Collaboration has increasingly become the watchword to guide research and health improvement.
Collaboration is at the heart of what we do in the CLAHRC – the clue is in the first word of the acronym given to us by our funding body, the National Institute for Health Research. We are the Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West).
We are part of a complex landscape of research and healthcare organisations with an array of inscrutable acronyms: CRN, BHP, AHSN, CCG, PHWE, STP, BRC (definitions below), all of which are united in a commitment to improve the health of the population and the delivery of health and social care.
CLAHRC West’s particular focus is on encouraging the use of research evidence.
We work collaboratively with patients and members of the public, providers of NHS services, NHS commissioners, universities, local authorities, charities and third sector organisations, to make research evidence more accessible so that it can be used to improve health and care.
We have highlighted some examples of our research below.
Preventing disabilities in babies
Babies born too early have a higher risk of dying in the first weeks of life than babies born at full term.
Those who survive often have damage including cerebral palsy, blindness, deafness or physical disabilities. Magnesium sulphate, used as a neuroprotective factor in pre-term birth, can prevent this damage.
Working with the West of England Academic Health Science Network, University Hospitals Bristol NHS Foundation Trust and hospitals across the country, we investigated whether an information support package introduced into maternity units would empower midwives and increase the use of magnesium sulphate recommended by NICE.
The findings from the first study in a small number of maternity units indicated that the package had been helpful in increasing the use of the drug in the short term.
We are now working with the same groups in a larger study for a longer period to refine the package and evaluate its use, funded by the Health Foundation.
Is it safe to drink when pregnant?
Guidelines about drinking in pregnancy are confusing for health professionals and pregnant women, leading to inconsistent advice.
Working with the MRC Integrative Epidemiology Unit, we undertook a systematic review of the literature.
While the serious effects of regular and moderate consumption of alcohol in pregnancy are well known, there is unfortunately little evidence about the effects of light drinking (one to four drinks a week).
However, some of that evidence does suggest there might be a higher chance of having a small baby or delivering early.
This evidence contributed to the Department of Health stating in 2016 that it is not possible to define a “safe” level of alcohol in pregnancy.
The advice now is that women who are pregnant or trying to conceive should avoid all alcohol.
We are working with midwives and pregnant women to refine the messages to women to ensure they are accurate and do not cause unnecessary concern.
Improving online GP consultations
Online GP consultations are potentially a way to improve patient access and to reduce GPs’ workload from face-to-face consultations.
Working with One Care Consortium of GP practices in Bristol, South Gloucestershire and North Somerset, and hearing from patients and GP practice staff, we found that consultations online worked best for simple and routine enquiries, such as repeat prescriptions or test results, but led to additional work and sometimes duplication of effort for contacts about new symptoms or complex health problems.
These results have provided NHS England and GPs with clear advice about how to introduce online consultation systems for particular enquiries rather than to solve overall workload pressures.
Safer syringes for drug users
Working with Bristol City Council, Bristol Drugs Project, Bristol Health Partners Drug and Alcohol HIT, the NIHR Health Protection Research Unit in Evaluation of Interventions, and people who inject drugs, we explored how best to encourage the use of syringes that had been proven to reduce the chances of experiencing serious infections.
We discovered that the new equipment needed to be introduced gradually, supported by verbal and written information to enhance the acceptability of the syringes.
We are now working on refining the information so that it can be used across the country.
Developing skills in research evidence
CLAHRC West also promotes the development of skills in understanding, using and producing research evidence for the health, public health and commissioning workforce, and patients and members of the public.
We do this through running courses, funding fellowships, offering training bursaries and collating other training opportunities in the region.
Since 2014, we have run 44 training events and trained over 500 people.
CRN: Clinical Research Networks; organisations funded by NIHR to encourage patients and health professionals to participate in clinical research – West of England
WEAHSN: West of England Academic Health Science Network
CCG: Clinical Commissioning Groups responsible for planning and deciding the NHS services that need to be provided for local areas.
PHWE: People in Health West of England; an initiative to promote innovative and effective public involvement in research within the West of England.
STPs: sustainability and transformation partnerships - in England, where local NHS organisations and councils have drawn up proposals ('sustainability and transformation plans') to improve health and care in the areas they serve
BRC: Biomedical Research Centres (Bristol BRC); organisations funded by NIHR that conduct innovative translational medical science research.