Strengthening partnerships to improve primary care in the Deep End

Posted by Dr Angela Wearn, Associate Member of Fuse and Advocacy and Engagement Lead for the Deep End Network North East and North Cumbria

In this blog, Angela reflects on what people living in some of the region’s most disadvantaged communities have told the Deep End Network about challenges they face when it comes to accessing primary care, including attending appointments, and what we can do to improve this.

The Deep End Network is a growing GP-led international movement that began in Glasgow in 2009 as a response to the ‘inverse care law’, which is that those who need care the most often struggle the most to access it.

The North East and North Cumbria Deep End Network was established in 2020, with support from Fuse, the Centre for Translational Research in Public Health, and the NIHR Applied Research Collaboration North East and North Cumbria, creating a space for practitioners working in areas of severe socioeconomic disadvantage to share experience, shape solutions, and influence how primary care can better meet the needs of the people it serves.

Funded by the North East and North Cumbria Integrated Care Board, the Deep End Network focuses on four core priorities:

• Workforce: Building and retaining a well‑supported workforce in high‑need communities.
• Education: Strengthening training at all levels so current and future health professionals understand health inequalities and access to opportunities
• Advocacy: Ensuring Deep End practices and communities shape local and regional decisions on funding, access and service design.
• Research: Evaluating Deep End initiatives to understand what works, why it works, and how effective approaches can be scaled to improve outcomes.

Since 2023, I’ve been working as Advocacy and Engagement Lead to build and strengthen partnerships between Deep End communities, practitioners and researchers, ensuring the experiences and perspectives of underserved patients and communities inform both our research portfolio and the wider support and initiatives we offer practices.

Over this time, additional funding and support from across NIHR infrastructure, including the NIHR Applied Research Collaboration North East and North Cumbria, NIHR Three Schools and NIHR Research Delivery Network, has further supported targeted involvement and engagement work with those living in Deep End neighbourhoods, the majority of whom have had no previous experience of involvement in research or service development.

Support through the NIHR Three Schools collaboration was made possible through membership of Fuse, which is part of the NIHR School for Public Health Research, one of the three NIHR schools within the collaboration.

What we’re hearing from Deep End communities

Many Deep End patients face multiple, overlapping challenges including low income, insecure housing, poor mental or physical health, caring responsibilities, trauma, or homelessness. These pressures make it harder to engage with primary care, even when people want to.

Through conversations, workshops, and community-led sessions, people have shared why engagement can feel difficult:

• Personal pressures: the emotional and practical effort of attending can feel overwhelming and ‘too much’ on the day of the appointment.
• Feeling unheard or stigmatised: which makes reaching out feel pointless.
• Time and capacity: life can be busy, chaotic, and demanding, with health often taking a backseat.
• Overwhelming contact routes: getting through to the practice or accessing a suitable appointment can feel impossible.
• Negative past experiences: GP practices don’t always feel welcoming or safe.

Overall, I regularly hear that disengagement is rarely about disinterest, it’s about the collective barriers that build up and make staying connected to care difficult.

What communities say needs to change

Improving patient engagement in Deep End areas is complex. There is no single fix, and practices are working under significant resource constraints. But through our involvement work, communities have highlighted three priorities for investment and change that they feel would make a meaningful difference:

• Improve connection and communication
• Strengthen co‑design approaches
• Build sustainable, community‑based partnerships

These priorities align strongly with national ambitions around personalised care, prevention, and reducing inequalities, and they reflect what people say would help them feel more able to engage with primary care as the wider system shifts towards more integrated neighbourhood-level working.

Moving forward together

The NHS encourages practices to work closely with Patient Participation Groups (PPGs), but Deep End practices face additional challenges: limited resources, diverse patient needs, and complex barriers to involvement. From the community perspective, awareness of PPGs is low, confidence is often limited, and many people are unsure whether their voice will genuinely matter. To support better partnership working, the Deep End Public Advisory Group identified three simple involvement principles that are easy to remember and act upon, and clear enough to come back to when things get busy or complex:

• Make it easy
• Make it worthwhile
• Value patient experience

These principles are practical, community-informed and can be applied across a range of contexts to guide diverse involvement.

New one‑page resources for practices

To help bring these messages to life, we’ve co‑developed two infographics with Deep End patients, communities, and Nifty Fox. They distil community insights into quick, usable one-page resources that GP practices and other decision-makers can draw on to strengthen engagement and build more inclusive partnerships.

Supporting Patient Engagement in the Deep End: insights from the community
Working Better Together in the Deep End: patients and GP practices as partners

These resources will sit alongside a wider collection of materials, including a public‑facing animation and an illustrated impact report, which will be shared over the coming months. A celebration event is planned for early next year.

Why this matters

The Deep End Network exists because tackling health inequalities requires more than goodwill, it requires meaningful partnerships and system‑level commitment. These new resources are an important step in supporting practices and others to work alongside communities in ways that feel respectful, realistic, and rooted in the experiences of people who face the greatest barriers to accessing and influencing the care they receive.

We hope they support teams across the North East and North Cumbria and beyond to strengthen relationships, reduce barriers, and create primary care environments that are more responsive to the needs of communities most affected by health inequalities.

If you would like to know more about partnership working, co-production or our involvement work in the Deep End please contact Dr Angela Wearn (angela.wearn@newcastle.ac.uk)

Find out more about the Deep End Network

About the author

Dr Angela Wearn is Advocacy and Engagement Lead for the Deep End Network North East and North Cumbria and a Research Fellow with the NIHR Applied Research Collaboration North East and North Cumbria. She is also an Associate Member of Fuse, the Centre for Translational Research in Public Health.

Why safer spaces matter for young people’s physical activity

Posted by Caroline Dodd-Reynolds, Professor of Physical Activity, Durham University

Fuse Associate Professor Caroline Dodd-Reynolds explores what can be done to create environments in which LGBTQ+ young people feel safe to enjoy physical activity. Fuse blog in Pride Month.

This work forms part of the Joyful and Safe Physical Activity (JASPA) project, funded by the National Institute for Health and Care Research (NIHR). This project, and the funding that supports it, are only possible through Fuse, the Centre for Translational Research in Public Health, and its membership of the NIHR School for Public Health Research (SPHR).

The 2026 Commonwealth Games come to Scotland this summer, showcasing elite athletes at the top of their game. But for most of us, physical activity looks much more ordinary: walking to school, joining a PE lesson, dancing in the kitchen or going to the gym.

Now think about how that kind of movement feels. Easy? Enjoyable? Safe?

For many LGBTQ+ young people living in disadvantaged areas, the answer to those questions is no.

In our creative joyful and safe physical activity project, young people aged 14-21 showed us how adults can make physical activity feel more fun, safe and inclusive. They did this by reimagining what it means to be active, and by bringing colour, creativity and vibrancy into traditional sport and exercise spaces.

Around 80% of adolescents globally do not do enough physical activity, and global physical inactivity has remained largely unchanged for the past two decades. This affects growth, development, mental health and physical health. We also know that some young people face greater barriers than others, including those living in poorer areas, disabled and neurodivergent young people, and those with questions around their gender or sexuality.

Every child and young person should be able to take part in movement and physical activity without feeling disengaged, excluded or unsafe. Physical activity can, and should, bring joy. But this is not only about competitive sport, PE or joining a gym. Movement can also mean walking, dancing, playing active games, skating in the park, or simply feeling able to move through a space without fear.

In our earlier research, young people often knew exactly where they could be active: outdoors, at school or college, or in a local leisure centre if one was available. But knowing where to go was not the same as feeling able to take part. They described feeling harassed, worried, unsafe or excluded from physical activity.

We call this “physical activity insecurity”: when a young person’s ability to be active is limited because a space feels uncomfortable, exposing or unsafe. This can be especially acute for young people whose experiences of poverty, disability, neurodiversity, gender or sexuality overlap. Some transgender and non-binary young people in our research described harassment, exclusion and gender discrimination that made ordinary movement feel difficult or risky.

We worked with young people to explore what safer, more joyful physical activity spaces could look like.

Creating inclusive spaces

So what can adults, schools, youth workers, leisure centres and other community organisations do?

First, the language we use matters. Terms such as sport, gym or exercise can be immediately off-putting for some young people, especially if they already associate these words with embarrassment, exclusion or previous bad experiences.

Thinking about physical activity more holistically and using the term “movement” instead can help. Physical activity can be something as simple as walking.

Second, adults need to have honest conversations with young people about how they relate to physical activity. This might include talking about stereotypes around sport, PE or exercise, and how these make young people feel. It might also mean recognising that some young people have many other pressures in their lives, making physical activity feel like one more difficult or exposing thing.

Young people are most likely to engage with someone they already know and trust, in a calm and welcoming space. From there, adults can help reimagine physical activity as movement that might be enjoyable, informal and part of everyday life. This could mean dancing in the kitchen, roller-skating in the park, going for a walk, or simply feeling able to enter a room without bracing for judgement. More traditional sporting examples may work too, but they should not be the only starting point.

Third, adults can ask what might help organised and formal physical activity spaces feel more like the spaces young people imagine for themselves. That means listening to young people’s ideas, being open to challenge and rethinking what counts as a good physical activity space. For example, a good space may not be the one with the best equipment. It may be the one where young people can choose whether to join in, wear clothes they feel comfortable in, see signs that they are welcome, and leave for a quieter area if they need to.

Welcoming and safe

On a practical level, most physical activity spaces, whether indoor or outdoor, can be made to feel more inclusive and safe. Small changes can make a big difference. These might include using more vibrant colours, displaying friendly messages and avoiding long lists of rules and instructions.

It can also help to make participation optional rather than compulsory, provide a quiet space where young people can step away when needed, and reconsider clothing rules, which can be a major barrier for some.

The point is not to make every young person love sport. It is to ask why some spaces make movement feel exposing, difficult or risky. If adults want young people to be more active, the first step is not another rule, target or campaign. It is creating places where they do not have to brace themselves before joining in.

Find out more

• Access practical guidance for adults working with children and young people disengaged from physical activity.
• Find out more about this work, including a Moving Spaces 'zine' co-produced with young people.

Adapted with thanks to The Conversation

Understanding the ‘zoppie buzz’ in Teesside

Posted by Hannah Poulter, Teesside University, Visiting Research Associate, University of Bristol

Hannah's post coincides with International Harm Reduction Day, which is observed each year on 7 May and is dedicated to harm reduction approach to drug addiction.

At the conclusion of our research into Heroin Assisted Treatment (HAT) in the North East of England, so many questions remained for me, one of which was: What’s with the zoppie (zopiclone) ‘buzz’ in Teesside?

Teesside gets quite a bad reputation when it comes to drug and alcohol use, which perhaps isn’t surprising when you consider in Middlesbrough you’re more likely to die from a drug related death than a car crash. What we don’t often hear about is the ongoing innovative and groundbreaking work to create solutions to complex problems such as those spanning multiple public budgets - health, justice and social care.

Through our research on HAT we got an insight into the havoc caused by street tablets (such as zopiclone) in Middlesbrough, a story also found in other places within Teesside and further afield. Street tablets are defined as illicitly manufactured prescription-like tablets (that look similar to prescription medication in packaging) bought from illicit sources (street dealers) and used without medical advice.

The prevalence and availability of street tablets here, such as zopiclone, combined with their adverse health consequences and impact on treatment engagement makes a rather toxic combination of risk factors for people who are already vulnerable. I feel empathy for both the marginalised people struggling with their addiction to street tablets (amongst other substances), who felt that there was no feasible offer of treatment for them and the healthcare practitioners tasked to support them, with little advice to draw upon beyond ‘don’t take them’.

While we found there were pockets of great work being undertaken, we also saw that the work wasn’t particularly joined up and that there were lots of gaps in knowledge:

• What was the appeal of zopiclone in Teesside, a seemingly unique feature of the local drug market here?
• What do people who use street tablets think could be done to help improve treatment?
• How could we increase knowledge, collaboration and capacity between local practitioners, academics, people with lived experience and the police to address this public health issue together?

As an Early Career Researcher with a ‘non-standard’ research career (I had a career in business development, research and policy in the housing sector prior to re-entering higher education), I was both confident and daunted by the prospect of leading a project in this area.

Confident because I was sure I could achieve this as I had led on, and been part of many projects focused on collaboration, capacity development and research in the past. Daunted because this was one of the first projects I had led in my own research area as an academic, and I wanted to prove that I was able to do so alongside delivering academic outputs and impact.

I feel proud and relieved now this project is over and am incredibly delighted that we delivered extra value for the funders alongside some solid impactful work in this important area. Here’s a summary of our work:

Engaging people who are often less well represented in research and involving them in the process and co-production of solutions to addressing street tablet use.

One workstream of this project used Community Based Participatory Research with a lived experience researcher, Peter DaSilva from Recovery Connections. With Peter’s knowledge of the local drug market, operating context, and behavioural factors we were able to engage some of the most marginalised people at risk of a drug related death into the research process.

I am so passionate about lived experience recovery organisations and their crucial work using lived experience to engage and retain people in treatment. We have a publication on this currently under review with the Harm Reduction Journal.

Understanding the harms associated with zopiclone use and unique features of the zopiclone market in Teesside.

Several smaller spin off projects have been developed as a result of this grant. We delivered two student projects which involved speaking to healthcare practitioners (HCPs) in Teesside about their perceptions of street tablet usage. I’m currently working with Dr Jenny Scott at the University of Bristol to combine our data with a larger multi-site project on HCP insights, funded by the Economic and Social Research Council. To support the completion of my Stage 2 Doctorate in Health Psychology I’m conducting a rapid review of the existing evidence base on zopiclone. Another paper we have nearly completed is one analysing prescription rates to understand how changes to safe prescription of zopiclone may be associated with the illicit market. Through this portfolio of work we will have a much better understanding of the unique features of the zopiclone market in Teesside.

Developing ways to share information and access better technology within Teesside for real-time testing to help reduce harms and overdose risk for people who use drugs.

Key relationships and mechanisms of information sharing have been built, improved and solidified through this project. Dr Gillian Taylor (Teesside University) has been testing locally seized samples such as zopiclone and pregabalin to improve local knowledge sharing. Gillian and I have worked with Joanne Russell from Public Health South Tees supporting their establishment of the Local Drug Information System in Middlesbrough such as the standard operating procedure. Dr Taylor is now sharing testing information of locally seized samples to supplement local overdose alerts and has a formal relationship with Cleveland Police which she has developed as a result of engaging on this project.

Better knowledge exchange between academics, practitioners, and policy makers locally, regionally and nationally.

Local regional and national connections were key ingredients to this project and have led to knowledge exchange beyond the remits of this funding stream. The connection which has personally stood out for me, has been with the team at University of Bristol, led by Professor Graeme Henderson, Professor Matt Hickman and Dr Jo Kesten. Through engaging with them on this project, I was appointed as Senior Qualitative Researcher within the School of Clinical Epidemiology and Public Health at Bristol between September 2022 and March 2024 on their project: Opioid overdose deaths: Understanding the lethal interactions between benzodiazepines and opioids to develop new harm reduction strategies funded by the Medical Research Council. I have learned so much from working on this project, and from my colleagues, which I hope will lead to other projects in the future. We are currently writing up the outputs from our qualitative work, have presented our findings at the Society for the Study of Addiction conference in 2023 and our team presented our work at the European Conference on Addictive Behaviours and Dependencies in Lisbon in October 2024.

Where next?

Now this project is over, (and following me being on maternity leave for a year), we are working on writing up the key outputs from our work. Our ultimate goal is to improve the offer of care for people who use drugs in Teesside and beyond.

What I’ve learned from this project is that we can only do work of this nature, with the right funding, and right support from senior members of Teesside University and local decision makers. Having the funding to support me to completely dedicate one day a week to capacity building enabled by the Targeting Health Needs grant from NIHR Clinical Research Network, gave me brain space from my busy role within the Evaluation and Impact Team, was transformational. It takes time to create good quality dedicated multidisciplinary and translational research, and often the intangible but important factors in this process such as ‘connection building’ can take the most time.

The Heroin Assisted Treatment (HAT) study was funded by the National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC)

Targeting Health Needs project funded by National Institute of Health and Care Research [NIHR] 2022/23 Clinical Research Network (ref: 17969707). 

Over the rainbow: research with an intersectional perspective

Posted by Dr Mark Adley, Research Associate, Newcastle University

• LGBTQ+ is an abbreviation for lesbian, gay, bisexual, transgender, queer or questioning, with the "+" sign recognising the multiple permutations of sexual orientation and gender identity.

• Intersectionality looks at how social inequities such as racism, sexism, or classism can interact and shape people’s social experiences.

"Reaching Out", pencil and pen drawing and digital collage by artist Sarah Li (2024)

In this Question and Answer blog, Mark shares some of his reflections on intersectionality when working with marginalised groups, and the importance of taking extra steps to make sure that the quieter voices are also heard. LGBTQ+ people are not a single group, and sexism, racism, classism and other social inequities can create unexpected intersections.

What was the focus of your PhD research project?
My PhD examined marginalisation in health and social care services in North East England, specifically looking at multiply marginalised LGBTQ+ people – those who had faced additional experiences of, for example, homelessness, substance use, racism, or domestic abuse. Seventy-two people across the region took part in interviews – 33 with professionals and 39 with marginalised LGBTQ+ people.

How would you explain intersectionality to someone new to the concept?
The shortest explanation would be that 1+1 does not equal 2. Intersectionality examines how different aspects of our identities can interact – creating unique experiences of discrimination. For example, a Black woman's experience isn't simply the addition of being Black plus being a woman. She may experience racism differently than a Black man, and she may experience sexism differently than a White woman. Her experiences as a Black woman are a unique intersection of race and gender. As Zora Neale Hurston perfectly captured in 1928: ‘I feel most coloured when I am thrown against a sharp white background’.

What challenges did you face in participant recruitment?
One major challenge was ensuring diverse representation. I noticed early on that lesbians and bisexual women were underrepresented, so I paused recruitment to address this. This led to an unexpected complexity – navigating the cultural and political debates around gender identity, particularly around use of the word ‘woman’ – and how to distinguish between cisgender and transgender women without causing offence.

How did you handle the sensitive terminology around gender identity?

It required extensive consultation with five women who held different perspectives on this issue. We eventually reached what I'd call a diplomatic compromise on language – while no one was completely satisfied, no one was seriously offended either. This highlighted the importance of careful navigation in sensitive cultural debates.

Recruitment flyers for lesbian, bi, queer, and pansexual women (left) and LGBTQ+ people of colour (right)

What adjustments did you make to ensure racial diversity in your study?

By March 2023 I had interviewed nine LGBTQ+ people from non-White British backgrounds, but only six were from non-White ethnic groups. After reflecting on the specific experiences of discrimination and invisibility shared by LGBTQ+ people of colour, I paused recruitment again. Following consultation with queer people from ethnically minoritised groups we rebranded the study, including removing rainbow imagery in favour of a brown background, as the rainbow was perceived as ‘very White-presenting’.

What key lessons did you learn about conducting research with an intersectional perspective?
The research required a constant shift in my own focus as a researcher. First, looking inward through reflexivity – examining my own unchecked biases and assumptions and their impact on how the study was conducted. Second, looking outward to understand the broader systems of power that influenced people’s experiences of marginalisation. It's a complex balance that requires both zooming in and out, while avoiding what has been called the ‘fetishization of complexity’.

The study’s key findings and recommendations

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Findings from the study are available in several formats

PDFs can be downloaded from the project’s website, with videos on YouTube and an Open Access scoping review published in BMC Health Services Research. Mark is involved in ongoing work exploring the experiences of LGBTQ+ people of colour, and collaborations with local organisations in consideration of intersectionality across the North East and Cumbria. To contact Mark or receive project updates via the mailing list click here.
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This study was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Saying farewell to Fuse and celebrating its remarkable women on International Women's Day

Laura Ritson, Programme Manager, NIHR Three Research Schools, Prevention Research Programme, Newcastle University

We are marking International Women's Day by saying thank you and a farewell to Laura Ritson, who helped to establish Fuse in 2008 and has been integral to the Centre's success, while at the same time welcoming new Fuse Manager Agata Robertson.

In this post Laura talks about her journey with Fuse.

Celebrating Fuse's 10th birthday

After an incredible 16-year journey, the realisation that my chapter with Fuse has come to a close feels surreal. I am deeply grateful for the opportunity to have collaborated with an exceptional group of colleagues. Their contributions not only fuelled the growth of Fuse but also played a vital role in my personal development, fostering a continuous journey of learning and growth throughout this period.

Casting my mind back to 2008, I had the privilege of supporting Professor Martin White in spearheading an application to the UK Clinical Research Collaboration (UKCRC) for a Centre for Translational Research in Public Health. This ambitious venture united our five esteemed North East Universities in a unique collaboration dedicated to advancing world-class public health research. Our mission was clear: to enhance health and well-being and combat inequalities. Professors David Hunter, Charlotte Clarke, Janet Shucksmith, and Ann Crosland, among others, joined forces with us in this endeavour. The success of the application was made possible through the invaluable support of policy and practice leaders in Public Health, including Professors Peter Kelly and Eugene Milne. Their ongoing commitment to flying the Fuse flag is truly commendable. The Fuse funding was allocated for infrastructure to build public health capacity in our region. Securing funding alongside four other national centres forged close working relationships that have endured over the years. In 2009, I was delighted to be appointed as the Administrator for Fuse.

Reflecting on the past, our initial funding contract mandated a two-year review due to concerns about the complexity of our collaborative model, one which we passed with flying colours. Fast forward to today, and it's evident that collaborative efforts are now an integral part of our professional landscape. Embracing collaboration with practice partners and the public has been a significant aspect of our growth during my tenure with Fuse. How times have changed, and how exciting it has been to witness and contribute to this transformative evolution.

There have been so many highlights that it’s difficult to know where to start, and impossible to cover them all!

We underwent a lengthy process to identify our name, debating between Fuse and Rede! The communications agenda has grown considerably since we first established Fuse, and we have produced this award-winning blog and our public partner led podcast, and found many other creative ways to share our research supported by Fuse Communications Manager Mark Welford. The Fuse network has expanded to 2000 members, and we now have a dedicated Public Partner network, thanks to the support of Fuse Public Involvement and Engagement Manager Ella Anderson.

Another jewel in the crown has been AskFuse, a rapid response and evaluation service for our policy and practice partners. Special thanks must go to Professor Janet Shucksmith and Rosemary Rushmer, who were integral to establishing the service, and Dr Peter van der Graaf, Lesley Haley, and Annmarie Ruse, who have supported the development and continued to lead the way with a service that has also inspired and influenced the development of other regional and national infrastructures.

Capacity building has been integral to the Fuse endeavour, and it’s been great to see the development of public health leaders of the future. I’ve witnessed Fuse PhD students progress to senior-level careers in local authorities, prestigious NIHR awards, and professorial appointments.

I have been delighted to be part of the founders and planning of the Fuse International Conference on Knowledge Exchange in Public Health, and I am looking forward to connecting with colleagues at Cornell in June for the 6th International Conference.

Receiving the Director's Award from Ashley at the Fuse Awards 2023

I’ve seen many changes over the years, including in directorship to Professor Ashley Adamson. Working with Ashley over the last 10 years has been truly inspirational. A successful woman leader, she has steered Fuse through two renewals of its membership to the NIHR School for Public Health Research (SPHR) and also successfully directed the national School since 2017, with the support of a fantastic directorate team at Newcastle University who I’ve been fortunate to work alongside. I’ve also been inspired by the work of Professors Eileen Kaner, Carolyn Summerbell, Clare Bambra, Susan Carr, Monique Lhussier, and Amelia Lake. All of them challenged and helped me grow in the Administrator role, which expanded considerably between 2008 and 2017, enabling a strong case for a promotion opportunity to Fuse Manager.

In 2018, we moved towards a Fuse sustainability model, transitioning away from research council funding and towards Fuse partner University contributions, one which took time, effort and challenging conversations. Sustainability funding covers core staff costs and non-staff activities, including successful research events that serve as a key opportunity for disseminating our research, engaging in dialogue about implications for policy and practice, making new and strengthening existing contacts, and building a dialogue around research results and potential future projects. These events are a crucial forum for knowledge exchange. There has also been the development of the Physical Activity network and Embedded Researcher network which attract national level engagement.

In 2020, I was an integral part of a Fuse-led application to the NIHR Public Health Interventions Responsive Studies scheme, in which PHIRST Fusion was established. The Fusion initiative takes an evaluability assessment approach to co-producing evaluation design that addresses the priorities of Local Authority stakeholders. Due to my experience with Fuse, I led the communications agenda for PHIRST at a national level and helped secure funding from the Department of Health and Social Care for a dedicated Communications Manager post, which we now host within PHIRST Fusion.

I’ve been dedicated to working with Fuse for a number of years, drawn by; the people, nature, and variety of the Programme Manager role, the difference public health research is making to the population, and the flexibility I’ve had during my career to bring up my children through a combination of part-time and flexible working and during a national pandemic. I was also enthused by the challenge each day brought my way.

I’ve been grateful to Cheryl Wiscombe for supporting Fuse Administration and, more recently, Ann Payne, who has supported me with Fuse’s membership in SPHR. 

I’m thrilled to have transitioned into the role of Programme Manager for the NIHR Three Schools Prevention Research Programme, hosted by the School for Public Health Research, all while pursuing a part-time MSc in strategic leadership. Considering the latter, I had never thought myself capable of undertaking such a commitment. However, thanks to the support and encouragement of close colleagues, I've grown in confidence to seize this opportunity.

I extend my heartfelt gratitude to everyone who has shown dedication to Fuse over the years. I wish Fuse the best of luck for the future under the leadership of the new Director, Professor Sheena Ramsay, and Programme Manager Agata Robertson. I am confident that the coming years will bring both joy and challenges, and I eagerly anticipate following your progress, including the expansion of Fuse into Cumbria and the reinvigoration of the Fuse research clusters.

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Visit the Fuse website to meet new Fuse Manager Agata Robertson, as she tells us about herself, her interest in public health, and what attracted her to working with Fuse.

One size fits none, watch your language, and keep pondering...

Insights from the Integrated Community Care to Promote Healthy Ageing event

Posted by Hamdi Hamzah, Research and Evaluation Coordinator with NECS Research & Evidence

It was my first time attending an event that saw people (some of us dressed in red) from across different professions – academics, healthcare professionals, voluntary, community and social enterprises (VCSE) professionals and members of the public – come together to share common interests and explore future opportunities or collaborations.

Being new to the health and social care sector and a career changer with experience working with large corporations through strategic human resource roles, the Integrated Community Care to Promote Healthy Ageing event co-hosted by Fuse introduced something that I felt was closer to what was happening on the ground, especially when research and practice interweave. From this event, I have identified seven insights that I felt were worth sharing.

But first... what exactly is Integrated Care? The NHS England website describes Integrated Care Systems as: “…partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.” They also provide a helpful video explainer.

So, on to my magnificent seven:

1. There is no “one-size fits all” approach to care

Throughout the event, this was a common theme from both presenters and attendees, who continued to stress the importance of putting individual needs at the forefront in providing care. To echo Dr Bethany Bareham (pictured right), Fuse Associate and NIHR fellow at Newcastle University through her talk on providing support to older adults with co-occurring alcohol and mental health problems, support for one individual may not be needed for someone else.

2. Similarly, there is no one way to answer a research question

The event brought together different questions, methods and groups of people to enhance our understanding of promoting healthy ageing. For example, a video presentation by Dr Vanessa Davey, a Research Associate at Newcastle University, on the feasibility of developing a data set in care homes to assist in care delivery and commissioning decisions was eye-opening. You might think that digital GP records could readily be used in one form or another to build this data set, but it is clearly not that straightforward as data from other systems, namely social care, could (and should) provide additional insights into this dataset. Most importantly, while we might take different approaches and target different populations, we are all aiming towards achieving the same goal.

3. Language can have an important effect on how we approach a question

Simply put, are we talking about the same thing? We might think that the terminologies that we are using are similar but they could mean different things to different people. For example, Dr Dan Cowie (pictured right), clinical lead with the North East and North Cumbria (NENC) Ageing Well Network (who also spoke about the Frailty iCARE platform) posed the question: are "personalised care," "personhood" and "person-centred" the same thing for the groups of people that researchers are interested in studying? How we phrase the topic we are researching could also help or hinder what we get out of our work.

4. Co-production of research through VSCE organisations

Local communities should be involved in every activity within the research lifecycle, such as research planning, analysis and dissemination, and not just during the delivery stage of the study – an opinion shared by Greta Brunskill from Voluntary Organisations' Network North East (VONNE) in one of the workshops. Patient and public involvement (PPI) is a useful platform to involve members of the public and co-produce research, but there is the risk of “professionalising” these platforms, which may lead to voices from certain communities not being heard.

5. But what about before we reach a specific age?

There was interest from the audience in exploring personal and environmental factors before someone even reaches a specific age. The idea of testing the impact of, for instance, universal basic income among young people on healthy ageing was food for thought and suggests that a lot of where we are now or – perhaps will be in the future – could depend on factors in the present such as lifestyle, socioeconomic status and access to relevant services.

6. Addressing health inequalities remains challenging

Expanding on points 4 and 5 above, health inequalities remain a hot topic in this field of work. Access to care, health literacy (a person’s ability to understand and use information to make decisions about their health), personal qualifications and involvement of underserved communities were mentioned by attendees either during the talks or workshops as challenging areas. Introducing care or support may not work if barriers to accessing care remain.

7. Keep pondering

The entire event not only provided the opportunity to know what research is being conducted but showed the tremendous volume of research questions left to be explored! One of the themes that came out of Tania Jones' workshop on maximising the use of pharmacy services was the bigger role that they may play in primary care, especially in 2026 once pharmacy graduates enter the job market with prescribing qualifications. This could in turn lead to more questions, for example, is there an inclination for pharmacists to prescribe pharmaceutical over non-pharmaceutical treatments?

While the possibilities are endless, identifying questions that are crucial and impactful may be the first step to starting a research journey and finding the right collaborators. Regardless, we should continue to think about things that we are working on, as Lesley Bainbridge (pictured right), clinical lead in the NENC Ageing Well Network, quite aptly put it, "Some of the best research questions come from what we ponder."

Images: provided with thanks to NHS NECS Research & Evidence Team

The Power of Partnership

Our Top Tips for co-production with inclusive and meaningful Public and Patient Involvement and Engagement 

Posted by Rosemary Nicholls, Patient and Public Involvement and Engagement (PPIE) member, and Charlotte Parbery-Clark, Fuse researcher at Newcastle University and Public Health Registrar

This image was co-produced with members of the public, researchers and film production company Kaleidoscope CFA as part of the UNFAIR research programme. You are welcome to use and share the animation or images whilst acknowledging the source (https://bit.ly/UNFAIRstudy) when doing so. 

Earlier this year, members of the public with researchers at Newcastle University launched an animation that explores public views of health inequalities. The animation was created as part of the UNFAIR project, which is funded by the National Institute for Health and Care Research (NIHR).

Here Rosemary and Charlotte share their experiences as co-applicants on the project and give some top tips for members of the public and researchers.

Rosemary

"A key factor in the success of this project was the leadership style of the professional UNFAIR researchers. Their excitement and commitment to the study and to us as members of the Patient and Public Involvement (PPI) advisory team was infectious. The timely exchange of emails kept us all informed of progress and involved in deciding next steps. There was ongoing respect for what we had to offer.

"I was confident in my views and sometimes doubtful about the practicalities of what was being proposed, thinking: “This isn’t going to work.” But I found various methods much more successful than I expected and I learned through my surprise that I’d been wrong!

"A risk of consulting people in disadvantaged settings is that they may assume that the researchers will be able to effect immediate improvement in their circumstances, so it’s important to be clear from the outset about the aims and likely outcomes of a project and I feel we succeeded in this. The people we met in community groups emphasised how vital it is for them to be treated with respect and I’m confident that we put their needs at the top of our agenda when we asked them questions.

"There were occasions when we had to reassess our approach and resilience became a useful quality. The excellent teamwork that Charlotte and I had developed over previous months enabled us to undertake a successful review of our methods and move forward."

Charlotte

"When the opportunity came up to co-lead the project, I was excited but also a bit apprehensive as I was new to this type of work and was unsure about how to 'get it right'. One thing I was sure of was that I wanted to involve members of the public throughout the project in a meaningful way and avoid it being 'tokenistic'. So, the start of my PPIE journey involved lots of reading and reflecting about how to approach it!

"Co-leading with Rosemary and working with the UNFAIR PPIE contributors was invaluable as we could bounce ideas off each other and consider a variety of perspectives. They kept me right with the 'academic speak' I would sometimes slip into. I learnt so much with so many firsts, such as applying for funding for this type of work (and being successful!), creating flyers, navigating remuneration, as well as being involved in creating an animation."

 

Top tips for members of the public (especially if considering a co-applicant role)

• Applying to be a co-applicant or public contributor can involve being selected from a group of interested people. Don't let that put you off as there are lots of opportunities. The Research Design Service (RDS) including Creating Connections, or People in Research are good places to start.

• Be confident about taking up the role, if you would like to do it. The researchers have asked you because they’re confident you can contribute relevant skills and experience.

• Check that you have the time to commit to being a co-applicant. In terms of hours, the commitment may not be very great, but being able to respond to emails quickly (within 48 hours) and to attend online and in person meetings at arranged times can be important. It’s likely that you will be consulted about suitable times, perhaps by doodle poll, but there may be occasions when you need to prioritise the project to ensure continuity and re-arrange your diary. Ongoing dialogue between you and the researchers to figure out the best approach together works well.

• Each stage of the project will be well-planned and costed in advance by the researchers and the lay co-applicant is paid by the hour in my experience, depending on the nature of the work. However, there may be occasions when lay co-applicants feel that they can offer further insights and they should feel freely encouraged to check that comments outside the box will be welcome and if so, volunteer their thoughts to the researchers by email.

• Be willing to ask questions of the researchers and put your point of view across with confidence, but be prepared to find that your assumptions may be proved wrong as the project progresses. Remember that it’s a learning process for us all. Be resilient when necessary and work together to keep the project on track.

Top tips for researchers

Ways of working:

• Decide how you will involve public contributors at each stage of the project in line with your budget.

• If working with a specific group of PPIE contributors on a project, decide together how you would like to work. There are tools to help you with this, such as Working Together.

Diversity and inclusion:

• Remove barriers for involvement as much as you can. For example, provide options such as different online and/or in-person sessions on different days/times, go to community groups and be flexible about timings to ensure it suits public contributors (not expecting people to come to you), or use online platforms, such as Padlet, for people who want to be involved but can't attend the session.

• Language is really important, be as clear and as simple as possible.

• To increase diversity of public contributors, networks can help promote the opportunities particularly in public health research compared to disease related research as public health research typically has a wider remit.

Time:

• Building relationships is key and takes time. It is good practice to keep people updated and adapt according to need where you can.

• Make sure you know how to remunerate public contributors in your organisation before any PPIE sessions to reduce delays.

• Build in extra project time for unforeseen events.

Challenges:

• Any challenges that may come about with PPIE work or co-production are opportunities to make the project even better, see them as gifts.

• Sometimes, what is feasible in the time/resources available may not align with the feedback so be clear that you may not be able to act on all suggestions at the outset. Compromise as well as sharing why you have not been able to act on certain suggestions is useful. Have a way of deciding what you will do if the feedback conflicts with others' feedback is important.

Involving members of the public is incredibly worthwhile strengthening the project in so many ways. Also, undertaking PPIE and/or co-leading provides opportunities for rich learning and skill development for both researchers and public contributors. There is lots of support especially if this is your first time doing this type of work, as either a member of the public or researcher. To find out more about PPIE or public co-applicants, the following resources may be useful:

Guidance:

• NIHR guidance on PPIE including guidance for public co-applicants and PPIE remuneration
• NENC RDS Public Involvement Guidance
• UK Standards for Public Involvement
• NIHR RDS Community Engagement Toolkit
• Working Together

Opportunities for public involvement:

• Contact your local Research Design Service (RDS); in North East and North Cumbria, opportunities for involvement are available, for example, through the RDS Consumer Panel and/or Creating Connections
• People in Research

 

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Rosemary Nicholls is a Patient and Public Involvement and Engagement (PPIE) Representative and Consumer Panel Member, National Institute for Health and Care Research (NIHR) Research Design Service (RDS) North East North Cumbria (NENC) and one of the UNFAIR PPI members.

We would like to thank the UNFAIR PPIE and research team, members of staff who helped facilitate the online workshop as well as everyone who took part in the workshops.

This project was funded by the Tilly Hale Award from Newcastle University and the National Institute for Health and Care Research (NIHR) (ref CA-CL-2018-04-ST2-010).The views expressed in this blog are of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or Newcastle University.

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.

Authors:

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

References:

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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477694/
2. Roberts L, Marx JM, Musher-Eizenman DR. Using food as a reward: An examination of parental reward practices. Appetite 2018;120:318-326. https://doi.org/10.1016/j.appet.2017.09.024
3. Hsu A BA. Designing for Psychological Change: Individuals’ Reward and Cost Valuations in Weight Management. J Med Internet Res 2014;16(6). https://www.jmir.org/2014/6/e138
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. http://doi.org/10.1111/jhn.13129
5. Human Relations Area File. Craving comfort: bonding with food across cultures. 2023; Available at: https://hraf.yale.edu/craving-comfort-bonding-with-food-across-cultures/
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) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623951/

My passion for research comes from always asking "why?"

Posted by Pascal Landindome Navelle, FRSPH, Public Health Research Operations Officer and Doctor of Public Health Student at Teesside University.

In today's Fuse blog, Pascal gives his top tips for anyone starting out in research, and shares his own experience which began working with Fuse and Teesside University.

His advice? A passion for the "why?" question and accessing the right mentorship.

As part of the NIHR ‘Your Path In Research’ campaign.

 

After working as a clinician for several years, I felt that my impact on service users was limited. So, upon a thorough reflection, I was inspired to progress into public health research, where I felt I would have a broader impact on society.

Research work is fascinating as it provides a clear pathway to contributing to advancing the knowledge of the disciplinary sector to which I am dedicated. The importance of research should go beyond conceiving theoretical works that would only find a physical location in a library. Research should be "living", circulating, interacting, multidisciplinary, and impacting the environment.

What I enjoy about research is that it allows me to pursue my interests, learn something new, hone my problem-solving skills and challenge myself in several unique ways. Working on a faculty-initiated research project enables me to work closely with a mentor–a faculty member, and other experienced researchers. With a self-initiated public health research project, I can leave the community with a service that represents the distillation of my interests and studies and, possibly, a real contribution to knowledge.

There are many training and support systems that I have found valuable during my career. Researchers usually embark on increasingly diverse careers, where collaboration, networking and interdisciplinarity have become more important. Critical reading, academic writing and critical analysis are valuable training and support required of a researcher. Transferable skills, such as effective communication and problem-solving abilities, have helped me operate more effectively in different work environments.

Starting a research career can be daunting but exciting! The challenge of getting the support needed to achieve my dream came true when I enrolled at Teesside University for a research degree. This began by getting involved with AskFuse (Fuse’s responsive research and evaluation service) and with Associate Professor Dr Peter van der Graaf, working on an enquiry to evaluate Northumbria NHS Foundation Trust’s staff health and wellbeing resources during the pandemic, as part of my PhD research. This then led to working on the South Tees Arts Project (STAR) with Peter, a pilot study to co-produce wellbeing measures with primary school children, their parents, teachers, and artists for a school-based dance intervention. I supported the data collection, analysis and report writing for the STAR project as a Research Assistant and even wrote a song for the engagement activities with children in the research!

I had the opportunity of getting mentorship and some academic resources to enhance my knowledge. I connected and contacted very experienced researchers in the field of public health who supported my interest in growing as a research professional. Through the people I’ve met, I have had the opportunity to work on exciting but substantial research projects that have had a massive impact on the public health community.

My top three tips for somebody starting out in research are:

1. First and foremost, you should be motivated, passionate, and curious about your research topic – do it for science, not tenure! No one ever became a successful scientist with the sole premise of being awarded the Nobel Prize. And remember that plans rarely work out the way you thought they would.
2. Be prepared for a challenging career. Research is ever-changing. Be prepared for the change that research comes with strengthening your problem-solving skills to enhance the fun aspect of research. Problem-solving skills refer to handling difficult situations and overcoming complex challenges. They involve breaking a problem down into its parts, thinking critically about each element, analysing the information you find and using that information to form an effective solution. Having strong problem-solving skills will help make you an asset in your research practice and help you advance your research career.
3. Finally, be proactive, network and connect more with like-minded professionals. Sometimes, the key to getting to places is not what you know but who you know. We can learn a lot from talking to peers and senior colleagues. Attending symposiums, seminars and conferences is a great way to meet people who share common interests with you but have different experiences.

The NIHR has supported my career development through the provision of training, access to leadership development opportunities, networking events, mentoring and guidance on research funding.

The NIHR launched the Your Path In Research campaign this week. Better research leads to better services for the public. That’s why the NIHR want to encourage organisations and social care and public health professionals to play an active role in research, as a way to deliver even better services.

The Your Path in Research campaign highlights how people can make research part of their careers. Some amazing researchers have shared their experiences, how they started in research and what advice they can give to researchers that are considering adding research to their careers.

Take your first step in research today.