University secures CSO funding for cutting-edge end-of-life care research
The University of St Andrews is one of five Scottish universities awarded up to £1 million each by the Chief Scientist Office to conduct major research programmes into population health issues. The grant, announced by Health and Social Care Secretary Neil Gray on 4 June, will support an Applied Health Research Programme focused on improving unscheduled care for people across Scotland in their last year of life. Collaborators include NHS Fife, NHS Highland / Highland Hospice, the Fife Community Advisory Council, the University of Edinburgh, and Yale University.*
The project arose in the context of unprecedented strain on the country’s unscheduled care services due to workforce shortages, demographic change, and widespread multimorbidity (when a person has two or more long-term health conditions). In 2022, Accident & Emergency waiting times hit record levels and over a quarter-million calls to NHS24 went unanswered. Alongside these services, unscheduled care also includes General Practice Out-of-Hours (GPOOH) and the Scottish Ambulance Service (SAS).
Previous research has identified that one group of people who use such services frequently is those in their last year of life. Although it plays an essential role in the healthcare system, unscheduled care is often not the most appropriate option for this population, being necessarily reliant on a reactive approach to care without the benefit of more nuanced, anticipatory, and coordinated planning. The result can often be more fragmented, expensive and less effective care, causing unintended additional distress to patients in their last year of life and their families.
“We are very aware that use of unscheduled care services increases for a person with a palliative diagnosis in the last year of their lives,” says team member and Clinical Partnership Director for NHS Highland/Highland Hospice, Michael Loynd. “We need to understand if better identification of this population and different supports such as dedicated helplines can enable an alternative route of support.” As part of this process, a key objective of the research programme will be to develop a single point of contact and care coordination for this vulnerable group.
This programme will use machine learning to analyse existing healthcare data and predict future patterns of unscheduled care use by patients in their last year of life. This will in turn allow for the identification of such patients who may be in need of social care reviews, prescribing interventions, or other anticipatory care measures that would reduce their need for unscheduled care.
“This funding will allow us to apply cutting-edge research methods to understanding what is driving increased use of unscheduled care, especially at the end of life,” says Lecturer in Academic Primary Care Dr Sarah Mills. “The analysis it enables us to perform will be key to developing better ways of identifying patients who need additional care and support.”
The team’s research will not only benefit patients, first and foremost, but aims to improve NHS sustainability by reducing the unscheduled care workload. “Better identification of this group of people will facilitate improved NHS care, but it will also increase the capacity of emergency care services”, says Prof. Colin McCowan, Head of the School of Medicine’s Population and Behavioural Science research division.
With this significant grant from the Scottish Government, the University of St Andrews and its partners are poised to make a profound impact on the healthcare landscape in Scotland. By leveraging advanced machine learning techniques and a deep understanding of the challenges facing the unscheduled care system, this research aims to not only enhance the quality of life for patients in their last year of life but also ensure a more sustainable future for NHS services.
*Research Team
University of St Andrews
University of Edinburgh
Professor Peter Hall
Dr Elizabeth Lemmon
NHS Highland / Highland Hospice
Mr Michael Loynd
NHS Fife
Dr Joanna Bowden
Dr Rishma Maini
Dr Christopher McKenna
Professor Frances Quirk
Dr Rajendra Raman
Yale University
Dr Andrew Taylor