Key Research Interests and Expertise

My research is aimed at improving the quality, safety and equity of health care, particularly for older people with long term conditions.

I collaborate with colleagues in Public Heath England and the Institute of Health Metrics and Evaluation in Seattle to analyse and interpret the findings of the Global Burden of Disease study at local level in the UK. See:

  • Steel N, Ford JA, Newton JN, Davis A, Vos T, Naghavi M, et al. Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018 doi: 10.1016/S0140-6736(18)32207-4

I am an investigator on the English Longitudinal Study of Ageing, in collaboration with colleagues from University College London, the University of Manchester, the Institute for Fiscal Studies, and the National Centre for Social Research. Analysis has been funded by the National Institute of Health Research HS&DR programme. See:

  • Zaninotto P, Di Gessa G, Steel N. The experience of older people with multimorbidity during the COVID-19 pandemic. ELSA COVID-19 Substudy rapid report, 2020. (https://www.elsa-project.ac.uk/covid-19)
  • Steptoe A, Steel N. The experience of older people instructed to shield or self-isolate during the COVID-19 pandemic. ELSA COVID-19 Substudy rapid report, 2020. (https://www.elsa-project.ac.uk/covid-19)
  • Steel N, Hardcastle AC, Clark A, Mounce LTA, Bachmann MO, Richards SH, Henley WW, Campbell JL, Melzer D. Self-reported quality of care for older adults from 2004 to 2011: a cohort study. Age and Ageing 2014;43:716–720; doi: 10.1093/ageing/afu091
  • Steel N, Bachmann M, Maisey S, Shekelle P, Breeze E, Marmot M, Melzer D. Self-reported receipt of care consistent with 32 quality indicators: a national population survey of adults over 50 years old in England. British Medical Journal 2008;337;a957

We have recently completed a NIHR funded trial of goal setting with high risk multimorbid patients in primary care, and have implemented the findings into an online open course for GPs interested in learning more about goal setting. See:

  • Ford J, Lenaghan E, Salter C, Turner D, Shiner A, Clark A, Murdoch J, Green C, Lipp A, Moseley A, Wade T, Winterburn S, Steel N. Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial. BMJ Open 3 June 2019;9:e025332. doi: 10.1136/bmjopen-2018-025332
  • Salter C, Shiner A, Lenaghan E, Murdoch J, Ford J, Winterburn S, Steel N. Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations. Br J Gen Pract 3 June 2019; bjgp19X704129. doi: 10.3399/bjgp19X704129
  • GP Training: Goal-setting for patients living with multimorbidity. https://www.futurelearn.com/courses/gp-goal-setting-training

I collaborate with colleagues to analyse large UK primary care datasets to inform prescribing decisions in general practice. See:

  • Richardson K, Fox C, Maidment I, Steel N, Loke Y, Arthur A, Myint P, Grossi C, Mattishent K, Bennett K, Campbell N, Boustani M, Robinson L, Brayne C, Matthews F, Savva G. Anticholinergic drugs and risk of dementia: case-control study. British Medical Journal 2018;361; doi: 10.1136/bmj.k1315
  • Gitsels L, Kulinskaya E, Steel N. Survival benefits of statins for primary prevention: a cohort study. PLOS ONE 2016;11(11): e0166847; doi: 10.1371/journal.pone.0166847

The rise in guidelines and performance indicators is not without risks from over treatment, and in collaboration with NICE and Nottingham University, we investigated the relevance of evidence in NICE guidelines to low risk patients in primary care. See:

  • Steel N, Abdelhamid A, Stokes T, Edwards H, Fleetcroft R, Howe A, Qureshi N. A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients. Journal of Clinical Epidemiology 2014 doi: 10.1016/j.jclinepi.2014.05.020 (http://authors.elsevier.com/sd/article/S0895435614003291)

Interest in the effects of pay for performance in primary care has led to primary and secondary research with colleagues from UEA, Cambridge and Lincoln. See:

  • Gillam S, Siriwardena N and Steel N (2012) Pay-for-performance in the United Kingdom : impact of the quality and outcomes framework: a systematic review. Annals of Family Medicine, 10 (5). pp. 461-468. ISSN 1544-1717

Key Research Words:

Quality of health care

Pay for performance

Primary care

Cohort studies

Older people

Routine data

Health policy

Health service evaluations

Clinical guidelines

Health services research

Postgraduate Research Student Supervision:-

Quality of health care

Primary care

Comparative effectiveness studies

Integrated care

Health care systems

Older people

Clinical guidelines

Long term conditions

Patient centred outcomes

Cohort data analysis

Selected Publications

  1. Murdoch J, Salter C, Ford J, Leneghan E, Shiner A, Steel N. The "unknown territory" of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions. Social Science & Medicine 2020. doi: 10.1016/j.socscimed.2020.113040

  2. Steel N, Ford JA, Newton JN, Davis A, Vos T, Naghavi M, et al. Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018 doi: 10.1016/S0140-6736(18)32207-4

  3. Richardson K, Fox C, Maidment I, Steel N, Loke Y, Arthur A, Myint P, Grossi C, Mattishent K, Bennett K, Campbell N, Boustani M, Robinson L, Brayne C, Matthews F, Savva G. Anticholinergic drugs and risk of dementia: case-control study. British Medical Journal 2018;361; doi: 10.1136/bmj.k1315

  4. Steel N, Abdelhamid A, Stokes T, Edwards H, Fleetcroft R, Howe A, Qureshi N. A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients. Journal of Clinical Epidemiology 2014 doi: 10.1016/j.jclinepi.2014.05.020 (http://authors.elsevier.com/sd/article/S0895435614003291

  5. Gillam S, Siriwardena N, Steel N. Pay-for-performance in the UK: the impact of the Quality and Outcomes framework - systematic review. Annals of Family Medicine September/October 2012;10:5:461-468, doi: 10.1370/afm.1377

  6. Steel N, Bachmann M, Maisey S, Shekelle P, Breeze E, Marmot M, Melzer D. Self-reported receipt of care consistent with 32 quality indicators: a national population survey of adults over 50 years old in England. British Medical Journal 2008;337;a957

Current Research Projects and Grants

  • English Longitudinal Study of Ageing UK Funders application (co-app 10%), Department of Health and Social Care, £2,065,556, 1 Apr 2018-31 Mar 2024

  • English Longitudinal Study of Ageing COVID-19 Substudy, Economic and Social Research Council, £498,303, 1 June 2020- 30 Nov 2021

  • Forward work on the England Burden of Disease programme (Principal Investigator), Public Health England, £34,757, June 2017-March 2021

  • Use of big health and actuarial data for understanding longevity and morbidity risks (co-applicant) Institute and Faculty of Actuaries £873,251, Oct 2016 –
    30 Sept 2021

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