Exeter HS&DR Evidence Synthesis Centre

We are one of two research groups in the UK commissioned by the National Institute of Health Research HS&DR (Health Services & Delivery Research programme) to conduct syntheses of evidence about the organisation and delivery of healthcare.

The University of Sheffield also host one of these nationally significant HS&DR evidence synthesis centres.

Visit our Twitter page: https://twitter.com/ExEvidSC

Our blog: https://siftingsensemaking.wordpress.com/

The work
The programme of work involves appraising and synthesising research and other evidence relating to the effectiveness, cost-effectiveness, patient experience, and implementation of models and initiatives for improving the delivery of healthcare and NHS organisation.  The evidence syntheses may also directly inform NIHR commissioning of new research.

The work mainly comprises systematic reviews, scoping reviews and rapid reviews, plus using other more innovative methods for evidence synthesis where the nature of the questions and evidence requires.  See our current and past projects below.

The Centre’s team
The Centre’s core team is:
Rob Anderson (Co-lead of the Centre)
Jo Thompson Coon (Co-lead of the Centre)
G.J. Melendez-Torres (Synthesis methods advisor)
Anna Price (Systematic Reviewer)
Siân de Bell (Systematic Reviewer)
Alison Bethel (Information Specialist)
Naomi Shaw (Information Specialist)
Sue Whiffin (Centre Administrator)

We also have established contacts with and experience of working directly with NHS staff and organisations in the south west region, through the NIHR ARC South West Peninsula (PenARC).

Current projects

Evidence Mapping systematic review of the effectiveness and cost-effectiveness Peer Support in health and social care
The financial pressure on the NHS is increasing, with the impact of slower growth in NHS funding exacerbated by increased demand from an aging population. Increased prevalence of long-term conditions such as diabetes and heart disease has led to renewed focus on supporting members of the public to manage their various lifestyle risk factors such as smoking and obesity (for example in the NHS Long Term Plan). A part of the policy response to these pressures is an increased focus on enabling patients and carers to support themselves more effectively. The NHS Long Term Plan outlines an intention to empower patients through increasing their involvement in their own care, focusing on patients’ own health and wellbeing goals, improved access to information and peer support within the community.  In July 2020 we were asked to systematically map the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care to enable evidence users to navigate the wealth of available evidence and identify and locate the research evidence (or evidence gaps) relevant to their patient/intervention focus.

For more details visit the project page.

Past projects

Strategies for fostering a strengths-based approach within adult social work: systematic review of effectiveness and implementation studies
A ‘strengths-based approach’ to doing social work focusses on peoples’ goals rather than their problems, and builds on their existing skills, resources and relationships. While many social work teams welcome strengths-based approaches, their uptake is variable. Little is known about how effective strengths-based way of working is.

In January 2020, We were asked to conduct a systematic review of the effectiveness and implementation of strengths-based approaches used in the area of adult social care in the UK to inform the work of the Chief Social Worker for Adults in the Department of Health and Social Care.

For more details visit the project page.

What is the evidence for the need for specialist treatment of people with acquired brain injury in secure psychiatric services?
An  estimated 1.5 million people in the UK have an acquired brain injury (ABI). ABI can lead to various physical, cognitive or emotional symptoms, with patients also being at increased risk of mental health difficulties. One possible consequence of ABI is the presence of behaviour that threatens the quality of life or safety of the patient or others. Such ‘challenging behaviour’ includes displays of aggression, sexually inappropriate behaviour or disinhibition. Individuals who display challenging behaviour that endangers their safety or that of others may need to receive their treatment in a secure setting. The availability of secure ABI rehabilitation settings is limited in the UK. The restrictiveness of the setting could constitute an infringement of the human rights of the patient if the referral is not appropriately justified, therefore decisions about referral need to be rigorous and evidence-based.  

In May 2019, we were asked to undertake a review of the evidence about mental health services for people with acquired brain injury for NHS England.

For more details visit the project page.

Reducing the length of hospital stay for older adults admitted to hospital for planned treatment: A systematic review of the evidence
Adults over 60 years of age who are admitted to hospital for planned treatment may be at greater risk of complications, both during the treatment they receive and their hospital stay afterwards. Examples of such complications include: infection, pressure sores, loss of mobility, poor nutrition and dehydration and reduced feelings of wellbeing. These complications may slow down a patient’s recovery and delay their discharge from hospital. This is not something which patients, their families or their carers want and risks putting increased demand on the National Health Service. As a result, it is important that hospitals have effective strategies to ensure timely discharge and reduction of excessive length of stay for older adults.

In June 2017, we were asked to review the evidence on the effectiveness of strategies to reduce the length of stay for older adults following planned admission.

For more details visit the project page.

Views and experiences of the Nearest Relative provision of the Mental Health Act (1983): A systematic review of the evidence
The Mental Health Act (1983) is a piece of legislation used to support people who need to be admitted to hospital because they may be at risk of harming themselves, or others, due to poor mental health. It is used in different formats, across England and Wales, Scotland and Northern Ireland. When a person is admitted to hospital against their wishes for a period of assessment and/or treatment (known as compulsory detention), there are several safeguards the Mental Health Act (1983) has put in place to make sure that people are not kept in hospital inappropriately and their rights are respected. One of these is the Nearest Relative Provision. This states that a person who has been admitted to hospital has the right to have a person to support them during their hospital stay. The Nearest Relative is entitled to receive confidential information about the care the person in hospital is receiving and, amongst other things, can:

• Ask for an assessment to see if their partner or relative needs to be admitted to hospital
• Object to their partner or relative being admitted to hospital for a period of treatment
• Request that the person be removed from hospital or a guardianship order

There are some concerns that the Nearest Relative provision of the Mental Health Act (1983) is too inflexible, and may not always represent the wishes of either the person admitted to hospital or the person identified as their Nearest Relative.

In January 2018 we were asked to undertake a review of views and experiences of the Nearest Relative provision of the Mental Health Act (1983).

For more details visit the project page.

Exploration of feasibility of reviewing evidence about different models of social work practice
(see our blog post reflecting on this exploratory work)