Title: Giving each child in the North East of England the best start in life: blending different types of knowledge to enhance local commissioning of public health services
Funder: Department of Health and Social Care

Abstract: Background Mobilising research evidence into practice in UK public health settingsis challenging because of a poor fit with local commissioning processes caused by disconnected timescales, contested evidence and lack of actionable messages (3,4). Moreover, research evidence has to compete with other types of knowledge in these processes, such as technical knowledge and practical wisdom (5,6). Blending different types of knowledges in decision making processes is an important but under-researched and underdeveloped skill. While some research exists on the blending of different types of knowledge in clinical settings, evidence is lacking on how different types of knowledge are mobilised within local authority commissioning processes (10,12). In 2015, the Directors of Public Health in the North East of England choose ‘Best Start in Life’ in May 2015 as the focus for a System Led Improvement (SLI) approach of public health in the region. In this approach the Directors of Public Health and their teams will review existing health services for children aged 0-2 through peer visits in which they support and challenge each other to identify whether or not they have appropriate evidence on which to base commissioning decisions. Aims This Fellowship aims to research the mobilisation of different types of knowledge within the SLI. Moreover, the Fellow will actively facilitate the blending of different types of knowledge by organising critical reflection and dialogue between academics and commissioners in the North East. Working in co-production with these partners, the Fellow will sustain the SLI approach and support its application to other areas and topics by developing a 'best practice' model and training for commissioners grounded in social learning networks. Plan of investigation An ethnographic approach will be applied to study knowledge mobilisation in a purposeful sample of six case studies. Blending of different types of knowledge will be actively supported from temporarily embedded positions within a subsample of three local authorities’ public health teams. Blending knowledge requires an in-depth understanding of local contexts. Temporary embedded research positions allow for building this understanding and for being responsive to identified knowledge gaps. A mixed methods design will be used that combines: 1) secondary analysis of data from an online survey among local commissioners on pre-SLI evidence use; with 2) in-depth observations at peer visits of local authority teams to explore how different types of knowledge are mobilised across different contexts and blended in each case study context; and 3) embedded research in three sequencial case studies, including semi-structured interviews with academics and commissioners (n=30) to reflect on their experiences of the SLI approach and how recommendations from the peer visits were taken forward. Research findings will be analysed at the end of each work package in co-production with commissioners and academics through interpretation sessions. Iterative data collection, analysis and interpretation with local authority teams across case studies will ensure ongoing reflection and development of the SLI approach in subsequent applications. Summary of potential benefits to patients and NHS The work of this Fellowship will: (1) inform timely, accepted and actionable recommendations for commissioning decisions about child health services across the North East of England; (2) build capacity among academics and commissioners to blend different types of knowledge and to reflect collectively on their knowledge use; and (3) support the application of the SLI approach to other settings and topics. Although outside the scope of this application, a structural regional approach to knowledge mobilisation and blending in commissioning decisions has the potential to create more effective care and services and, in doing so, improve child health, school readiness and reduce persistent inequalities from pre-conception to age 2 across the region in the long term.

Lay abstract: Aims The aim of this Fellowship is to study the use of research evidence in the commissioning of health services for young children (0-2 years old) in the North East of England. I will evaluate a new collaborative approach between academic researchers and policy makers in the region. I will also actively support policy makers in accessing evidence from academic research and help them to blend this evidence with other sources of knowledge (such as technical expertise and practical wisdom). My position as a researcher in local authority public health teams will enable me to facilitate conversations and learning between policy makers and academics. Background to the research We know from previous research that the sharing of evidence between academics and policy makers is not straightforward. Research evidence is not always clear, available in time or a format that is useful for commissioners of child health services. Moreover, policy makers often use different sources of evidence to inform their decision making. This raises questions for policy makers in local authorities about how to combine different types of knowledge effectively. In 2015, the Directors of Public Health in the North East of England chose ‘Giving each child the best start in life’ as the focus for a new way of working together with academics. In this new approach commissioners from different local authorities assess the extent to which their policies and commissioning plans are evidence based and then host a peer review group of colleagues from other public health teams to look in detail at their policies. I will assess this new approach to see if it helps commissioners to make more evidence informed decisions about health and social care services for young children in their area. The research will also make suggestions for how this new way of working could be used for other areas of public health. Design and methods used I will examine data from a self-assessment questionnaire that commissioners complete as part of the new approach about the types of evidence they currently use in their decision making. I will subsequently observe six different public health teams in their own work setting as they are visited by their peers, to explore how or whether the system led initiative is helping commissioners to access and use different types of knowledge. This will be followed by individual interviews with commissioners and academics in three public health teams about their experiences of working together. The interviews will also look at how the evidence they shared and the ways in which they combined different types of knowledge helped them to decide on new services for young children. I will analyse this data and the findings will be discussed with commissioners and academics in a repeated and collaborative process to make suggestions for how both can make better use of available research evidence and other types of knowledge. To support the adoptation and implementation of these recommendations, I will be a member of three public health teams after they have been visited by their peers. From this position, I will help the teams to access evidence from academic research. I will also facilitate conversations between commissioners and academics using communication techniques (such as critical reflection and learning as a group) that will enable them to combine different sources of evidence more effectively. Patient and public involvement An advisory group will be set up for the research that includes parents of young children in the North East, commissioners of children services, academics with expertise in children’s health and representatives from voluntary and community organisations that work with young children. The advisory group will provide guidance in the design of the research, the organisation of learning activities, and the interpretation and dissemination of research findings. I will champion the voice of parents and carers as an additional source of knowledge that commissioners can use to inform their commissioning decision and will actively engage with public and patient organisations, such as Involve North East, and feed their knowledge into the team visits to ensure that their voices are heard. DisseminationThe findings of the research will be translated into training events for other policy makers in the UK. Using his local and regional networks developed through managing AskFuse (a rapid response service within the North East public health research centre called Fuse) and his national and international networks developed through the training programme. The research findings will also be promoted through conference presentations, the use of social media and by publishing academic papers.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE