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    PATIENT SAFETY TRANSLATIONAL RESEARCH CENTRES ANNUAL REPORT 2017/18 Financial Year (1 August 2017 – 31 March 2018) The accompanying NIHR Patient Safety Translational Research Centres – Guidance on Completion of Annual Reports for 2017/18 Financial Year (1 August 2017 – 31 March 2018) contains essential guidance on the information you need to provide when completing this proforma. Please complete the form using a font size no smaller than 10 point (Arial) and submit it as a Word Document. 1. CENTRE DETAILS Name of the NIHR Patient Safety Translational Research Centre: Greater Manchester Patient Safety Translational Research Centre Contact details of the individual to whom any queries on this Annual Report will be referred, and to whom feedback on the annual report will be sent: Name: Professor Stephen Campbell Job Title: Director - Greater Manchester PSTRC Address: Division of Population Health, HSR & Primary Care,School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Williamson Building, Oxford Road, Manchester. M13 9PL Email: stephen.campbell@manchester.ac.uk Tel: 0161 275 7655 2. DECLARATIONS AND SIGNATURES Contact details of the NHS Organisation administering the NIHR Patient Safety Translational Research Centre award: Name: Salford Royal NHS Foundation Trust Address: Mayo Building, Salford Royal, Stott Lane. Salford. M6 8HD Name of the Chief Executive of the NHS organisation: Sir David Dalton I hereby confirm, as Chief Executive of the NHS organisation administering the NIHR Patient Safety Translational Research Centre award, that this Annual Report and the Financial Report have been completed in accordance with the guidance issued by the Department of Health and Social Care and provides an accurate representation of the activities of the NIHR Patient Safety Translational Research Centre: Signature …………………………………….. Date: ………………………. (Chief Executive) NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 1


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    3. OVERVIEW OF ACTIVITIES (up to 1000 words) Progress against short term objectives for the 2017/18 financial year as detailed in your approved application – provide an update against ALL of your approved objectives The PSTRC has three core aims: 1. Develop and test evidence-based digital and behavioural interventions to improve patient safety in primary care and at transitions between care-settings; 2. Deliver a unique devolved ‘Learning Health System’ and translation pipeline from GMPSTRC to CLAHRCs/AHSNs and Patient Safety Collaboratives etc; 3. Further build capacity in safety research within and between research and practice communities. Short-term objectives (1-2 years): progress against approved objectives (in italics): Within 6 months, building from our existing GMPSTRC critical mass and partnership, we will have fully established GMPSTRC and gained regulatory approvals for our first studies. The project list file shows that that there were 19 projects open in 2017-2018, addressing core aim 1, showing that the PSTRC is fully established. Progress against the objectives of each theme is described in Section 4. Progess against leadership, governance, management and finance is described below and Patient and Public involvement is described in Section 5. Progress against specific agreed objectives include: Establish operational Theme management and governance structures • Research Leaders Group (chair: Director), which meets monthly to review progress across all Themes and ensure integration of the work. Membership includes Theme Leads across Manchester and Nottingham (see section 4), senior researchers and Centre Manager. • Operations Team (chair: Centre Manager), which meets weekly providing the day-to-day operations of GMPSTRC (Director, Deputy Director, Centre Administrator, Director’s PA). • University of Nottingham Group: The Director and Centre Manager meet regularly with PSTRC leads in Nottingham (Avery, Waring). • Review meetings take place with each theme and theme staff 3-times a year, chaired by the Director. Appoint staff and students to all roles. • As of 31 March 2018 all Research Fellows / Associates have been recruited bar one RA in the Marginalised Groups theme, who commences on 16/4/2018 - addressing core aim 3. • Please see Investigator and research and student staff lists. All PhDs are recruited or are expected to be recruited to begin in September 2018 or April 2019 - addressing core aim 3. Recruit patients/public to the GMPSTRC PPI group. • The PSTRC has appointed two non-executive lay-members of the Executive Management Board (David Edwards, Angela Ruddock), who attend also theme review meetings and are members of the PSTRC Involvement and Engagement Group. They attend also theme Involvement and Engagement meetings; • Each individual project within the PSTRC is assessed against an Involvement and Engagement pro- forma with milestones, objectives and outcomes relevant to that project, addressing core aim 3. Deliver early research output milestones from existing GMPSTRC research platforms. • Please see project list (19 active projects), publications (19) and conferences (15 attended) lists Create a national doctoral network for safety research. • Plans underway with Yorkshire & Humber PSTRC and Imperial PSTRC for a network to commence in Autumn 21018 Consolidate partnership working with Health Innovation Manchester, GM AHSN, EM AHSN and across GMHSCP. • Please see sections 8-9-10, addressing core aim 2 NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 2


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    Within 12 months Submit a PPI/E strategy that delivers and embeds exemplary PPI/E through partnership. • PPI/E strategy will be submitted by end July 2018 and is part of a wider Involvement and Engagement strategy; • The PSTRC has recruited two executive lay-members of the Executive Management Board; • Each project has Involvement and Engagement objectives and milestones, including PPI and wider external stakeholder involvement. Establish scheduled research projects in all Themes. • Please see project list Fully participate in Health Innovation Manchester • Please see below, addressing core aim 2 Any changes to the approved strategy for the PSTRC in pulling advances from basic research… • No changes to approved strategy Any significant developments in implementing the strategy; • There will be no changes to the delivery of the approved strategy. Top three achievements of the PSTRC during the 2017/18 financial year. 1. The Greater Manchester PSTRC has developed two new themes on Safer Care Systems and Transiitons and on Marginalised Groups. These themes, along with our established themes on Safety Informatics (Impact case study 4) and Medication Safety (see Impact Case Studies 1 [self-harm in adolescents] and 2 – [CPPE]), are fully operational; 2. PINCER is being used in 30% of GP practices in England and has been incorporated into national guidelines to support medicines optimisation by both NICE and NHS England (see Impact Case Study 3); 3. The PSTRC will deliver, as per the approved strategy, on additional research capacity building in terms of doctoral fellowships, with two funded by the University of Manchester School for Health Sciences (SHS) on health economics, two funded by Christies NHS Foundation Trust and one funded by CLAHRC-EM. In addition, the PSTRC will partner with SHS on a joint funded PhD on PPI. Progress with leadership, governance and management arrangements, and any significant changes to these arrangements from your approved application. There are no changes to the agreed structure of leadership, governance or management of the PSTRC. The Executive Management Board oversees the Greater Manchester PSTRC and holds the NIHR Greater Manchester PSTRC Leadership to account for the management and performance of the Centre. The EMB is chaired by Dr Chris Brookes (Medical Director: SRFT) and includes Sir David Dalton (CEO SRFT and Northern Care Alliance NHS Group), Diane Morrison (Director of Finance, SRFT), Prof Kay Marshall (Head of the School of Health Sciences, UoM) and two non-executive lay members (David Edwards and Angela Ruddock). The PSTRC has: 1) a robust set of performance indicators relevant to delivery of the contract as agreed with NIHR as well as academic standards, augmented by 2) progress review criteria, milestones and a risk register, related to each active project. Both are standing items at Executive Management Board meetings. Due to staff turnover Prof Iain Buchan has been replaced by Prof Niels Peek as theme lead for Safety Informatics. 4a. PROGRESS MADE IN EACH THEME (up to 750 words per theme – Safety Informatics) NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 3


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    Safety Informatics has a dual focus on: 1) digital and behavioural interventions, and 2) data-intensive approaches, which use audit and feedback and actionable information to transform safety management and improve patient safety. The short-term objectives of the theme as per the approved bid, were to: • Further develop computerised audit and feedback (e-A&F) dashboard across Salford (44 practices, 1 hospital), extending from medication safety to long-term conditions management; • Develop computable indicators of diagnostic error (risk) in primary care; • Develop software to help patients and GPs monitor and act on laboratory test results; and extend this to self-testing and preparation for hospital visits/admissions; • Assess the feasibility of identifying late toxicity of cancer care (e.g. radiotherapy-induced hypothyroidism) with primary care information systems. Projects have commenced focusing on: • The Patient safety dashboard (SMASH) project “Patient safety dashboard: scalable, sustainable audit & feedback”, is on track for evaluation against serious harm outcomes (gastrointestinal bleeding, exacerbation of asthma, heart failure, stroke, acute kidney injury, hospital admission, or death). • Patient-led monitoring of test results and proactive safety Planned projects to commence in 2018-2019 are in the project list and include projects outlined in our approved bid, such as: • Patient-connected, system-wide diagnostic error surveillance • Co-produced monitoring of late effects of cancer treatment The Safety Informatics Theme leverages the GM Connect and Connected Health Cities agendas to provide the PSTRC with unique infrastructure to undertake early translational research using learning healthcare systems methodology. All Themes in the PSTRC draw upon the capability and technology platforms provided by this Theme. Details of any significant challenges faced in delivering the work programme during 2017/18; • Delays in some researcher recruitment but will these will create no significant challenges in delivering the work programme Progress with leadership of the theme, including any changes or challenges faced; ● Research Theme Lead: Prof Niels Peek. No changes or challenges faced. Prof Iain Buchan has left the University of Manchester. Dr Ben Brown (academic GP) has joined the theme (please see staff list) Details of the progress of the theme’s strategy, including any changes e.g. discontinuation of originally planned work or new areas of research; No discontinuation of strategy or originally planned work. The theme leverages the data sharing environment in GM (Salford Integrated Record; Information Sharing Gateway; GM Local Health and Care Record; and HeRC Trustworthy Research Environment) and advanced analytic capability (Health eResearch Centre; GM Connected Health City). This enables new areas of research and additional patient safety capacity building in linked projects to PSTRC: For example: • Developing Actionable Free-Text from EHRs for CardioVascular Disease clinical decision support in primary care (DAFT-CVD). • Patient Automated Triage and Clinical Hub Scheduling (PATCHS) • A linked project to a Wellcome Trust Fellow project, led by PSTRC researcher Dr Ben Brown on Actionable Analytics Linking Patient, Practitioner and Population Primary Care Major grant awards received as a consequence of NIHR PSTRC funding. • Demonstrating the feasibility of a Learning Health System for cancer diagnosis in Primary Care, Cancer Research UK C37891/A25310, 2018-2021, £284k (Delaney B, Peek N et al) • Developing and implementing Machine Learning driven analytics for quality improvement in healthcare, Health Foundation, 2018-2021, £400k (Wolfe C, Peek N et al) NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 4


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    4b. PROGRESS MADE IN EACH THEME (up to 750 words per theme: Medication Safety) We are building on the 2012-2017 theme on Medication Safety with its focus on data-intensive approaches, which use audit and feedback and actionable information to transform safety management and improve patient safety. We are also developing our work in line with goal-setting legislation to develop risk management techniques to define and further support the testing of interventions, aiming to develop and evaluate optimal design-based risk control solutions. The aims of this theme in the approved application were to: • Develop electronic audit and feedback (e-A&F) software to support trainee GPs to learn more effectively from patterns of medication error and suboptimal prescribing; • Develop a patient safety assessment and improvement toolkit for community pharmacies; • Assess the feasibility of establishing new models of medicines optimisation involving electronic referral of patients from hospital directly to community pharmacists on discharge. Progress with each of these projects has been achieved as planned, and summarised below: • We are working currently with IT specialists to build the e-A&F platform (REVISIT project) and we will then design our pilot evaluation with trainee GPs. Alpha testing of the new platform will take place in 2018/2019 once governance and ethics approvals are secured. Our medication safety surveillance dashboard (SMASH) has now been rolled out to 43 general practices across Salford CCG. Our process evaluation for this pharmacist-led e-A&F intervention is now complete (paper submitted for publication) and our summative evaluation of the impact of the intervention will commence once one year follow-up with all participating practices is reached (scheduled Oct –Dec 2018). • Work is underway to develop the Patient Safety Toolkit for community pharmacies, co-designed with our Community Pharmacy Patient Safety Collaborative (see below). As part of this work programme, we have worked closely with the Centre for Pharmacy Postgraduate Education to further develop their risk management training resources that were the core components for a national training campaign with the pharmacy workforce – see Impact Case study 1. • Plans are currently being developed to evaluate the implementation adoption and utilisation of an innovative system that provides electronic transfer of information relating to patient’s medications to a community of general practice pharmacists. This system will be launched in 2018/19 at Salford Royal NHS Foundation Trust and enable hospital pharmacists to refer patients to community pharmacists upon discharge for medication review, counseling or the completion of a compliance aid. • PhD project on non-technical skills in community pharmacy to improve patient safety commenced in January 2018 (Ahmed Ashour) • University of Manchester funded linked PhD project, as per the approved bid, commenced in September 2017 on the economic impact of hazardous prescribing (Leonne Brinkman) Planned projects to commence in 2018-2019 are in the project list and include projects outlined in our approved bid, such as: • The impact of an electronic refer-to-pharmacy scheme to improve medicines optimisation on discharge from hospital • Feedback on first 100 prescriptions to trainee GPs (REVISIT) Details of any significant challenges faced in delivering the work programme during 2017/18; ● None Progress with leadership of the theme, including any changes or challenges faced; ● Research Theme Lead: Prof Darren Ashcroft (University of Manchester). No changes or challenges faced. Details of the progress of the theme’s strategy, including any changes e.g. discontinuation of originally planned work or new areas of research; No discontinuation of strategy or originally planned work. NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 5


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    Our Greater Manchester Community Pharmacy Patient Safety Collaborative has been involved in several projects that will feed into our Patient Safety Toolkit. The collaborative embodies the PSTRC’s approach to co-design in developing applied interventions that improve safety at the point of care and service delivery and will be integral to our ongoing work examining: • feasibility of measurement tools and potential solutions to manage unwanted distractions/interruptions in the workplace • task analysis and process mapping, with a view to using and testing these in risk assessment tools. Other notable achievements: • Profs Ashcroft and Avery were members of the Department of Health Working Group to Improve Medication Safety (2017-2018) established in response to WHO Global Challenge focused on “Medication without Harm”. The working group report informed the Secretary of State’s response to the Global Challenge: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/683430/short-life- working-group-report-on-medication-errors.pdf • Prof Ashcroft was appointed to the Pharmacovigilance Expert Advisory Group at the MHRA • Prof Avery was appointed as a NIHR Senior Investigator • Dr Lyons was appointed as Fellow of the International Institute of Risk and Safety Management. Grant awards received as a consequence of PSTRC funding: • Developing a Mental Health Patient Safety Research Centre. Greater Manchester Mental Health NHS Foundation Trust Research Capability Funding (£157,780, Profs Ashcroft and Kapur). NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 6


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    4c. PROGRESS MADE IN EACH THEME (up to 750 words per theme Safer Care Systems & Transitions) To underpin the focus of the PSTRC on the safety of individuals within the wider system, as per the approved bid, we started a new theme on 1 August 2017 on Safer Care Systems and Transitions, to make care safer for patients moving within and between care settings. A patient’s journey through different parts of the health and social care services is called a “pathway,” and patients can be put at particular risk when moving along their pathway and receiving care from different organisations. The short-term aims of this theme as per the approved bid were: • To produce ‘state of the art’ evidence syntheses on transitional safety; • To determine priorities for transitional safety with regional health and social care partners; • Ensure that all Themes capture system and organisation factors (including devolution) influencing safety. Projects have commended focusing on, In particular: • Safer care transitions in mental health (in collaboration with the Marginalised Groups (Mental Health) theme; • Evidence synthesis of patient-held care records across pathways; • Evidence synthesis of health care service provision for homeless people. Theme leaders and staff have been focusing on this short term aim in terms of identifying synergies, sharing learning and developing opportunities across themes, such links with mental health sub-theme and the ongoing plans to link patient-held care records with the informatics theme. This also links to refining the priorities for the theme and developing the work plan. Planned projects to commence in 2018-2019 are in the project list and include projects outlined in our approved bid, such as: • Effective legal and regulatory responses to patient safety incidents at transitions of care (PhD project, under advertisement) • Knowledge sharing and transfer systems – to compare strategies and intervention to promote knowledge sharing for safer care transitions Details of any significant challenges faced in delivering the work programme during 2017/18; ● There has been a delay in recruiting the Research Associate at the University of Nottingham. No delay in theme or project progress or delivery is expected. Progress with leadership of the theme, including any changes or challenges faced; ● The Research Theme Lead is Prof Justin Waring (University of Nottingham), which underpins the strong collaboration between the PSTRC partnership and the University of Nottingham. No changes or challenges faced. Prof Harm van Marwjik has left the University of Manchester and Dr Blakeman has joined the theme. Prof Campbell has become University of Manchester theme project lead and Dr Tom Blakeman has joined the theme (please see staff list). Details of the progress of the theme’s strategy, including any changes e.g. discontinuation of originally planned work or new areas of research; No discontinuation of strategy or originally planned work. The theme leverages the research infrastructure of the University of Nottingham Business School and links to CLAHRC-EM and the East Midland Patient Safety Collaborative; for example: • Mental health needs for marginalised groups (i.e. homeless, modern slavery) • Working with Greater Manchester Patient Safety Collaborative to develop future work around deteriorating patients Major grant awards received as a consequence of NIHR PSTRC funding. • Blakeman T, Tsang, JY, Brown B, Campbell SM. Targeting Acute Kidney Injury (AKI) to improve patient safety: informing a learning healthcare system. SPCR, 2018-2019, £49,737 NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 7


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    4d. PROGRESS MADE IN EACH THEME (up to 750 words per theme: Marginalised Groups) The short-term aims of this theme, as per the approved bid were to: • Identify specific mental health services features that have been most effective in reducing suicide rates after national service changes; • Investigate the gap between evidence and practice in providing routine psychological treatment following self-harm; • Explore whether the ‘volitional help sheet’ is effective among wider groups of marginalised people; • Understand barriers to digital participation and provision of feedback in marginalised groups; • Test the PSTRC Patient Safety Guide; • Develop mobile applications for safe care amongst marginalised groups and carers; See project list for details of all projects open and in set-up in 2017-2018. In summary: • Mental health: 1) Components of a safe mental health service; 2) Treatment gaps in the care of people who self-harm, 3) clinical management and risks of non-fatal self-harm, suicide and other causes of premature death among GP registered children, adolescents and young adults diagnosed with common mental illnesses (PhD project: Lukasz Cybulski, and 4) safer mental health transitions in collaboration with the Safer Care Systems and Transitions theme; • Patients and carers: 1) evidence synthesis of marginalised groups,2) testing of the PSTRC patient safety guide; 3) HealthUnlocked (reporting of ADRs using text mining techniques); 4) preparatory work for a project on homelessness, and 5) MoRPhEME: re-analysis of data from 18 focus groups on safety issues for marginalised groups. Both researchers in the MH sub-theme will commence in April 2018. However, projects 1) and 2) have been set-up by senior staff and are ready to begin. Planned projects to commence in 2018-2019 are in the project list and include projects outlined in our approved bid, such as: • Safety in the context of childhood long-term conditions (Anna Waware, PhD student began 9/4/18) • Adapting a brief psychological intervention to reduce suicidal ideation and behaviour (PhD project, under advertisement) Example 1: • Working in collaboration with the Medication Safety theme we have generated an important output reporting on temporal trends in incidence, clinical management and subsequent incidence of self-harm in children and adolescence. This paper (Morgan et al. BMJ 2017) highlighted a sharp rise in incidence that was specific to girls aged 13-16, and also strong evidence for Tudor Hart’s Inverse Care Law (The Lancet 1971), with self-harm incidence being greatest in the most social disadvantaged areas and yet likelihood of referral to specialist mental health services being lowest in these deprived localities. Its publication generated widespread media attention (Altmetric score: 493) with the findings reported on in The Guardian, The Telegraph, Daily Mirror, BBC News, ITV News and Reuters (Impact case study 1). Example 2: • The PSTRC Patient Safety Guide is a co-designed guide to support patients and carers to address key patient safety questions and identify key points where they can make their care safer in primary care. We have held two co-design events with patients, GPs and pharmacists and are developing an App, with the same co-design approach, to test as an intervention. The Guide will be used flexibly with paper and digital versions, to support patients/carers as active partners in their care. Details of any significant challenges faced in delivering the work programme during 2017/18; ● There has been a delay in recruiting the 2 Research Associates within the mental health sub-theme. However, both researchers start in April 2018. No delay in project progress or delivery is expected. Progress with leadership of the theme, including any changes or challenges faced; ● Research Theme Lead: Prof Nav Kapur. The theme on Marginalised Groups has two defined sub- themes: Dr Caroline Sanders leads the Patients and Carers sub-theme and Prof Roger Webb leads the Mental Health sub-theme under the overall theme lead (Prof Kapur). No changes or challenges faced. Details of the progress of the theme’s strategy, including any changes e.g. discontinuation of originally planned work or new areas of research; • No discontinuation of work – please see project list; • New areas of research are focusing on marginalised groups in relation to homelessness. This extends to public engagement work on homelessness (see section 5); • University of Manchester funded linked PhD project, as per the approved bid, on the Economic impact NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 8


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    of mental health policies and services to reduce suicide rates (Beatriz Rubio Huete). Major grant awards received as a consequence of NIHR PSTRC funding. • Horwood, J, Fedder G, Morris R et al. ‘Investigating the unintended consequences of the use of digital health tools in primary care’, NIHR SPCR FR16 bid, 1.5.2018 - 29.02.2020: £293,241 NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 9


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    5. PATIENT AND PUBLIC INVOLVEMENT, ENGAGEMENT AND PARTICIPATION (PPI/E/P) (up to 1000 words) Please summarise and report on progress in the following areas: a) Patient and public involvement (400 words) Involvement and Engagement Lead: Prof Stephen Campbell / PPI Lead: Dr Sally Giles Patient safety isn’t just about medical procedures or treatment options, it is about people; both those who deliver care and those who receive it or work in partnership together. The PSTRC has a strong involvement and engagement agenda working with healthcare professionals, the NHS, local authorities, industry and patients, carers and members of the public. i. Any significant changes or revisions to your PPIE strategy and action plans The 2012-2017 PSTRC reviewed its involvement and engagement strategies and procedures on an ongoing basis, as discussed in annual reports, in full partnership with the PPI members and researchers. In the April 2017 Research User Group (RUG) meeting, chaired by Simon Denegri, it was agreed and recommended by the RUG that PPI should be focused at project level with governance from a lay-perspective embedded within the Executive Management Board. The 2017-2022 PSTRC has recruited two non-executive lay-members as full members of our Executive Management Board (David Edwards and Angela Ruddock). The 2017-2022 PSTRC continues to review its involvement and engagement and PPI strategies and procedures on an ongoing basis, in conjunction with an Involvement and Engagement Group and the Executive Management Board. ii. Progress made in delivering the objectives in your PPIE strategy The PSTRC has an Involvement and Engagement Strategy, that incorporates its PPI/E strategy (please see separate document), which has been written by the Director (Prof Campbell), PPI Lead (Dr Giles) and members of the Involvement and Engagement Group including Executive Management Board non-executive lay members (David Edwards, Angela Ruddock). The PSTRC is committed to actively consulting, listening to and involving patients, carers, publics and stakeholders at all stages of research to deliver and embed PPI/E through partnership. Indicators include: • An Involvement & Engagement plan incorporating PPI/E (please see attached) • An established governance and monitoring structure, • Partnership working with other NIHR PPI/E infrastructure and within Greater Manchester, • Project level PPI/E review criteria (including objectives, milestones, dissemination, outcomes) • PSTRC public engagement strategy • Research priorities reviewed by patients and GM partners iii. Examples of the impact your PPI activities are having. • The PSTRC coordinated and co-funded a PPI workshop on 7/2/18 on Managing Difficult Situations in Patient and Public Involvement (PPI) along with the SPCR PRIMER PPI group; • Multiple meetings have taken place with key potential PPI/E and stakeholder partners for work on homelessness: GM Health & Social Care Partnership, Urban Village medical practice, Shelter. b) Public engagement (400 words) i. Any significant changes or revisions to your PPIE strategy and action plans. Please see 5ai above NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 10


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    ii. Progress made in delivering the objectives in your PPI/E Please see 5ai above. In addition, in relation to public engagement specifically: • The PSTRC works in collaboration with, and commissions the Public Programmes Team at Manchester University NHS Foundation Trust in developing and delivering public engagement events; for example, using poetry as a pivotal art-form and a shared language for engagement and reimagining mental health; • The PSTRC continues to use innovative co-design and public engagement activities to disseminate early translational findings and generate discussion and co-design with the public and stakeholders; • Plans are ongoing for an event that will take place in Autumn 2018 in collaboration with the Museum of Homelessness (http://museumofhomelessness.org/); • An audio play on sharing patient health data building on the PSTRC commissioned play The Nest, which explores patient safety issues on data sharing and was awarded a Making a Difference Social Responsibility Commended Certificate from The University of Manchester; • Ongoing #DataSaveslives campaign; iii. Examples of the impact your PPE activities are having. • Dr Sanders has collaborated with Health Innovation Manchester regarding its Pan-Manchester PPI strategy and especially widening participation • Public Programmes Team, Manchester Foundation Trust, is a test-bed for the NIHR PPI Standards (Bella Starling, Leah Holmes) c) Participation (200 words) i. How you make people aware of the opportunities to take part in research that takes place in your centre/unit/facility and elsewhere. The benefits of research are lost unless knowledge is disseminated to the people who need to act on that knowledge. To be effective participation, dissemination and evaluation activities need to be tailored to the specific requirements of each target audience. We do not view the audience as a homogeneous group and tailor our messages accordingly. Key audiences include participants that read our open-access peer- reviewed publications, attend conference our conference presentations, and opportunities to learn, interact and participate through encompass a variety of media to enhance communication ‘reach’. From 1/8/2017 to 31/3/18 the PTRC website hosted 37 blogs written by PSTRC researchers, PPI members and members of the public. The blogs have been viewed by 3794 people. The website attracted 5815 visits. The PSTRC twitter account had 1214 followers and the meds safety account has 1678 followers. The most recent PSTRC newsletter had an open rate of 58.8% (industry average 18.2%) and a click rate of 25.9% (industry average 1.8%). During the period 1/8/17 – 31/3/2018 the PSTRC part or fully funded research resulting in 19 publications and 23 conference presentations. NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 11


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    6. TRAINING (up to 1000 words) 6.1 Progress. Please provide progress against the training plans outlined in your approved application, addressing any feedback provided by the review panel. Please include any additional objectives for the coming year. PSTRC Training Lead: Prof Campbell Core aim 3 of the PSTRC is to further build capacity in safety research within and between research and practice communities. Training and capacity development objectives in our approved application, included: • Recruiting 11 PhD students – with the equivalent of 6.5 being funded through partner contributions; • Focusing equally on capacity building in research leaders, established researchers and early career researchers and trainees; • Involving health professionals in the development and conduct of research projects and building research capacity in patient safety research through collaborative approaches; • Developing a national doctoral network for safety research; • Developing skilled support staff to support patient safety research; Progress is demonstrated by: • In the financial year from 1/8/17 – 31/3/18, £24,949 was allocated to training Expenditure on training includes training for staff and students (£1,540), doctoral training stipend or salary and fees for PhD students (£4,195) and attendance at conferences for training and dissemination purposes (£9,512). • 4 PhD students have commenced their doctoral training: 2 (Cybulski and Ashour) funded fully by the PSTRC and 2 funded fully by institutional commitment as a direct cash and kind contribution by the School of Health Sciences at the University of Manchester, as per our approved application (Brinkman and Huete); • All remaining PhD students are scheduled to commence in 2018-2019; • The PSTRC invested an additional £21,715, via RCF, on the Pharmacy Collaborative from 1/8/17 – 31/3/18, involving pharmacists in 8 community pharmacies across Greater Manchester; • The PSTRC is in discussions with the Imperial PSTRC and Yorkshire & Humber PSTRC about a doctoral network to commence in Autumn 2018; • Applied PEP student (Aziza Abdulle) placement working on digital feedback in the mental health services for people with severe mental illness; • Edward Sinclair, ACF In Dentistry, is working with Prof Campbell, on patient safety in community dentistry; • NIHR SPCR FR15 grant awarded with Academic GP ST3 Doctor (Dr Tsang) and PSTRC staff (Dr Blakeman, Dr Brown, Prof Campbell) on Targeting Acute Kidney Injury; • NIHR SPCR FR16 grant award as co-applicant to PSTRC trainees (Dr Morris) on Investigating the unintended consequences of the use of digital health tools in primary care; • NIHR SPCR FR16 grant award to trainee Dr Panagioti and Prof Ashcroft on ’Investigating burnout in general practitioners and indicators of suboptimal patient care using the Clinical Practice Research Datalink; • Adam Sutherland secured a NIHR Clinical Doctoral Research Fellowship: Medicines Optimisation in Paediatric Patients (MOPPet): A qualitative human factors study on the causes of Drug Related Problems in hospitalised children, £242,662 – awarded January 2018 and start June 2018 (supervised by Prof Ashcroft and Dr Denham Phipps) • Two GP fellows have applied for NIHR awards for IPF/ career fellowships to be supervised by Dr Sanders:  Dr Aaron Poppleton - Exploration and cultural adaptation of mental health treatment strategies for central and eastern European migrants within primary care  Dr Xavier Haider Quli - Delivering high quality primary care for common mental health problems in military settings: a qualitative study of diagnostic decision-making among primary care physicians in UK-based Service Medical Centres. Examples of dissemination activities and conferences and training attended by PSTRC research and support staff, include: NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 12


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    • British Journal of General Practice Research Conference 2018 (March 2018) • th North American Primary Care Research Group 45 Annual meeting (November 2017) • th Diagnostic Error in Medicine 10 International Conference (November 2017) • th International Society for Quality and Safety in Healthcare 34 International conference (October 2017) • NIHR Train the Trainer sessions (Sept-Oct 2017) • Analysing Patient-Level Data using HES Workshop (Dec 17) • Email Campaigns with Mailchimp (January 2018) 6.2 Deviations. None 6.3 Impact. Please describe what has worked well and provide examples of impact. Examples include: • Three of the six 2012-2017 PSTRC PhD students have been recruited to full time research posts related to patient safety at the University of Manchester (Drs Fraccaro, Gorton and Stokes), a fourth to a full time post related to PPI at the University of Bristol (Dawson), a fifth to a full-time post at NHS England (Thomas) and he sixth to a full time post in Germany (Wulff). • Horwood, J, Fedder G, Morris R et al. ‘Investigating the unintended consequences of the use of digital health tools in primary care’, NIHR SPCR FR16 bid, 1.5.2018 - 29.02.2020: £293,241; • The PSTRC used RCF funding in 2017-2018 to fund Dr Maria Panagioti, who has been awarded a SPCR FR16 grant with Prof Ashcroft on ‘Investigating burnout in general practitioners and indicators of suboptimal patient care using the Clinical Practice Research Datalink.’ 1/04/2018 - 30/09/2019: £177,600; • Sutherland A, NIHR Clinical Doctoral Research Fellowship: Medicines Optimisation in Paediatric Patients (MOPPet): A qualitative human factors study on the causes of Drug Related Problems in hospitalised children (supervisor: Ashcroft D, £242,662); • Richard Williams SPARC: Short Placement Award for Research Collaboration; 6.4 Collaborations. • The PSTRC training lead is a member of the University of Manchester NIHR Training Leads/ Coordinators group chaired the Faculty for Biology, Medicine and Health Vice Dean for Teaching, Learning and Students (Prof Wallis) and including the NIHR Manchester BRC, CLAHRC-GM, Clinical Research Facility and GM-PSTRC; • The PSTRC is in discussions with the Imperial PSTRC and Yorkshire & Humber PSTRC about a doctoral network to commence in Autumn 2018; • CLAHRC-East Midlands will a FTE PhD student commencing in 2018; • The Christie will fund 2 FTE PhD students commencing in 2018. 6.5 Sharing best practice. Our approach to training focuses equally on capacity building in research leaders, established researchers and early career researchers and trainees. It is based on partnership working with other NIHR Infrastructure and on building critical mass. This PSTRC aligns closely with the University of Manchester’s commitment to research excellence, which enhances the value of the PSTRC award by contributing direct cash and kind contributions to leverage additional research capacity building in terms of fully-funded PhDs. 7. LINKS WITH INDUSTRY (up to 1000 words) The short-term aims of the PSTRC, as per the approved bid, in relation to industry, were: Within 12 months: NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 13


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    • Fully participate in Health Innovation Manchester agenda in order to strengthen industry links and formulate strategic engagement plan with target industries; • Collaborative programmes established with regional and national patient safety leads (AHSNs, Patient Safety Collaboratives and NHS England) to develop recommendations for safer health and social care settings (e.g. nursing homes) based on GMPSTRC's early translational research. Please describe your Centre’s engagement with industry. The PSTRC works closely with Health Innovation Manchester, which is an academic health science system that brings together the research, education and clinical excellence of the DH designated Manchester Academic Health Science Centre (MAHSC) with the expertise and national connections of the Greater Manchester Academic Health Science Network (GM-AHSN) to enable the adoption and spread of innovation across local and national health economies. Examples of progress: • The PSTRC via the Safety Informatics theme is working with industry partners and NICE to translate the methodology of the Patient Safety Dashboard to the national context of integration with a broad spectrum of electronic health record systems; • The medication safety theme are working currently with IT specialists to build the e-A&F platform (REVISIT project) and we will then design our pilot evaluation with trainee GPs / • Prof Campbell and Prof Ashcroft are members of the Health Innovation Manchester Patient Safety Collaborative Steering Group; • Prof Campbell is a member of the Health Innovation Manchester (HInM) Research & Education Committee; Any strategic plans for increasing engagement with industry that are not outlined in your application. • Safety Informatics is setting up a stakeholder engagement group with significant participation from the digital health industry. Key examples of working with Small and Medium Enterprises (SMEs), related to the list requested in the Finance & Activity Report (submitted via NIHR Infrastructure Annual Reporting Portal). • In the Patient Automated Triage and Clinical Hub Scheduling (PATCHS) project, the Safety Informatics theme works closely with Spectra Analytics, a data analysis and research consultancy. Brief details of key examples of studies active in financial year 2017/18. These may include Contract commercial studies, industry collaborative research studies, or other academic commercial research including Investigator-led industry funded clinical research, as defined in Annex 1 of the PSTRC Annual Report guidance. • The PSTRC Community pharmacy patient safety collaborative includes a range of independent and regional chain community pharmacies across Greater Manchester; • The PSTRC Patient Safety Guide project co-design approach includes a range of independent and regional chain community pharmacies across Greater Manchester; Key examples (including name of funder/grant scheme) of any partnerships or studies with industry which have led to further industry, public or charity research funding, including as part of consortia. • Productive (working on creation of App for patient safety guide) • HealthUnlocked (online yellow cards) NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 14


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    8. LINKS WITH OTHER NIHR INFRASTRUCTURE (up to 500 words) Please describe progress for linking with other NIHR infrastructure as detailed in your approved application. The relevant short-term aims of the PSTRC, included: • Capitalising upon Health Innovation Manchester (HInM), CLAHRC-GM and GM-AHSN, M-BRC, CLAHRC-EM and EM-AHSN, to support and accelerate evidence-based translation into practice; • Exploiting the increased scale of investment to secure further public/private/charity funding; • Appointing an NHS Engagement Officer; • Enhancing collaboration with the NIHR School for Primary Care Research; Examples of progress against approved aims: • PSTRC leaders are members of the HInM PSC Steering Group and Research & Education Committee; • NHS Engagement Officer will be appointed at SRFT in 2018-2019; • Multiple grants awarded with other NIHR Infrastructure, including SPCR e.g. theme pages 4a, 4c and 4d; • Integration between the PSTRC and PRIMER PPI Group (funded originally by the NIHR SPCR). Dr Giles (PSTRC PPI lead), is research coordinator for PRIMER. The PSTRC builds on and leverages our existing memberships of and collaborative links to multiple parts of the NIHR Infrastructure, including the SPCR, CLAHRC-GM and CLAHRC-EM, NIHR Manchester BRC, GM- AHSN and EM-AHSN. HInM is an academic health science system that brings together MAHSC and GM- AHSN to enable the adoption and spread of innovation locally and nationally. Examples include: • Profs Ashcroft, Avery and Peek lead a NIHR Programme Grant for Applied Research avoiding patient harm through the application of prescribing safety indicators in English general practices (PRoTeCT); • Prof Ashcroft is working with the Clinical Practice Research Datalink (CPRD) for a number of studies – Added Value Case Study 1 is an example; • Prof Armitage is: 1) deputy theme lead in the NIHR Manchester Biomedical Research Centre, 2) co- leader of a NIHR Programme Grant enhancing the quality of psychological interventions delivered by telephone (EQUITy) and 3) a sub-panel member for NIHR Programme Grants for Applied Research (PGfAR); • Dr Blakeman is Clinical-Academic Lead for the CLAHRC GM Kidney Health Programme; • Dr Blakeman, Dr Brown and Prof Campbell lead a SPCR FR15 project on Targeting Acute Kidney Injury (AKI) with Dr Tsang; • Dr Blakeman and Prof Campbell have been awarded an RCGP Quality Improvement Project on Acute Kidney Injury with CLAHRC-GM, AHSN Kent Surrey and Sussex and AHSN North East and North Cumbria, to improve: a) AKI care; and b) primary care response to AKI Warning Stage Test Results; • Prof Campbell is: 1) a member of the NIHR Infrastructure Short Placement Award for Research Collaboration (SPARC) panel, 2) a member of the NIHR Trainers Forum, and 3) chairs the PGfAR Programme RP-PG-1214-20017 Committee (Partners at Care Transitions (PACT): Improving Patient Experience and Safety at Transitions of Care) (PI: Prof Lawton); • Prof Peek leads the Informatics and Data Science cross-cutting theme in the Manchester-BRC; • Dr Sanders is a member of multiple NIHR funding panels including PRP and programme grants; • Prof Waring Leads the Implementing Evidence & Improvement Theme for NIHR CLAHRC-EM; • Dr Morris is working with the NIHR Manchester BRC (Prof Bruce) on children and young people with hearing loss (PONCHO study). • Co-established with Yorkshire & Humber PSTRC and Imperial PSTRC a: 1) Centre Managers group, and 2) Training Leads group; • PPI links – see section 5. NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 15


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    9. PROGRESS ON INVOLVING A RANGE OF HEALTH AND CARE SECTORS IN THE PATIENT SAFETY RESEARCH UNDERTAKEN (up to 500 words) Please summarise and report progress made towards achieving the PSTRC’s strategy for involving a range of health and care sectors The PSTRC’s second core aim in the approved bid is to deliver a translation pipeline from GMPSTRC to CLAHRCs/AHSNs, Patient Safety Collaboratives and DHSC and its relevant Arms-Length-Bodies etc within a ‘Learning Health System’ approach. The PSTRC has developed strong links with the Health and Social Care system and Health Innovation Manchester, as well as the Patient Safety Collaboratives and Academic Health Science Network in Greater Manchester Eastern Cheshire and the East Midlands. This will ensure scarce financial and workforce resources are used to provide value for money and safer care. Examples include the PSTRC working with: • Greater Manchester Eastern Cheshire Patient Safety Collaborative on its deteriorating patient agenda with plans to develop an ‘early warning’ tool for identifying and responding to deteriorating patients following discharge from hospital to a community setting; • The Christie NHS Foundation Trust on doctoral research as per the approved bid. The collaboration is with Professor John Radford (Professor of Medical Oncology: Director of Research for the Manchester Cancer Research Centre and Clinical Academic Section lead for cancer in the Manchester Academic Health Science Centre); • A range of health and care and voluntary organisations in developing its research on homelessness through the Safer Care and Transitions and Marginalised Groups themes; for example, Greater Manchester Health & Social Care Partnership, Urban Village medical practice, Shelter; • NHS England and NHS Improvement to reduce the level of medication error across the NHS; • NHS and DHSC to reduce avoidable significant harm in primary care; • NICE, DHSC, NHS England and Health Education England to reduce suicide rates and self-harm: • The PSTRC is working with Christies NHS Foundation Trust in collaboration with Health Innovation Manchester on developing digital platforms on optimising safe follow-up and patient experience after discharge from out-patient care; The PSTRC Partnership will be appointing an NHS Engagement Officer to commence in 2018-2019, to inspire interest, stimulate debate, and engage in dialogue with all stakeholders about GMPSTRC's and the wider NIHR Infrastrcuture in Greater Manchester, including CLAHRC GM's research and findings. Examples of PSTRC work that has involved health and care sectors, include: • The 2012-2017 PSTRC project on “Incidence, clinical management, and mortality risk following self- harm among children and adolescents: cohort study in primary care” (Dr Cathy Morgan, Prof Ashcroft et al) has been published in the British Medical Journal (2017;359:doi:https://doi.org/10.1136/bmj.j4351), It received extensive media coverage including BBC News, the Guardian, Reuters Science and Health News: and Sky news (see Impact Case Study 1); • The PSTRC Community pharmacy patient safety collaborative includes a range of independent and regional chain community pharmacies across Greater Manchester; • The PSTRC Patient Safety Guide project co-design approach includes a range of independent and regional chain community pharmacies across Greater Manchester. NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 16


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    10. WORKING WITH NHS ENGLAND, NHS IMPROVEMENT AND THE WIDER HEALTH AND CARE LANDSCAPE TO ENABLE IMPLEMENTATION OF RESEARCH FINDINGS (up to 750 words) Please provide an update on any engagement and/or joint work between your Centre and NHS England, NHS Improvement, the Academic Health Science Networks (AHSNs), Patient Safety Collaboratives led by the AHSNs and Local Authorities, and how this is supporting the implementation of research findings. Please provide key examples of PSTRC projects that have led to implementation of research findings to improve patient safety. The PSTRC works with the Manchester and East Midlands Academic Health Science Centres, Greater Manchester Eastern Cheshire and East Midlands Patient Safety Collaboratives, Health Innovation Manchester, and the integrated Health and Social Care Partnership, which serves three million people across Greater Manchester with significant health inequalities. This helps spread innovation and findings and generalise our research so it can be implemented rapidly throughout the UK. As per the approved bid, an NHS Engagement Officer will be appointed at SRFT in 2018-2019 to inspire interest, stimulate debate, and engage in dialogue with all stakeholders about GMPSTRC's and the wider NIHR Infrastructure in Greater Manchester, including CLAHRC GM's research and findings. PSTRC staff are engaged in a wide range of joint work with the wider health and care landscape. Examples include: • Prof Campbell and Prof Ashcroft are members of the Health Innovation Manchester Patient Safety Collaborative Steering Group; • Prof Campbell is a member of the Health Innovation Manchester (HInM) Research & Education Committee; • Prof Armitage is 1) a member of the British Psychological Society’s Behaviour Change Advisory Group and 2) NICE hearing loss guidance committee; • Prof Waring is Chair of the Research and Evaluation Committee for Patient Safety Collaborative-EM; • Dr Sanders is qualitative research lead for the NHS Diabetes Prevention Programme; • Prof Ashcroft’s and Prof Avery were members of the working group for the response to the WHO Patient Safety Global Challenge; • Prof Kapur’s roles include, at 1) NICE: Chair Depression Guideline, Topic Expert on Suicide Prevention Guideline, induct new NICE chairs; 2) DH: Member National Suicide Prevention Advisory Group, 3) NHS England: co-lead, national quality improvement process to prevent suicide, and 4) Health Education England: Chair, group developing core competencies for NHS staff in self-harm and suicide assessment. • The PSTRC is working on 2 PhD projects with Prof John Radford at Christie NHS Foundation Trust, who is Director of Research for the Manchester Cancer Research Centre (MCRC) and Clinical Academic Section lead for cancer in the Manchester Academic Health Science Centre (MAHSC); Examples of specific projects showing translation into significant patient safety improvements are: • The PINCER intervention has reduced a range of clinically important and commonly made medication errors in primary care. PINCER is now being used in 30% of GP practices in England and has been incorporated into national guidelines to support medicines optimisation by both NICE and NHS England. Expected impacts include (see Added Value Case Study 3) and https://gmpstrc.wordpress.com/2018/03/16/making-prescribing-safer-with-pincer/ ); • Roll-out of the patient safety dashboard (SMASH) has caused the overall prevalence (proportion of patients with at least one medication safety hazard) in Salford primary care to drop from 1979 (on 1-1- 2015) to 936 (on 31-3-2018), a reduction of 53%. Analysis of effects on serious harm outcomes is in progress; • The PSTRC is working with the Greater Manchester Eastern Cheshire Patient Safety Collaborative to implement the Patient Safety Toolkit across Greater Manchester (http://www.rcgp.org.uk/clinical-and- research/resources/toolkits/patient-safety.aspx); NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 17


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    This form, together with the PSTRC Added Value pro forma (using the structured template provided) must be submitted, by email, no later than 1pm on Friday 18 May 2018 to Rupesh Paudyal (rupesh.paudyal@nihr.ac.uk). The Finance & Activity Report must be completed via the NIHR Infrastructure Annual Reporting Portal by 1pm on Friday 18 May 2018. A signed copy of this report should be sent no later than Friday 25 May 2018 to: Dr Rupesh Paudyal NIHR Central Commissioning Facility Grange House 15 Church Street Twickenham, TW1 3NL NIHR Patient Safety Translational Research Centre – Annual Report 2017/18 18


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