant teams are now under the Trust governance structure and being managed internally by Prof Andrea Cipriani, Associate Director of R&D.

The Dementia Nursing Team manager left the Trust in January 2018 and the Delivery Teams, led by Prof Andrea Cipriani are looking into long term planning of research delivery across the Trust, with teams being offered opportunities to act up into more senior post while the R&D Senior Management Team look to the changing needs of the department. In addition maternity cover replacements are also being sought for the Research Implementation Manager.

10 Estates The R&D SMT has put the move to UNIPART in Cowley to join the joint research office (JRO) (Oxford University Hospitals NHS FT (OUH) and the University of Oxford R&D Teams) on hold. Although this move was deemed an opportunity many of the research teams in Oxford welcomed the close links with the small team. This will be reassessed as needs change.

A business case to use the ECT Suite at the Whiteleaf centre has been approved and refurbishment is ongoing. There has been an increase in the number of experimental medicine studies taking place on the CRF, in addition to the BRC pipeline that will flow through the CRF, therefore was becoming increasingly difficult to accommodate later phase research on the CRF due to the funding restrictions on the NIHR CRF infrastructure and occupancy rates within the facility. The ability to conduct trails elsewhere in the Trust will relieve the pressure on the CRF in addition to providing increased opportunities to staff and patients in Buckinghamshire. in Aylesbury that could be used to conduct research activity when not in clinical used. Work is progressing with this option.

11 Communications

11.1 Significant Communications

The communications team handled several major research stories over the last six months, including handling the media for the first NIHR Oxford Health BRC research paper: this comprehensive study demonstrated that antidepressants are on average more effective than placebos, and received front page coverage in The Times, the Guardian, with the researcher being interviewed on BBC’s Newsnight and Radio 4’s Today programme. The communications team worked closely with the Lancet’s press team, as well with the Science Media Centre, to refine the press release, and then managed the very large volume of media requests.

Study finds that antidepressants are more effective than placebo at treating acute depression in adults* https://www.oxfordhealth.nhs.uk/news/study-finds-that-antidepressants-are-more-effective-than-placebo-at-treating-acute-depression-in-adults/

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https://www.oxfordhealth.nhs.uk/news/study-finds-that-antidepressants-are-more-effective-than-placebo-at-treating-acute-depression-in-adults/

https://www.oxfordhealth.nhs.uk/news/study-finds-that-antidepressants-are-more-effective-than-placebo-at-treating-acute-depression-in-adults/

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The altmetric score puts the paper in the top 5% of all research outputs scored by Altmetric, which is the highest ever scoring research output measured by Altmetric in Psychiatry: https://www.altmetric.com/details/33494156

Similarly, work led by Prof Daniel Freeman (https://youtu.be/wC378xuUSp4) and Simon Lovestone (https://www.thetimes.co.uk/article/dementia-in-dolphins-could-give-clues-to-alzheimer-s-in-humans-5nthk2876) also received extensive national and international media coverage.

In keeping with the National Institute of Health Research’s new communications policy encouraging joint work across different NIHR institutions, the communications team has also organized a joint public talk on Parkinson’s and Alzheimer’s Disease research, featuring both researchers from both Oxford Health and Oxford University Hospitals NHS Foundation Trusts.

A full list of research-related stories handled by the communications teams is below: items marked with an * were also sent out to local and/or national press.

All of these stories were also supported by outreach on social media, and where applicable, highlighted on the NIHR Oxford Health BRC website:

Early Intervention in Psychosis lead on the BBC https://www.oxfordhealth.nhs.uk/news/early-intervention-in-psychosis-lead-on-the-bbc/

Dementis Awareness Open Day https://www.oxfordhealth.nhs.uk/news/dementia-awareness-open-day/

Oxford health helping recruit patients for pioneering dementia study* https://www.oxfordhealth.nhs.uk/news/oxford-health-helping-recruit-patients-for-pioneering-dementia-study/

Event: public talk on Parkinson’s and Alzheimer’s Disease* https://www.oxfordhealth.nhs.uk/news/event-public-talk-on-parkinsons-and-alzheimers-disease/

£4 million project to make VR treatment available to NHS mental health services* https://www.oxfordhealth.nhs.uk/news/4-million-project-to-make-vr-treatments-available-to-nhs-mental-health-services/

Oxford Health researchers on BBC 2’s ‘Trust me, I’m a Doctor’ https://www.oxfordhealth.nhs.uk/news/oxford-health-researchers-on-bbc-2s-trust-me-im-a-doctor/

Dementia care improved by just one hour of social interaction each week* https://www.oxfordhealth.nhs.uk/news/dementia-care-improved-by-just-one-hour-of-social-interaction-each-week/

Dolphin brains show signs of Alzheimer’s Disease Figures show rise in Oxfordshire NHS research* https://www.oxfordhealth.nhs.uk/news/dolphin-brains-show-signs-of-alzheimers-disease/

Research on World Mental Health Day* https://www.oxfordhealth.nhs.uk/news/research-on-world-mental-health-day/

Preventing dementia: how hard can it be? https://www.oxfordhealth.nhs.uk/news/preventing-dementia-how-hard-it-can-be/

Oxford Health staff awarded Associate Professorships https://www.oxfordhealth.nhs.uk/news/oxford-health-staff-awarded-associate-professorships/

£1.24 million for new medial diagnostics hub https://www.oxfordhealth.nhs.uk/news/1-24-million-for-new-medical-diagnostics-hub/

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https://www.oxfordhealth.nhs.uk/news/1-24-million-for-new-medical-diagnostics-hub/

https://www.oxfordhealth.nhs.uk/news/1-24-million-for-new-medical-diagnostics-hub/

https://www.oxfordhealth.nhs.uk/news/oxford-health-staff-awarded-associate-professorships/

https://www.oxfordhealth.nhs.uk/news/preventing-dementia-how-hard-it-can-be/

https://www.oxfordhealth.nhs.uk/news/preventing-dementia-how-hard-it-can-be/

https://www.oxfordhealth.nhs.uk/news/research-on-world-mental-health-day/

https://www.oxfordhealth.nhs.uk/news/research-on-world-mental-health-day/

https://www.oxfordhealth.nhs.uk/news/dolphin-brains-show-signs-of-alzheimers-disease/

https://www.oxfordhealth.nhs.uk/news/4-million-project-to-make-vr-treatments-available-to-nhs-mental-health-services/

https://www.oxfordhealth.nhs.uk/news/4-million-project-to-make-vr-treatments-available-to-nhs-mental-health-services/

https://www.oxfordhealth.nhs.uk/news/event-public-talk-on-parkinsons-and-alzheimers-disease/

https://www.oxfordhealth.nhs.uk/news/oxford-health-helping-recruit-patients-for-pioneering-dementia-study/

https://www.oxfordhealth.nhs.uk/news/oxford-health-helping-recruit-patients-for-pioneering-dementia-study/

https://www.oxfordhealth.nhs.uk/news/dementia-awareness-open-day/

https://www.oxfordhealth.nhs.uk/news/dementia-awareness-open-day/

https://www.oxfordhealth.nhs.uk/news/early-intervention-in-psychosis-lead-on-the-bbc/

https://www.oxfordhealth.nhs.uk/news/early-intervention-in-psychosis-lead-on-the-bbc/

https://www.thetimes.co.uk/article/dementia-in-dolphins-could-give-clues-to-alzheimer-s-in-humans-5nthk2876

https://www.thetimes.co.uk/article/dementia-in-dolphins-could-give-clues-to-alzheimer-s-in-humans-5nthk2876

https://youtu.be/wC378xuUSp4

https://www.altmetric.com/details/33494156

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Clinical psychologist recognized for their work with older people https://www.oxfordhealth.nhs.uk/news/clinical-psychologists-recognised-for-their-work-with-older-people/

New mobile app tackles paranoia* https://www.oxfordhealth.nhs.uk/news/new-mobile-app-tackles-paranoia/

Ilina Singh/Rupert McShane paper on responsibly testing ketamine treatment for depression* (received extensive media coverage) http://www.oxfordhealth.nhs.uk/news/researchers-highlight-need-for-responsible-development-of-ketamine-for-severe-depression/

The NIHR Oxford Health Biomedical Research Centre officially launches on 1st April 2017* http://www.oxfordhealth.nhs.uk/news/the-future-in-mind/

Oxford Health to spearhead development of digital technology in mental healthcare nationally* http://www.oxfordhealth.nhs.uk/news/oxford-health-named-as-global-digital-exemplar/

Major research grant to study how VR can help with persecutory delusions* http://www.oxfordhealth.nhs.uk/news/new-funding-for-virtual-reality-treatments-for-mental-health-problems/

11.2 Additional communications activities:

The communications team supported the extensive media interest in the Lancet paper by Prof Andrea Cipriani, managing interviews, providing a patient case-study, compiling media coverage, and where possible, publishing it on the Oxford Health YouTube channel.

The team is also currently supporting Prof Cipriani to organize a google hangout discussion of the paper: we successfully identified the originator of the #medsworkedforme twitter hashtag which began as a reaction to the paper’s findings, and we will be managing the invitation to join the discussion. The finished discussion will also go up on YouTube, so that it is available for use elsewhere.

The team has also continued to work closely with the central NIHR communications team, who invited the Oxford Health team to give a presentation at the regular NIHR communications leads meeting.

R&D held a research event within the Trust with the Linking Leaders Program in November 2017. The event was well attended and provided an opportunity for researchers to present their research, in addition to hearing from a lay representative regarding the importance of research. The event also provided an opportunity for staff to discuss research and feedback. There was very positive feedback from the event with increased communication being welcomed going forward

Work is continuing to provide updates and refinement to the R&D web pages

Authors and Title: Professor John Geddes, Director of R&D, BRC and CRF

Emma Stratful, Deputy Director Research Strategy and operations, Senior Manager for NIHR BRC

Dr Mark Hancock, Medical Director

Lead Executive Director: Dr Mark Hancock

1. A risk assessment has been undertaken around the legal issues that this paper presents and there are no issues that need to be referred to the Trust Solicitors.

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http://www.oxfordhealth.nhs.uk/news/new-funding-for-virtual-reality-treatments-for-mental-health-problems/

http://www.oxfordhealth.nhs.uk/news/new-funding-for-virtual-reality-treatments-for-mental-health-problems/

http://www.oxfordhealth.nhs.uk/news/oxford-health-named-as-global-digital-exemplar/

http://www.oxfordhealth.nhs.uk/news/the-future-in-mind/

http://www.oxfordhealth.nhs.uk/news/researchers-highlight-need-for-responsible-development-of-ketamine-for-severe-depression/

http://www.oxfordhealth.nhs.uk/news/researchers-highlight-need-for-responsible-development-of-ketamine-for-severe-depression/

https://www.oxfordhealth.nhs.uk/news/new-mobile-app-tackles-paranoia/

https://www.oxfordhealth.nhs.uk/news/new-mobile-app-tackles-paranoia/

https://www.oxfordhealth.nhs.uk/news/clinical-psychologists-recognised-for-their-work-with-older-people/

https://www.oxfordhealth.nhs.uk/news/clinical-psychologists-recognised-for-their-work-with-older-people/

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2. This paper (including all appendices) has been assessed against the Freedom of Information Act and the following applies:

THIS PAPER MAY BE PUBLISHED UNDER FOI

3. This paper provides assurance and evidence against various Care Quality Commission Outcomes

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clinical quality and care · web viewthe generic measures for depression and anxiety (phq9 and...

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