Impact of the Health and Social Care Institute

The Health and Social Care Institute produces research with substantial impact on health policy and practice, with 100% of our impact rated ‘outstanding’ or ‘very considerable’ in the 2014 Research Excellence Framework (REF). The REF sub-panel for Allied Health Professions, Dentistry, Nursing and Pharmacy commented that our Institute had a 'well-developed and strategic approach to impact that is conducive to delivering future impacts of very considerable reach and significance.'

We work collaboratively with clinical and practice colleagues to narrow the gap between knowledge translation and impact, placing strong reliance on the synthesis of best evidence to drive intervention development and evaluation. The main non-academic audiences benefiting from our research are clinicians and policy makers within the NHS and beyond, commissioners within local authority public health departments and Clinical Commissioning Groups, along with health and well-being policy partners and senior decision-makers. We focus on delivering impact in a variety of ways, including evidence-based solutions to problems identified in practice. Below is a summary of the three impact case studies submitted to REF 2014.

Fluoride research: Changes to national and international policy and practice in dental health

According to the World Health Organization (WHO), 60% to 90% of school children are affected by tooth decay in industrialised countries. At low levels, fluoride can reduce tooth decay, but high levels can damage developing tooth enamel in young children. Research by Professor Vida Zohoori and colleagues has informed the revised WHO guidelines for monitoring community tooth decay prevention programmes and the UK National Fluoridated Milk Advisory Group’s recommendation to increase the amount of fluoride added to school milk. The WHO guidelines are accepted and implemented internationally. The recommendation to increase the amount of fluoride in school milk UK-wide is significant, as it will further control and reduce dental caries, especially in deprived areas with non-fluoridated water supply. In addition, our research has led to better measures of babies’ and children’s actual and ideal fluoride intake, including improved techniques to determine the fluoride content of foods, a protocol for monitoring fluoride intake through urinary excretion, and experimentally-based models to monitor community preventive programmes. The REF 2014 sub-panel remarked that the impact arising from the fluoride research was 'judged to be outstanding in terms of its reach and significance.'

Changes to healthcare practice within the NHS: Prehabilitation, rehabilitation, and perioperative care research for patient benefit

A programme of research conducted by Professors Alan Batterham and Gerard Danjoux and colleagues resulted in a collection of impacts on healthcare in the NHS summarised in the Table below. The impact arising from this work was rated as ‘very considerable’ in its reach and significance.

Collection of impacts on healthcare in the NHS
Research Impact Reach and Significance
Observational study of the difference in blood pressure between arms in vascular surgical patients Directly informed new care pathway for surgery to unblock a carotid artery Patients from Durham Tees Valley and North Yorkshire; eliminates risk of clinical error in blood pressure monitoring during surgery thus reducing potential harm (stroke, heart attack)
Validation of the 6-min walk test (6MWT) in non-cardiac surgical patients 6MWT now included in the North East Care Pathway for Abdominal Aortic Aneurysm (AAA) Repair Patients across the North East NHS; 6MWT is a useful low-cost addition to the battery of pre-operative screening/ risk stratification tests
Randomised controlled trial (RCT) of exercise prehabilitation in AAA patients Exercise training now recommended to AAA patients awaiting surgery using brief negotiation in the clinical encounter Patients from Durham Tees Valley and North Yorkshire; likely improved fitness for surgery
RCT of exercise rehabilitation in intensive care unit (ICU) survivors Exercise training now recommended in ICU follow-up clinics via brief negotiation ICU patients in South Tees Foundation NHS Trust; likely accelerated return to adequate functional fitness
Diagnostic accuracy study of the STOP-BANG screening tool for obstructive sleep apnoea (OSA) in specialist weight management patients Directly informed new pathway for referral of bariatric and specialist weight management patients into clinical Sleep Services Patients from Durham Tees Valley and North Yorkshire; Improved accuracy of diagnosis of OSA likely to require medical intervention

Development of national guidelines for the diagnosis, assessment, and physiotherapy management of contracted (frozen) shoulder

A programme of research led by Dr Nigel Hanchard and colleagues led to the development and dissemination of the first ever physiotherapy guidelines (2008) for contracted (frozen) shoulder (CFS). CFS is painful and disabling, affects approximately 9% of the UK working-age population, and costs the NHS > £13.5 million annually. Appropriate physiotherapy could improve outcomes and reduce costs by up to £2,000 per case. Endorsed by the Chartered Society of Physiotherapy (CSP), the guidelines have generated great interest, have already influenced practice and will improve the quality and cost-effectiveness of clinical management, as well as patients’ experiences. The research leading to this impact included a rigorous synthesis of the evidence and a questionnaire survey with responses from 300 UK physiotherapists on the diagnosis and management of contracted (frozen) shoulder. The guidelines will provide a better framework for research into frozen shoulder and, as a ‘live’, electronic document, will evolve with future research. The impact of the research was rated as ‘very considerable’ in its reach and significance.

See the UoA 3 (Allied Health Professions, Dentistry, Nursing and Pharmacy) results on the HEFCE website