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Exeter HSDR Evidence Synthesis Centre

Exeter HSDR Evidence Synthesis Centre

Exeter HSDR Evidence Synthesis Centre

We are one of two research groups in the UK commissioned by the National Institute of Health Research HSDR (Health and Social Care Delivery Research) to conduct syntheses of evidence about the organisation and delivery of healthcare.

The University of Sheffield also host one of these nationally significant HSDR evidence synthesis centres.

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:

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

Status: Ongoing

Background

Identifying and managing risks and hazards to ensure the provision of safe and quality care to patients, and the avoidance of preventable harm, is critical in healthcare. In other high-risk industries such as aviation, nuclear, and the oil and gas industry, safety management systems provide a structured approach to managing safety. Whilst they differ depending on context, they are considered to have four main pillars: safety policy and goals, safety risk management, safety assurance, and safety promotion. In the NHS, some of these components, such as safety policies and risk reduction strategies, already exist. Others, however, will need to be developed in order to implement a healthcare safety management system. Research is needed to identify these attributes and assess how a safety management system approach might be applicable to the NHS in England.

Aim of our project

This project aims to identify the principles that have been used to inform healthcare policy, management and practice related to patient and staff safety in high-income countries which are applying the safety management system approach.

Research questions

How are the components of safety management systems reflected in the healthcare policy documents of the high-income countries applying the safety management system approach, or their regional healthcare systems?

What research (e.g. formal evaluations, or based on routine data) and other relevant evidence (e.g. staff and patient narratives) is available regarding the effectiveness, implementation or experience of safety management systems within healthcare?

What does existing research and other relevant evidence from beyond the UK tell us about the effectiveness, implementation or experience of safety management systems within healthcare?

What we are doing and how we are doing it

We will produce a systematic review of policy documents, published research, and other relevant evidence. We will begin by identifying high-income countries which are using safety management system principles in their healthcare systems e.g. Australia, and relevant organisations within these countries. We will search the websites of these organisations for policy documents, research and other relevant evidence (e.g. patient stories) as well as contacting them for further information. Study selection and data extraction will be completed independently by two reviewers. We will collect information on the way in which a safety management system approach has informed patient and staff safety policy and practice in each healthcare system, including factors related to implementation. For more detailed information about what we are planning to do, please see our project protocol.

Plans for sharing our findings

As well as publishing a report in the NIHR Journals Library, we will produce a briefing paper and aim to publish the review in a relevant peer-reviewed journal. Please check this web page or follow us on Twitter @ExEvidSC for updates.

If you have any feedback or comments about this review, please email Zhivko Zhelev z.zhelev@exeter.ac.uk or Sian de Bell sd.c.de-bell@exeter.ac.uk.

Previous projects

Status: Completed

Background

In the UK, the population is aging and, as a consequence, demands on health and social care services are changing. People are more likely to have multiple health conditions and complex needs as they grow older, requiring the involvement of care professionals from different disciplines and sectors. Organisations and individuals need to work together effectively to ensure the best possible care for patients. Whilst there is existing evidence on how to improve communication between health and social care, there has been little focus on data-sharing. Data-sharing is the transfer of information about an individual patient (e.g. an electronic patient record) between care organisations or professionals, and is essential in enabling care professionals to provide continuity of care.

We were commissioned by Health and Care Research Wales and Social Care Wales to produce a review focusing on improving data-sharing between health services, social care services and social care providers that provide care for older people. It was primarily intended to inform the development and operation of health, social care and other care and support services for older people in Wales.

Research question

What are the factors perceived as influencing effective data-sharing between healthcare and social care, including private and voluntary sector organisations, regarding the care of older people?

Aims of our project

The project aimed to:

  • Identify factors that may influence effective data-sharing between healthcare and social care organisations, including private and voluntary sector organisations, relating to the care of older people.
  • Identify factors that may influence effective data-sharing between care professionals who work in healthcare or social care providing care for older people.
  • Identify factors that affect the successful adoption or implementation of initiatives to improve data-sharing between healthcare and social care organisations and/or care professionals.

What we did

We produced a review of qualitative evidence (studies using methods such as focus groups or interviews). This was a transparent and unbiased process, bringing together the findings of all the available relevant studies to find out what is already known about factors that improve data-sharing between healthcare, social care and other organisations providing care for older people.

The project involved searching eight databases for qualitative and mixed-methods studies. We included studies if they focused on older people, as defined by the study, and data-sharing, defined as the transfer of information between healthcare and social care organisations, or care professionals, regarding a patient.

We then analysed the relevant information (i.e. any information on data-sharing) from the papers identified by our searches. This involved identifying themes in the information from the included studies and comparing these themes across different groups of studies.

Throughout the project, we collaborated with stakeholders to help us understand current data-sharing practice, the implications of our findings for service delivery, and how to present the results of the review in formats suitable for use by stakeholders. More detailed information about our methods available in our project protocol, which is registered on PROSPERO (CRD420234166210).

Plans for sharing our findings

As well as publishing a report in the NIHR Journals Library, we will produce a 4-page briefing paper and blog. Please check this web page or follow us on Twitter @ExEvidSC for further updates.
If you have any feedback or comments about this review, please email Sian de Bell sd.c.de-bell@exeter.ac.uk or Zhivko Zhelev z.zhelev@exeter.ac.uk.

Remote monitoring allows health care professionals to assess and manage the health of a patient, without the need for the patient to be seen face-to-face. This may involve the use of technologies such as wearable or assistive home devices, offering opportunities for innovation in the health care system. Remote monitoring could contribute to effective self-management and the delivery of personalised care as well as increasing efficiency and reducing health care costs. Access to current evidence on the most effective forms of remote monitoring, and factors affecting their successful use, will support health care providers in delivering these interventions.

We have been commissioned by NHS@home to produce an evidence and gap map of recent systematic reviews on the effectiveness of remote monitoring, and its acceptability and implementation, for people living with long term physical health conditions.


Status: Complete

Briefing paper: We have produced a 4-page Briefing paper which summarises the project and the main findings

Background

Remote monitoring allows health care professionals to assess and manage the health of a patient, without the need for the patient to be seen face-to-face. This may involve the use of technologies such as wearable or assistive home devices e.g. blood pressure monitors or fall sensors, offering opportunities for innovation in the health care system. Remote monitoring could contribute to effective self-management and the delivery of personalised care as well as increasing efficiency and reducing health care costs.

We were commissioned by NHS@home to produce an evidence and gap map of recent systematic reviews on the effectiveness of remote monitoring, and its acceptability and implementation, for people living with long-term physical health conditions.

Aim of our project

This project aimed to identify and provide an overview of recent systematic reviews of remote monitoring for people living with long-term physical health conditions.

Our specific research objectives were to:

  • Map recent systematic reviews of the effectiveness of remote monitoring interventions for adults living with long-term physical health conditions.
  • Map recent systematic reviews of the acceptability and implementation of remote monitoring interventions for adults living with long-term physical health conditions.

Research question

What is the volume, diversity and nature of recent systematic reviews about the use of remote monitoring interventions for adults living with long-term physical health conditions?

What we did

We produced an evidence and gap map. Evidence and gap maps provide a visual overview of the current research on a topic. Rather than synthesising findings or research, evidence and gap maps summarise key characteristics of existing studies, allowing users to identify and access the research evidence (or see the evidence gaps) most relevant to them.

How we did it

We searched ten bibliographic databases as well as conducting web searches for relevant studies. We looked for systematic reviews with searches conducted in, or after, 2018. We included reviews that focused on adults with a long-term physical health condition(s) and considered any form of remote monitoring, as long as data from monitoring was being passed to a health care professional.

We were interested in all outcomes relating to effectiveness, acceptability and implementation. For reviews of effectiveness, we included only those containing comparative evaluation study designs e.g. randomised controlled trials, whilst for acceptability and implementation we included reviews focusing on any study design.

We produced an interactive evidence and gap map – this visually represents the key characteristics of the included studies. The map shows key outcome domains as columns and key intervention domains as rows, with multiple layers to allow access to more detailed information on the studies containing information on particular combinations of outcomes and interventions. It is also possible to filter the map e.g. to focus on specific populations.

Our findings

Our interactive evidence and gap map is available online, along with an NIHR Journals Library report giving further information on how we produced the map.

Follow us on Twitter @ExEvidSC for further updates.

If you have any feedback or comments about this review, please email Sian de Bell s.c.de-bell@exeter.ac.uk, Zhivko Zhelev z.zhelev@exeter.ac.uk or Rob Anderson r.anderson@exeter.ac.uk.


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.


Status: Complete

Briefing paper: We have produced a 4-page Briefing Paper which summarises the project and the main findings.

This page provides some information about the background of this project and how the team carried out the research.

Background

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.
 
There is considerable variability in peer support delivery, content and underlying mechanisms which present a challenge to commissioners and services who may wish to identify evidence of effective peer support interventions relevant to the needs of the community they wish to support and which is consistent with the structure of existing services in the area.

Aims of our project

Our aims were to:

  • Map the recent, robust evidence for effectiveness of peer support interventions across health and social care, and
  • Map the recent, robust evidence for cost-effectiveness of peer support interventions across health and social care
  • To bring together and organise the existing evidence to help users to identify and locate the research evidence or evidence gaps relevant to their area of interest

We used the following definition for peer support:
Peer support involves people drawing on shared personal experience to provide knowledge, social interaction, emotional assistance or practical help to each other, often in a way that is mutually beneficial. With the additional condition that there is an identifiable peer support worker role which is ongoing and formalised in at least one of the following ways: they have received training to fulfil the peer support role; they receive ongoing support to fulfil the peer support role; they are paid or have a contract to fulfil the peer support role.

Research question

What is the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care?

What we did

We produced an evidence and gap map. As with systematic reviews, this involved a transparent and unbiased process which found and organised the existing evidence. Evidence and gap maps help users to identify and locate the research evidence or evidence gaps relevant to their area of interest.  

For more detailed information about how we made the map, please see our project protocol and full project report.

Evidence and Gap Map

The finished evidence and gap map is available online and includes links to a glossary and instructions for using the map.

Please email Anna Price a.price@exeter.ac.uk, Sian de Bell s.c.de-bell@exeter.ac.uk or Jo Thompson Coon j.thompson-coon@exeter.ac.uk.

Mental health problems are common among children and young people in the UK, and there is evidence that they are experienced in different ways and to a greater extent for young people from some ethnic minorities. There is also evidence suggesting that children and young people from non-white-British ethnic backgrounds have greater difficulties accessing sources of mental health support, different levels of engagement with mainstream mental health services, and may prefer to seek advice and support in different ways to their White British peers.

We have been commissioned by the Mental Health Policy Team at the Department of Health and Social Care to conduct a rapid systematic review of research evidence relating to how and why children and young people from ethnic minorities seek, access and engage with care and support services for mental health problems.


Status: Complete

Background

Mental health problems are common among children and young people in the UK, and there is evidence that they are experienced in different ways and to a greater extent for young people from some ethnic minorities. There is also evidence suggesting that children and young people from non-white-British ethnic backgrounds have greater difficulties accessing sources of mental health support, different levels of engagement with mainstream mental health services, and may prefer to seek advice and support in different ways to their White British peers.

Aims of our project

Our rapid scoping review aimed to identify and provide an overview of qualitative research studies that provide evidence about the experiences of children and young people from ethnic minority backgrounds in seeking or obtaining care or support for mental health problems.

Research questions

  1. What is the nature and scope of the qualitative evidence on the experiences, views and perceptions of children and young people from non-white-British backgrounds and their parents/carers in accessing and engaging with mental health care and support?
  2. What is the nature and scope of the qualitative evidence on the experiences, views and perceptions of those who refer to, provide, and commission mental health care and support, about how children and young people from non-white-British backgrounds access and engage with mental health care and support?

What we did

We conducted a rapid scoping review for the Mental Health Policy Team at the Department of Health and Social Care of research evidence relating to how and why children and young people from ethnic minorities seek, access and engage with care and support services for mental health problems. 

How we did it

We searched seven bibliographic databases. We also searched the references of included sources, and relevant reviews and websites. We found 22 diverse qualitative studies from the UK, two-thirds (14) of which were about children or young people with particular types of mental health problems, and over a third (9) of which were among young people from particular ethnic backgrounds (i.e. the majority of studies included young people from a range of different ethnic backgrounds).  Four studies were among university students, and 5 were among refugee or asylum seeker young people or children.  The scoping review also identified a range of factors that influence care-seeking and access to mental health care in these groups.

For more detailed information about how we did this, please see our project protocol.

Sharing our findings

We shared our results with NHS England and prepared a Briefing Paper.

Alternatively, you may like to read the full report

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.


Status: Complete

Briefing Paper: We have produced a 4-page Briefing Paper which summarises the project and the main findings

In January 2020, the Exeter HS&DR Evidence Synthesis Centre were asked to review the evidence on 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.

This page provides some information about the background of this project and how the team carried out the research.

Background

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. The basic tenets of strengths-based working have been advocated and adopted by social workers for decades. However, the Care Act of 2014 has given formal, legal impetus to the implementation of strengths-based approaches. While many social work professionals and organisations have effectively adopted more person-centric and strengths-based care management and have responded to calls to practice in a ‘strengths based way’, they have also highlighted the challenges of doing this within organisational and resource constraints. The difficulty of incorporating the features of strengths-based approaches into a single integrated model, or an easily defined strengths based intervention, contributes to the challenges in implementing these approaches.

Aims of our project

Our aim was to summarise research evidence on the effectiveness and the implementation of different strengths-based approaches within adult social work in the UK.

Research questions

  • What is the effectiveness of different strengths-based approaches used within adult social work within the UK?
  • What factors enable or inhibit the implementation of different strengths-based approaches in adult social work within the UK?

What we did

We carried out a systematic review of the evidence. This is a transparent and unbiased process, bringing together the findings of all the available relevant studies to find out what is already known about strengths based approaches to adult social work within the UK.

How we did it

We searched seven bibliographic databases. We also searched the references of included sources, relevant reviews and websites, which enabled the identification of relevant grey literature or evaluations. To assess effectiveness research we aimed to include all comparative evaluation study designs (e.g., randomised and non-randomised controlled trials). Effectiveness was defined as improvements in the lives and wellbeing of those adults, families or communities being supported by social workers. To assess factors influencing implementation, we sought qualitative evaluative studies that included a focus on the process of implementation of the strengths-based approaches. This enabled the potential inclusion of the perspectives of service users, carers, family members, social work professionals, policy makers and legal professionals. Study selection, data extraction and assessment of study quality were completed independently by two reviewers. For more detailed information about how we did this, please see our project protocol.

Sharing our results

We shared our results with the Chief Social Worker for Adults in the UK so that they could use it to inform their work. We also wrote a blog post that talks about the results of our review. There is space for you to comment on the work we’ve done. We would welcome your views. We presented a slide presentation at a NIHR Policy Research Units and Social Care event in September 2020, and shared a poster of our findings at the Society for Social Medicine and Population Health virtual conference in September 2021.

Alternatively, you may like to read the Full Report

If you have any feedback or comments about this review, please email: Rob Anderson r.anderson@exeter.ac.uk

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.


Status: Complete

Briefing Paper: We have produced a 4-page Briefing Paper which summarises the project and the main findings

In May 2019, the Exeter HS&DR Evidence Synthesis Centre were asked to review the evidence about mental health services for people with acquired brain injury for NHS England.

This page provides some information about the background of this project and how the team carried out the research.

Background

People living with an ABI are more likely to experience mental health difficulties, and are at increased risk of engaging in offending behaviour or drug use and present a higher risk of harm to others and/or themselves. One study estimates that over 60 per cent of the UK prison population have a brain injury.  Delivering services for people with an ABI can be complex as differences in the aetiology and severity of the injury can lead to variations in level of functioning and range of potential needs across different individuals. The needs of individuals with severe difficulties may mean secure inpatient services are best equipped to care for them. However, the availability of secure ABI rehabilitation settings is limited in the UK and the restrictiveness of the setting could constitute an infringement of the human rights of the patient if the referral is not appropriately justified (Human Rights Act, 1998). It is important that the assessment, care and/or treatment needs of the patient, match with the availability and referral to an appropriate service.

Aims of our project

Our aim was to systematically review the evidence that could inform the arrangements for the specialist care of adults with ABI who may require secure psychiatric services.

Research questions

  1. Is there evidence to support the differentiation between different groups of adult patients with ABI as a criterion influencing the most appropriate care setting for treatment of adults with ABI?
  2. Is there evidence to support the use of diagnostic, disease- or symptom-severity assessment criteria in influencing the most appropriate setting for care and treatment of adults with ABI?
  3. Is there evidence to support the use of risk assessment tools in influencing the most appropriate setting for care and treatment of adults with ABI?

What we did

We carried out a systematic review of the evidence. This is a transparent and unbiased process, bringing together the findings of all the available relevant studies to find out what is already known about arrangements for the specialist care of adults with ABI who may require secure psychiatric services

How we did it

We searched seven bibliographic databases. These searches were supplemented with citation searching; inspecting relevant reviews; searching trial registry platforms, searching relevant websites; liaising with clinical experts and affiliation searches.

We sought evidence about adults with non-degenerative ABI placed in, eligible for referral to, or being assessed for eligibility for referral to secure psychiatric services in any high-income country published in English from 2000 onwards. Eligibility for referral to secure services was based on assessment or observation of challenging behaviours. Psychometric studies of tools used in assessments were also eligible for inclusion.

Study selection, data extraction and quality appraisal were completed independently by two reviewers, with disagreements resolved through discussion.

For more detailed information about how we did this, please see our project protocol.

Sharing our results

We shared our results with NHS England and prepared a Briefing Paper

Alternatively, you may like to read the full report.

If you have any feedback or comments about this review, please email: Jo Thompson Coon j.thompson-coon@exeter.ac.uk, Liz Shaw e.h.shaw@exeter.ac.uk or Michael Nunns m.p.nunns@exeter.ac.uk

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.


Status Complete

Briefing Paper: We have produced a 4-page Briefing paper and a comic which summerises the project and the main findings.

The Exeter Evidence Synthesis Centre were asked to review the evidence on strategies that hospitals use to reduce the length of time older adults spend in hospital following a planned inpatient stay.

This page provides some information about the background of this project, how the team carried out the research and why we had members of the public to have a say on how the project was carried out.

Background

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.

Aims of our project

We aimed to assess the effectiveness of different strategies used by hospitals to reduce the length of stay of people over the age of 60 admitted for planned treatments or procedures. This will be used to inform guidance for hospital managers, commissioners and clinical teams on how to improve patient recovery from elective surgery, reduce the time patients need to spend in hospital and suggest potential areas for further research.

Research questions

  1. What is the effectiveness of hospital-based strategies which aim to reduce the length of inpatient stay for older adults following a planned admission?
  2. What is the value for money of hospital-based strategies which aim to reduce length of inpatient stay in hospitals for older adults following planned admission?

What we did

We carried out something known as a systematic review. This involved bringing together the findings of lots of different studies to find out what is already known about different hospital based strategies which aim to reduce the time older adults need to spend in hospital.

How we did it

We searched different online libraries for all the research papers which have been written about this topic and searched the references lists of these papers. We then filtered out the ones that did not meet our selection criteria.

We will then took out the information we needed from the relevant papers identified by our searches. This information included;

  • The age of the people being treated in hospital,
  • What type of treatment they are receiving,
  • The strategy the hospital use to keep their length of stay as short as possible
  • The number of days people spend in hospital.
  • Any complications people experience during their stay in hospital or if they are readmitted after being discharged.

We brought this information together in a way which best answered our two research questions. For more detailed information about how we did this, please see our project protocol here.

Involving Patients and the Public

We wanted to make sure that our review is relevant to patients and that its findings make sense.

Therefore, we discussed the review with a group of adults aged 60 or above who have experience of being admitted to hospital for a planned treatment or procedure. We also asked patient’s partners and carers for their views. Together, along with separate meetings with health professionals, this helped us to analyse our results and share our findings.

We met with these different groups of people 2-3 times over 8 months, whilst we carried out the project.

Sharing our results

We shared our findings of our research to the relevant people, including hospital managers, doctors, nurses, patients and families.

You can listen to our podcast on our blog to learn more about what we found.

Alternatively, you may like to read the full report, found here: https://doi.org/10.3310/hsdr07400

If you have any feedback or comments about this review, please email: Liz Shaw: E.H.Shaw@exeter.ac.uk or Jo Thompson Coon: J.Thompson-Coon@exeter.ac.uk

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).


Status: Complete

Briefing Paper: We have produced a 4-page Briefing Paper which summerises the project and the main findings.

In March 2018, the Exeter Evidence Synthesis Centre were asked to carry out a six-week rapid review, looking at people’s experiences of the Nearest Relative provision of the Mental Health Act (1983). Below we explain what the Nearest Relative provision is, the aim of our project and how the team carried out this review. We also talk about how we involved people in this review and how people can read about what we have found and give their views.

Background

The Department of Health and Social Care has published an Independent Review of the Mental Health Act (1983).

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.

Aims of our project

We aimed to summarise and explore the different views and experiences of the Nearest Relative Provisions of the Mental Health Act (1983). We were interested in the perspectives of service users, family members, carer and professionals who work with the Act. This was to help the Department of Health and Social Care decide if any changes to the Nearest Relative provision of the Mental Health Act (1983) are needed.

Research question

What are the experiences of services users, family members, carers and relevant professionals of the use of the ‘Nearest Relative’ provisions in the compulsory detention and ongoing care of people under the Mental Health Act (1983)?

What we did

We carried out a systematic review of the evidence. This is a transparent and unbiased process, bringing together the findings of all the available relevant studies to find out what is already known about people’s views on the Nearest Relative provision.

How we did it

We searched different online libraries and organisation websites for all the research papers which have been written on this topic since 1998. We also contacted the authors and experts in the field and searched the reference lists of the papers we found. We only chose papers which met our selection criteria.

We then took out the information we needed from the relevant papers identified by our searches. This information included:

  • What people had said about their experiences of the Nearest Relative provision
  • Who was giving their views
  • How many people were giving their views
  • The country in which the person giving their views had experienced the Nearest Relative provision

We brought this information together to answer our research question. For more detailed information about how we did this, please see our project protocol here.

Involving Patients and the Public

We wanted to make sure that our review was relevant to people who are admitted to hospital against their wishes, their families and their carers.

Although we only had a short time available to carry out the review, we were able to check our final results with a carer who had experience of the Nearest Relative provision to see if they made sense.

Sharing our results

We shared our results with the Department of Health and Social Care so that they could use it to inform the independent review of the Mental Health Act.

You can listen to our podcast on our blog sifting and sensemaking to learn more about what we found.

Our blog also talks about the results of our review and how we found doing this piece of work in six weeks. There is space for you to comment on the work we’ve done. We would welcome your views.

Alternatively, you may like to read the full report, found here:  https://doi.org/10.3310/hsdr06390

If you have any feedback or comments about this review, please email: Liz Shaw: E.H.Shaw@exeter.ac.uk or Jo Thompson Coon: J.Thompson-Coon@exeter.ac.uk

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