CLAHRC Yorkshire and Humber Delivering innovative research through effective partnerships

Executive Summary Annual Progress Report Year One 1st January 2014 - 31st March 2015 Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber NIHR CLAHRC YH

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What are CLAHRCs? National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are collaborative partnerships between National Health Service, public services and Higher Education Institutions, focused on improving patient outcomes through the conduct and application of applied health research and evidence based implementation. The CLAHRCs were set up to improve patient outcomes across the geographical area covered by the Collaboration through three key interlinked functions: • • •

conducting high quality applied health research implementing the findings from research into clinical practice increasing the capacity of NHS organisations to engage with and undertake applied health services research

Nine CLAHRC pilots ran between 2008 - 2013, becoming established NIHR Infrastructure from 2014 with 13 CLAHRCs across England.



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Welcome Welcome to the first Annual Report Executive summary for CLAHRC Yorkshire and Humber. This summary report contains the highlights of the first 15 months of our collaboration. We hope you will recognise the impact of our work regionally and nationally and the potential of the collaboration going forward. This impact has been delivered in areas with significant levels of social deprivation and health inequalities. In addressing this we have been able to enable Local Authorities and the NHS to explore and develop new ways of working to improve the health and wellbeing of our Yorkshire and Humber population. Furthermore, we have worked in partnership with patients and the public ensuring that our work is driven by their priorities and needs, generating evidence of the highest value, with the greatest potential for change. Going forwards, we are confident that our rigorous approach to research and implentation science will continue to inform and change practice across our region and beyond. On a personal note I remain committed to the vision and principles of CLAHRC YH and it is an honour and pleasure to lead this incredibly talented group of researchers, practitioners, patients and carers. Professor Sue Mawson Director, NIHR CLAHRC Yorkshire and Humber

Governance and Leadership CLAHRC YH is co-ordinated by the core team who are Hosted by Sheffield Teaching Hospitals NHS Foundation Trust. The core team consists of the Director, Programme Managers, Capacity Lead, Communication Lead and administrative support. We have an Executive Board which meets every 6 weeks, at which our 9 research themes are represented. Our Strategic Partnership Board is chaired by Lord Willis of Knaresborough (pictured right with Prof Sue Mawson in the House of Lords). The Board meets quarterly, all our regional partners are represented together with representation from other NIHR Infrastructure in the region. Alongside our partners we also work with the other NIHR infrastructure in our region, specifically the Clinical Research Network (CRN), School for Public Health Research (SPHR), The Research Design Service (RDS) and Devices for Dignity (D4D) who represent the Health Technology Cooperatives (HTCs) throughout Yorkshire and Humber. We share resources and collaborate specifically around communication and Patient and Public Involvement. Finally we have an External Advisory Group, with internationally acclaimed academics to provide guidance as ‘critical friends’ to our strategy and operation.

Working in partnership CLAHRC YH is a partnership of 32 different organisations. These include the NHS, Higher Education, Local Authorities, Charities, Industry and the Regional Innovation Hub. A full list is available on our website at www.clahrc-yh.nihr.ac.uk/our-partners/partners-and-collaborators We are uniquely funded through a match model so for each pound of funding from the NIHR our partners contribute one pound. This ‘match’ funding usually takes the form of ‘people time’ spent working on projects. Universities also provide student stipends, and some partners also provide financial resource. Delivering innovative research through effective partnerships

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CLAHRC YH Vision and Principles Our Vision We will undertake high quality applied research and evidence based implementation that is responsive to, and in partnership with, our collaborating organisation, patient, carers and the public. The outcome being an improvement in both the health and wealth of the population of Yorkshire and Humber.

Engagement We believe that meaningful engagement delivers successful collaboration that has an impact. Through communicating our passion for the work we do, we will develop ownership of the CLAHRC YH within individuals and organisational partners.

Co-production We believe that all people have a right, if they wish, to be involved in the organisation and delivery of health and health research. Through co-production we will support the key stakeholders in our work to contribute to the development of better knowledge, healthcare services and products

Capacity building We believe that people are innovative and if empowered can reach their potential. Through our capacity building work we will support individuals, teams and organisations to increase their research activity, and through this, the health and wealth of Yorkshire and Humber

Addressing health inequalities We believe that everyone has an equal right to be as healthy as they can be and have equal access to healthcare. Through implementing our Health Inequalities strategy we will strive to reduce inequalities.



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CLAHRC in numbers

136 projects 14,306 participants recruited 26 projects working across Themes The total grant capture

£18 342 197

29 peer reviewed publications ‘Big data’ work has information on 500,000 episodes of care

31 partners Our website had 2,500 visits from 62 countries We have We

4 White rose fellows

£12,000,000 in Match funding

We have 400 people working with CLAHRC Twitter followers 1018

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CLAHRC YH is having an impact The CLAHRC YH is focussed on making a difference in practice and research through working in partnership, our choice of key achievements seeks to demonstrate this ‘closeness to practice’. As a CLAHRC we are very proud to demonstrate impact in a range of ways. We think of impact in four key domains: Health, Wealth, Science and Capacity development The examples below are some of our CLAHRC YH highlights, as with all the examples in this report you can find out more from our website www.clahrc-yh.nihr.ac.uk

Health By Health we mean the impact our work has on patients, the public, services, policy and practice that directly affects the health of the population of Yorkshire and Humber and beyond.

Impact on National Policy and Practice Smoking Cessation Support for People with Serious Mental Illness (SCIMITAR) An innovative research project originating from the Mental Health and Comorbidity Theme is the SCIMITAR study. This study has informed the NICE guidance on smoking cessation in secondary care: acute, maternity and mental health service (NICE PH48). Nationally, NHS Secondary Care Trusts are currently implementing a total smoke-free policy within the next 12 months, and the Mental Health Theme is supporting implementation of the smoke-free policy in four Mental Health Trusts in the YH region. Implementation and impact through training is underway through providing expert advice to the UK Centre for Tobacco and Alcohol Studies (UKCTAS) expert review group, and the National Centre for Smoking Cessations Training (NCSCT) on training people working in mental health services to help service users to quit.

Development of an electronic Frailty Index (eFI) The Primary care-based management of frailty in older people Theme has been working on the Frailty Index in Primary Care. A electronic frailty index (eFI) has been developed from routinely collected primary care data. The eFI allows frailty to be identified and it’s severity graded, enabling General Practitioners (GPs) to quickly identify the frailest people within their practice. The eFI has been made available to practitioners through SystmOne, the electronic patient record platform used by over 2000 GP practices and the predominant system across Yorkshire and Humber. The eFI has been recognised nationally by British Geriatric Society’s ‘Fit for Frailty Commissioning Guidelines’.

Patient Reported Outcome Measure (PROM) The Recovering Quality of Life PROM (ReQol) is a health economics questionnaire. It was developed with, and for patients to complete and will be available for use by health services in September 2015. It is the first PROM to look at recovery, and has drawn interest from far and wide. CLAHRC YH (Health Economics and Outcome Measurement and Translating Knowledge to Action Themes) working together with the ReQoL team are involved in planning its implementation, with the aim to adapt it for use in different conditions and countries.



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Impact on Regional practice Patient Reporting and Action for a Safe Environment (PRASE). This tool was developed by the Evidence Based Transformation with the NHS Theme. It is an actionable tool that provides feedback from patients to trigger service improvement, through diagnosing areas of strength and areas for improvement. The tool has been adopted by the Academic Health Science Network (AHSN YH) and in the last year has been used in 33 wards, demonstrating changes in service provision. PRASE is being used in Australia and New Zealand as part of interventional research studies, and is currently being adapted by the NIHR Primary Care Patient Safety Translational Research Centre, University of Manchester, for use in general practice.

Impact on Local practice Make Every Contact Count (MECC) Sheffield Hospitals Charitable Trust are providing funding to CLAHRC YH to develop, deliver and evaluate a locally tailored ‘Healthy Conversation’ training programme for community based Sheffield City Council employees. Up to four diverse staff groups will receive the training, which will be delivered by an experienced member of SCC’s Learning and Development team, working in collaboration with CLAHRC YH researchers in the Public Health and Inequalities Theme. This project aims to increase staff skills and confidence to offer targeted support to vulnerable communities or population groups and motivate individuals to achieve optimal health and wellbeing. It will also examine the impact of training on staff health and wellbeing. The training materials will be widely shared and disseminated locally and across the region.

Wealth By wealth we mean the impact our collaboration can have through working with industry, improving or informing cost effectiveness, and improving the health of the workforce. This is alongside the direct investment attracting research money into the region brings.

Impact on service provision Telecare Implementation Research There is a national drive to make the best use of Telehealth/care to deliver services throughout healthcare. The Telehealth and Care Technology Theme explored the potential use of Telehealth for patients with early-stage Chronic Obstructive Pulmonary Disease (COPD) newly discharged from hospital, showed tele-monitoring was unlikely to be effective for these patients, and the service model was not adopted, thus saving significant NHS resources (£1,170 per annum per patient treated). The Theme is currently working on the development of a self managed rehabilitation application of patients discharged from hospital with COPD

Enhanced Community Palliative Support Service (EnComPaSS) Through existing relationships the CLAHRC YH has supported a Small and Medium Size Enterprise (SME) Sensory Technologies, from Canada, to establish offices in Yorkshire and Humber. This has allowed the company to work with Health providers in looking to implement and evaluate a technology enabled nursing solution in palliative care. In collaboration the CLAHRC, local Palliative care providers, international industry and academic partners have secured £250,000 in funding from the NHS England Technology Fund for the implementation and evaluation of the technology in a Hospice. Our work with Industry is highlighted on page 10. Delivering innovative research through effective partnerships

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Science By Science we mean the impact the research and research teams has on the way we do research. Pioneering and developing new methodologies (ways of doing research) and new theories to explain the way health services work.

Innovative Methodologies Big Data Much ground breaking work has been undertaken in this first year to expand our use of Big Data and routine data to explore the impact of care pathways on patients: Our Avoidable Attendance and Admissions Theme has created the first ever emergency and urgent care linked dataset of 500,000 patient episodes, showing how people pass through the Ambulance and emergency care pathways in our region. This dataset will be expanded to reach 1.5m in 2016. The Primary care-based management of frailty in older people Theme have development the electronic Frailty Index (eFI) into SystmOne, the clinical software system used by over a third of UK GP practices for over 25 million patients, to allow General Practitioners (GPs) to identify frail older people from the health records enabling an infrastructure for a more proactive approach to this vulnerable population. The Evidence Based Transformation with the NHS Theme has used Hospital Episode Statistics (HES) and Patient Safety Thermometer data to identify high performing teams in order to better understand the components of excellent care. The Healthy Children, Healthy Families Theme has linked data from the Born in Bradford cohort to primary care records to determine best practice, improve care and reduce hospital admissions for asthma and childhood wheeze up to the age of three.

Using Cohorts In its simplest sense a cohort is a group of people, when we talk about cohorts in terms of research we are referring to members of a population who have consented to give some of their heath and demographic information to researchers to look for commonalities or track changes in health over time. Building on our previous CLAHRC work, we are continuing to establish Cohorts as platforms for research and further grant capture using the cohort multiple randomised controlled trial (cmRCT) approach. This innovative methodological approach is used in the Yorkshire Health Study, the CARE and mental health cohorts, and will bring the YH research ready population to over 32,000 individuals, with an ambition to double this within the lifetime of the collaboration. The Born in Bradford Cohort has acted as an exemplar in the successful £49m Big Lottery bid for the Better Start Bradford Innovation Hub, which will initiate a new birth cohort using the cmRCT approach. Further work has begun to link our research cohorts to other routine datasets including primary care and Hospital Episode Statistics (HES).



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Pioneering Theory We are delivering innovative and progressive implementation research as evidenced by the novel positive deviance approach developed by the Evidence Based Transformation with the NHS Theme (Lawton 2014, www.qualitysafety.bmj.com/content/early/2014/07/21/bmjqs-2014-00311). This approach uses routinely captured data to identify areas performing exceptionally well, and then strives to understand why and how this is happening so the practice can be translated to the real world context via the Academic Health Science Network (AHSN) and the Patient Safety Collaborative, producing real patient and practice impact.

Capacity building By capacity building we mean the increasing the ability of people and the organisations they work for to do research and develop skills CLAHRC builds research capacity in individuals, themes and service provider organisations.

Capacity building in individuals We have a dynamic cohort of 56 PhD students. Many of these students started their research in the pilot CLAHRCs, and are finishing their studies with us. Five students have been awarded a PhD this year including Dr Chris Littlewood pictured right, who held an NIHR PhD fellowship. Fifteen students are in their write up year. This cohort demonstrates a diverse range of practitioner-researchers supported by the CLAHRC. This includes two Occupational Therapists, four Physiotherapists, one optometrist, four medically qualified practitioners, one midwife, and four nurses. We have attracted national and international recognition in our capacity building work, and have had exchange visits from Finland and Scotland this year. Jo Cooke, who leads the strategy, has been invited to deliver a number of international workshops describing our work. We have introduced a new research internship scheme, which has been been cited in the Department of Health (DH)/NIHR Annual Report as an example of good practice. This scheme aims to strengthen research capacity in nurses and Allied Health Professionals (AHPs) after completing a master’s degree, and has secured five placements across the infrastructure including the CLAHRC; Leeds Musculoskeletal Biomedical Research Units (BRUs), and Devices for Dignity (D4D). Other capacity building work linking D4D with CLAHRC has supported a range of activity where developing clinical, and design researchers have been supported through secondment and fellowship applications. This activity has attracted success in two fellowship applications, with another in preparation. It has also secured grant capture of over £1.5 million and initiated work with a number of industrial partners, which has resulted in match funding of £100,000.

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Capacity building in organisations Capacity in organisations has been developed through the ACORN (Addressing Capacity in Organisations to do Research Network) group. Nine organisations (eight NHS trusts and one Local Authority) have signed up to this network. Each organisation is undertaking a review of capacity building activity using evidence-based indicators. The ACORN collaboration includes adapting organisational research strategies based on the ACORN review, and will provide evidence of progress to CLAHRC YH over the next four years. Some notable examples of progress this year include: • • •

Three ACORN Trusts have developed posts specially to facilitate boundary spanning and research capacity (Sheffield Teaching Hopistals NHS Foundation Trust, Rotherham, Doncaster and South Humber NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust). One Trust has used cash match into CLAHRC to support secondment and joint CLAHRC/Trust activity (Doncaster and Bassetlaw NHS Foundation Trust). One ACORN site has achieved academic directorate status at Sheffield Teaching Hospitals NHS Foundation Trust.

Impact in Industry With the publication of ‘Innovation, Heath and Wealth: Accelerating adoption and diffusion in the NHS’ by the department of Heath in December of 2011, and the subsequent publication of designation guidelines for the Academic Health Science Networks (AHSNs) it has become even more apparent that the government’s growth agenda is clearly linked to closer partnerships between the NHS, academia and industry. CLAHRC YH has developed a strong emphasis on working with industry as a research partner and implementation broker where research and development evidence exist within a given clinical area. Through this partnership work we have been able to negotiate matched funding from a number of industrial partners locally, and internationally together with Nursing Technology funds to support novel technology implementation. Much of our work has been with SMEs, Kinematix, Longhand Data and Sensory Technologies being examples. Our work with Kinematix has developed from our original stroke ‘intelligent’ shoe research to the field of musculo-skeletal conditions such as osteo arthritis and we are scoping the use of the technology in the areas of peripheral neuropathy and paediatrics. Both would open up a significant market opportunity for the company and a potential health economic benefit to the NHS. One of our most exciting partnerships has been with a Canadian company Sensory Technologies, supported by the CLAHRC to be incorporated as a UK plc, we are facilitating the implementation and evaluation of their enhanced palliative care technology across the region with national initiatives through Hospice UK and Marie Curie.

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Impact through legacy CLAHRC YH was preceded by two pilot CLAHRCs in our region, Leeds, York and Bradford and South Yokrshire. Work from these pilots continues to deliver real impact for the people of Yorkshire and Humber as new projects moved forwward.

Extended Newborn Screening The national newborn screening programme (baby heel prick test) now includes screening for a further four conditions as a result of the findings of the CLAHRC SY pilot project. Clinical and health economic evidence was submitted to satisfy the National Screening Committee that expanding the existing national screening programme was appropriate. As a consequence, children born since January 2015 are now offered expanded screening in England and Wales. Around 700,000 - 800,000 children are born in England each year, and expanded screening is estimated to offer significant health benefit, or be lifesaving, for 20 - 30 children per year. www.expandedscreening.org/site/home/start.asp

Universal Screening of Gestational Diabetes

Bradford Teaching Hospitals Trust (BTHFT) was the first UK centre to provide universal testing for gestational diabetes as part of a CLAHRC LYB project. The evaluation of universal testing demonstrated an increased detection rate from 2% to 7% of pregnant women. One of the team has now been invited onto the NICE guideline committee for diabetes in pregnancy, providing the opportunity for feed the results into national practice

Keeping Warm in Later Life projecT (KWILLT) A key output of this project was the production of six ‘pen portraits’ (www.kwillt.org/index.php/products) to describe types of vulnerable older people who are at risk of being cold in order to support service and community planning. The impacts from these outputs has been recognised by the Council of Deans as an exemplar of good practice for impact in the Research Assessment Exercise and KWILLT findings have been identified in the National Cold Weather Plan for England The method of using social marketing techniques to create a segmentation model and pen portraits have been used to translate insight of heating practices and was used in the Well Warm Families project.

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CLAHRC YH Principles into practice

Engagement We aim to engage with a wide variety of people, partners and organisations throughout Yorkshire and Humber. Our Twitter channel www.twitter.com/clahrcyh and our CLAHRC YH website www.clahrc-yh.nihr.ac.uk are two ways we do this. To date our website, which showcases our vision, principles and Themes, has had approximately 2,500 visits from 62 countries, totalling 27,341 page views; we have tweeted and retweeted approximately 1700 times and have over 1000 followers. In January 2015 we held a profile raising week that increased our Twitter and website traffic and enabled followers to see the people behind the collaboration. All social media activity linked to our website and enabled us to share our projects and activities. We have developed a set of brochures, presentations and newsletters about our vision, principles and Themes, and have worked closely with a copywriter to develop materials which are appropriate for a broad range of audiences. We use the Wordpress Blogging Platform and Mailchimp to circulate relevant information and opportunities to colleagues thus enabling regular interaction. To try to help address the many challenges of translating research into practice we have developed an e-repository, which is a collection of ‘actionable’ research-derived tools developed from our project work. Finally, we have a case study library which enables quick access to impact information for enquirers such as ministers, industry and voluntary organisations. We are constantly looking for opportunities to share the passion we have for the work we do, and work nationally with other CLAHRCs

Health Inequalities Yorkshire and Humber is a diverse region characterised by areas of relative social affluence through to poverty and disadvantage. Avoidable inequalities in mortality and morbidity that stem from the social patterning of health have profound effects within our region; a male born in Hull has on average 4 years less life expectancy than one born in Harrogate, 34% of adults living in Barnsley are obese compared to 19% in Craven district, ethnic minority women in Bradford are only half as likely as white women to have their psychological distress recognised. Significant health inequalities can be found between two adjoining neighbourhoods, between people of different ages and varying life chances. CLAHRC YH has a principle and goal to reduce health inequality in our region. Disadvantaged populations are often less likely to benefit from health interventions which can increase existing health gaps, and we have particularly focused on ensuring that CLAHRC YH interventions are equitable for all. Over the last year we have raised awareness by feeding back on proposed projects, presenting a health inequality agenda to CLAHRC YH members and partners and are designing further general and bespoke training events and workshops. We have additionally supported members by developing and placing monitoring and mitigation strategies within several projects and provided design support for grant applications.



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Capacity Building The strategy for research capacity building focussing on individual, theme and organisational levels www.clahrc-yh.nihr. ac.uk/capacity-building based on Cooke’s evidence-based framework. The strategy understands that capacity building is more than ‘training’, and recognises the need for generating environments that encourage research activity and career development, as well as building a strong infrastructure to undertake research. As well as more traditional training opportunities, we have also developed a number of ‘learning by doing’ placements, these include a research internship scheme described earlier, and secondment opportunities. Examples of secondments include supporting existing NHS YAS staff to undertake an evaluation of pre-hospital 999 provision for mental health patients; secondment of public health specialist to support the prioritisation process of research into Local Authorities; three clinical secondments by junior doctor to undertake a projects aimed at reducing acute kidney injury, and measurement and monitoring of patient safety (a Health Foundation funded project);and experience for three Clinical Academic Trainees (CAT) masters graduates, and Local Authority manager to support the Making Every Contact Count (MECC) project. Work at an organisational level in NHS and local organisation support the practicalities for making these placements work.

Co-production A Public and Patient Involvement and Engagement (PPI) working group has been established within the CLAHRC YH core team. A strategy has been developed and approved by the executive team, which recognises that public involvement and engagement is a broad church and that flexible and multifaceted approaches are necessary. Members of the working group interact with colleagues within the region and nationally e.g. as active contributors to the Yorkshire and Humber Strategic Localism PPI Group and as a member of the INVOLVE Board. Our Themes recognise that coproduction of research and other forms of knowledge is at the core of their activities. Several Themes work closely with patient groups to coproduce projects and guide Theme activities such as formal priority setting. The Evidence Based Transformation within the NHS Theme has produced a formal framework for the involvement of patients, such as participation in Theme projects and membership of the research team; the Primary Care Based Management of Frailty in Older People Theme has worked with patient groups to develop and evaluate a Frailty Index for use in GP settings. A key component of our approach is to engage with patients and the public as active partners in our individual projects, in particular in projects using human centred design methodologies such as the Telehealth and Care Technology Theme Intelligent Shoe project, or taking part in interviews with the Health Economics and Outcome Measurement Theme to determine themes for patient reported outcome measures. Public engagement forms part of our communications strategy where we are continuing to explore various channels of engagement using social media alongside more conventional print and visual forms of dissemination.

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Moving forward We believe this report shows how the vision and objectives of our CLAHRC Yorkshire and Humber are being realised and achieved, as we stay true to our core principles and deliver impact through applied health research for the people of Yorkshire and Humber. We will continue to move forward and show leadership in key areas, where we can demonstrate world leading expertise. Our experience and success in the field of Medical Technology research has been demonstrated through both inward investment to the region and impact in terms of the successful implementation of innovative technologies to support integrated service delivery and improvements in the population’s health. We are at the leading edge of research practice both nationally and internationally, pioneering the use of large-scale cohorts to understand the life course of our population from birth to later years. The scale of this access to a “research ready” population is unique to Yorkshire and Humber and offers a very real potential for insights and improvements to our health and social care services. As Director I would like to take this opportunity to thank our partners, collaborators and expert research teams and wish them and us continued success in this remarkable collaboration. Sue Mawson NIHR CLAHRC YH Director

Our Theme contact details Avoidable Attendance and Admissions Theme Lead: Professor Sue Mason Theme Manager: [email protected] Evidence-Based Transformation within the NHS Theme Lead: Professor Rebecca Lawton Theme Manager: [email protected] Health Economics and Outcomes Measurement Theme Lead: Professor John Brazier Theme Manager: [email protected] Healthy Children, Healthy Families Theme Lead: Professor John Wright Theme Manager: [email protected] Mental Health and Comorbidities Theme Lead: Professor Simon Gilbody Theme Manager: [email protected]



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Primary Care Based Management of Frailty in Older People Theme Lead: Professor John Young Theme Manager: [email protected] Public Health and Inequalities Theme Lead: Professor Liddy Goyder Theme Manager: [email protected] Telehealth and Care Technologies Theme Lead: Professor Mark Hawley Theme Manager: [email protected] Translating Knowledge into Action Theme Lead: Professor Kate Gerrish Theme Manager: [email protected]

www.clahrc-yh.nihr.ac.uk

Our Partners across Yorkshire and Humber

National Health Service

Higher Education Institutions

Barnsley NHS Foundation Trust Bradford District Care Trust Bradford Teaching Hospitals NHS Foundation Trust Doncaster and Bassetlaw NHS Foundation Trust Hull and East Yorkshire Hospitals NHS Trust Leeds and York Partnerships NHS Foundation Trust Leeds Teaching Hospitals NHS Trust NHS Sheffield Clinical Commissioning Group NHS Yorkshire and Humber Commissioning Support Rotherham, Doncaster and South Humber NHS Foundation Trust Sheffield Children’s NHS Foundation Trust Sheffield Health and Social Care NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust Yorkshire and Humber Ambulance Service NHS Trust

Sheffield Hallam University University of Bradford University of Hull University of Leeds University of Sheffield University of York

Local Authorities

Charities Barnsley Hospital Charity Sheffield Hospitals Charity Yorkshire Cancer Research

Other Medipex National Centre for Sports and Exercise Medicine Patient Opinion White Rose Consortium Yorkshire and Humber Academic Health Sciences Network

Barnsley Metropolitan Borough Council Doncaster Metropolitan Borough Council Rotherham Metropolitan Borough Council Sheffield City Council

We work collaboratively with other organisations and a full list can be found on our website. www.clahrc-yh.nihr.ac.uk/our-partners/clahrc-yh-wider-network

Contact us Director: Professor Sue Mawson [email protected] Enquiries: [email protected] 0114 226 5518 Website: www.clahrc-yh.sth.nhs.uk Twitter:

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National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Yorkshire and Humber (NIHR CLAHRC YH) This Executive summary presents independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH). www.clahrc-yh.nir.ac.uk. The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.Produced Summer 2015 © Sheffield Teaching Hospitals NHS FT