NIHR ARC South London is a research organisation that brings together academics, health professionals and local people in south London to develop new and improved ways of delivering health and social care. We are one of 15 ARCs across England and received our funding from the NIHR in October 2019. Each ARC works with local providers of health and care services, commissioners, local authorities, universities, charities and communities to carry out high-quality applied health and care research that addresses the specific health or care needs in their region.
The priorities that drive our work in south London
In south London, many people are affected by a complex range of health and social issues, including living with more than one long-term health condition, and facing poverty or other inequalities. Alongside this, south London’s healthcare system is under pressure, facing the challenges of a growing and ageing population. The impact of the Covid-19 pandemic, particularly on individuals from Black, Asian, and minority ethnic backgrounds, people with lower incomes and living in socially deprived areas, has been an important focus in our work.
The health and care priorities that drive our applied research are to:
- improve care for vulnerable and older populations
- support people living with multiple health conditions
- address wider inequalities in health and care.
We deliver research that improves the quality, delivery and efficiency of health and care services, improving outcomes for patients and the public, both locally and nationally.
Impact case studies
Our work is actively translating into tangible improvements in people's lives on local, national, and international scales. Find out more about the impact that our work is having in these case studies.
Informing national policy on perinatal mental health and maternity care
What is the problem?
Up to one in four women experience mental illness during pregnancy and up to one year after birth, often with long-term adverse consequences for mother and child. In the UK, suicide is the leading cause of maternal death in the postpartum period and one of the leading causes during pregnancy. It is crucial that health professionals identify women experiencing mental health problems so that women can access mental health treatment and support, and we can improve outcomes for mothers and families.
What did we do?
The ARC’s maternity and perinatal mental health researchers have investigated perinatal mental health-related causes of near misses – events where a woman comes close to maternal death. Our researchers have also evaluated the delivery of the Maternal Mental Health Service (MMHS) programme, which aims to provide psychological interventions, integrated with maternity services, for women experiencing moderate to severe, or complex mental health difficulties during pregnancy.
What has been the impact?
- Findings from our research into perinatal mental health-related causes of near misses have influenced clinical guidance for women with serious mental illness.
- Our findings were cited in the 2022 Royal College of Psychiatrists Annual Report, ‘Perinatal Mental Health Services: Recommendations for the provision of Services for childbearing women’ and NHS England’s ‘Equity and Equality: Guidance for local maternity systems.’
- Our research has also informed recommendations to support the national implementation and sustainability of MMHS, and lessons to support the local development of new MMHS.
Improving health outcomes for women and babies at higher risk of complications during pregnancy and birth
What is the problem?
While maternity care for mothers and babies in the UK is of high quality overall, it could and should be more consistent and provide greater equity of outcomes. Around 8% of babies in the UK are born prematurely - higher than elsewhere in Europe. There are also major disparities in maternal health outcomes for women belonging to ethnic minorities and those living in disadvantaged areas.
What did we do?
Researchers in the ARC’s maternity and perinatal mental health theme led research to explore how health outcomes for women and babies at risk of complications could be improved, including an influential international review into the evidence on models of midwifery continuity of care.
What has been the impact?
- The ARC’s maternity research has been cited widely in policy, including in the Department for Health and Social Care’s strategy ‘Safer Maternity Care’ (December 2017), the World Health Organization’s (WHO) antenatal guidance (2016) and NICE intrapartum care guidance (2017).
- The ARC’s systematic review of continuity of care model was cited in the NHS Long Term Plan and informed NHS England’s report: Saving Babies Lives Care Bundle version 2, providing evidence for the benefits of midwifery-led continuity of carer for women, particularly those from Black, Asian and minority ethnic communities living in areas of high social disadvantage.
- The ARC's research on specialist midwife continuity models of maternity care for women with social risk factors has been cited in the NHS Equity and Equality guidance for local maternity systems, NHS Implementing Better Births strategy, Royal College of Midwives position statements on midwifery continuity of carer and women with severe and multiple disadvantage, and the NHS Race and Health Observatory’s review of ethnic inequalities in healthcare.
Improving care for children and young people in south London
What is the problem?
Children and young people’s healthcare in England should be better. Child mortality rates are worse than in comparable countries, and children with common long-term conditions receive poorer care. In Lambeth and Southwark research by the ARC children’s and young people theme revealed significant problems with children and young people’s health services, including high and increasing hospital use, poor management of long-term conditions and healthcare needs not being met.
What did we do?
ARC researchers developed and tested a new integrated model of care designed to improve care for all children and young people living in Lambeth and Southwark, the Children and Young People’s Health Partnership (CYPHP). The CYPHP was co-designed by local clinicians, parents, carers, children and young people, researchers, commissioners and providers. The model includes enhanced primary care clinics, targeted early interventions for children with long-term health conditions, and population health initiatives to identify children with unmet health and care needs.
What has been the impact?
- The new clinical model has been tested and implemented. It is now embedded across Lambeth and Southwark, providing more integrated, fairer and higher-quality care.
- The CYPHP trial showed improvements in care quality and health status for children receiving CYPHP interventions for existing long-term conditions, including asthma and eczema.
- The model is increasing access to care, particularly for children living in the most deprived neighbourhoods.
Developing a new diabetes self-management programme for African and Caribbean adults
What is the problem?
Type 2 diabetes is a common, chronic condition that causes the level of sugar (glucose) in your blood to become too high. If not managed effectively, it can cause disabling and life-threatening complications, including heart disease and stroke. In the UK, African and Caribbean communities are 2-4 times more likely to develop type 2 diabetes than White Europeans. They also develop the condition, on average, 10 years earlier. In south-east London, an area with a large African and Caribbean population, 40% of people with newly diagnosed type 2 diabetes are of Black-British ethnicity.
What did we do?
Public health and multimorbidity researchers at the ARC worked with the Health Innovation Network to develop a new online programme specially designed to support adults of African and Caribbean heritage living with type 2 diabetes. Launched in south-east London, the Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) programme helps participants to manage their diabetes better, improving their health and quality of life.
What has been the impact?
A service evaluation of the online version of HEAL-D carried out with the Health Innovation Network showed:
- 78% of people who completed the programme reported weight loss
- 98% ‘strongly agreed’ or ‘agreed’ that HEAL-D Online has helped them to manage their diabetes
- The proportion of patients experiencing ‘diabetes-related distress’ (a wellbeing measure for diabetes patients) reduced from 49% to 23% after attending
HEAL-D Online is now available across south London and is being piloted in other parts of the country.
Informing decision making about provision of tobacco dependence treatment
What is the problem?
Each year, around half a million admissions to acute hospitals are attributable to people smoking tobacco, at an estimated cost of £850m. People who currently smoke or used to smoke also use primary care services and outpatient secondary care services more than those who have never smoked, which costs an extra estimated £1.1bn and £696m, respectively.
What did we do?
Smoking researchers in our public health and multimorbidity theme have been working collaboratively with local NHS Trusts and commissioners for several years to establish tobacco dependence treatment pathways in hospital settings and have evaluated a smoking cessation programme for patients admitted to local hospitals in south London.
What has been the impact?
- The researchers have completed an evaluation of 2,084 patients who received tobacco dependence treatment started in hospital and supported after discharge (in King’s College Hospital and Guy’s and St Thomas’ NHS Foundation Trusts).
- Our research showed that implementing a tobacco dependence treatment programme for hospital patients who smoke, reduces readmissions and provides significant cost-savings to the NHS.
- Among patients who are readmitted, the hospital costs were £491,000 less than the benchmarked equivalent and they spent 275 fewer bed days in hospital. This report is influencing local commissioning decisions about funding tobacco dependence services.
Using the Therapeutic Engagement Questionnaire to measure the impact of mental health care
What is the problem?
Therapeutic engagement is perceived as the crux of mental health nursing. But prior to the development of the Therapeutic Engagement Questionnaire (TEQ), there was no metric to measure this objectively in acute inpatient mental health settings.
What did we do?
ARC researchers developed the Therapeutic Engagement Questionnaire, a tool for measuring the impact on service users of therapeutic engagement by mental health nurses.
What has been the impact?
- TEQ is now being implemented into routine clinical practice in England and internationally.
- TEQ has been fully implemented in the adult acute wards of seven NHS mental health trusts in England.
- A further three NHS mental health trusts are at the initial implementing phase including forensic services.
- Internationally, it has been implemented in Finland, Malta, Jordan and Slovenia.
Transforming the management of breathlessness in advanced illness
What is the problem?
Breathlessness is the feeling of being out of breath as your lungs work harder to draw in more oxygen. It is a common symptom in patients with advanced diseases and is frightening and distressing for patients, families and carers. Breathlessness affects over two million people in the UK and 75 million people across the world.
What did we do?
Palliative and end of life care researchers at ARC South London have a longstanding programme of research that tackles breathlessness across advanced respiratory disease, cancer and other serious conditions. As part of this work, they gathered evidence on effective treatments for breathlessness, including non-drug interventions like hand-held fans and walking aids. They discovered that non-drug interventions could be effective in improving mobility, self-care and reducing the burden of breathlessness. This led to the development of the Breathlessness Support Service in London, a comprehensive programme that addresses the whole experience of breathlessness, not just its physical aspects.
What has been the impact?
This programme of work has transformed how breathlessness is recognised and managed in the UK and around the world. It has:
- Equipped professionals to better recognise, assess and manage breathlessness
- Helped patients manage their breathlessness, improving their quality of life
- Helped policymakers and commissioners improve the quality of services
- Widened access to helpful non-drug therapies
- Benefited hospices and palliative care services
- Provided a rapid response during the Covid-19 pandemic
Addressing real-world problems
At ARC South London, our work is designed to find solutions to real-world problems. We want our research to move beyond academia to inform decisions around policy and service delivery with the latest evidence.
Identifying gaps in services
- Our vascular researchers have identified the long-term unmet needs of stroke survivors, providing recommendations for policymakers and care systems to address these problems.
- Our palliative and end of life care researchers published a report that identified gaps and inconsistencies in palliative care services across the UK, working with the national charity Marie Curie. They also developed a new brief measure to help assess and treat patients with severe Covid, as part of CovPall, a multinational study.
Understanding the impact on services caused by the pandemic
- Our maternity researchers evaluated the pandemic's effects on maternity services, highlighting the higher risks of mortality for individuals with severe mental illness following Covid-19 infection.
- Our social care researchers carried out work to understand what happened in care homes during the pandemic, resulting in practical policy recommendations and overdue recognition of care home staff.
Implementing and evaluating services
- Our alcohol researchers have explored the wider implementation of our alcohol assertive outreach team (AAOT) in south London with the support of South London and Maudsley NHS Foundation Trust. This work has informed a project by the NIHR Mental Health Implementation Network (led by ARCs Greater Manchester and Yorkshire and Humbers), to implement new integrated care for patients with severe mental illness, substance and alcohol misuse.
- Implementation science experts at the ARC have helped to develop new national guidelines for anaesthesia that will be implemented across the NHS in the UK.
Influencing policymakers in the UK and internationally
- Our maternity researchers have successfully made the case to policymakers of the health and care value of continuity of midwife care models. Our evidence on impact of continuity of midwifery care was cited in the Core20PLUS5 NHS England inequalities strategy and has informed the current strategy for enhanced continuity of midwifery care targeting areas of deprivation, high ethnic diversity and social exclusion.
- ARC researchers have co-led The Lancet Commission on Ending Stigma and Discrimination and are leading an implementation process for this report.
Supporting inclusive research
Impact on care and services only happens by people working together, sharing data and expertise, generating new knowledge, and listening and responding to diverse voices. We are committed to expanding public participation in research and engaging diverse communities.
- Researchers from the ARC have pioneered a novel approach to foster greater diversity in recruitment for research studies, known as the King’s Model.
- Collaborating with partners, the ARC has led initiatives designed to develop inclusive research in the local area, including our successful collaborative bid to enhance community involvement.
Building research skills capacity
An important area of the ARC’s work is offering training and building research skills capacity among the health and care workforce, and engaging with local communities. We have led the way in showing how new fields of research such as implementation and improvement science, and the involvement of patients, service users and carers can help to improve services.
- Our guides to improvement science, produced by the team at King’s Improvement Science, feature as a resource on NHS Impact’s webpages on building improvement capability and capacity.
- Our Implementation Science Masterclass for health and care professionals is now in its 7th year, and we set up the first conference in the UK dedicated to implementation science research, now in its 5th year. In 2023, our implementation science conference explored how implementation science can help sustain health and public services in an uncertain future.
- Our most recent annual Active Involvement in Research event aimed at people and diverse communities living in south London explored south London health and care needs and inequalities.
- Our Applied Research Leadership Academy is cultivating diverse leadership in applied research. It received 100% positive feedback from participants and has been commended by the NIHR.
ARC highlights in numbers:
Since October 2019, NIHR ARC South London has:
- Recruited 16,167 participants to studies
- Published 1,806 research papers
- Leveraged £52.8m of external research funding
- Attracted hundreds of international delegates to our annual implementation science events
- Supported 7 PhD students
- Funded 4 postdoctoral fellows in social care
