Our COVID-19 Response

Bradford District COVID-19 Scientific Advisory Group (C-SAG)

The Bradford District COVID-19 Scientific Advisory Group (C-SAG) was established in March 2020 to support the local response to COVID-19. Praising the value of this unique research-practice partnership, Kersten England, Chief Executive of the City of Bradford Metropolitan District Council said “C-SAG has provided strategic decision makers with the insights needed to understand the impacts of this unprecedented situation and to help target our response”.

C-SAG, a partnership between Bradford Institute for Health Research, City of Bradford Metropolitan District Council and the NHS, has added value to the Bradford District COVID-19 response by collecting and combining data and evidence into intelligence. Responses from over 2000 parents and approximately 1000 children who took part in Born in Bradford surveys and in-depth interviews hold key findings in the project. Similarly, data from Connected Bradford have helped to address pressing questions including, the impact of COVID-19 on individuals from Black, Asian and Minority Ethnic backgrounds, impacts of the pandemic on healthcare use and the changes in hospital admissions.

The Born in Bradford family of birth cohorts, CARE75+ cohort and Connected Bradford have all supported the work of C-SAG. C-SAG has worked with other regional partners including Public Health England and West Yorkshire and Harrogate Health and Care Partnership to share findings and shape future research activities and partnerships.

Read more about these initial findings on the Bradford C-SAG website here: https://www.bradfordresearch.nhs.uk/c-sag/

Behavioural Activation in Social isoLation (BASIL): Benefiting from activities to improve your mood while you are socially isolating

The Behavioural Activation in Social isoLation (BASIL) project tests whether ‘Behavioural Activation support’ can help prevent or reduce depression and loneliness during COVID-19. The study focuses on - people over 65 with multiple long-term conditions who are socially isolating during the pandemic. Our results will help improve future support offered to older adults with long-term health conditions who may experience low mood or loneliness during enforced social isolation.

Behavioural Activation is a type of talking therapy which aims to help people maintain or introduce activities which are important to them. By helping people to stay connected with the world and remain active, this can benefit physical and emotional wellbeing.

100 people will take part in the BASIL trial, with 50 receiving ‘Behavioural Activation support’, and 50 receiving their usual care. Participants in the Behavioural Activation support group are offered up to eight support sessions with a BASIL support worker over the phone or by video call over a four to six weeks period. All participants will complete three follow-up questionnaires over 12 months.

Older adults who have long-term physical health conditions, such as diabetes, asthma or heart problems, are more likely to experience depression, which can lead to poorer quality of life. During the COVID-19 pandemic, the UK government instructed people in this group to follow social distancing and isolation guidelines to protect their own and others’ health. This enforced isolation will lead to a disruption of daily routine, loss of social contact and loneliness and this in turn may further increase the risk of depression and anxiety in this group.

Learn more about this project here: https://arc-yh.nihr.ac.uk/what-we-do/mental-health/basil

Optimising Wellbeing during Self-isolation (OWLS)

The Optimising Wellbeing during Self-isolation (OWLS) study examines how people with serious mental ill health problems are affected by the current pandemic.

We want to know whether:

  • people are able to access health services when they need to

  • they are able to use the internet to access services and contact friends, and if they are feeling lonely

  • they made any changes to reduce the risk of COVID-19 such as stopping smoking

The results of the study will be used to make recommendations about how best to support people with severe mental illness during a pandemic, and how to reduce the impact of pandemic restrictions.

People with severe mental ill health (SMI) such as schizophrenia and bipolar disorder experience some of the most profound health inequalities of any sector of society and are at greater risk of being affected by COVID-19 and the pandemic restrictions. This is because they are more likely to live in impoverished circumstances and are less likely to be able to access the internet. Many people with mental health problems have physical health problems too, which may mean they are in a group that needs to isolate for long periods of time.

We will carry out an initial survey of over 300 people with SMI, and follow up with interviews. Participants will be followed up over 12 months. Follow up questionnaires will be developed, with information from the initial survey, allowing participants' health and wellbeing to be mapped over time.

Learn more about this project here: https://arc-yh.nihr.ac.uk/what-we-do/mental-health/owls

The impact of Covid-19 on unrelated urgent and emergency presentations

Our Urgent and Emergency Care theme and Health Economics, Equality and Evaluation theme are collaborating to explore how admissions to the Emergency Department (ED) for both serious and less urgent cases has changed in England during the pandemic.

The covid-19 pandemic has changed the way patients access urgent care in England almost overnight. The most eye-catching example was a dramatic and sudden decline in patient numbers attending the ED. This project will look at routine hospital data for the whole of England to assess the impact that this has had on population health, including in the longer term.

One of the main concerns is the fall in ED admissions for patients with conditions such as stroke and heart attacks (myocardial infarction MI). This has potentially had, and continues to have, a huge effect on patient health both in the short and long-term. We will therefore be focusing on analysing data from several time-critical illnesses: strokes, MI and other cardiovascular events, aneurisms, meningitis, cancers and ruptured ectopic pregnancies.

We will also explore whether the rate of covid-19 infections and local lockdown restrictions further influenced the likelihood of patients attending urgent care systems, and what impact the level of local deprivation plays in this relationship.

We hope that this research will inform commissioners and policy makers about:

  • the impact of delays in treatment during the pandemic for long-term patient health

  • the extra costs to the NHS of future care

  • how services must respond to these challenges

We hope to identify areas most badly hit by infections and assess where interventions should be made to help services and population health return back to pre-COVID levels.

For further information please contact:

Seb Hindes (HEEE Theme) - sebastian.hinde@york.ac.uk

Colin O’Keeffe (UEC Theme) - c.okeeffe@sheffield.ac.uk

Caring in a Crisis: Understanding the stressors and uplifts for NHS frontline staff and those supporting them during Covid-19 crisis.

This study aims to better understand the experiences of healthcare staff during the COVID-19 crisis and the support that staff need. We hope to gain a better understanding of how the wellbeing and mental health of healthcare staff can be safeguarded as a crisis progresses, and how psychological interventions can meet the needs of those who may suffer from psychological distress in the aftermath of a crisis.

NHS healthcare staff face unprecedented pressure, intensified due to the Covid-19 crisis, and amplified by NHS-wide staffing shortages, where 100,000 jobs stand vacant and this number is rising. The shortage is primarily due to a high number of healthcare staff leaving their jobs, with many naming stress as their main reason. High stress and sickness levels impact on patient care, leading to the delivery of poor quality, less safe, care.

Led by the NIHR Yorkshire and Humber Patient Safety Translational Research Centre with support from our Improvement Science theme, the study uses a mixture of social media (a Facebook group for frontline NHS healthcare staff), diaries and interviews. We plan to publish this work and we anticipate it will be of particular interest to Clinical Psychologists and those who are providing services for frontline NHS staff to support their wellbeing.

For more information, please contact: Rebecca Lawton - r.j.lawton@leeds.ac.uk

Remote collection of ReQoL Patient Reported Outcome Measure data

We have adapted our successful ReQoL Patient Reported Outcome Measure (PROM) to enable information to be collected from service users over the telephone or video link. As part of our Health Economics, Evaluation and Equality theme, the University of Sheffield and Oxford University Innovation have collaborated to develop guidance on the practicalities of collecting ReQoL data remotely.

For many mental health professionals, the coronavirus pandemic will have had a profound impact on their clinical practice which may now include a greater number of online or telephone appointments. For many, the collection of PROMs, such as ReQoL is an important and integral part of the support they offer their mental health patients.

By allowing mental health patients regular, continued access to their clinician during the pandemic, we hope to provide a positive impact to patients during the pandemic. Using the ‘Instructions for remote use of ReQoL during routine clinical contact’ resource, clinicians with less experience of providing patients with remote support, will have the confidence to continue to maintain regular contact and collect ReQoL data, and critically maintaining the support of their patients’ care.

For further information, click here: http://www.reqol.group.shef.ac.uk/ReQoL_English_UK_Remote_Collection.pdf

Contacts for further information:

Dr Lizzie Taylor Buck – e.taylor-buck@sheffield.ac.uk

Amanda Lane - a.j.lane@sheffield.ac.uk

Life in lockdown: a telephone survey to investigate the impact of COVID-19 lockdown measures on the lives of older people (75+)

Our Older people with frailty theme investigated the impact of COVID-19 lockdown measures on the lives of older people. Using a cross-sectional telephone survey, with questions identified and informed by the Bradford COVID Scientific Advisory Group (C-SAG), we received a ‘snap shot’ of the lives of 142 older people living in Bradford during the COVD-19 lockdown.

When the UK government introduced social distancing measures and identified who was at high risk from the virus, all people over 70 years were deemed ‘clinically vulnerable’. These social distancing measures were aimed at reducing the risk of contracting COVID-19, but can potentially also have a negative impact on older people who may become social isolated and may have challenges accessing the services they need.

After analysing the survey, we found that most people reported good health with low levels of health anxiety, general anxiety and depression. Many were able to identify positive aspects to lockdown and may be better equipped to deal with lockdown than anticipated. Strategies may be required to improve the impact of loneliness for a small number of older people, and help some resume previous activity levels and interests.

We hope the results from the study can inform a comprehensive longitudinal investigation of the quality of life, mental health, physical health, frailty and independence of older people across England. We have submitted a grant application to be able to undertake the additional investigation. We hope that evidence could enable national policymakers and local system leaders to target and support older people who have been negatively impacted by COVID-19.

The full results of the survey are reported here https://academic.oup.com/ageing/advance-article/doi/10.1093/ageing/afaa255/5970510

Contact for more information: Lesley Brown - Lesley.Brown@bthft.nhs.uk

Co-producing COVID-19 research priorities with communities and decision makers

Early in April 2020, Born in Bradford (BiB) researchers started to work with our BiB families to understand the impact of the COVID-19 pandemic on their lives. This work was part of a programme coordinated by the Bradford District COVID-19 Scientific Advisory Group (C-SAG).

Specifically we wanted our research to help understand the impact the pandemic was having on local communities but also to provide useful information for people and organisations responding to the pandemic in Bradford. It was important to us that we captured information on the things that mattered the most to people locally and that this research answered some of the key questions that local policy and decision makers were asking.

We built on good relationships with community contacts, which have been developed over many years, to understand emerging issues, concerns and priorities. These contacts include:

  • members of our research patient participation involvement and engagement (PPIE) groups

  • active citizens

  • staff from community and voluntary sector organisations

  • representatives from smaller groups serving the underserved communities in Bradford

We also talked to stakeholders and decision makers from the Local Authority, Clinical Commissioning Group, NHS and wider to understand their priorities and the questions they needed answering.

A report of our findings, detailing the impacts and concerns of different communities in the Bradford District has triggered local responses to the emerging issues. These include connecting a local charitable organisation to a community experiencing problems with accessing sanitary products, and contributing to a local mental health needs assessment. This co-production approach is directly shaping BiB research, but is also helping to connect communities with the support they need.

Further information:

  1. Bradford District COVID-19 Scientific Advisory Group https://www.bradfordresearch.nhs.uk/c-sag/

  2. The Born in Bradford COVID-19 Research Study: Protocol for an adaptive mixed methods research study to gather actionable intelligence on the impact of COVID-19 on health inequalities amongst families living in Bradford https://wellcomeopenresearch.org/articles/5-191/v1

  3. Experiences of lockdown during the Covid-19 pandemic: descriptive findings from a survey of families in the Born in Bradford study https://wellcomeopenresearch.org/articles/5-228/v1

  4. Community Soft Intelligence Report May 2020 https://www.bradfordresearch.nhs.uk/wp-content/uploads/2020/05/CSAG-Community-Soft-Intelligence-Report-060520.pdf

Contact:

Aamnah Rahman – Aamnah.Rahman@bthft.nhs.uk

Shahid Islam – Shahid.Islam@bthft.nhs.uk

Figure 1 – Born in Bradford Adaptive Research Methodology.pdf

Impact of COVID-19 pandemic on care home pathways, outcomes and safety of care

To gain a clearer picture of how COVID-19 patients were managed in UK care homes, our Urgent and Emergency Care theme are working on a 12-month project addressing gaps in research as part of the Government’s Scientific Advisory Group in Emergencies (SAGE). The project focuses on care homes in North East England – a region that was particularly badly hit, with the highest proportion of care homes affected by COVID-19 cases in the country.

The coronavirus pandemic has led to an increase in deaths among care home residents, particularly during the April 2020 peak. It is important to understand how residents were managed during this period to learn lessons around provision and outcomes. Through interviews with staff and clinicians, we hope to discover how decisions were made about whether ill residents were transferred to emergency departments in hospitals. We also seek to find out if residents displaying COVID-19 symptoms were transferred back from hospitals to care homes.

Data from 68 care homes and more than 2,500 residents, will provide information on care home residents linked with their health service record. The research will show us how different homes dealt with the crisis and provide valuable information to inform policy decisions, actions and measures that can be taken to deliver the effective, safe management of care home residents in future crises.

For more information on this work, contact Colin O'Keefe.

Clinical Care for Cardiovascular disease in the COVID-19 Pandemic (4C Initiative)

The Yorkshire and Humber ARC Urgent and Emergency Care Theme is collaborating with the 4C Initiative of the CVD-COVID-UK consortium to understand the impact of the COVID-19 pandemic primarily on cardiovascular (CVD) hospital service provision.

Routine data on presentations, diagnoses and treatments for a number of CVD conditions was collected and analysed across 9 nine hospitals in the UK before and during the pandemic (October 2019 to May 2020). There was a clear reduction in both total attendances and total admissions for cardiac, cerebrovascular and other vascular conditions (between 31% and 88% during the period of study).

Evidence suggests that there are concerns around how the COVID-19 pandemic will continue to effect wider patient care in the UK. To cope with increased demand and the impact of patient and clinician behaviour change in response to the crisis, healthcare services need to make crucial changes to monitor and react to these impacts.

For more information on this work, contact Colin O'Keefe.