Friday, 21 April 2023

A public partner’s guide to podcasting

Posted by Victoria Bartle, Fuse Public Partner, with tips for guests from Cassey Muir, Fuse & NIHR School for Public health Research (SPHR) funded PhD Researcher from Newcastle University

Everyone seems to have a podcast these days and there are lots discussing research, but how many can say that they are totally led by the public? I have been participating in public involvement in research since 2016 and believe that it is a vital part of improving everybody’s health, but find that getting other people involved and informing the public about research projects is really difficult.

I was excited to be involved with the Fuse podcast Public Health Research and Me as I’ve wanted to start my own for a while now, and felt as if this would be a perfect opportunity to learn about podcasting and give it a try, as well as being part of creating a platform to help engage the public in research and hopefully increase awareness and involvement. I joined the podcast team made up mainly of other public partners and took part in some excellent training which went through equipment, hints and tips for selecting guests, how to phrase and deliver questions, different podcast formats, as well as recording and editing. I was buzzing after the training and keen to get started.


I was lucky enough to be selected to be the first host for the podcast and was matched with Cassey Muir, one of the Fuse researchers who is working with children and young people who have been affected by parental substance use. Her work is fascinating and I was soon enthralled reading everything I could to prep for the interview and come up with a very long list of questions. As brevity is not my forte the rest of the team helped to cut these down to around five or six questions which is about all that you need to create a 30 minute podcast.

We then had a pre-record meeting with Cassey, where we discussed the questions. Talking to her about her work helped me to edit and refine the questions for the interview. Once the questions had been finalised and approved by the podcast team and Cassey, we set a recording date.

I was quite nervous before the record. I’d been a panel member on a podcast before and had so many technical issues that I was really stressed and anxious by the time I managed to get everything sorted. So for this recording I made sure I had tried all of the equipment and was all set up with my notes, drinks, tissues and cough medicine…because of course I had a cold! Recording when one of the presenters keeps coughing is really difficult for the editor, but Cassey was a pro and kept pausing whenever I coughed so that we would have a second or two to edit it out. We talked for ages and the record went really well. I was able to bring in some of my own lived experience of the topic and this helped to make the conversation more natural and less like me firing questions at Cassey, although I did say “wow” and “that’s amazing” a lot which I was determined not to do as much the next time.

Now to the technical part! Although we had had some training on editing podcasts, the team decided to use an external editor as we wanted it to sound as professional as possible, and none of us were confident in using the software just yet. Listening to the edited version we were able to make requests for changes, but I felt that it generally sounded great, and asking to cut out all of my embarrassing “wows” was my own issue and not necessary. We had to write our bios to go with the podcast, an overview of what it was about, and make sure that the projects and references that we discussed were all available for the listeners to link to directly from the podcast page.

Going live was exciting, I sent the link to all of my friends and family, it was tweeted on the Fuse twitter feed and is also on the Fuse website so everyone can access it. We’ve had over 100 listens and the bonus video has had nearly 300 views so far. I’ve had lovely feedback from my friends and family who said they found it really interesting. My Mum was especially impressed as she now has something that she understands to tell people when she’s trying to explain what public involvement in research is and what I do.

Round two  

The second recording went a bit differently. I had loads of background information to read about Eugene Milne, his career history, his involvement in establishing Fuse, his role in public health and his recent MBE which was all very exciting. I had lots of questions about all of the different projects that he had been involved in, their impact on public health in the North East, as well as his plans for retirement, but during the pre-record chat I decided to take a more focused direction as his responses to some of the topics were just so interesting. We narrowed it down to his involvement in establishing Fuse, what his initial expectations were and how he feels it has developed over the past 15 years; the impressive results from the public health initiatives that he oversaw (including North East tobacco and alcohol control programmes Fresh and Balance); as well as responding to Covid-19 during his time as the Director of Public Health for Newcastle.

Again the public partner team reviewed the questions and the theme of the podcast and we went ahead with the recording. This time I didn’t have a cough which made recording much easier, but I still responded with lots of “wow’s” and “that’s amazing” as I found Eugene very engaging and his career so interesting. I then got myself a bit confused towards the end of the record. I’d skipped a question as it didn’t fit with how the conversation was flowing, but I wanted to come back to it at the end. I’d already said the outro lines so I had to pause for a second or two, ask the missed question, and then remind the editor to swap the order of the last two sections around. I was a bit embarrassed about this, but it was absolutely fine and you can’t tell in the final version.

Things don’t always go to plan

The third recording with PhD student Joanne McGrath has been different again. We had already decided to focus on one of Joanne’s current projects looking at women experiencing homelessness as it fitted in with International Women’s Day and an event that Fuse was hosting for the occasion. This meant that I had a bit less reading to do while prepping the questions this time. They were approved by the podcast team and Joanne, and she steered the direction of the podcast from the outset as she knows her research best and which areas are being focused on currently. The recording has been beset with challenges, technical issues, diary clashes and unavoidable life events that have meant that we have had to postpone the recording three times. Is it cursed!?

These challenges actually led us to writing this blog, as well as the hints and tips below. We have all learnt so much from the first three podcasts and as I pass the hosting responsibilities to the next public partner we wanted to make sure that we were learning from our experiences. At the point of writing this blog, we have now managed to record Joanne’s episode, so keep an eye out for it. Her work with women experiencing homelessness is so important and will benefit an often overlooked group of people by supporting positive changes in their lives.

Our top tips for podcasting

For hosts

Preparing for the podcast:

  • Give yourself enough time to read through all of the guest’s work and discuss with them and the team the possible theme of the interview.
  • Write down all the questions you can think of; you can always edit and rearrange the order later.
  • Have a pre-record meeting with the guest; this helps you and your guest to feel comfortable, and to try out the microphone and recording platform. This can also help to define the questions and theme of the podcast.
  • After the guest and the team have reviewed the questions and decided on five or six to use, arrange them in an order that should flow like a conversation.
  • Write your own intro, a couple of sentences about yourself to introduce you to the listeners and practice this a few times so that you are familiar and comfortable saying it.
  • Also practice the intro and outro sections that have already been created, changing some of the words if it fits better with how you speak.
The podcast recording:
  • Login to the meeting for the record early, have everything you need set up around you, and make sure you have all devices on silent so you won’t be disturbed.
  • Check the mic in advance, you may need a USB port to attach to your computer and headphones with a connector jack. If you use an Apple Mac (or similar) you may have to use a USB adapter.
  • Place the mic approximately 15cm (6”) in front of you.
  • Find a small quiet room that is preferably well furnished to absorb any echo.
  • Have a little chat with the guest, try to make them feel comfortable and start when you’re both ready.
  • Mute yourself if you need to cough, sneeze or drink etc.
  • Avoid rustling any paper or notes that you may have prepared.
  • Turn off non-essential devices using wifi and reduce the tabs/windows on your device. This will reduce the likelihood of buffering during the Zoom/Teams call.
  • If you do cough, sneeze or make a mistake then pause for a second or two and start again (or mark by saying “edit point”), this gives the editor a space to remove the noise.
After the recording:
  • Re-record any sections you feel necessary, or let the team know if you think a section will need to be moved, cut or edited and they can pass this on to the editor.
  • Once the edited version comes back, with the “umms”, “aaahhhhs”, coughs (etc.) removed, you will be able to listen through and request any further edits that you’d like.
  • Write a bio and provide a photo to go on the podcast platform.
  • Help with any promotion through your own networks, and enjoy listening!

For guests

Preparing for the podcast:
  • Identify and share your relevant publications, resources, and information with the host and podcast team, which allows them to focus the conversation and questions (e.g., do you want to provide a wide variety of resources or only those on a specific topic?).
  • Help clarify any specific points of interest or themes you would like to get across about your work as this will help with determining relevant questions.
  • Pre-record meetings and/or emails are helpful, which can take away some of the nerves by building a relationship with the host or testing out the equipment.
  • Ask for a copy of the questions if you would like to make notes and think about your answers ahead of time.
The podcast recording:
  • This should be/is a fun experience where you get to talk about your work with someone who is keen to listen and explore different topics with you. It is a great chance to discuss your research in a way that you might not normally and possibly from a different viewpoint, so try to ease into it and enjoy it. If you lose your train of thought or stumble over your words it is okay, that is the benefit of editing and not being live.
  • If you have made them, have your notes to hand, either printed (but not rustling) or on the screen to help you remember important points that you want to make during the podcast.
  • As this is meant to be somewhat conversational, remember to go with the flow of questioning as some of your answers may spark interesting follow-up questions that you are unprepared for.
After recording:
  • Ensure you have provided links to the important items you discussed during the podcast, which can then be shared alongside the podcast.
  • You get to listen/watch through the edited podcast before it goes live, which is your chance to highlight any changes you would like to be made (although the editing team do a fab job, so there may be no necessary changes at this stage).
  • Once the podcast is live, this is a great opportunity to share your work and the podcast with relevant networks and/or on your social media.
  • Enjoy listening or watching the podcast!

Friday, 17 March 2023

What can be done to improve the mental health of LGBTQ+ young people in schools?

By Liam Spencer, Research Assistant and ARC NENC Mental Health Research Fellow, Fuse & NIHR School for Public Health Research, Newcastle University

Young people who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) experience significant mental health inequalities in comparison with their peers. School environment is a major risk factor and is consistently associated with negative mental health for LGBTQ+ young people, as shown in research herehere and here. The UN Convention for the Rights of Child Committee has also specifically emphasised the need to take effective action to protect LGBTQ+ young people from all forms of violence, discrimination or bullying, and to improve mental health.

Our research

Our Creating LGBTQ+ Affirming School Environments (CLASS) research project aimed to investigate the impact of school-based interventions (schemes or initiatives) on the mental health of LGBTQ+ young people. In the first stage of our study, we reviewed published evidence, and identified positive interventions that supported LGBTQ+ mental health in school, however the focus tended to be on the outcomes rather than detailing how they were done.

We also interviewed 10 young people aged between 13 and 18 years, nine practitioners (e.g. people working in organisations who had delivered LGBTQ+ inclusivity interventions in UK schools), and three members of school staff, and analysed the data to identify interventions that improved mental health. We used this information to develop a theory model that aimed to explain how, why, for who, and in what context school-based interventions can prevent or reduce mental health problems in LGBTQ+ young people, in collaboration with these key stakeholders.

McDermott, E. et al. Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality:
A Realist Approach. Int. J. Environ. Res. Public Health 2023, 20, 4274.

Our model (diagram above) has three levels at which interventions may work, on psychological, behavioural, emotional, cultural, and social levels. It explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils’ mental health. 

Our findings

We found that contextual factors such as a ‘whole-school approach’ and ‘collaborative leadership’ were crucial to the delivery of successful interventions. Our theory suggests three ways (causal pathways) that might improve mental health:
  1. Interventions that promote LGBTQ+ visibility and ‘usualise’ the presence of LGBTQ+ identities, school belonging, and recognition.
  2. Interventions for talking and support that develop safety and coping.
  3. Interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety.
Our findings suggest that providing a school environment that affirms and ‘usualises’ LGBTQ+ identities, and that promotes school safety and belonging can improve mental health outcomes for LGBTQ+ pupils. The causal pathways we present are a starting point as theories, however more research to develop our understanding of how school interventions work to improve school climate and the mental health of LGBTQ+ young people is needed. We now need the UK, and other countries, to take seriously LGBTQ+ young people’s rights and ensure they are afforded equal respect and protection as their peers in schools. We may then find that the mental health of LGBTQ+ young people improves.

Read the full research paper here: Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach, 28/02/23

Funded as part of the NIHR School for Public Health Research (SPHR) Public Mental Health programme, the Creating LGBTQ+ Affirming School Environments (CLASS) research project, led by Professor Liz McDermott, aimed to investigate the mental health impact on LGBTQ+ young people of school-based interventions. Fuse is a founding member of the NIHR SPHR.

Friday, 10 March 2023

North East women share their experiences of inequalities in powerful poems for International Women's Day

Posted by Claire Smiles, Fuse PhD student from Newcastle University and experts by experience Marie Warby and Kayleigh Cookson

Presenters and experts by experience at the Fuse event on International Women's Day 
On International Women’s Day 2023 we at Fuse celebrated by showcasing the lived experiences of women in the North East. This event brought together experts by experience, researchers and practitioners who engaged with presentations, shared experiences and devised top priorities to tackle women’s health inequalities. 

I presented the early findings from the ‘Women’s Sexual Wellbeing’ study alongside wonderful women with lived experience. During my presentation Marie and Kayleigh shared powerful poetry they had written for our IWD Fuse event. Their poetry about womanhood and motherhood reflected on personal experiences and demonstrated the challenges and the resilience of women. A big thank you to Marie and Kayleigh for agreeing to share their poems in this blog post and to Kirsty for taking the videos below.

Catch up with all the discussion on Twitter using #FuseRE and International Women's Day using #IWD2023 and #EmbracingEquity. For more information about the event visit the Fuse website.

** Content/trigger warning: adult language and references to abuse and suicide **

Womanhood by Marie Warby

The road to womanhood wasn’t so kind to me. 

I look at infancy and I see abuse; I look at puberty and I see a noose. 

A very painful past as I recall, I didn’t allow it to stop me, I refuse to fall. 

I felt like an adolescent, stuck in a woman’s body, 

Screaming out hoping someone would hear, my body always stuck in a constant state of fear 

Very submissive that’s what I’d become, all I needed was a way to find home. 

Without a map nor a tool, just a woman to teach me from her school, 

A wealth of knowledge to show me the way, I know ill be powerful and independent one day. 

My inner child is reaching out and ready to kneel, this little girl needs to heal. 

With a blank sheet of paper where do I start, it's time to mend my broken heart. 

I look at my past with no regret, for every challenge of womanhood I’ve met. 

To say it’s been easy that would be wrong, and here I stand singing my song. 

Shining a light for others to see, some days I can’t believe it's me. 

Womanhood is such a beautiful place to be, and now finally I can nurture Marie.

Needs to be everything by Kayleigh Cookson


The expectations of a mother is not easy,
I need superpowers and multi-tasking skills.
I have to be a role model and provide a clean tidy house,
I have to budget and pay all the bills.

I need to be very organised,
Always plan ahead every time I go shopping.
I have to be a cook, a baker, I'm never out the kitchen,
And I am a professional at washing.

I need to be brilliant at cleaning,
Wash the dishes, hoover up, pick up mess.
I have to negotiate and play referee,
My patience constantly at test.

I need to be very responsible,
Be a doctor, nurse, councillor, therapist.
I have to be handy at odd jobs round the house,
There's no problem that I cannot fix.

I need to be an expert encyclopaedia,
To answer all the why's, how's, what's, where's and when.
I have to be fun and play lots of games,
Again and again and again.

I need to be a smart tutor,
Help with homework, teach right from wrong.
I have to be a PA, hairdresser, taxi driver,
And always put things back where they belong.

I need to make lots of dreams come true,
I am Santa, the tooth fairy, Easter bunny.
I have to cure boredom on cold and wet rainy days,
Go out and make memories when it is sunny.

I need to be rich with empathy,
Be supportive, wipe away lots of tears.
I have to be a hero and never be scared,
And chase away all the nightmares and fears.

I need to be a care giver,
A good communicator and be able to detect lies.
I have to be an agony aunt and a shoulder to lean on,
I've got to know how to save lives.

I need to be an active listener,
Good at advice and have psychic abilities.
I have to be ready and always prepared,
To provide mental and emotional stability.

I need to be loving and caring,
Tend to wounds, scars, bumps, patch up scrapes.
I have to be a healer and always the best one,
To pick up pieces every time a heart breaks.

I need to be strong, be a survivor,
Put on a brave face no matter the weather.
I have to paint on a smile, show no pain, head up high,
Always cope, always hold it all together.

I need to always have time,
There's no relax, no switch off, no escape.
I have to put everyone's needs above my own,
Oh the guilt if I make a mistake.

I need to never be ill,
Cope with bleeding monthly and raging hormones.
I have to put up with mood swings, hot flushes and cramps,
Then not to mention the menopause.

I need to be forever perfect,
Can't shout or swear coz I'll face stigma and shame.
I have to never go out coz I'll be a bad mam and a slag,
Not worthy, always judged, the one to blame.

The expectations of a mother is not easy,
I need to also then be a friend, a partner, a wife.
I have to be a daughter, a sister, an aunty, a nana,
I am never just me, a woman living my life.

Friday, 10 February 2023

Treats: a helpful reward, or to be approached with care?

Posted by Anita Attala, Lead Adult Weight Management Dietitian from Northumbria Healthcare NHS Foundation Trust, and research team from Teesside University

We all like to have a ‘treat’ and to give ‘treats’ to others. Indeed, the use of food, and in particular what we in public health call ‘high fat, sugar, and salt’ containing foods or ‘HFSS’, are often chosen as rewards. The notion of food cultures is certainly a social anthropological (study of humans) concept, with an example being the use of food in positive reinforcement; using ‘treat’/HFSS foods to reward children in particular. Taken at ‘face-value’ such treats may appear harmless, however repeated use of HFSS in this way has been shown to physiologically influence the human food reward system, and impact on our ability to regulate how much food we eat. This, together with other detrimental impacts, has led to advice not to regularly use food as a reward. Research has also shown that using food rewards in adults can hinder healthy weight management, especially from a psychological perspective.

But what exactly is a ‘treat’? Why do we feel the need to ‘treat’ someone? Are ‘treats’ always a positive experience or can they be used in a detrimental or harmful way?

While working in a forensic service I saw patients gain weight, and often gain this weight very rapidly. I also noted that some staff seemed frustrated and concerned about the weight gain some patients experienced. However, I also noticed that HFSS food was frequently used as part of patient care. This sparked my interest in wanting to understand this apparent conflict.

Forensic services provide care for people with a severe mental illness or learning disability, who have committed a crime but are too vulnerable to be in prison. For example, they are high risk either to themselves or the public, and therefore are unable to live in the community. People in these environments are often here for a long time and are reported to die 15-20 years prematurely, often from avoidable diseases. There are often restrictions imposed on the person and their environment. These restrictions will depend on the level of security required and the risk posed by the patient, and can be directed by the Ministry of Justice. An example of a restriction might be the person is not able to leave the ward.

Limited research seems to have been undertaken around the use of HFSS food ‘treats’ for adults, let alone adults who are in hospital. Yet, it is something many of us seem primed to do – bring (HFSS) food to someone when they’re ill.

The word ‘treat’ conjures up a particular thought of food – which is often high in calories, high fat and high in sugar. What you view as a ‘treat’ and how to ‘treat’ can often have been learnt in childhood and can differ from person to person. But, while it is entirely possible to have a non-food ‘treat’, it’s often harder to think of one and can be more difficult to provide while in hospital (particularly one with restrictions such as forensic wards).

You could argue that ‘treats’, by definition, can only be a ‘treat’ if you don’t consume them on a regular basis. As research shows, regular behaviours of any kind, can soon develop into habits.

Wanting to learn more about the use of ‘treats’ to show care and kindness, particularly in a hospital setting, I applied for research funding from my Trust (Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust). Also, in 2020, I was successful in obtaining a clinical academic internship with Health Education England (HEE) and the National Institute for Health and Care Research (NIHR). Both awards enabled me to research the use of treats in forensic inpatient care settings.

Using this funding, I decided to focus on whether ‘treats’ were being used to prompt a particular behaviour from a person, while in inpatient care settings; whether these ‘treats’ impacted on a person’s weight and physical health; and why treats were chosen and if it was related to ideas of care and kindness. Certainly, from my observations this is what seemed to be happening - often perhaps unconsciously – but this research allowed us to evidence what may be happening.

What we found

Our research into treats in the health care sector has now been published. It found that treats were used for a number of reasons including:
  • Being an affordable way to reward someone
  • An incentive to encourage patients to participate in activities, and
  • A way to express love/care for someone.
Of course, food as a bonding mechanism is not a new phenomenon, and the idea of certain foods providing comfort is well-established.

It’s entirely possible to have ‘treats’ as part of a healthy balanced diet, and that the origin of using HFSS as treats may be from a place of nurture, but the advice is that food treats should be infrequent and limited in quantity. While it would appear ‘easy’ to say that those working in institutions, like in NHS care services, need to be mindful of how food is being used, our research findings suggest that it may take a much bigger system/cultural change to reduce the use of HFSS as treats in services. I think the idea of a ‘positive food culture’ is useful here. One where the focus is on preserving and nurturing good health and wellbeing through the use of healthy, positive, food behaviours, attitudes and values.


Anita Attala, Lead Adult Weight Management Dietitian from Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, and postgraduate student from Teesside University.

Jo Smith, Consultant Dietitian (Clinical Academic) from Tees, Esk and Wear Valleys NHS Foundation Trust, and PhD student from Teesside University

Amelia Lake, Fuse Associate Director and Professor of Public Health Nutrition from Teesside University

Dr Emma Giles, co deputy-lead of the Fuse Behaviour Change Theme and Associate Professor Public Health from Teessside University

  1. Alonso-Alonso M, Woods SC, Pelchat M, Grigson PS, Stice E, Farooqi S, Khoo CS, Mattes RD, Beauchamp GK. Food reward system: current perspectives and future research needs. . Nutr Rev 2015;73(5):296-307.
  2. Roberts L, Marx JM, Musher-Eizenman DR. Using food as a reward: An examination of parental reward practices. Appetite 2018;120:318-326.
  3. Hsu A BA. Designing for Psychological Change: Individuals’ Reward and Cost Valuations in Weight Management. J Med Internet Res 2014;16(6).
  4. Attala A, Smith J, Lake AA, Giles E. Investigating ‘treat culture’ in a secure care service: a study of inpatient NHS staff on their views and opinions on weight gain and treat giving for patients in a forensic secure care service. J Hum Nutr Diet 2023; 1-13.
  5. Human Relations Area File. Craving comfort: bonding with food across cultures. 2023; Available at:
  6. Mingay E, Hart M, Yoong S, Hure A. Why We Eat the Way We Do: A Call to Consider Food Culture in Public Health Initiatives. International journal of environmental research and public health 2021; 18(22)

Friday, 3 February 2023

Welcome to your Wrapped, Fuse Open Science Blog

Posted by Mark Welford, Fuse Communications Manager, Teesside University

If you use Spotify (other streaming platforms are available) then you will no doubt have received your own personalised ‘Wrapped 2022’. A helpful (if somewhat creepy!) summary of your annual listening habits in one eye-searing psychedelically coloured package. Apparently, my most listened to song in 2022 was Baby Shark - I have a 3 year old.

Around this time of year I do a similar (if slightly less garish) job of pulling together the top 5 Fuse blog posts from the previous year.

But this year is a little different.

It’s award season and this year the blogs listed below were in the running for a coveted gong. Not at the GRAMMYs, Oscars, Emmys, BAFTAs, or BRITs but the (much more prestigious) first ever Fuse Awards!

Earlier this week (30 January), the post with the most views was crowned best blog of 2022 with the author awarded a shiny trophy at our ceremony in Durham *link may contain SPOILERS*.

So without further ado, here is the full list of the runners and writers in reverse order, culminating with the post that received the most views...

Posted by Tim Townshend, Professor of Urban Design for Health, Newcastle University

“...primarily designing around the needs of the private car - rather than humans - has been a disaster.”

Prof Townshend explores how we can plan for a healthier future by intervening in the built environment. From the 'toxic high street', to the green (and blue) spaces in our cities that encourage physical activity and social interaction, positive for physical health and mental wellbeing.

Posted: 13 May 2022

4. Science, and the art of communication

Posted by Louis Goffe, Research Associate, NIHR Policy Research Unit in Behavioural Science

"...building the evidence-base isn’t enough, we all need to work on at least one aspect of the artistic craft of research promotion."

COVID19 has brought into sharp focus that health promotion takes more than good science, there is an art to the delivery. In this post, Louis explores vaccine misinformation, the infodemic, involving the public and advocacy.

Posted: 28 January 2022

3. What support do children and young people actually want when their parents use drugs and alcohol?

Posted by Cassey Muir, Fuse & NIHR School for Public health Research (SPHR) funded PhD Researcher from Newcastle University and Kira Terry, Lived Experience Expert.

“No-one has ever asked me about how I feel in any of this.”

Fuse PhD student Cassey shares her research aiming to understand the experiences, perceived impacts and coping strategies of young people whose parents use substances. The post ends with Kira’s thoughts about contributing to the project as a Lived Experience Research Advisor.

Posted: 9 December 2022

2. Is a picture truly worth a thousand words?

Posted by Emma Adams, NIHR ARC NENC Mental Health Fellow at Newcastle University, and Experts by Experience from Fulfilling Lives Newcastle Gateshead & #HealthNow Newcastle

Find out how Emma and her Experts by Experience worked together to develop striking visuals to share what they had learned from a study exploring access to community based mental health and substance use support during the COVID-19 pandemic for individuals experiencing homelessness and those providing support.

Posted: 25 March 2022

And in at number one our award winner...

1. Universal Credit experiences and research co-production

Posted by David Black, Fuse Public Partner and Expert by Experience. Introduction by Mandy Cheetham, Research Fellow in the Applied Research Collaboration North East and North Cumbria (ARC NENC), Northumbria University

“In the past I'd always found the process of seeking
 help from the unemployment benefit system to be
 relatively easy, but Universal Credit was a disaster
 for me.”

Ever wondered how you could help shape research as a member of the public? In this Fuse blog, David shares his personal experiences of claiming benefits and how this has informed research to assess the impact of Universal Credit.

Posted: 11 March 2022

Below is a photo of David (second from the right) along with the other Fuse Award winners. Congratulations to all! 

Catch up with all the award winners using #FuseAwards23 or see the event programme on the Fuse website for all those shortlisted.

Join Fuse to be in with a shout of winning a coveted Fuse Award in 2024!

Friday, 27 January 2023

Public Health at a crossroads again: meeting the challenge of a reformed system in England

Posted by David Hunter, Newcastle University, Peter Littlejohns, King’s College London, and Albert Weale, University College London

With health policy understandably preoccupied with the pressures on, and changes occurring in, the NHS arising from the impact of COVID-19, implementation of the Health and Care Act 2022, and various strikes among the workforce, it is imperative not to overlook the public health system reforms in England.

Public Health England’s (PHE) sudden demise in August 2020 followed mounting criticisms of its performance during the early stages of the pandemic and general unpreparedness.1 Rather than consider how PHE might be reformed, the government rushed to replace it with two new bodies: UK Health Security Agency (UKHSA), and Office for Health Improvement and Disparities (OHID). Like PHE, the UKHSA is an executive agency with close ministerial oversight while still permitting ‘independence in the delivery of policy advice’. It will act as a ‘system leader’ for health security with responsibility for pandemic preparedness and external threats across the UK while bearing in mind that health is a devolved responsibility.

PHE’s remaining functions in respect of the wider public health, including health improvement and population health, lie with OHID. Located within the Department of Health and Social Care (DHSC) and jointly accountable to the Secretary of State for Health and Social Care and the Chief Medical Officer for England, it enjoys even less independence than the UKHSA. Building on the work of PHE, OHID’s priorities include tackling obesity, improving mental health, promoting physical activity and other population health issues, notably inequalities.

There is merit in taking stock to identify any lessons which might be gleaned from the mixed life of PHE and whether the new bodies offer hope to do things better.2

Learning the lessons

The findings from a research project to explore the circumstances surrounding the rise and fall of PHE may assist with the learning process.3 Five broad underlying issues were identified in the research which contributed to PHE’s demise.
  • PHE did not possess the capacity to undertake a testing regime
     of the size and complexity required by the pandemic
    Severe funding cuts in public health spending, nationally and locally, since 2010 meant that PHE functioned with reduced capacity when the pandemic struck
  • PHE did not possess the capacity to undertake a testing regime of the size and complexity required by the pandemic, the absence of which was the basis of the case against the organisation
  • The governance of PHE as an executive agency meant it lacked independence
  • While decisions made by PHE at the start of the pandemic were later considered mistakes (and judged outside the law by a judicial review) at the time there was little information about the nature and possible effects of the virus and limited capacity in the health system which required tough prioritisation decision to be made
  • The sudden closure of PHE without any consultation was widely reported to be due to blame-avoidance behaviour on the part of key actors, principally Dominic Cummins (as former Chief Advisor to the Prime Minister, Boris Johnson) and Matt Hancock (as former Secretary of State for Health and Social Care). There was also a view that the decision was based on policy favouring use of the private sector and contracting out functions like test and trace.
Key lessons from these findings centre on two major areas of concern: the respective remits of the new bodies, and their governance.


The respective remits of UKHSA and OHID need to be clearer and more transparent if the risk of fragmentation is to be avoided. A welcome feature of PHE was its attempt to bring together the key public health functions that had previously operated in separate silos. As things now stand, separating communicable diseases (CDs) from non-communicable diseases (NCDs) is a retrograde move since, as the pandemic highlighted in stark terms, close links exist between them when it comes to those groups and communities which suffered most in terms of illness and death. A syndemic understanding of diseases and their underlying social factors is pivotal in preventing disease in the future and avoiding fragmentation.4


Governance of the new public health bodies requires careful attention. As an executive agency, PHE was criticised for its lack of independence from government which restricted its ability to ‘speak truth to power’. Given UKHSA enjoys the same status, it remains unclear how it intends to avoid a similar fate. The problem is a deep-seated and pervasive one within government. The idea that OHID being housed in the DHSC will allow it to exercise greater influence and have a closer collaboration with ministers could be a good move, or, more likely if history is any guide, it may be overly optimistic. There is a risk that OHID may disappear into Whitehall and become invisible, lacking even the limited degree of independence PHE had. To succeed, OHID has to be visible and have allies inside government.

A further issue concerning the governance and working style of both agencies, especially OHID, centres on their ability to operate effectively across government. Public health comprises numerous ‘wicked issues’, that is, multi-faceted problems that are complex and for which there are no simple or single solutions. Confronting them will be especially challenging for a government which, for all its rhetoric about ‘levelling up‘, remains topic- and department-focused, operating in silos rather than concerned with cross-government issues.5

OHID has a steep hill to climb if it wants to lead a transformational agenda across the wider determinants of health which demands a whole-of-government approach. The hill just got steeper following government delays in tackling child obesity and its failure to implement a national food strategy. In keeping with the prevailing political ethos, there is a renewed focus on individual behaviour change and lifestyle choices rather than tackling the influence on health of commercial interests via taxation and regulation.6,7 If significant inroads into the population health agenda are to be made, then confronting powerful vested interests in, and lobbying from, the food and drinks industry and their ’friends’ in government engaged in what has been termed ’institutional corruption’ cannot be avoided.8 Whether OHID has either the backing from government or competences for such a struggle remains doubtful in the extreme.


Public health once again finds itself at a crossroads. It can either continue to ‘muddle through’ with a broken political and public policy system that is not fit for purpose.9 Or there is an opportunity to construct a strong and confident public health system that is well-placed to confront the challenges facing it. The aftermath of COVID-19 should make the choice of options self-evident. However, as things stand, it is unlikely that the UK’s broken political system with its focus on short-term fixes is up to the challenge. Without major systemic change aimed at overhauling the UK’s political system, a risk of further deterioration in the state of the public’s health may be unavoidable.

  1. Calvert J, Arbuthnott G. Failures of state: the inside story of Britain’s battle with coronavirus. London: Mudlark, 2021.
  2. Vize R. Controversial from creation to disbanding, via e-cigarettes and alcohol: an obituary of Public Health England. British Medical Journal 2020; 371:m4476
  3. Littlejohns P, Khatun T, Knight A, Hunter DJ, Markham S, Coultas C, Kelly MP, Ahuja S. (2022) Lessons from the demise of Public Health England: where next for UK public health? London: NIHR ARC South London.
  4. Horton R. Offline: COVID-19 is not a pandemic. The Lancet 2020; 396: 874.
  5. Pope T, Shearer E, Hourston P. What levelling up policies will drive economic change? The need for a long-term focus on skills and cities. London: Institute for Government, 2022.
  6. British Broadcasting Corporation (BBC). Junk food: obesity strategy falling apart, Jamie Oliver says. 15 May 2022
  7. Ralston R, Smith K, O’Connor CH, Brown A. Levelling up the UK: is the government serious about reducing regional inequalities in health? British Medical Journal 2022; 377:e070589
  8. Draca M. Institutional corruption? The revolving door in American and British politics. SMF-CAGE global perspectives series: 1. 2014.
  9. Ricketts P. Hard choices: the making and unmaking of global Britain. London: Atlantic Books, 2022.

David J Hunter, Emeritus Professor of Health Policy and Management, Population Health Sciences Institute, Newcastle University

Peter Littlejohns, Emeritus Professor of Public Health, Centre for Implementation Science, Institute for Psychiatry, Psychology and Neurosciences, King’s College London

Albert Weale, Emeritus Professor of Political Theory and Pubic Policy, University College 

The views and opinions expressed by the authors are those of the authors and do not necessarily reflect those of Newcastle University, King’s College London, University College London, or Fuse, the Centre for Translational Research in Public Health.

Friday, 6 January 2023

What’s really going on when a child is ‘overtired’ – and how to help them have a silent night in the New Year

Posted by Helen Ball, Professor of Anthropology, Director of the Durham Infancy & Sleep Centre (DISC), and Fuse Associate at Durham University

Anyone who’s cared for a young child will recognise the signs. They’ve had too little sleep or missed a nap, they’re cranky, tearful, and stroppy, and they can’t or won’t fall asleep. They are “overtired”. But is such a thing really possible – to be more tired than tired?

What we tend to call overtiredness happens when an emotional state, such as anxiety, distress or fear, blocks our ability to go to sleep even when we’re really tired. This is a survival response that helps us to stay awake when in danger, no matter how tired we are. It suggests overtiredness can be reframed to help us better respond to our child’s needs when it happens.

At the end of the day, the feeling we have of needing to sleep is called sleep pressure. The longer we stay awake the more sleep pressure rises. Typically, the higher it gets, the easier it is to fall asleep. If we stay awake for long enough, eventually we’ll fall asleep even if we are trying not to.

The sensation of sleep pressure is caused by the build-up of chemicals (called adenosines) in the brain. These are proteins that are removed from our brains while we sleep, and build up again while we are awake.

For adults, this process takes about 14-16 hours. When we delay sleep past this point the build-up of adenosines cannot go on unchecked. At some point, eventually, we must sleep.

Babies’ sleep pressure builds up more quickly than adults. Young babies often fall asleep after being awake for an hour or two. As children get older, sleep pressure builds more slowly. But it takes several years until a child is able to stay awake all day.

What stops us sleeping?

To fall asleep we must be calm, relaxed and able to switch off our brains so that the build up of sleep pressure can tip us into sleep. When something blocks the action of sleep pressure, such as fear, pain or racing thoughts, we may struggle with sleeplessness.

In the same way, sleep happens more easily for a baby or child when sleep pressure is high, they are in a calm relaxed state, and nothing is preventing sleep onset. But sometimes babies and children need help to become calm before sleep pressure can kick in and they can nod off.

When a baby or young child’s sleep pressure is high and the need to sleep is strong, but they are emotionally unable to calm themselves, or they are in a situation where they cannot relax – where there is noise, lights, or activity – we may label them as overtired. Emotional exhaustion, which is a form of stress, prevents both children and adults from sleeping and makes them cranky.

Some responses to overtiredness are heavy-handed. Ordering a child to their room, putting them to bed in the face of distress or punishing them for not falling asleep when told to do so will dial up the child further and push sleep further from reach. After all, none of us can fall asleep on command.

Helping babies to sleep

In this situation, we must remember that babies and young children need our help to manage their emotions. It is our job as parents to help them become calm, dial down, and relax in preparation for sleep.

We can do this in many ways. Physical contact such as cuddling, rocking, stroking or patting works for most children, although it must be remembered that some neurodivergent children can find touch irritating rather than calming.

Non-contact methods also work. The presence of a relaxed slow breathing adult can calm a child, as can listening to gentle talking, singing and humming. In the Czech Republic, there is a specific word for lying with and helping a child to relax so they can fall asleep: uspávání.

There is no name in English for the process of helping a child relax so that sleep pressure can tip them into slumber, so we often don’t discuss or acknowledge it. We can use it, though. And we can understand that what we have named “overtiredness” is the conflict between sleep pressure being high and something blocking the effect of that sleep pressure.

In this situation actively removing the blockage – fear, pain, anxiety – by helping babies and children to become calm is the quickest way to help them fall asleep.

Next time your baby is having a meltdown at bedtime, or your child is throwing a tantrum at the end of the day, hug them, cuddle them, talk gently to them and calm them. Let sleep pressure do its thing, and they’ll be snoozing in no time.

The Durham Infancy & Sleep Centre (formerly the Parent-Infant Sleep Lab) is a research centre of the Department of Anthropology. It is the home for a group of researchers examining various aspects of infant and child sleep and parenting behaviour since 1995. Its work with more than 5,000 parents and babies during the last 20+ years has substantially increased parents' understanding of babies' sleep, how best to care for babies during the night, and how best to keep them safe when asleep. 

This article is republished from The Conversation under a Creative Commons license. Read the original article.