Title: NIHR ARC Northwest London
Funder: Department of Health and Social Care

Abstract: Our aim is to improve health in NW London through maximising the effectiveness of health improvement in areas such as prevention, early detection of disease, management of acute and long-term conditions, reducing unwarranted variation in care, and thereby achieving more equitable health outcomes. There will be a strong focus on implementation of evidence-based practices and policies, working collaboratively with our member organisations, patients and the public, and with community organisations. We will help NW London deliver high-quality, evidence-based health and social care services; and deliver a greater proportion of services in community settings. We will make use of the exceptional clinical, public health, NHS management and academic capabilities in the sector to develop a system that allows innovations to be developed, adopted and evaluated rapidly. NHS efficiency will be improved and resources used more optimally by cutting duplication through the integration of services. Achieving these aims is critical to ensuring the UK has a sustainable NHS and internationally leading health outcomes. We are well-positioned to contribute advancements in these areas by bringing world-leading academics in public health, primary care, mental health, biomedical science and digital technology together with a strong partnership of health and care providers, patients and the public. We will continue to make significant impacts in care quality, patient outcomes and patient experience; addressing areas of significant population need. There will be a sustained focus on prevention and health improvement, as well as on mental health and social care, in our work. We will embed health economic analysis of interventions across all themes. To do so, we will conduct feasibility assessment of economic data collection; estimate return on investment from interventions; and use simulation modelling to assess long-term cost effectiveness of programmes. This work programme will be conducted via four research themes and three cross-cutting themes. An overarching research enquiry that all 7 themes will contribute to is: How can we build sustainable infrastructure for a continual improvement in health behaviours and population health; and a reduction in health inequalities in NW London? Using informatics resources Underpinning our work will be the large investments in informatics capability in NW London. This includes information from the Whole Systems Integrated Care (WSIC) Programme, which was established to facilitate better co-ordinated care, particularly for patients with complex health needs. The WSIC informatics resource contains linked primary care, acute, mental health, community and adult social care data for 2.2 million people. Through the use of data from WSIC, we can evaluate patient journeys through the health and care system in our sector. WSIC will be supplemented by other informatics resources such as the One London Local Health and Care Record Exemplar, which aims to use information to achieve step changes in health outcomes and NHS efficiency in London. Three research themes aim to address local and national priorities (Child Population Health, Multimorbidity, Digital Health), building on our strengths; including committed healthcare professionals, academics and patients. These themes aim to achieve major population health impact, learning from and contributing to international experience in these areas. Supporting the breadth of innovation, implementation and improvement activities in NWL The fourth research theme (Innovation and Evaluation) will contribute to NWL infrastructure, capitalising on world-class discovery science in the Imperial AHSC for rapid spread of innovations in prevention, early diagnosis and better, targeted treatments, to benefit patients, including frugal innovations from low- and middle-income countries (reverse innovation), sharing learning within and beyond NW London. Translating research findings to deliver changes in practice The four research themes will be supported by three cross-cutting themes (Information and Intelligence; Patient, Public, Community Engagement and Involvement; Collaborative Learning and Capacity Building). They will produce generalizable research on how to maximise the efficiency of health improvement programmes and support high quality services. Objectives Short term objectives (1-2 years) Establish foundations for health improvement in NW London, building relationships, engaging diverse communities and establishing shared aims. Collaborate with partners to unlock the potential of health and social care data to improve health outcomes and NHS efficiency. Co-produce research to address identified problems and translate evidence into practice. Demonstrate initial improvements in priority areas, with economic evaluation. Build capacity for research, implementation and health improvement; including infrastructure for commissioned evaluations. Develop collaborations with other ARCs in areas such as unscheduled care, multi-morbidity, and prevention. Medium term objectives (3-4 years) Acting responsively to emerging system changes to identify further areas for co-produced research in priority areas. Demonstrate reproducible improvements in care quality and patient outcomes for priority areas. Demonstrate the economics of health improvement and implementation work, and propose how the efficiency and effectiveness of large-scale NHS transformations can be increased. Foster new career pathways that support the development of academic, practitioner and patient leaders for applied health research. Demonstrate the real-world implementation of innovative practices adopted from industry, academic partners, or international exemplars. Long term objectives (5+ years) Demonstrate sustained improvements in health outcomes and reduction in health inequalities for priority areas and population groups. Demonstrate increased effectiveness and efficiency of health improvement work through application of learning to optimise improvement initiatives. Produce national guidance for the implementation and evolution of digital health tools. Establish critical mass of researchers, practitioners and patients working in applied health research with career pathways and succession planning strategies in place. Research theme success will be measured through evaluation including process measures, outcomes, inequalities, economic impact and patient and staff experience. Cross-cutting theme success will be determined through assessment of the effectiveness of our approach in supporting system reconfiguration and health improvement, through mixed-methods analysis published in high impact journals, and the development and evaluation of novel methods and roles. Programme level success will be assessed through ARC-NWL s ability to apply health research to support health improvement initiatives; with joint working between academics, healthcare professionals, patients, industry and other stakeholders; build expertise (including number of stakeholders engaging with the programme, higher degrees awarded, external funding obtained, and number and impact of academic outputs); and, build a reputation as a national centre of excellence for research on health improvement.

Lay abstract: About us: As an experienced team we build from a 10 year track record of research dedicated to understanding how to put research evidence into practice to benefit patients. We will continue to work with the skills and expertise of patients, carers, communities, frontline staff and academia to improve care. What could be done better? We need to respond to future health challenges: an ageing population, living with more than one health condition, the need for mental health services and increases in health inequalities. Despite the availability of research evidence, not all people receive the best care for their needs, and some individuals and communities are more disadvantaged than others. There are persistent difficulties about how to improve care quickly and concerns that resources are being wasted. What we plan to do: We plan to improve health and care for the population of NWL. Our aim is to boost the pace at which improvement happens and to make sure that time and money are used to get the best results. We learn how to put research evidence into practice to improve services so that people can live well and enjoy high quality of life. This includes preventing ill health; providing care during acute illness and when living with a long-term condition; in early years and to the end of their lives. How we will help: Our research will understand health and care needs of the NWL population and learn how to effectively and efficiently achieve improvements in care. More attention needs to be paid to the everyday problems that people face receiving and providing care. Research questions, new ideas, products and practices are more likely to help understand and solve everyday problems if they are thoroughly tested in the real world . We will support patients, carers, clinicians, managers, commissioners, researchers and communities to work more closely together. This will build a better understanding of how care is coordinated, identify problems, and allow new ideas to be tested. We will take care to check that changes meet the needs of diverse communities, settings and cultures. We will focus on three areas: Promoting health and wellbeing for children, supporting people living with more than one condition, and helping people to manage their self-care through, for example, community networks and advances in technology. We will promote relevant and promising ideas, products and services across NWL working with our member organisations. What we aim to achieve: Short-term: An in-depth understanding of problems and opportunities in NWL, drawing on insights from patients, carers, diverse communities, data, and evidence reviews. Medium-term: Show improvements in care quality for the wider population, including for diverse communities and those with additional needs, for example with learning difficulties or with sensory impairment. Long-term: Mature working partnerships to carry out continual improvement in health and care. Create new research evidence about how to make improvements using data and engaging patients and staff to coproduce change. More people will feel confident to take part in improvement research.

Research activity codes: 7.4 RESOURCES AND INFRASTRUCTURE (DISEASE MANAGEMENT);8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE