Just after our launch in October 2019, the world changed in profound ways that I hadn’t expected and I’d never experienced before. I’ve been working in community mental health services in south London for over thirty years, and this is the most severe health crisis in my working lifetime. As you will know, pre-existing health inequalities have been cruelly exaggerated, harshly hitting Black, Asian and minority ethnic groups, care home residents, and people in the poorest areas and communities. Prior to the pandemic, the ARC South London had set as one of its main aims the need to tackle health inequalities, including understanding how to better support people living with multiple health conditions.
In early 2020 ARC staff had to rapidly re-focus our applied health and care research to the pandemic and its shorter and longer-term impacts, particularly in relation to palliative care, social care, maternity and perinatal mental health, applied informatics and public health. In total, we initiated over 60 new research projects and activities to better understand and to counteract the impact of Covid-19 on individuals, families, communities and populations. In this blog I’d like to mention just a few examples of how our work is contributing to this global pandemic response.
In the earliest days of the pandemic, our applied informatics team analysed data from electronic mental health records at South London and Maudsley NHS Foundation Trust using the Clinical Record Interactive Search system, developed by NIHR Maudsley Biomedical Research Centre. Their near real-time analysis revealed that Covid-19 was causing higher rates of mortality in people with mental health difficulties, compared to the general population, and having a disproportionate impact on people in particular ethnic groups. This led to key policy recommendations, including that people with serious mental illness (SMI) should be prioritised for vaccination. We also worked closely with the local Academic Health Science Network to ensure people in south London with SMI who contract Covid-19 are provided with oximeters, enabling them to safely monitor their own blood oxygen levels at home, and to detect any problems at an early stage.
The ARC’s palliative and end of life care team at the Cicely Saunders Institute at King’s College London has also rapidly deployed their resources to play an active role in responding to Covid-19. The team launched new research to understand how palliative services have responded to Covid-19. They produced new Covid-19-specific clinical resources, including recommendations for hospital clinicians to support bereaved relatives and guidance for patients and respiratory professionals on treatments and support for people with Covid-19. These guidelines are having a huge international impact and have been translated into 15 languages to date. They also produced a practical guide to help people experiencing breathlessness to manage their symptoms at home, which has also been shared widely across the world.
Our social care research team is working with local care providers and service users and has developed practical resources for day care centres to safely re-open after the first national lockdown, and these have been shared widely across England with social care networks.
Later in 2020, it became clear that Covid-19 could cause complex and debilitating long-term symptoms, including fatigue and cognitive impairment. Our implementation science researchers are now carrying out a study working with people living with Long Covid to design personalised self-management support and training for community rehabilitation teams. Looking ahead, our maternity and perinatal mental health team are examining post-pandemic planning for maternity care across the UK and how to better prepare for such future contingencies.
The ARC South London has moved quickly to work in new ways. For example, we were one of the first research organisations in the UK to offer a fully virtual research conference in July 2020, with participants joining from all over the world for our annual Implementation Science Research Conference. ARC implementation science researchers are collaborating with a new learning health system in London to evaluate the shift to remote mental health services and what can be learned for improved services in the future. One part of this project was a systematic review, which found that many mental health service users were able to continue accessing support using remote methods, but that digital methods of care failed people who are not online or connected.
The pandemic has also shown it is vital to understand the experiences of diverse local communities and under-served groups in health and care research. At the ARC, we have initiated online community events since early in the pandemic to understand the unequal impacts of Covid-19 (for example, engaging local women in maternity research), which informed our submission to a UK Parliamentary call for evidence on issues raised by the Women and Equalities Committee (published in the BMJ). We also established a new reference group to ensure that community representation and oversight of the work of the ARC reflects the diversity of the local population.
The pandemic has clearly demonstrated how highly interconnected and dependent we are on each other for the health of everyone. Our efforts to contribute to the global Covid-19 response continue. In September 2021, we brought together around 200 palliative care researchers, clinicians, policymakers and patient and public involvement members from across England to discuss the public health response to Covid-19 and the implications for commissioning services.
Alongside this Covid-related work, our pre-existing programme of applied research continues and is having a significant impact on policy and services. For example, our maternity and perinatal mental health team’s work on continuity of care models for women at risk of preterm birth has informed a commitment in the NHS Long Term Plan to enable all pregnant women in England to access care from the same midwife or team of midwives throughout their pregnancy, during birth and after their baby is born.
At the local level, researchers in our children and young people’s research theme, are implementing and evaluating a new programme to improve the way health care is delivered for the 190,000 children and young people living in Southwark and Lambeth. The Children and Young People’s Health Partnership (CYPHP) model has been prioritised by the Integrated Care System for south-east London as an exemplar service.
This year, we will be pressing forward with our work co-leading the Mental Health Implementation Network, which is a national collaboration to fundamentally improve mental health care across England. We have four priority mental health interventions following consultation with service users, mental health professionals, providers and researchers. These address the needs of under-served groups in health and care research, including ethnic minority communities, and children and adolescents with mental health problems. At the start of this year, I also was delighted to see that ARC social care researcher Dr Caroline Green called for an end to harmful isolation practices in care homes and for a more nuanced approach to visiting that respects the rights of people living in care settings.
The ARC South London is now changing. At our first ARC executive meeting of 2022, I was delighted to welcome six new public, community, and staff members to increase the diversity of our governance. These appointments are the practical consequence of our new Involvement Strategy, which was co-produced with over 100 local people from a wide range of backgrounds. Initiatives such as this will help us to deliver meaningful improvements in health and social care for people in south London, and to respond to the needs and priorities of local communities, while also actively contributing towards national and international health and care challenges in the future.