Many people experience physical disabilities throughout their life, requiring advice and management from clinicians such as physiotherapists. Usually a hands-on detailed movement assessment is taken to help formulate a plan to deal with each individual's needs. For most this face-to-face approach has not been possible during the Covid crisis, and this is likely to continue for some time with social distancing, particularly in older people and those with health issues. In response to the crisis clinicians have found new ways of working. They have used telephone & web-based consultations (known as telerehabilitation) to help people continue to rehabilitate at home. This approach, however, has many challenges when assessing people with movement disabilities, such as those experienced by people recovering from Covid-19, with long term neurological conditions, arthritis or diabetes. For example there are risks associated with assessing balance and mobility in frail older persons at risk of falls. Yet this information is essential to create a plan to ensure recovery occurs as quickly and fully as possible. Unfortunately relevant guidance and training for NHS/Social care staff about this is extremely limited, relying mainly on experience gained on the job. No specific guidance is in place to ensure telerehabilitation is delivered effectively and equitably for people with physical disabilities. We will work closely with NHS/Social care staff to quickly develop an assessment toolkit and training to provide them with practical guidance to increase their skills and confidence. This is important now & for the future.

This research programme will positively affect health and well-being and improve healthcare effectiveness to benefit the UK population. The aim is to create a team to deliver high impact research to improve the user experience of healthcare environments, through user participation in design, engineering and decision making. This research will produce (1) better healthcare environment designs; and (2) new methods for end user participation in engineering.Engineering produces things (environments, products, processes) to improve our quality of life, yet the people who will ultimately use these things are often not involved in their design (or if they are, this often amounts to tokenistic consultation , rather than embedded best practice). Decision making needs to directly involve the people who use these things, to capture their subjective opinions, ideas, language, feelings, and needs and translate these into a format meaningful for engineers. Involving people in engineering can have a transformative effect on new products and environments, but since this is not traditionally part of formal engineering training, the benefits of participation still have huge, untapped potential. Furthermore, the notion that engineering can be enhanced through working with other disciplines is only just beginning to have an impact in engineering practice. A radical step change is needed now, to equip our next generations of young engineers with the know-how to think in new creative waysParticipation is most powerful when it contributes to improving quality of life, and healthcare is the most timely and relevant application of this. The UK has been left with a legacy of aged hospital buildings that are unsuitable for the needs of today's increasing and ageing population. The design of healthcare environments can be linked to health outcomes so it is increasingly important to optimise the design and user experience of new build and redeveloped healthcare projects. The challenges faced by healthcare environment design are complex. Infection control, safety, security and environmental issues all impose constraints, and now the advent of patient choice means that the whole hospital environment must effectively sell the hospital as a carefully packaged experience. Improving healthcare design through participation requires a highly inter-disciplinary approach. This research programme draws together engineering with design, architecture, psychology, science, ICT and healthcare. Hospitals and industry will provide real life users and opportunities for piloting novel participatory design approaches (for example, in creating a better experience for patients in the Emergency Department). Government involvement will help to drive forward policy change, and crucially, end users (patients, staff, decision makers) are involved throughout. This programme of research is executed through 4 core research themes: (1) methods of participation, including exploiting developments in Information and Communication technology (ICT) as an enabler to participation; (2) best-use of representations of future healthcare environments for co-designing with, and presenting concepts to stakeholders; (3) data capture from these representations, and the best use, re-use and presentation of data to decision-makers; and (4) production of an evidence-base for this research by measuring the effects of engineering and design interventions on health and healthcare effectiveness. The ultimate vision is that this work will launch a step-change in engineering research, which will impact upon practice and education. This programme will set a precedent for user involvement in engineering, demonstrating how highly inter-disciplinary research teams can inject creativity and humanity into the creation of environments, products and services in new ways - which will lead to true innovation in design and engineering in the 21st Century.

We know that health disparities vary by geography, that community assets have been proposed as one way to approach health inequalities, and distribution of these assets varies by place. It is also not well understood how formal public organisations can best link with community assets for health, which is particularly important as new organisations form in England. Our proposal brings together academics, three public health teams, primary care networks, Voluntary, Community and Social Enterprise (VCSE), residents and other stakeholders to better understand how we identify, value and support community assets in delivering health and social care in Devon Integrated Care System (ICS), we propose an integrated model of developing community-based approaches to mapping/data linkage and understanding the needs of that locality. We aim to build a research-in-practice consortium with the capability to carry out research to identify and map diverse community assets, understand the conditions which created these assets and develop approaches to more fully integrate such groups and activities into Devon ICS to address health disparities. We will work with three distinct localities, each made of a cluster of Primary Care Networks within Devon ICS. These areas have significant deprivation and represent distinct coastal typologies: Central Plymouth; Paignton; and South Brent. Whilst diverse and multi-method approaches will be employed, our proposal adopts a realist informed approach and we will develop an overarching programme theory for how community assets can contribute to addressing health disparities. We propose three workstreams (WSs). WS1 will build the collaboration, and undertake activities to build trusting relationships, embed researchers within localities and organisations and prepare the ground for work to be undertaken in later stages. Work in WS2 will explore novel ways of mapping groups, people and places where community assets are developed and sustained. We will test methodologies for the identification of population subgroups who would benefit from preventive interventions. WS3 will bring together the insights and intelligence gathered in WS1 and WS2, as well as the literature, and seek to develop theoretical models of both 'currently feasible' (based on current technology and modest investment) as well as 'future oriented' (10 years on) asset hubs. We will examine innovative ways of assessing the value of such assets, their support and mechanisms of linkage. Overall, these activities will create a learning partnership (consortium) between residents, community partners, VCSE, ICS practitioners and researchers, in three localities, which can identify local community assets; develop and evaluate innovative ways of bringing together community health and social care in each locality; and contribute to the evidence base as to how inequalities can be mitigated or addressed. We will work closely with a steering group of local VCSE and ICS leaders and agree how the consortium will both be part of local asset hubs and link to ICS wide commissioning, public health and intelligence functions.