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BristolHealthP-13-HIT(UoB)V9

Health Integration Teams (HITs) Background and Accreditation Guidelines

Bristol Health Partners Many of the leading hospitals and universities in North America, Europe and East Asia have established highly successful, formal collaborations to enhance their shared activities in health services, innovation, research and education. This is achieved through various means, including bringing research into practice more quickly and effectively, involving more patients and populations in research, clinical trials and teaching, and accelerating the commercial development of new research.

Bristol Health Partners is addressing the major public health imperatives and disease areas in the city through the integration of primary, secondary and tertiary care with community service provision, public health (including preventative strategies), education, training, innovation and research. This unified and focused approach will deliver healthier lives, earlier prevention of illness and disease, and better integration of healthcare across Bristol. Bristol Health Partners has a tripartite mission to integrate healthcare delivery, research and innovation, education and training across the partner organisations. It is a formal collaboration between three NHS Trusts and three Clinical Commissioning Groups (CCG’s) serving the Bristol area; Avon and Wiltshire Mental Health Partnership NHS Trust, North Bristol NHS Trust, University Hospitals NHS Foundation Trust, Bristol CCG, North Somerset CCG and South Gloucestershire CCG; and the two Universities in Bristol, University of Bristol and the University of the West of England. Bristol City Council is an Associate Member of Bristol Health Partners and the partnership was established in May 2012.

Bristol Health Partners is governed by a Board, chaired by Andrea Young, whose members include the Chief Executives of the three NHS Trusts, the Vice-Chancellors of the two Universities and the Chairs of the three CCGs. Bristol City Council is represented on the Board by The City Director. David Relph is the Director of Bristol Health Partners and Lisa Wheatley is the Programme Manager. The Director chairs an Executive Group which has representatives from the partner organisations and key stakeholders as well as area experts.

Bristol Health Partners has established close to 20 Health Integration Teams (HITs) to date and is anticipating developing additional HITs. HITs are cross-organisational and interdisciplinary groups set up to harness research, innovation, education, healthcare and prevention strengths to improve health outcomes. They are tackling major health priorities by working together in a new integrated way. Some examples of approved HITs are:

Musculoskeletal Integration to avoid hospital admission Sexual Health Improvement for Populations and Patients Improving Care Pathways for Self Harm Dementia Supporting Healthier Neighbourhood Environments

Health Integration Teams (HITs) HITs have been the primary modus operandi of Bristol Health Partners to date. All HITs will be aligned with the priorities of the partners and with the research, education and healthcare strengths in Bristol.

What a HIT should aim to do: 1. Improve outcomes across the patient pathway so that services are of the very best quality, using evidence based innovative approaches [where available, and/or developing new evidence where necessary] to the delivery of prevention programmes, early intervention, clinical quality, patient safety and patient experience.


2. Create an integrated whole health system approach to provide more holistic healthcare leading to better outcomes for patients, ensuring that this is cost-effective and sustainable and works across patient pathway and organisational boundaries. Engagement with health and social care commissioners, current and future, is key, due to their role in representing the needs of their population when driving service redesign and purchasing care. Engagement with funding bodies and industry is also envisaged. 3. Promote and facilitate translational research, including access to external funding, to ensure that Bristol is at the forefront of developing innovations; be they in public health, service design, research methodologies or new technologies. 4. Ensure that successful innovations are embedded and become best practice and that this is spread across all partners, cross-fertilised to other pathways and communicated beyond Bristol. 5. Ensure that the HIT benefits from the widest possible evidence base and external relationships by working with other collaborators, industry etc. 6. Ensure that alignment with improvements in education and training is achieved where possible

Why try to become a HIT and why become involved in a HIT?1. Help deliver the very best evidence-based care for our patients - leading to outcomes that meet or exceed the national and international standards/targets. Becoming a HIT will enable you and your colleagues to have a direct positive impact on the standard of public health and health care in Bristol and beyond.2. Increase grant income - Research funders increasingly emphasize the importance of collaboration and impact. HITs will harness local strengths and address clear priorities; their cross-organisational, multi- disciplinary nature plus their potential for rapid and substantial impact will appeal to funding bodies. 3. Influence future investment in research infrastructure and staff - A successful HIT with a coherent integrated cross-institutional strategy and clearly defined milestones and health outcomes will be in a good position to identify resource needs and influence the agreements with commissioners about the ways their services are delivered. Similarly, business cases for maintenance, enhancement or new development of resources or facilities will be strengthened by the evidence base from the HIT 4. Accelerate the adoption of research findings, new methodologies and technologies - HITs will be the vehicle through which our research and the global research evidence base will inform and transform public health, health service delivery, health outcomes, training and education in Bristol and beyond. 5. Work with others to break down barriers - By taking a health system, holistic approach and working with a dedicated cross-institutional team a HIT will identify barriers and be in a position to remove them.

HIT General Guidelines 1. We anticipate that HITs will be designed in a variety of different models by the nature of the partners and people involved, the priority they are addressing, and the way in which they will need to operate to achieve their objectives. We have therefore not been prescriptive about how HITs could be configured other than identifying the following requirements:

A HIT must address at least one Bristol Health Partners Trust partner priority (see Annex 2). A HIT must seek to integrate primary, secondary and tertiary care with community healthcare provision

and public health. A HIT must aim to address the entire health promotion/prevention or disease/treatment pathway but

it is recognised that it will not always be appropriate or possible for HITs to attempt to do all of this from the outset. Some HITs may start by addressing sections of a pathway or one interface and then expand over time.

A HIT is expected to have the involvement initially of at least 3 Bristol HealthPartners organisations:


two must come from the NHS or BCC and one must be a university. The intention should be to involve all partners or to justify why this is not appropriate or possible.

Each HIT needs to identify one partner organisation (not a University) to act as Sponsor and support it in the development of its Business Case(s). The role of the Sponsor is to champion the HIT, help remove roadblocks and to fully embed and integrate the HIT so that it becomes an equal partner in all managerial functions and is seen to be integral to the delivery of targets or metrics that are important to the Trust. This does NOT mean that the focus of the HIT is solely within the Sponsor organisation.

HITs are accredited for an initial period of 3 years, with quarterly and annual reporting and review. There is an expectation that they will seek renewal thereafter subject to satisfactory performance, delivery and business plans.

2. HIT leadership is critical. Leader(s) must have the credibility and authority, as well as the support of the community they propose to lead, to create a fully integrated cross-institutional team and meet the challenging milestones and deliver the healthcare transformation they propose.

At least one HIT Director must be employed by one of the nine Bristol Health Partner Organisations.

3. Modest funding will be available to support the development of the HIT Business case(s) as well as access to shared infrastructure.

Accreditation Stages 1. HIT Expression of Interest (EOI): This is a short EOI application form which includes: The health and healthcare delivery challenges which the HIT will focus on and the specific prevention or

disease/treatment pathway that will be addressed. How the HIT addresses one or more priorities of the Bristol Health Partner organisations. How the HIT will benefit patients and/or health outcomes (quality and/or cost), how the improvements will

be measured plus predicted timelines within the short-term (1-3 years) and longer term (5 years and 10 years).

How the HIT adds value to what is already going on (i.e. beyond business as usual). Which partners are involved in the HIT, and if not all 9 partners why some partners are not included. How the HIT has, or expects to, engage with and help inform commissioners (Clinical Commissioning

Groups – CCGs, the NHS Commissioning Board, Bristol City Council) and the Health and Wellbeing Boards. In broad terms how the HIT’s PPI (Patient and Public Involvement), communication and engagement plans

will ensure all constituents of the HIT are actively involved in its development. How the HIT has, or expects to, engage with and/or collaborate with industry and other partners What innovative education and training plans the HIT has or is considering The proposed leadership of the HIT: note the Directors/Leads can come from any relevant partner. The HIT’s management structure, including identification of the NHS partner (or Bristol City Council) that

will act as Sponsor.

You will need to identify an appropriate Bristol Health partner to act as a Sponsor for the HIT. This can be one of the NHS Trusts or Bristol City Council. The Chief Executive of this Trust must sign the EOI application form prior to submission. We strongly advise that HIT teams discuss their EOI application with their sponsoring Trust well in advance of any deadline.

2. Full Proposal: The full proposal is a longer application (about 10 pages) in which the HIT leaders will be asked, in addition to


expanding the various areas outlined in the EOI, to: Describe in detail the HIT’s evidence-based strategy for the next 3, 5 and 10 years Detail the research base which the HIT is connected to Provide practical and deliverable performance milestones and actions with clear timetables Provide an organogram showing the HITs management structure and accountability Provide a detailed summary of the pump-priming funds necessary to undertake the initial activities; this

might include protected and ring-fenced time for Director(s)/Leads or other requirements. Address any comments, questions or concerns raised by the Executive Group panel at the EOI stage

Each section on the application form has short explanatory notes to guide you.

The Chief Executive of the NHS Trust sponsoring the HIT or the Director of Public Health if the sponsor is Bristol City Council, must sign and provide a supporting statement on the full proposal application form. We strongly advise that HIT teams liaise with their sponsoring Trust well in advance of any deadline.

Support for HIT Teams Developing HITs - Bristol Health Partners will continue to run the very successful HIT drop-in surgeries and other events to bring HIT teams and/or individuals together with cross-cutting and/or underpinning activities (methodologies and approaches, models, technologies, resources, expertise, facilities etc). A broad range of expertise and contacts are available across the partnership on all aspects of HIT development.

Approved HITs – Each HIT will be assigned a member of the Bristol Health Partners Executive Group to act as a mentor and critical friend. They will also be assigned an Innovation Working Group link member to help them access the broad range of expertise on health innovation, service redesign, industry collaboration, intellectual property, commercialisation etc. available across the partnership. Each HIT will be able to work with the Joint PPI Strategy Team to develop their PPI plans as well as having access to the Bristol Health Partners PPI Facilitator, for hands on assistance with PPI activities. Communications support is available from the Communications Manager and HITs will be able to work with the Bristol Health Partners communications lead from their sponsoring partner organisation to develop their communication plan. Advice around effective evaluation is also provided by our Evaluation Officer. There will be a wide range of other expert advice and support (e.g. education and training etc) available to all our HITs. In addition Bristol Health Partners runs workshops and training specifically designed for approved HITs on a number of topics such as business case preparation, innovation, evaluation and PPI etc.

HIT Application Process Development of a fully fledged HIT is expected to be an iterative staged process. Feedback will be given at each stage. The feedback is intended to help a potential HIT to continue to develop their vision, strategy, operational and business plans, build their team and where and when appropriate be approved and then progress onto full accreditation.

Submissions at the EOI and full proposal stages will be considered by a review panel formed by the Bristol Health Partners Executive Group. The panel will meet formally to discuss each proposal.

The Expression of Interest (EOI) Review:Each prospective HIT team must complete an EOI application form which will be reviewed by a panel. Prospective HIT teams will receive feedback and be informed by email of the outcome.

Full Proposal Review:The review has two parts. Each prospective HIT team must complete a full proposal application form and attend a panel meeting to give a 10 minute presentation. This is followed by 20 mins of questions and


discussion. Between three and five team members should attend the meeting, one of whom should be a commissioner. Teams will receive feedback and be informed by email of the outcome. HITs which are successful will be formally accredited as HITS.

Application forms and Submission Deadlines For copies of application forms for EOIs and Full Proposals please contact Lisa Wheatley ([email protected]).

The HIT review panel meets monthly to review applications. If you are considering developing a HIT proposal you should contact the Programme Manager, Lisa Wheatley to discuss your idea at the earliest opportunity. You should also contact Lisa at least ONE MONTH prior to your intended date of submission. If you have been invited to submit a FULL proposal you should contact Lisa once you have had time to review the panel feedback, to discuss the most appropriate submission date and attendance at a review panel meeting. Contact usFor copies of application forms; deadlines for submission; details of HIT drop-in surgeries; or help with any aspect of your HIT application please contact:

Lisa WheatleyProgramme Manager Bristol Health Partners 07875 [email protected]

REGISTER with Bristol Health Partners and stay informedTo receive news and information by email about Bristol Health Partners, HITs, events etc. please register your details with us. Email Lisa Wheatley ([email protected]) with the following information:

Your name:Position:Organisation affiliation(s): Email:Postal address:Phone:HIT(s) involved in:Annex 1: BHP Partner Health Priorities

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP)

1. Dementia – one of the top 5 public health burdens in high income countries, there are over 5000 patients with dementia in contact with AWP (out of a total of about 35,000 per year). Mainly managed in primary care settings but with major impacts in DGHs.

2. Depression – also one of the top 5 health burdens particularly at times of economic strain in which we have clinical expertise. Much of the work takes place in primary care.

3. Addictions – alcohol addiction being one of the top 5 health burdens in high income countries. We have highly respected addictions services in AWP that also combine with criminal justice and prison inreach services giving reach across the whole of the SW. Also major impacts on DGHs ( ED & In-patient episodes)

4. Long Term conditions in mental health – including Schizophrenia, where repeated relapses and admission are disruptive to life and expensive; Developmental disorders such as Autism, Aspergers, Attention Deficit

mailto:[email protected]


Disorder and Personality Disorders are also a prevalent range of conditions mainly managed in a primary care context but require the expertise we have. Will have an impact on reducing hospital admissions

5. Integrated Care Pathway Development- mental health services are introducing Payment by Results for 2012 based on care clusters supported by development of care packages offering real choice to individuals and their health team advisers. Care pathway management within shared care models is an open field for both research & innovation with major opportunities for “quick wins” in terms of translation into practice. This would also impact on a general theme. Will have an impact on reducing hospital admissions

6. Service user and carer involvement – we need to respond rapidly to the needs of SUCs and prepare for the move to service user led commissioning. We host two research networks where SUC involvement in research is becoming a key performance indicator. (Cross cutting)

7. Healthcare professionals – with 3,400 staff in AWP and sickness rates around 5% we are keen to improve the wellbeing, morale and skills of our major asset and resource. Further, MH problems amongst Healthcare professionals are a largely unspoken but acknowledged problem across all provider organizations. Development of discrete & discreet services would have wider benefits. (Cross cutting)

AWP’s current improvement programmes focus on: Working more efficiently so that staff have more therapeutic time to spend with service users Reorganising our services to provide more effective, recovery focused treatment Improving access to our services through improved ways of working with GPs and other healthcare

providers.AWP Provides:Adult acute inpatient servicesLater life inpatient services (Dementia) Low secure servicesPsychiatric intensive care RehabilitationAcute hospital liaisonAdult recovery servicesComplex intervention teamEarly intervention in psychosisIntensive servicesLearning disabilitiesDrugs and Alcohol Bristol City Council (BCC)

Bristol City Council’s Health and Wellbeing Board has developed a health and Wellbeing Strategy which outline 10 priorities:

1) Built Environment: Using council owned property to create affordable, safe, healthy places to grow up and grow old in, built with sustainable resources, with good walking and cycling access to local services, green space, play and food growing opportunities and powered by renewable energy. Setting a benchmark for positive building and planning. Promoting walking and cycling as the primary methods of getting to and from places through transport planning and encouraging the everyday take up of physical activity. Ensuring neighbourhoods are planned and designed to support healthy lifestyles.


2) Food: Procuring good food for patients, staff and visitors accessing health and care services.Encouraging a culture of cooking from scratch, local food growing and the use of fresh, seasonal and fairly traded food through local government, schools, health sector led programmes and services. Help to keep our high streets vibrant and diverse, championing the use of local, independent food shops and traders so that everyone has access to affordable food. Helping to minimise food waste by encouraging the composting of inedible food, and the redistribution of good food that would otherwise be sent to a landfill. Using our combined influence and commissioning to support work to tackle obesity, nutritional deficiency and food poverty.

3) Domestic Violence: play a vital role in preventing violence, identifying abuse early, and referring on to appropriate care. These services must be places where victims feel safe, are not stigmatized and receive quality, informed support. Play a vital role in preventing violence, identifying abuse early, and referring on to appropriate care. These services must be places where victims feel safe, are not stigmatized and receive quality, informed support. Encouraging abused and vulnerable people to seek help. Change the culture of complicity and condoning violence and challenge the acceptability of it in our city.

4) Smoking: Through supporting specialist services focusing on the high smoking prevalence groups, such as:- People with mental health and learning difficulties.- Patients with long term conditions.- Socially excluded and isolated groups, for example; the prison population. - Pregnant women who smoke.

Increasing the access to stop smoking services by including weekend and evening hours in a greater number of locations, including community venues and workplaces. Offering a wider range of ‘routes to quit’ and harm reduction programmes. Supporting the call for the plain packaging of cigarettes. Greater partnership with other services including: mental health agencies, drug treatment services, fire service, licensing authority, the police, prison services, leisure centres, children’s centres, schools and colleges. Creating a culture of smoke-free behaviours.

5) Alcohol Misuse: Support preventative work to help people reduce their alcohol misuse before it becomes a real problem. Provide treatment services for those that need help. Deliver targeted services for the most vulnerable.

6) Children: Leading the development of a joined-up, strategic response across the whole health, care and education system to identify where services can better work together and meet the needs of our growing child population. Tackling poverty and inequality through supporting measures that increase employment, enterprise opportunity, and maximise benefit uptake for young people and their families. This includes action on child poverty, children leaving care, young offenders, support for young carers and young people not in education, employment or training (NEETs). Supporting Bristol’s Preventing Homelessness Strategy (PHS), and encouraging our partners to help deliver its agenda. This includes: mental health services and young people’s services to ensure early intervention and to help people achieve independence and avoid homelessness. Supporting the emotional health and wellbeing of children through targeted and integrated ‘whole’ family support services as the foundation for healthy development, offsetting the risks relating to disadvantage.

7) Mental Wellbeing and Social Isolation: Identify, coordinate, and promote initiatives to address social isolation, and jointly agree priorities for action based on good evidence, national best practice and work together to deliver them.


Develop and promote the Mental Wellbeing Strategy for the city with a view to achieving real and measureable improvements, and raise mental health and wellbeing to the same priority level as physical health. Support the use of the ‘5-ways to Wellbeing,’ a set of evidence based actions to promote wellbeing, drawn from national research into the most effective ways to build mental capital and improve wellbeing.

8) Dementia: Helping everyone to understand dementia and removing the stigma attached to it. Signposting to information and services for early diagnosis and treatment of symptoms associated with dementia as quickly as possible. Supporting a range of good quality services that meet the changing needs of people with dementia and their carers, helping to keep people in their own homes where at all possible. Where people need more specialist support, this will include services delivered through the Strategic Partnership with Bristol City Council to develop 3 new care homes across the city, offering residential care and support to people in the local area.

9) Maternity Services: Working together to plan our city’s ante-natal and post-natal services, meeting both patient needs and delivering good quality services. Not only in terms of community and culture, but also geographically, to make sure that there are no gaps in services where they are needed the most. Making sure that that the views of mothers and families influence the shape of planned and commissioned maternity services. Supporting expectant mothers to make healthy lifestyle choices for themselves and their babies, both while they are pregnant and after their child is born. For example help to stop smoking, good nutrition advice and the use of alcohol. Providing signposting to services which help mothers experiencing postnatal or postpartum depression.

10) Integrated Care

North Bristol NHS Trust (NBT)

1. Redesigning services around patient pathways - as part of the ‘Building our Future’ programme, the operating plan for the new hospital will be designed around patient pathways rather than individual specialities, which includes moving more care into community settings

2. Continuing to improve quality whilst taking out 6-7% savings annually - focus on Trust wide implementation of recognised best practice and tested safety interventions. Increase productivity and efficiency to be consistent with upper quartile performance nationally

3. Whole system partnership working - recognition that future challenges can only be met through an integrated health and social care approach. Early clinical priorities for joint working are:

• Care of the frail older people • Urgent and emergency care • Long term conditions • Dementia

4. Development of a centre of excellence for specialist and tertiary services - includes securing national designation for certain services, e.g. major trauma, neurosciences, burns etc as well as supporting cross community integration of specialities such as head and neck, breast, urology and pathology services

5. Be a great place to work - recognised as a good employer and able to recruit high calibre staff because of the profile of clinical services, opportunities for personal development and access to education and research opportunities.

University Hospitals Bristol NHS Foundation Trust (UH Bristol)

1. Transforming Care through Innovation - the Trust has recently launched a transformation programme that aims to ensure the Trust maintains, and wherever possible improves, the quality of its service office whilst


reducing the cost base of the organisation. This programme is focused on innovation as a means of driving new practices

2. Vision & Values1 - to continue to embed the Trust’s values1 and secure organisation wide buy in to vision for our services

3. Establishing, with partners, a formal research and innovation collaboration - successful realization of the AHSC / Bristol Health Partners vision and the local fore runner to the creation of a HIT

4. Leading Through Partnership - to play a greater role in health system leadership through forging effective partnerships with all of the key players; recognizing the vision described in Health, Wealth & Innovation will rely upon robust cross-organisational working

5. Promoting Teaching and Learning - strengthening the profile and standing of teaching and learning within the Trusts business

6. Acute Service Configuration - to ensure we organize our services for success in the future by ensuring service resilience and strategic coherence which will position Bristol to take advantage of research and innovation opportunities that present in the future

7. Secure national and regional service designation - to position the trust for success in local and national service designations with the aim of being viewed by external commentators, and funding bodies, as a “significant player” in the field of research and innovation

8. Promoting quality and managing risk - ensuring quality of care remains the organizing principle for the Trust, ensuring that we bring the evidence from research and the practices from innovation to patient care at speed

9. Improving the built environment - successful completion of the BRI Redevelopment, the Children’s Hospital expansion and the Bristol Haematology and Oncology Centre development with the aim of improving patient experience, service efficiency and physical capacity for enhanced research and innovation through the creation of a single JCRU (Joint Clinical Research Unit)

UHB have identified eight specialities and four pathways which will be the focus of their service line strategy over 2013 – 2016. These areas are those UHB anticipate that there is most potential for performance and quality improvement, and operational and financial efficiencies both from an organisational and a wider system perspective.

Specialities:

1. Musculoskeletal services2. General Surgery (to include acute GI Surgery) 3. Maternity 4. Cardiology 5. Dermatology and plastic surgery 6. Gynaecology 7. Clinical Haematology 8. Neonatal Intensive Care

Pathways:1. Stroke Care:2. General Medicine

1 UH Bristol’s values are: Respecting everyone, embracing change, recognising success and working together


3. Geriatric medicine4. Urgent Care (A&E)

University of Bristol (UoB)

1. Focus on our research strengths, especially population health. Organ-based theme areas of strength include cardiovascular, neuroscience, musculoskeletal. Methodological expertise includes epidemiology, clinical trials units, statistics, health economics, health services research and public health.

2. The Faculty of Medicine and Dentistry has primary responsibility for the training and education of medical and dental students and we will continue to provide this education in a research-led environment. We wish to see greater integration with postgraduate education and training and with the education and training of other members of the multi-professional healthcare workforce.

3. Across the wider university, we see the creation of the University Research Institute for Health (URI-Health) as a powerful vehicle for the promotion of interdisciplinary working, bringing research to translational application and maximising research income and outputs. The alignment in time with the development of Bristol Health Partners is a deliberate policy to ensure integration and avoidance of duplication.

4. We aim, in collaboration with the other partner organisations, to increase our NIHR footprint, maximize the success of our two current Biomedical Research Units (in Cardiovascular and in Nutrition), planning an application for a Biomedical Research Centre in 2015 and adding to our successes in other NIHR funding schemes including programme grants and fellowships.

5. We wish to promote and encourage collaborations with other academic partners, including but not limited to the Universities of Bath and Exeter and extending into Wales by building on our existing strong links with Cardiff University.

6. We recognise the need to strengthen our linkages with the devices, biotechnical and pharmaceutical industries.

Priorities also include;

1) Population healthPopulation Health researchers tackle many key public health and health care related issues facing high and low income countries, such as obesity, AIDS, mental illness, child health, cancer detection and treatment. These issues are complex in nature and require a multi-disciplinary approach using epidemiological, statistical and social science methods.

2) Infection and ImmunityThe Infection and Immunity research theme studies the mechanisms that cause and spread disease. From emerging infections, spread around the world by modern travel or by environmental change, to chronic inflammatory conditions that strain the resources of first-world economies to breaking point, research in this area has immediate relevance to diseases that affect us all.

3) Cardiovascular ScienceThe Cardiovascular Science research theme is led by Bristol CardioVascular (formerly The Bristol Heart Institute - BHI), which comprises more than 230 researchers and clinicians across the University and the Bristol NHS Trusts, working to translate basic scientific research into novel clinical practice, thereby improving patient outcome and care.

4) Cancer


Cancer research in Bristol focuses on core strengths in cancer cell biology, genetic and lifecourse epidemiology and health services research. In partnership with Bristol NHS Trusts and UWE it aims to accelerate the identification and translation of novel and existing biomarkers into clinical practice for the early detection and treatment of cancer.

5) Bristol VisionVision science research at Bristol is at the forefront of the study of human and animal vision, artificial vision systems and image analysis. The theme is embodied by the Bristol Vision Institute (BVI), which stimulates interdisciplinary research in order to promote future development of this field.

6) Bristol NeuroscienceWorld-leading research into the fundamental science of the brain and nervous system lies at the heart of the Neuroscience research theme at Bristol. This is embodied by Bristol Neuroscience (BN) which represents a large, diverse neuroscience community with an excellent international reputation

University of the West of England (UWE)

1. Child Health: We have particular research strengths in medicines for children, language and communication impairment and in accidental injury and prevention. This final strand is supported through collaboration with the Centre for Child and Adolescent Health, located at UoB.

2. Long term conditions: This theme consists of a number of areas of strength, many of which are supported by key collaborations with local trusts; these include musculoskeletal, rheumatoid arthritis, fatigue management, pain mechanisms and management, stroke recovery and rehabilitation.

3. Appearance Research spans specialist research around visible different (disfigurement) and body image as well as having relevance in terms of more general health and wellbeing issues. Key research areas include; interventions for children, cleft gene bank and cohort studies, psychosocial needs of people with a range of appearance concerns and public attitudes to appearance.

4. Healthy Living and assisted living encompasses the user experience, the development of complete sensing systems and evaluation of assistive technologies. The work spans a number of faculties and draws on industry links through our Bio-medical iNets.

5. Bio-sensing Technologies and Diagnostics for Health research includes work on electrochemical (bio) sensors, novel electroactive materials for biosensors and luminescent bacteria-based sensors.

6. Bio-markers research at UWE focuses on both the rapid detection of illnesses such as specific cancers, diabetes and dementia, as well as biomarkers to protect food quality in relation to human health.

7. New ways of public health addresses high profile societal and government concerns around creating a resource efficient, low carbon future and a healthy society, through contributing to policy and practice in the thematic areas of; ‘Healthy, Sustainable Communities’ and ‘Low Carbon Futures’, in addition to the ‘Healthy University’ and ‘Education for Sustainable Development’.

8. PPI: Patient and public engagement in research is important to all areas of research and learning and led by one of the national figures in the field. PPI is supported by a Service User and Carer Office, with recognised status as ‘research partners’ for members of the public who are involved in research (cross-cutting theme).

9. Health service evaluation focuses on providing evaluative research in a range of health and social care settings and draws on a wide range of evaluative methodologies. The area is seen as important for cross Bristol collaborations, the development of which is being supported through a partnership Senior Research Fellow post funded by NHS Bristol and managed by UWE and UoB (cross-cutting theme).


10. Partnership working: UWE prides itself on being ‘the Partnership University’ and this is expressed in health research and innovation through collaborative focus of both the Institute for Sustainability, Health and the Environment

Bristol Clinical Commissioning Group

1. Urgent Care Including Frail and Elderly Patients

2. Long Term Conditions More support at home, reduced rates of hospital admissions for these conditions, reduced rates of diabetic amputation.

3. Dementia CareEveryone who wants a diagnosis receives one, carers and families as partners in care - able to access carer breaks, reduction in hospital stays, Bristol as a dementia friendly city, more access to innovative treatment and research.

4. Elective care (routine operation or treatment)Operations only when patients have followed agreed pathways developed by their GP (primary care) and supported by hospitals (secondary care) Increased range of local services where safe and cost effective.

5. ChildrenImprove the health of vulnerable and excluded children and young people, reduce childhood obesity reduce infant mortality, improve access to health services and experiences for children with complex health needs, improve emotional health and wellbeing, improve the physical health of children.

6. MaternityImprove maternal health and reduce infant mortality rates, reduce risk taking behaviour which impacts on health, improve emotional health and wellbeing, reduce rates of infant mortality.

7. Mental HealthIncreased quality of service, improved access to mental health services

8. CancerReduce the mortality rate of people with cancer under the age of 75, improving access to earlier diagnosis for the less advantaged, achieve earlier diagnosis of cancer to increase the scope for successful treatment

9. Learning DifficultiesImproved standards of care: improved health outcomes for people with learning difficulties, fewer people in high cost provision away from their local communities, compared to 2012/13, implement the Winterborne View recommendations with Bristol City Council

10. Medicines ManagementSupport quality and cost effective prescribing, deliver a locally agreed agenda helping to improve health outcomes as well as achieve a financial balance, specific work with nursing homes to improve the quality of medicines management, ensure patient agreement with their oxygen prescribing.

11. End of Life


A programme of support for patients with end of life needs and their family and carers, 5% reduction in the number of palliative care patients dying in hospital, increase in the number of people on the palliative care register. South Gloucestershire Clinical Commissioning Group

1. Community Health ServicesTo improve the quality of services provided by community health services, deliver seamless services in the community which wrap around the patient, ensure a robust set of community services to care for patients in the community unless admission to hospital is clinically necessary; increase the overall proportion of care which is provided in a community setting; improve capacity and capability of nursing homes to care for more complex patients in the community; Improve discharge practice at NBT.

2. Promoting IndependenceThis area has 3 key themes; Self-care and management; Out of hospital care and Reduction in hospital services and cost. In order to achieve this there is a Focus upon the following long term conditions: COPD, fracture Injury, diabetes, spinal care, ophthalmology, heart failure, stroke and neurological conditions

3. CancerEarlier detection of cancers with increased diagnosis through the elective rather than emergency route. Improved public knowledge and awareness of how lifestyle changes can reduce risk of developing certain cancers. Creation of personalised care plans for all patients with new diagnoses of cancer. Supporting the Cancer Clinical Site Specific Groups to continue their work

4. End of Life CareCommunication – communicating with patients to decide their plan and between healthcare professionals to ensure everyone knows the plan. Co-ordination –ensuring everyone is organised in order to provide the best possible care for the patients. Education – Educating the staff enabling them to properly carry out the above actions.

5. Rehabilitation and ReablementEnhanced opportunity to live more independently for longer. Accessible services, with care being provided closer to home. A greater emphasis on returning home as soon as possible, with an associated reduction in the time spent in hospital. More co-ordinated care through the whole system, ensuring that they access the right services, at the right time, all the time. A more responsive pathway flexible to individual needs. Patients better informed about their rehabilitation and reablement goals and therefore able to work towards them.

6. Children and MaternityChildren and young people should have access to complete evidence-based care pathways for the treatment of obesity. Increase emotional and behavioural support service capacity within mental health service for primary and secondary school-age children. 24-hr community paediatric nursing service to meet the needs of acutely unwell children. Commission services that fully understand their roles and responsibilities in relation to early intervention for safeguarding children and that processes support the use of the Common Assessment Framework. Identify the mental health needs of young mothers and service development to meet these needs. Increase the availability of talking therapies within secondary mental health providers. Work with local providers of primary care to ensure that patients with ambulatory care sensitive conditions receive timely and appropriate care to manage their conditions outside of an acute hospital setting. Work with emergency departments to ensure that they see patients who are clinically appropriate for emergency departments and


patients with primary care needs are redirected to their GP. Commissioners to ensure that children and young adults are treated in the clinical environment that is most suited to their condition and maturity GP Membership priorities: Improvements in mental health services for adults should be extended to children and young people, including primary care liaison service.

7. Mental HealthAttention deficit-hyperactivity disorder (ADHD). Autism diagnostic service with specialist assessment and provision of on-going therapy, support and practical assistance. Increase the availability of talking therapies within secondary mental health services. Suicide and self-harm prevention via a new SG suicide prevention partnership and strategy led in partnership with Public Health. Improved safeguarding practices within mental health services. Improve access to mental health services, including for people with learning difficulties. Services for mental health should also take into consideration the additional impact of sensory loss.

8. Learning DifficultiesImprove access to health services for people with learning difficulties, including mental health services. Ensure safeguarding practices are improved within the mental health and learning difficulties services. Services for dementia, mental health and learning disabilities should also take into consideration the additional impact of sensory loss.

9. DementiaImprove physical activity services for people with long term conditions and those with physical and mental disabilities. Personalised care planning for all patients with long term conditions, including dementia. Respite care for ‘unseen carers’. Service consideration of additional impact of sensory loss. Improved provision of information and advice during the weeks after diagnosis. Partnerships with local voluntary organisations. Partnership between the local authority and health commissioners to support local care homes to provide a quality service for residents with dementia. Make South Gloucester more ‘dementia friendly’. Increase the capacity of health services to meet needs of people with dementia and improved capacity in dementia nursing support.

10. Medicines managementProvide clinically appropriate, evidence based and cost effective prescribing advice. Effective budget management. Safe introduction of medicines into the care pathways and management of long term conditions

North Somerset Clinical Commissioning Group

1. Reduce under 75s mortality rate from cancer 2. Reduce under 75s mortality rate for cardiovascular disease 3. Improve health related quality of life for people with long term conditions 4. Reduce emergency admissions for alcohol related liver disease

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