SPHERE: Systems and People-Centric Innovation in Healthcare Redesign

Research Question: How to transition to person-centric health services, and improve the experience of persons/carers living with multiple long-term conditions (MLTCs) and those delivering the care whilst considering system resources?

Background: The Southwest of England has a population of 1.5 million in rural and coastal areas across Somerset, Cornwall and Devon. It has sparse spread but significant numbers of deprived and ageing populations with MLTCs, with the least number of healthcare professionals per capita. Addressing these challenges requires crucial research and innovation.

The Hub’s focus, co-created with our partners (patients/carers and health and social care professionals), will be on coastal and rural regions and improving coordination and continuity of care for MLTCs. Aim: The aim is to bring together, through a systems design approach, the following perspectives:

1. Patients/carers: to understand requirements for patient-centric services and ensure patient empowerment. 2. Professionals (health and social care): to understand their needs, roles and functions. 3. Whole system: to consider the wider system (regulation, profession, cost).

4. Inequality: the contextual factors for individuals (social, local environment and economic capital) and impact on the access and experience with services and subsequently on health and wellbeing. Objectives:

1. To establish priority problem areas from lived experiences (individual and population), health and social care professionals. 2. To co-produce with our wider team two initial cases (MLTC and service intervention area) with committed partners. 3. To define the Toolbox (System Design process and Tools) and underpinning research.

4. To identify and create opportunities for shared cross-disciplinary learning with existing and future NIHR, EPSRC research, including Hubs and other relevant UKRI activities.

5. To develop a coherent engagement strategy for our wider team, identifying additional partners or areas of academic expertise, whilst ensuring equality, diversity and inclusivity.

Methods: Through novel and transformative research, applied and tested within health and social care, we will define a Toolbox design for the Hub, consisting of:

1. An overall System Design process: a tested process to be embedded within the health and social care system to inform person-centric service design for MLTC patients and carers.

2. Specific research Tools: a) Novel approaches for user profiling to identify needs (AI, patient stratification), b) Personalised pathways within complex systems (dynamical systems modelling/discrete-event simulation), c) Whole system approach (modelling impact of pathways and evaluating alternative pathways, digital twins), d) Beyond individual systems (transferring knowledge and informing policy).

Activities are co-created with our partners, including 3 committed ICBs (Somerset, Devon, Cornwall) and SWAHSN: WP1 enable problems reframing, understanding of needs and requirements; WP2 co-produce possible solutions with associated risks; WP3 synthesis of learning for a visionary research agenda and Tool design. EDI principles will be implemented throughout.

Deliverables:1) Two MLTC use cases with committed partners, enabling co-design and live iterative testing; 2) Defined Toolbox and research areas; 3) An expanded team and partner network, aligned with persons/carers of MLTC and health and social care decision makers with clear engagement structures.