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RA5a: Structure,environment and staffing policy

Research in community-based clinical subjects at Sheffield is centred on a vigorous inter-disciplinary research culture. Our research attracts international interest and informs and guides national health policy and practice, especially through the work of the Medical Care Research Unit on emergency services, the work on Health Technology Assessment in the wider School of Health and Related Research (ScHARR), and the work of the Sheffield Institute for Studies on Ageing (SISA).
Our research is growing in capacity and reputation. Since the 1996 RAE research income has more than doubled to nearly £3m pa, and research income per research active fte is now approximately £80K pa. Since 1996 we have published over 300 research articles in peer-reviewed journals; there are 35 post-graduate research students including 5 MRC and regional training fellows, and 51 research assistants.
Most of the research in community-based clinical subjects is carried out in ScHARR which came into existence in 1996. It brings together researchers in the clinical disciplines of public health medicine, general practice, and psychiatry as well as one of the country’s largest groups of health economists and medical statisticians. Together with research active staff in sociology, psychology, nursing and information sciences, ScHARR is a thriving inter-disciplinary and innovative research collaboration (see www.shef.ac.uk/~scharr/ for further information). ScHARR also includes the core of the Trent Institute for Health Services Research which is a widely admired collaboration across the Universities of Sheffield, Nottingham and Leicester.
Our main field of research is in Public Health and Health Services Research with research groups in emergency care, HTA, geographical variations in health and health care, and methods of health services research focusing on valuation methodologies in health economics. There are substantial research groups in primary care based in the Institute of General Practice and Primary Care, and ageing based in SISA. In addition, a substantial investment has recently been made in developing biological clinical psychiatry and this has led to the emergence of a new research group focusing on neuroimaging led by Professor Woodruff.

A. Public Health and Health Services Research
The Public Health and Health Services Research group has four particular themes, between which there is substantial cross-collaboration – emergency care, health technology assessment, geographical variations in health and health care, and methods of valuation in health economics.
Emergency Care (Nicholl (part), Munro, Clancy, Pickin (part), Parry, McCabe (part)). Through primary empirical research the Emergency Care group is a leading influence on shaping health services providing unscheduled care. For example, in the past five years the group has established that emergency nurse practitioners are as effective as junior doctors in caring for minor injuries in A and E; that paramedics are associated with poor survival in serious trauma but that IV fluid admininstration protocols are not responsible for this; that neither helicopter ambulances nor trauma centres contribute to survival in major trauma in the UK; that neonatal intensive care unit league tables are literally meaningless; and that NHS Direct is a well-liked out-of-hours service which has had little impact on demand for other emergency care services. The main funding has come from the Medical Care Research Unit’s Department of Health programme grant (£1.75m over five years), as well as the MRC (£0.72m for paediatric intensive care + £0.14m for adult intensive care in collaboration with Dr. Rowan at the Intensive Care National Audit and Research Centre), the HTA programme (£0.55m for pre-hospital care + £0.43m in collaboration with ICNARC) and the NHSE (£0.75m for NHS Direct + £0.44m for neonatal intensive care in collaboration with Tarnow-Mordi in Dundee + £0.25m for other emergency care research).
The group has 7.1 fte research assistants and 4.0 fte PhD students working on emergency care studies, and has published over 40 peer-reviewed journal research papers on emergency care in the last five years. The group has close links with the UK trauma audit group in Manchester, ICNARC in London, and a European research collaboration on post-impact care is being developed. New developments include a second MRC training fellow (start August 2001), a new senior lecturer post in Accident and Emergency Medicine, and in 2001 the group will begin the national audit of paediatric intensive care units (DH £560K). The quinquennial scientific peer review of the Medical Care Research Unit in 1999 concluded that it had demonstrated "very high standards of research" and the new Unit programme will focus principally on emergency care and will grow to £2.5m over the next five years.
Health Technology Assessment. (Akehurst, Booth, Nicholl (part), Pickin (part), Walters, Brazier (part), McCabe (part), Machin (part)). The group is one of the UK’s leading contributors to HTA and has for example helped define policy on pre-operative testing and statin prescribing. The group has published 7 systematic reviews through the UK’s HTA Programme, and has completed and published more primary research funded through the HTA programme than any other UK institution. It produced 12 reviews for the Trent Development Evaluation Committee and is now commissioned to produce 1/5 of all UK NICE reports (£2.4m over 5 years from the HTA programme). It produced Netting the Evidence, the international web resource used by the Cochrane collaboration.
Major grants include an RCT of telemedicine in dermatology (£0.60m), studies of treatments and services for varicose veins (£0.60m with Michaels returned in UoA3), and an evaluation of nurse-led pre-operative assessments (£0.61m with Southampton) (all through the HTA programme), plus an evaluation of clodronate in the prevention of hip fracture (MRC £1.1m, Trent £0.3m, Leiras £0.7m with Kanis returned in UoA3). Current national HTA programme grants are worth £1.15m.
The group has exceptional strength in health-economics and modelling and the international conference convened in Sheffield by the group in 2000 produced a definitive series of peer-reviewed journal articles on the subject.
The group has 7.6 fte research assistants, 4.0 FTE PhD students, and is planning to expand its research capacity with the appointment of two further staff.
Public Health (Maheswaran, Payne, Machin (part), Campbell (part), Hall, Hutchinson (part), Peters). The focus of the Public Health HSR group is on geographical variations in health and health care. The group has carried out three major population health surveys examining health care utilisation (coronary revascularisation, statin prescribing, admissions for respiratory disease, gastroscopies in dyspepsia, hip and knee replacement surgery, ophthalmic services) in relation to estimated need in different geographical population groups, and has developed new methodology to examine inequalities in use/need ratios. The group has set up innovative record linkage systems for linking survey data with routine mortality and morbidity information, establishing the foundation for large population based cohort studies. This group has programme grants for the Public Health Observatory (£560K) and the Public Health GIS Unit (£360K), which are being used to establish a GIS based platform for geographic information and analysis. The geographical variations group has established strong research links with the Small Area Health Statistics Unit, Imperial College, London (Professor Paul Elliott) for geographical and environmental epidemiology. There is a collaborative research programme with St. Georges Hospital Medical School (Professor David Strachan) and the Centre for Longitudinal Studies, Institute of Education, London. The first European conference on Geographic Information Sciences in Public health has been organised by the group and will be held in Sheffield in September 2001. New developments include plans for a qualitative research arm to complement the quantitative approach to assessing the use of health services in relation to need.
Valuation methodologies in health economics. (Brazier (part), Dolan, Shackley, Tsuchiya).
The group is a leading contributor to methodological developments in preference elicitation, particularly in the valuation of health states. Dolan’s work has generated a tariff of values for the EQ-5D which is now being used by NICE in its evaluation process and Brazier is developing a similar tariff for the SF-36. Dolan's ESRC project will provide a set of equity weights for use in economic evaluations. Major research underway includes generating a population-based tariff of values for the SF-36 (Glaxo-Wellcome £200K) and the King’s Health Questionnaire (Pfizer £55K), and ESRC-funded research (£115K) into the measurement of preferences regarding equity and fairness in health, and an HTA programme grant to examine issues in the aggregation of cost utility analyses (£60K). Brazier leads an ESRC funded seminar series on measuring health related quality of life for use in decision-making.
This new research group has 2 research assistants, 3.5 fte PhD students (including an MRC studentship) and has published over 40 papers in the area in the last five years.
The group has strong links with clinicians and policy-makers in the NHS as well as internationally with academics from a range of disciplines. Following his sabbatical at Harvard University, Brazier is developing a joint proposal for the National Institute for Health with Dr. John Ware (the developer of the SF-36) and Professor Milton Weinstein’s team at the Harvard Centre for Risk Analysis. Dolan is a visiting Professor at Oslo University. The group works closely with the Department of Health and the Departments of the Environment, Transport and Regions.

The group is developing research into the role of adaptation and expectation in health valuation, via a collaborative MRC bid with Newcastle and Dundee. The group also aims to develop methodologies in the use of informed members of the public and citizens juries in valuation work.
B. Primary Care
The primary care group (lead: Mathers) has created a vibrant research culture and has recently won two national primary care researcher development awards, three national HAZ fellowships for transcultural research initiatives and for the development of family health policy, and three regional HSR fellowships. The group has been a lead contributor in the development and implementation of national policy on underperforming GPs and in providing evidence based practice guidance to the NHS, as well as playing a major role in the development of the NHS information authority and NHS GP-Net. The Primary Care research group has three themes: Innovations in Primary Care (led by Campbell), Clinical Effectiveness in Primary Care (led by Hutchinson), Medical Education Research (led by Jolly)
Innovations in Primary Care. (Campbell (part), Hall, Morrell, Thomas, Machin (part)). The primary care innovations subgroup has collaborated in a number of RCTs in primary care including the Hampshire depression project and a trial of patient centred education in diabetes which has stimulated considerable methodological research into cluster RCTs, and three invitations to give courses in Europe about this. The Innovations group has initiated and conducted RCTs in the psychological treatment of insomnia in primary care, leg ulcer care and postnatal community support workers (£588k NHS R&D funding) and ongoing evaluations of complementary therapies in primary care [acupuncture (£160k HTA) and homeopathy (£120k Linbury Trust)]. The group has received substantial European funding for the CASE project investigating the impact of different treatment modalities on children of heroin addicts (£500k Framework V). Research by Hall on links between general practice and community paediatrics has shaped national policy. The Trent Focus partnership between the Universities of Sheffield, Nottingham, Leicester, and De Montfort has recently developed a joint research programme based in the collaborative research practice network. Important future developments include a centre for integrated medicine, the evaluation of inter-ageing collaborations focusing on health and social services, and the design of trials using the Trent Focus GP network.
Clinical effectiveness (Hutchinson (part), Goyder). This group has developed national evidence based guidelines for the NHS on acute back pain and type 2 diabetes on behalf of NICE (£264k), a series of clinical review documents to support NSF implementation in primary care (£360k DH), has undertaken policy research for the GMC on poor performance and is leading policy development and practical guidance for the NHS on chronic fatigue syndrome and the practical development of NICE guideline methods (£300k HTA). In addition, the RCGP Effective Clinical Practice Unit is based within this group (£300k). International work on guideline development by the effective primary health care group continues with two European funded projects and a multi-centre collaboration in Australia. In 2001 a NICE primary care collaborating centre will be established for a three year period (£850K) to develop clinical effectiveness methods.
Medical education (Jolly, Mathers, Howe, Fox) This group has played a leading role in the development of community based teaching and multidisciplinary continuing professional development (LOTUS-UK £55k Trent NHSE). A successful controlled trial of portfolios in continuing medical education for GPs and qualitative studies of undergraduate medical education have been completed. The group has pioneered the use of ICT in multidisciplinary education with the creation of virtual classrooms in primary care (WISDOM £120k Trent NHSE) and the production of innovatory educational resources including evidence based CD-ROMs, distance learning programmes in research methods and web based resources in health needs analysis, change management and clinical audit. The group has recently completed a successful transnational project evaluating shared learning in primary health care teams in 4 European countries (LOTUS-EU £188k Leonardo).
Close research collaborations exist between the innovations, effective practice and medical education subgroups and the University of Leuven, Belgium, the University of Nijmegen, Holland, the Institute of Public Health in Granada, Spain and the University of Zurich which have resulted in the two large European research grants described above (LOTUS-EU, CASE).
C. Biological Clinical Psychiatry (Woodruff, Spence, Zheng, Papadakis)
Since the appointment of the new Professor of Psychiatry in July 1999 (Woodruff), an exciting new research group is beginnning to investigate the brain mechanisms underlying psychotic illnesses, using functional and structural brain imaging techniques in collaboration with the Dept. of Psychology. Research is also assessing the effects of treatment, evaluating new pharmacological and psychological treatments for psychosis, and developing and evaluating novel treatments for psychosis and depression, eg. transcranial magnetic stimulation (TMS).
The group uses neuroimaging to define brain regions involved in components of social behaviour and is applying these approaches to abnormalities of social interaction in schizophrenia, and investigating clinical applications of TMS and its use to determine cortical connectivity in schizophrenia. The appointment of Papadakis, an MR Physicist renowned for his work on diffusion tensor imaging, considerably strengthens our research into brain connectivity, and complements Zheng’s mathematical skills for our work using MR data in mathematical models to predict clinical outcome.
Collaborations exist with the University of Manchester and Rampton Hospital to investigate the neural basis of impulsivity and impoverished empathy in patients with anti-social personality disorder. New collaborative partnerships have been established with Olu, Finland; Ulm, Germany; INSERM, France, Utrecht and Maastricht, Holland, and the University of South Carolina, USA, with whom new neuroimaging studies are planned.
The Sheffield Cognition and Neuroimaging Laboratory (opened March 2001) reflects the strategic collaboration that has developed between Clinical Psychiatry and Radiology, Psychology, Medical Physics, Human Communication Sciences, Biomedical Sciences, Neuropathology and Clinical Neurology. The group has embarked on 16 major new collaborative projects, mostly using functional MRI, results of which have been given to 7 national and international conferences. These include the novel findings: a) that empathy and forgiveability judgements and telling lies utilise distinct brain regions, b) the neural correlates of social cognition tasks change with cognitive behavioural therapy, c) spatial localisation of speech external to the head has a defined anatomy.
A major investment in MRI scanning facilities has been made. An Academic Psychosis Unit is planned which will provide expertise in the investigation, diagnosis and treatment of severe mental illness. A new Senior Lecturer in neuropsychology to bolster the neuropsychological and scanning research has been appointed (Parks), and further clinical and non-clinical lecturer posts are currently being recruited.
D. Ageing (Philp, Warnes, Crane, Gariballa, Gott, McKee, Parker, Young).
Research on older people’s services and quality of life clusters in the Sheffield Institute for Studies on Ageing (SISA), which is both a multi-disciplinary group in the School of Medicine (the UoA2 research active staff), and a cross-faculty network of gerontology researchers. SISA is a leading UK applied gerontology research centre, with an unrivalled combination of clinical and social science expertise. (see www.shef.ac.uk/~sisa/ for further information).
The section’s principal research fields are: health care needs assessment and clinical practice (Philp, Young, McKee, Gariballa); the organisation and effectiveness of health and social services for older people (Parker, Philp, Gariballa, Warnes); and meeting unmet and specialist needs (Gott, McKee, Warnes, Crane). Five EU grants since 1996 (>£1.5m) have supported Philp’s multi-centre research into older people’s health care needs assessment. Philp, Parker and Young lead the British Geriatrics Society HSR Interest Group, and SISA staff have pioneered research on: sexual health in old age (Gott), the design of nursing homes for dementia patients (McKee), and older homeless people’s services (Crane). Warnes leads research supported by Age Concern and government agencies on ageing population impacts in Yorkshire & Humberside.
SISA has collaborative projects with many European research groups, and is leading the UK contribution to the International Longevity Centre World Cities Project with collaborators in New York, Paris and Tokyo. McKee is contracted to develop research at a Swedish university. Crane has established a comparative prospective study with providers in Boston (Mass.) and Melbourne. SISA works closely with ScHARR’s Primary Care, Health Economics and PH Sections, and on NHS R&D through NHS Trusts in Sheffield (Philp), Barnsley (Parker, Gariballa) and Bradford (Young). The cross-faculty network links substantial research programmes in ageing and social policy, assistive technologies, building design, nursing, therapy, osteoporosis, molecular and genetic medicine and end-of-life care. SISA teams have grants from EPSRC, MRC, ESRC, PPP Health Care Trust and the European Science Foundation. All SISA academic staff are submitted as research active: collectively they published during 1996-2000 95 peer-reviewed papers. SISA has been designated as the EU Marie Curie Training Site for Gerontological Research Training during 2001-04.
Established in 1994, from 2001 SISA is leading the development of ‘ageing’ as an element of one of the School of Medicine’s six Research Themes. It is building a portfolio of HSR for the S. Yorkshire coalfield communities; initiating new projects on ‘assistive technologies’, older renal replacement therapy patients and nutrition; and expanding its pioneering research on assessment in primary and community care, sexual health, older homeless people and end-of-life care.

ScHARR and SISA are not conventional University departments, but are recently founded research institutions whose focus and culture is research. All of the senior management of ScHARR and SISA are research active. ScHARR’s strategic framework for 2000-2003 has as its principal aim the conduct of high quality research, particularly HTA and HSR. The research income has increased by 20% pa, and Sheffield has already established a very strong reputation as one of the UK’s leading health research groups particularly in HSR, HTA and Ageing. There are research seminar programmes in HSR, Public Health, Primary Care, Psychiatry, and Ageing with a total of 25 seminars per semester on average. ScHARR has its own research stimulation fund to pump-prime research. The fund is open to anyone in the School but is aimed at supporting junior staff.
ScHARR and SISA support 6 taught MSc programmes, with a 7th coming on stream in September 2001. Three are research methods courses which provide a free, open access modular research training programme for our junior research staff, training fellows, and other post-graduate research students from ScHARR and elsewhere in the University.
The number of post-graduate students in community-based clinical subjects has been steady over the last five years, but the number with competitive fellowship awards has increased year on year. We have now won 4 MRC training fellowships, 5 Regional training fellowships, 3 national HAZ fellowships as well as 2 national primary care development awards. There are plans to further increase the number of postgraduate research students funded through competitive fellowships, bursaries, and other studentships. Considerable attention is paid to the quality of research training and supervision and we have an active programme for establishing and supporting a postgraduate research culture, assuring the quality of supervision and addressing student progress issues.

ScHARR and SISA are housed in enviable accommodation at two main sites – on the main University campus area and at the Northern General Hospital NHS Trust. ScHARR has its own nationally renowned library (Director: Booth) offering search and information retrieval for EBM and carrying out Cochrane Reviews as well as the more traditional services. Technical infrastructure and support are first-class. Postgraduate students usually have shared offices within sections, and there are also dedicated facilities on both sites with on-line computer links.
As well as an information resources section in ScHARR, there are 11 medical statisticians, 13 health economists, and a clinical trials unit, supporting community based clinical research across the School and University. Most of the sections of ScHARR have members working with more than one of the research teams, and most projects that are undertaken include members from across the School and SISA, as well as from outside departments and Institutions. Out of 47 ongoing externally funded research projects, 15 involve collaboration across research groups within UoA2, 12 involve other departments within the University of Sheffield, 8 other Universities, and 13 NHS or other collaborators. ScHARR and SISA have 29 honorary research fellows from across the UK. The School has formal links with overseas University research groups in Leuven, Maastricht, Barcelona, Linköping, Nijmegen, Aveiro, Bielefeld, Hamburg and the Jagiellonian University Krakow.
As well as housing the core unit of the Trent Institute for Health Services Research, members of ScHARR and SISA lead the Trent Focus, a collaborative network of research practices. The N. Trent Cancer research network involves most of the Trusts in N. Trent in a collaborative research programme orchestrated from ScHARR.

The rapid growth in research activity described above has meant that most of the planned structural and staffing developments which were outlined in the 1996 RAE submission have been accomplished. ScHARR was created as a School of the Faculty of Medicine (1996); the Centre for Psychotherapeutic Studies has been established (1996) (returned in UoA11); the Information Resources Section has been expanded and now has 6 full-time staff; the developments in Age and Ageing outlined were all accomplished and the changes consolidated in the Sheffield Institute for Studies in Ageing in the School of Medicine (1998); the proposed Chair in epidemiology was not filled but two senior lectureships were established and filled instead (Payne and Maheswaran); the Chairs in Health Care Development (Edwards, recently retired) and Primary Care (Mathers) were filled. In psychiatry we have been able to go further than anticipated, appointing chairs in Clinical Psychiatry (Woodruff), Forensic Psychiatry (Cordess, UoA11) and Mental Health (Brooker, UoA 12).
In 1996, the UoA planned to develop its HSR focus in health outcome measurement and valuation, HTA, especially in trauma care; community services for the elderly; patient care at primary/secondary and health/social care interfaces; research into introduction of evidence based medicine; health informatics; and sociology and health care. Most of this strategic plan has been fulfilled as is evidenced by the research groups and their activities summarised above.

Support and training for research staff. The University provides a comprehensive Staff Review and Development scheme which ScHARR supplements by providing training and development funds for all research staff to enable them to take specialised courses, and to attend and contribute scientific papers to conferences and meetings. Younger researchers are particularly encouraged to contribute to conferences, and the University travel fund administered by ScHARR is primarily aimed at supporting junior academic-related research staff. Indeed it is an explicit part of ScHARR’s policy that such staff are to be treated on exactly the same footing as established academic staff. We have created established (ie. not time-limited) contracts for several research staff. Research contract staff have the same rights to study leave, the same promotions board, common career pathways, and the same access to travel, training, and staff development funds as established staff.
Junior staff are encouraged to register for higher degrees if appropriate, and time is usually set aside for them to complete their degrees (since April 1996 5 full-time staff have completed higher research degrees).
Staff profile. There have been several major additions to the staff since the last RAE. The notable addition of Woodruff as Professor of Psychiatry has led to a strategic policy to develop a research focus in neuro-imaging in psychiatry and has resulted in the addition of Spence and Papadakis this year, and the establishment of four further posts. Professors Parker and Young joined SISA and this is now one of the country's largest academic research groups in ageing. Campbell and Machin have joined the Institute of Primary Care to provide further expertise in Medical Statistics. Hutchinson was appointed Professor of Public Health Medicine and has developed a large programme of research into effective primary health care and has overseen the development of the geographical variations research programme with the appointments of Payne and Maheswaran, both in the last 4 years. The development of the Sheffield Health Economics Group has continued with the appointment of Dolan, Shackley, and Roberts (returned in UoA 38, Economics), and this is now one of the UK’s leading health economics groups. Jolly was recruited in 1999 and is now leading a growing programme of research in medical education based in the Institute of Primary Care.

There have been no notable departures.

Users of this website should note that the information is not intended to be a complete record of all research centres in the UK

Copyright 2002 - HEFCE, SHEFC, ELWa, DEL

Last updated 17 October 2003

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