Justin Strain < Back Thinker, sailor, author, physio Justin's journey so far.. Justin Strain Justin Strain I began my healthcare career a little later than most. At the age of thirty, after a short career in the Royal Navy, I took my first steps into the University of Southampton’s School of Health Professions. I was interested in research from day one. The importance of evidenced-based practice was drummed into us throughout our time at university. From the moment we first wielded a tendon hammer or a stethoscope we were encouraged to ask ourselves those all-important questions: What is the best treatment? Does it work? Why am I doing this? Starting out as a musculoskeletal physiotherapist, I threw myself into clinical practice, desperate to learn every treatment technique and test I could get my hands on. I believed that being a great clinician was about perfecting those tricky manual techniques and learning everything there was to know about anatomy. Or so I thought. Thinking differently Later, as I developed in confidence, I began to think differently about my practice. It seemed to me that what made most difference to my patients was the therapeutic relationship. Understanding the patient’s experience and learning to listen more and communicate better (and sometimes talk less!) started to seem more important than having the biggest toolbox of treatment techniques. Specialising in pain management helped me to appreciate how peoples’ experiences of health-conditions and healthcare were shaped by a complex web of social and personal interactions, making each person’s experience unique to them.The need to understand these unique experiences drew me to qualitative research. I wanted to go further than comparing different interventions. I wanted to understand the stories of the people at the heart of those interventions – our patients. The importance of narrative was not new to me. In my non-clinical life, I write children’s novels – I’ve written two so far and I’m working on a third. In my novel writing, I enjoy the magic of exploring fictional worlds from other peoples’ perspectives. I’ve always found that what brings a novel to life is the personal connection between the reader and the characters. I wanted to apply a similar approach to understanding patients’ stories - listening to, understanding and recording other peoples’ perspectives, and acknowledging the role of the researcher and the reader in interpreting those perspectives. While I was taking my first tentative steps towards qualitative research, the world of healthcare research was changing. The n=1 campaign was gathering momentum, and recognition of qualitative research was increasing. I wanted to get more involved, and found myself looking for the right opportunity. Then, at the beginning of 2020, the world turned upside down with the advent of the COVID 19 pandemic. Along with many other things, the COVID 19 situation has highlighted the need for research – to explore the impact of immediate responses to the crisis, and also to understand how the pandemic will influence longer term changes in how healthcare is delivered. One of those long-term changes is likely to be the proliferation of online healthcare. The plethora of online health interventions now on offer enables people to access consultations and courses that might previously not have been available to them, in a safe, socially distant way. I felt this area was worthy of more exploration, and I wanted to listen to the stories of service users, to understand how these changes had impacted on their experiences. I resolved to start a research project looking at patients’ experiences of online pain management in our own service, but I was struggling to find the time - alongside a busy job in clinical practice, dealing with redeployment and the current challenges of COVID 19, and being dad for our two wonderful children. The NIHR ARC Wessex Clinical Academic Internship has given me that time. It has enabled me to build and apply my skills in research as part of my clinical job, making a difference to how I can support patients within my service. So where am I now? I am in the early stages of my project – a systematic review of qualitative literature about patients’ experiences of online pain management, combined with semi-structured interviews with patients who have completed the online pain management programme within our own service.As well as time, the Clinical Academic Internship has provided a network of similarly minded people, interested in research and qualitative exploration of issues. The excellent events run by NIHR ARC Wessex have introduced me to new research concepts and skills. My supervisors, Dr Euan Sadler and Dr Lindsay Welch , have been extremely supportive and with their help my skills and confidence are growing. I am planning to complete my project in Autumn this year and I am hopeful that this will lead on to a pre-doctoral, and eventually a doctoral fellowship with NIHR ARC Wessex in the future. Dr Euan Sadler is an Associate Clinical Professor of Older People and Frailty within Health Sciences at the University of Southampton. Dr Lindsay Welch is a Lecturer in Adult Nursing and a Researcher in long term conditions. Previous Next

7982ebd7-aab7-4e3f-8493-b1caebcd4bea The Wessex FRIEND Toolbox (Family Risk IdEntificatioN and Decision) Identifying high risk groups early to improve health in young families in Wessex Principal Investigator: Professor Nisreen Alwan and Dr Dianna Smith Team members: Professor Nisreen Alwan (Professor in Public Health, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Dr Dianna Smith (Lecturer in Geographic Information Science, Geography & Environment, University of Southampton), Professor Paul Roderick (Professor of Public Health, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Dr Ivaylo Vassilev (Principal Research Fellow, School of Health Sciences, University of Southampton), Dr Grace Grove (Clinical Research Fellow, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton), Dr Nida Ziauddeen (Research Fellow, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton),Dr Lauren Wilson (Research Fellow, Geography & Environment, University of Southampton) Read report: Food Insecurity Risk Indices for Neighbourhoods 2021 Food Insecurity Brief LSOA Level Estimates Sept2021_online[2] .pdf Download PDF • 363KB Start: 21 October 2019 Ended: 30 September 2022 Project Partners: University of Southampton, Solent NHS Trust, Southampton City Council, Portsmouth City Council, Hampshire County Council, Health Education England, Oxford Brookes University Lay summary We know that prioritising health is complex, particularly for families living in social and economic disadvantage. The SLOPE CORE tool estimates the future risk of childhood overweight at the start of primary school. It can be used by health professionals in consultation with the families they are working with to help facilitate various interventions towards the prevention of childhood obesity. We have tested the acceptability and feasibility of this tool in the first phase of the Wessex FRIEND project, as part of a broader programme of work, aiming to improve the health of children and families in Wessex. We have trialled it with health visitors in the first instance, just so that we can get some initial feedback and improve it before combining it with other components of interventions. We have also been refining and tailoring area-based child poverty, food poverty and greenspace access measures to the local and regional context and population, so that our risk tool takes into account the area profile and resources where the family lives. These area-based measures, which represent neighbourhoods, may also be used independently by local governments and civil society/third sector to help in targeting resources to better support people living in areas of higher risk for food and child poverty, or with poorer access to greenspaces. What have we found out? We tested a digital tool called SLOPE CORE which predicts if preschool children are likely to be overweight by the time they start school. Health visitors and parents found the obesity prediction tool quick and easy to use. Using the tool provided the opportunity for health promotion, and may facilitate difficult conversations by giving an objective result and removing the perception of professional judgement. This may encourage conversations on healthy weight and could influence health visitor practice by increasing provision of anticipatory support on feeding. Health visitors felt that, when using the tool, the healthcare professional should have sufficient time to have a sensitive discussion and explain a conceptually difficult concept (risk). Parents felt that the tool provides an opportunity for behaviour change and potential to improve health for the child but can also provide reassurance. They appreciate the provision of additional resources and support with the results. However, before using the tool the healthcare professional should consider whether the tool is appropriate, as it may be unsuitable for some parents. We refined and tailored area-based child poverty, food poverty and greenspace access measures to the regional context and population. These provide improved tools for better planning and targeting of services by the local councils. These area-based measures are combined with the individual childhood obesity estimation provided by the SLOPE CORE Tool on one platform, which can be utilised by frontline professionals dealing with disadvantaged families. We also tested the feasibility of the Generating Engagement in Network Involvement (Genie), a facilitated social network intervention, as a means towards reducing risk of adverse family health outcomes. We tested this with Home-Start in Portsmouth which is a voluntary organisation. Staff found Genie simple to use, really liked the concept and found that familiarity with the system meant the process was much smoother for later entries. Staff felt that being able to fill out Genie on a phone or app would be quite useful. The option of other languages or built-in translation could also make it easier to use. Staff felt that Genie was particularly good for families feeling isolated or new to the area but was unlikely to be relevant for all. However, staff thought it was less realistic for them to use it within the timeframe of visits and other things that need to be done during a visit but they could potentially facilitate the use of Genie by encouraging people to do so themselves. The network mapping was useful as it made people realise what they have and what they need. Staff found it an interesting exercise to start the conversation and find out what was going on in the lives of individuals/families they were supporting. A potential barrier to the use of both tools is lack of wi-fi/internet connectivity. What difference can this make? Using the obesity prediction tool could provide the opportunity for health promotion and facilitate discussions by giving an objective result and removing the perception of professional judgement. This could encourage conversations on healthy weight and potentially influence health visitor practice by increasing provision of anticipatory support on feeding. Using the tool antenatally, or with a younger infant may allow for an easier conversation, allowing the healthcare professional to focus on prevention, as opposed to ‘correcting’ a parent’s current behaviour. Health visitors felt that parents were more likely to be receptive to a preventative approach. The refined area-based measures provide improved tools for better planning and targeting of services by the local councils. Network mapping using Genie made people realise what they have and what they need and help staff start the conversation to find out what was going on in the lives of individuals/families they were supporting. Why in this important? The Childhood Obesity Risk Estimation Tool has the potential to focus targeted intervention for the early prevention of childhood obesity. The updated food insecurity risk index has enabled local government to target available resources to those with greatest need. It has been included in the Joint Strategic Needs Assessment (JSNA) for Hampshire County Council. It has also contributed to food aid planning in Dorset, Hampshire and further resource planning in districts across the country. What’s next? The SLOPE CORE tool combined with the area based measures will require further testing to establish how it can be best used in practice, and any impact it may have on childhood obesity. This could be as part of a new or existing pathway which includes interventions designed to reduce risk of childhood obesity. Healthcare professionals using the tool should be trained in risk commination, be able to advise the parent on next steps, and have time to discuss what can be a sensitive topic. As SLOPE CORE only requires routinely collected data, it may be possible to build the tool into existing systems - such as healthy weight pathways, routine health visiting contacts and relevant GP consultations, which could save time and support existing work rather than further adding to workload for healthcare professionals. If internet access is unreliable, then a paper data collection sheet could be used to capture data required to use the tool at another time. After determining optimum timing and setting for tool use, a longer term evaluation is necessary to explore the impact of the tool on parents and healthcare professionals behaviours in the short term, and childhood obesity in the longer term. Publications: Ziauddeen, N., Roderick, P., Santorelli, G., Wright, J., & Alwan, N.A. (2022). Childhood overweight and obesity at the start of primary school: external validation of pregnancy and early-life prediction models. PLOS Glob Public Health. 2(6): e0000258. Ziauddeen, N., Roderick, P., Santorelli, G., Wright, J., & Alwan, N.A. (2020). OP55 Childhood overweight and obesity at the start of primary school: external validation of pregnancy and early-life prediction models. Journal of Epidemiology & Community Health, 74(Supplement 1), A26. https://doi.org/10.1136/jech-2020-SSMabstracts.54 Smith, D.M., Rixson, L., Grove, G., Ziauddeen, N., Vassilev, I., Taheem, R., Roderick, P., & Alwan, N.A. Household food insecurity risk indices for English neighbourhoods: measures to support local policy decisions. MedRxiv 2022:22273530. https://doi.org/10.1101/2022.04.06.22273530 (preprint and minor revisions requested at PLOS ONE) Smith, D. and Thompson, C. (2022) Food Deserts and Food Insecurity in the UK. Routledge. Further funding because of this research: ARC Wessex - Wessex DIET: Determining the Impact of covid-19 on food sEcurity in young families and Testing interventions MRC Clinical Research Fellowship (Dr Grace Grove) - Investigating the impact of food vouchers on diet composition and the prevention of childhood obesity Other impacts: The food security risk index has been included in the JSNA for Hampshire and has contributed to JSNAs and food aid planning in Dorset, Hampshire and further resource planning in Lancaster, Hull Hertfordshire and Greater Manchester to name a selection of Local Authorities, demonstrating the wider reach beyond Wessex.

b45fdd12-d569-4bd5-a0c4-1547cfa6f910 PARTNERS II: Testing implementation and evaluation of a digital tool for multisectoral support and management of people living with Parkinson’s disease and/or arthritis. Chief investigators: Professor Mari Carmen Portillo, Professor of Long Term Conditions, School of Health Sciences, University of Southampton. Dr Dorit Kunkel, Lecturer, University of Southampton and Research Design Service, School of Health Sciences Team: Dr Katherine Bradbury Health Psychologist, Senior Research Fellow NIHR ARC Wessex Digital Health Lead University of Southampton. Dr Lindsay Welch, Associate Professor of Nursing Practice, Bournemouth University & University Hospitals Dorset Sandra Bartolomeu Pires, PHD Researcher, School of Health Sciences, University of Southampton. Professor Christopher Edwards, Consultant Rheumatologist, Honorary Chair of Clinical Rheumatology, Associate Director Southampton NIHR Clinical Research Facility, University Hospital Southampton (NHS) University of Southampton. Dr Lindsey Cherry, Associate Professor (Podiatry Rheumatology), School of Health Sciences, University of Southampton. Francesca White, Senior Strategic lead for Partnerships, Hampshire and Isle of Wight Integrated care board. Dr Hayden Kirk, Clinical Director Adults Southampton, Solent NHS Trust ( Hampshire and Isle of Wight NHS Foundation Trust) Caroline Aylott, Head of Research, Versus Arthritis, Carolyn Fitton, Senior Research Assistant, School of Health Sciences, University of Southampton. Gillian Merritt, Service Improvement Manager, Parkinson’s UK. Peter Rhodes, Senior Programme Manager, Industry & Innovation, Health Innovation Wessex. Partners: University of Southampton, Bournemouth University & University Hospitals Dorset, Hampshire and Isle of Wight NHS Foundation Trust, NIHR Clinical Research Facility, University Hospital Southampton, Hampshire and Isle of Wight Integrated care board, Versus Arthritis, Parkinson’s UK, Health Innovation Wessex. Start: 1 October 2024 End: 30 November 2025 Summary Self-management can help people with long term conditions manage their health better. Existing self-management tools focus on healthcare (medication management, appointments) and fail to understand how people live with and adjust to their long-term conditions. This includes social support (family/friends) and other resources and networks available like the voluntary sector, industry and community groups. We have created an intervention (an action to improve a situation or prevent it getting worse) to support self-management for people with Parkinson’s Disease and/ or Arthritis and their family/carers. This intervention recognises the role of social support, charities and other organisations in adjusting to living with a condition. Based on previous study findings where we looked at the literature and talked to patients and health care professionals, we co-produced a digital tool website/app ready for testing. Aim of the research: To explore the acceptability (ease of use) and how helpful the tool is in supporting self-management by collecting data and by talking to patients and carers who have used it and health care workers. The PARTNERS tool will support professionals and other organisations to connect, share resources and optimise communication and referrals, leading to more personalised and cost-effective use of resources (beyond healthcare) in the community. Design and methods: Mixed methods acceptability and implementation study. The research will take place in community settings in Wessex. We will prioritise disadvantaged groups (those less comfortable using technology and less able to access available resources and support). We will test the PARTNERS tool with patient, carers, health professionals and voluntary organisations (Parkinson’s UK and Versus Arthritis). Testing will help understand how the tool is used and what helps or hinders its success. We will talk to people who used it to identify how useful and helpful it was and how to integrate it with their normal care. The research will support better self-management of Parkinson’s Disease and/or Arthritis, make recommendations for policy development and provide evidence for how to improve NHS services. PPI: We are working with people with Parkinson’s Disease and/or Arthritis and their families/carers. We will work together as equal partners to decide their level of involvement, roles, ways to input and training needs. We will also explore what works best or what we should do differently in their involvement. Dissemination: We will share our learning across the different groups involved. This will include presentations, policy briefings, newsletters and public events.

eda5a835-7cd7-4129-9513-a5eae9f5b7ce ADOPTED: An observational longitudinal cohort study to investigate Cortical Disarray Measurement in Mild Cognitive Impairment and Alzheimer’s disease (CONGA) Principal Investigator: Professor Chris Kipps Team: Steven Chance, Oxford Brain Diagnostics Ltd Robyn Davies, Cardiff and Vale University LHB Gail Hayward, University of Oxford, Nuffield Department of Primary Care Health Sciences, Margaret Glogowska, University of Oxford, Nuffield Department of Primary Care Health Sciences Jane Wolstenholme, University of Oxford, Health Economics Research Centre Filipa Landeiro, University of Oxford, Health Economics Research Centre Angus Prosser, University of Southampton Main Funding: NIHR i4i Starts: 6 March 2022 Ends: 31 December 2026 Summary Dementia is an umbrella term for a group of neurodegenerative diseases that cause cognitive and/or behavioural impairment that affect an individual’s function and daily living. Alzheimer’s disease (AD) is the most common dementia subtype, accounting for 60-70% of cases, followed by vascular dementia, mixed dementia, dementia with Lewy bodies, and frontotemporal dementia. Timely and accurate diagnosis of dementia is essential for appropriate care planning and signposting to sources of support. Early diagnosis and implementation of carer and patient interventions has been shown to improve patient and carer outcomes including health-related quality of life (HR-QoL) and delayed patient institutionalisation. With the promise of new therapeutic targets that may slow the progression of Alzheimer’s disease with early and targeted intervention, accurate and timely diagnosis is critical. Diagnosis is however challenging. Difficult cases can leave patients with uncertain diagnoses for long periods of time, where a “wait and see” approach is often employed when diagnostic tests are inconclusive. This can cause significant stress to both individuals living with cognitive impairment or dementia and their families. Definite dementia subtype diagnosis can currently only be obtained through post-mortem histopathological confirmation. Participants will be recruited through secondary and tertiary centres where diagnostic investigation or patient monitoring is underway. Participants will be followed for two years at 6 monthly intervals to determine change on standard cognitive and functional measures and collection of participant and companion reported health and social care events, with MRI examination at baseline and 24 months. What do we hope to achieve? We hope that the CONGA study will show that the CDM technology can be effective in identification of those who are likely to progress to Alzheimer’s disease. Early detection of dementia and timely diagnosis for patients has been shown to improve patient and carer outcomes, including quality of life, and is critical for appropriate care planning and signposting to sources of support. Accurate diagnosis and prediction of decline also allows identification for those who might be eligible for treatments. If the study shows that CDM is effective in identifying dementia earlier and can predict who is most likely to decline, we will look to promote and implement the technology in current clinical pathways.

Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. < Back What do nurses want? Improving nurses’ shift patterns - where do we start? Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. In this blog, she summarises some key results from her recent research paper that explored nurses’ views and values around their shift patterns and working time. Talia Emmanuel -University of Southampton. As a PhD student, one must be well-prepared to answer the question…“What is your research about?”. I typically answer with “I’m trying to find ways of improving shift patterns for nurses when they’re working in hospital”. Enthusiastic nods usually follow, along with a quippy reply: “Wow, that sounds important and complicated ”. Although simply put, “important and complicated” neatly summarises the nuances of this topic. We recognise the significance of improving nurses’ working conditions in the context of persistent health workforce shortages, both nationally and internationally. However, we also realise that singular cure-all solutions are non-existent – there are too many factors at play. So, where do we start? Some of those complicating factors centre around how nurses’ working hours are organised. In hospitals, nurses often have to work in shifts that cover different periods of the 24-hour day. Previous research has identified various repercussions of working shifts (and in particular, working long shifts of 12-hours or more and night shifts): increased burnout , poor work-life balance , and risk of chronic illness and cancer on the long-term. Impacts to nurses’ performance and safety while at work have also been flagged, which pose knock-on effects on the quality of care patients ultimately receive. Despite these risks, shift work is a necessary reality for many nurses working in hospitals. Therefore, administrators and managers are tasked with organising nurses’ shifts into rotas that balance staff wellbeing with service demands and operational costs - and this is no easy feat. Further complications come from recent increased pressure on NHS employers to offer staff more say over their working patterns as a way of improving job satisfaction and their experiences of work. But this raises the question: What do nurses want? More specifically, what shift patterns do they prefer, and why? While there is some existing literature on this (an excellent summary can be found here ), our understanding of the factors that lead nurses to prefer certain shift patterns needs more work. As part of my doctoral research, I was eager to do a deep-dive into this area: I know that in order to find ways to improve nurses’ shift patterns, it is crucial to ask nurses themselves about their views and values around the organisation of their working hours. Fortunately, I had access to a rich data source around this topic: a recent survey study funded by the NIHR ARC Wessex that collected responses from nurses working across the UK and Ireland. My supervisors and I were particularly interested in nurses’ responses when asked: “ If you could choose your shift patterns, what would be the most important factor in that choice?” While we expected nurses to describe many diverse factors/preferences, we were hopeful of commonalities too. Nearly 800 nurses provided their open-ended responses to this question. We analysed all of them and developed 3 overarching themes: Theme 1, “When I want to work ”: Nurses shared many preferences for when they wanted to work, and equally, how they wanted their rest days to be arranged. Even though individual preferences differed, three general scheduling practices were also repeatedly mentioned as helpful: working less ‘harmful’ shift patterns from the start, working more consistent/predictable patterns, and having more flexibility and control over when to work. “Not working consecutive shifts so that I am exhausted by the time I get a day off.” “Know what I am doing each week, either set days or set nights, so I can predict what I am working…” “Having the freedom to give myself more days to recover between weekly shifts.” Theme 2, “Impacts to my life outside work” : Many factors emerged from nurses wanting shift patterns that enable a good work-life balance and minimise disruption to their lives outside work. Their preferences and priorities related to wanting quality recreational time with family and friends, to be able to arrange childcare easily and inexpensively, and having enough rest/recovery time to protect their own wellbeing. “Quality time with my children and family without being permanently drained, exhausted, and sad” “That the pattern could stay the same each week so it would be easier for childcare needs. Many nurseries like set days and when our rota is changing from week to week this can be difficult.” “…Not mixing days and nights in a week […] this does not observe HSE best practice guidelines and messes with the body clock and sleep patterns. It should not be allowed to happen.” Theme 3, “Improving my work environment” : Some nurses mentioned job-specific factors that influenced their choices, like wanting to work the shift patterns they believed to be best for patient care, or, working the best configuration of shifts for optimal take-home pay. But other concepts, like having sufficient staffing numbers and being able to take breaks, were also stressed. “A shift where I feel I have accomplished the care I have wanted to give for my patients” “To not have so much pressure on the shift, with the right amount of staff on and to take my break when needed”. When thinking back to the question “What shift patterns do nurses prefer, and why?”, these themes provide several helpful clues. They also highlight that while there is variation in nurses’ specific shift preferences, there are also more general scheduling practices that also support their priorities. For my research, this finding is particularly striking, as it moves away from the oft-assumption that there are “countless individual preferences that are difficult to accommodate” and toward the idea that there are more universal preferences too. Moreover, when these universal preferences are used during the scheduling process, nurses’ shift patterns can be improved overall. That sounds like a good starting point! Read our full analysis of nurses’ survey responses in the open-access research paper here Follow Talia: Twitter/X | ResearchGate Follow the UoS Health Workforce & Systems team: Twitter/X | UoS website Previous Next

Research Fellow < Back Laila Khawaja Research Fellow Long Term Conditions Dr. Laila Khawaja holds a PhD in Social Sciences from the University of Southampton and is an experienced qualitative researcher with a strong background in public health, well-being, and social engagement. She has worked extensively on projects that explore the intersection of mental health, agency, and lifestyle behaviors, particularly among young people. Laila was involved in a National Institute for Health and Care Research (NIHR) project that focused on empowering young individuals to enhance their sense of agency and well-being. This work aimed to positively influence their mental health, dietary choices, and physical activity habits through participatory engagement strategies. Currently, Laila is contributing to the Applied Research Collaboration (ARC) Wessex Long-Term Conditions theme, where she is actively engaged in two key projects: the SCALE project, which examines enablers and barriers of using a long term conditions-scale tool and a study on Social Prescribing for Link Workers , which investigates how healthcare professionals can better connect individuals to community-based resources to improve well-being and health outcomes. Her research interests include health inequalities, patient and public involvement in healthcare, and the role of social interventions in managing long-term conditions. Previous Next

1ab7e5e6-86e2-4f8e-a9c6-1bc46e56207d ADOPTED: Personalised social and self-management support for better living with multiple long-term conditions in the community (CO-ACTION) Chief Investigators : Dr Dorit Kunkell, School of Health Sciences, University of Southampton and Professor Mari Carmen Portillo, School of Health Sciences, University of Southampton. Team: Dr Hannah Wheat, Professor Victoria Allgar and Professor Richard Byng from the University of Plymouth. Miss Francesca White, Hampshire and Isle of Wight Integrated Care Board (ICB). Dr Tom Blakeman and Professor Peter Bower from the University of Manchester. Professor Daniel Prieto-Alhambra, Associate Professor Rafael Pinedo-Villanueva, Dr Annika Jödicke and Miss Maria T Sanchez-Santos from the University of Oxford. Dr Lindsey Cherry and Dr Kate Lippiett from the University of Southampton. Mr Eric Compton, Patient and Public Contributor, Southampton. Start: 1 June 2024 End: 30 November 2028 The CO-ACTION programme aims to improve wellbeing for people with multiple health problems. Living with Multiple Long-Term Conditions often called ‘Multimorbidity’ (MLTC-M) involves multiple appointments and care plans. Patient priorities are often overlooked. Common issues include pain, mobility problems and fewer interactions with friends and family. This can lead to loneliness and poorer mental health. The research team will work with fellow researchers, health, social care and VCSE sector workers to co-design and test a health and wellbeing intervention with and for people living with MLTC-M . To evaluate the CO-ACTION intervention: We will run a trial involving 500 people living with MLTC-M and carers. Half will receive the intervention. The other half will continue with usual care. We will recruit participants (with Patient and Public Involvement support) in health and community settings in Manchester, Leeds, Plymouth, and Southampton. Wellbeing, quality of life, unplanned hospital admissions, and costs will be assessed at the beginning, 6 and 12 months later. Researchers will test how this intervention can be adopted in the NHS in six case study sites. Public and patient (PPIE) contributors will help us design materials, consider challenges and provide feedback on findings.

Rajneesh Kaur and Eloise Radcliffe < Back PPI reflection on experience in attending an academic conference "Prescribing and deprescribing is something we do to patients so their viewpoint does matter." Rajneesh Kaur and Eloise Radcliffe Picture: Kinda Ibrahim, Eloise Radliffe, Nina Fudge, Jalpa and Rajneesh Kaur In September 2024 I attended an International Conference on Deprescribing in France (ICOD2). I'd been looking forward to this event since first coming to know of it about a year before. When registering for the conference it stated that they welcomed all 'researchers, clinicians and teachers in the deprescribing field'. This prompted me to email the organisers to ask if I could attend as a non-healthcare professional. They were very welcoming and reassured me that anyone can attend. I was excited not only to see what was happening at the cutting edge of deprescribing but also because I was going to meet the Southampton team in person for the first time at the conference. We had communicated over Teams before but the conference was a great way to meet each other in person. We recognised each other straight away and were in close company over the two days at the conference. The actual content of the conference reconsolidated a lot of what I had learnt about deprescribing so far. It was great to see leading figures deliver live and to be able to ask questions and have conversations with them. When mingling in the workshops and over lunch, people were interested to gain our perspective — I was attending with a good friend of mine who is also a non-healthcare professional like me, but as she is a solicitor, the healthcare professionals at the conference seemed very interested in the legal angle of deprescribing when speaking to my friend. This legal area does need exploring I feel. The viewpoint of patients and carers seemed like something the healthcare professionals valued, yet I felt it was under-represented in the conference. Prescribing and deprescribing is something we do to patients so their viewpoint does matter. I enjoyed listening to the presentation from David Gardner in particular, who shared a patient's experience, with the patient (George) interacting live on the call. This really brought to life how deprescribing can make a difference. Bringing the patient's perspective forward can bring inspiration and motivation to healthcare professionals to be more comfortable with stepping into the unknown and trying something new. I also appreciated that the conference organisers were trying to be open and ethical about their funding, especially pleased that they were not accepting funding from pharmaceutical companies. This made it seem OK that we didn't have any extravagant lunch arrangements, I'd rather that and keep the soul of the conference alive. Also, my friend and I were humbled and surprised to see that every other person at the conference was a pharmacist. It was almost as if after working with medication so closely, these pharmacists realise the harm as well as the good that medicines can do and therefore have come to the conference to understand and acknowledge the importance and challenges of deprescribing. Although deprescribing should be a part of prescribing, it is practised far less than prescribing. In fact, I would say that the benefits of deprescribing are just now being realised and are not mainstream at all. As a result, it seemed very challenging when I first set out looking for pathways to come off medication safely and only then eventually even came across the term deprescribing. The conference was international and it opened doors to meet people from other countries who were on the same page. I especially remember my encounter with a researcher from Denmark who said something very profound, she explained that it's not the patients that need educating, if we make a safe space where people can be deprescribed from medication — they will come. This researcher had struggles with a loved one who is on medication. This conference was a great platform to network and strengthen beliefs in deprescribing. It was only the second international conference ever held on this topic and I am very much looking forward to ICOD3 Eloise: One of the highlights of attending the International Conference on Deprescribing in Nantes, France, was meeting Rajneesh in-person, our highly valued and very engaged Patient and Public Involvement (PPI) team member. She has been a PPI group member of the ARC Wessex-funded MODIFY study (Medication review and deprescribing intervention for older people living with frailty in primary care) and is now chairing the PPI group for a new ARC Wessex-funded study DOMINO-HF (Deprescribing and medicines optimisation in older people with heart failure). I had previously only met her online and the conference was a great opportunity to talk in-person about the presentations and workshops by international leaders in the field of deprescribing and discuss Rajneesh’s ideas for future projects. The conference was a very welcoming and supportive environment and I would definitely agree with Rajneesh that more patients and caregivers should be represented at the conference, and will hopefully be encouraged to attend and participate in the next one, ICOD3 in 2 years time! Previous Next

8549d888-5b96-445e-9088-9a757edd9282 ADOPTED: IneQUIty in end of life care for children: Investigating experiences and families’ Needs after sudden and unexpecTEd deaTh in children and young people – the QUINTET study Chief Investigators: Professor Anne-Sophie Darlington, School of Health Sciences, University of Southampton and Dr Katherine Hunt, Senior Research Fellow, School of Health Sciences, University of Southampton Team: Dr Vicky Payne, School of Health Sciences, University of Southampton, Miss Sarah Hodkinson, Associate Professor, Department of Music, University of Southampton, Professor Heather Gage, Professor of Health Economics, School of Biosciences and Medicine, University of Surrey, Dr Emily Cooper, Law and Policing, University of Central Lancashire, Dr Jamal Hossain, Lecturer in Applied Statistics, School of Health Sciences, University of Southampton, Dr Joanna Garstang, Consultant Community Paediatrician, University of Birmingham, Dr Nicola Speed, SUDC (UK), Miss Emma Kneebone, 2wish, Miss Stacey John, Forget Me Not Children's Hospice. From: 01/12/2024 to: 30/11/2027 BACKGROUND Around 3000 children die each year in England and Wales, and 30% of deaths represent infants and children who die unexpectedly or suddenly from accidents, suicide or unexplained deaths. Clear guidance and palliative care services exist for children who die of a life-limiting condition, including emotional and psychological support for their families, which extends into bereavement. However, clear guidance and care are not available for sudden and unexpected infant and child deaths, even though these are often the most tragic, brutal and shocking deaths. We do not know very much about what it is like for families, what care they need, what care is available, how they manage and cope in the longer term after their child’s death, and how professionals need to be supported after often traumatic experiences. PLAN We recently brought together organisations and professionals who care for families when a child has died suddenly (e.g., health professionals, fire department, police, hospices, charities, schools) to commit to working together to improve care for these families, and improve training and support for professionals. This network helped develop this project. We want to investigate these aspects (organised in Work Packages -WPs), focusing on different questions: WP1: What care is available for these families – around the time of the death and into bereavement, and where do children die. We will investigate this through 1) past research, and 2) existing database with information on child deaths. WP2: Which services are available to families and who provides that care, and what are the experiences and needs of the professionals providing that care? We will 1) interview professionals who carry out the Child Death Review and 2) interview professionals who provide care in different settings. WP3: What are the experiences of families, what care helped and what do they need? And what are the long-term consequences for parents, such as grief and depression and physical health? - we will investigate this by 1) interviewing bereaved parents about their experiences, and 2) asking bereaved parents to complete a questionnaire about grief, depression and quality of care. WP4: What recommendations around care and support should we make? We will use the information from the previous work packages to develop recommendations on how to improve care around the time of the death and in bereavement. We will agree what the needs are for training and supporting professionals. INVOLVING FAMILIES We will involve bereaved parents though the organisations included in our network. We have two parent and two other lay members as co-applicants on the study. A formal parent advisory group will be set up to help us with research questions, materials, design of the study, recruiting parents, content, social media presence and study branding, and dissemination. We will also work with a team of parent investigators who will provide guidance to the researcher and support participants during interviews. DISSEMINATION We will produce scientific papers, develop recommendations for care and maintain a network of parents and professionals to support the project. We will create national awareness of the needs of these families and work with a policy engagement organisation to influence policy and change practice. We will produce newsletters, social media posts, and result postcards to update families and the wider network.

d6d7fb08-5eb7-4cab-afcf-359d64b8fe12 ADOPTED PROJECT: Young people’s barriers to mental health services Lead: Dr. Corine Driessens Co-Investigator: Professor Peter W F Smith Kim Markham Jones & Fiona Lacey – YoungMinds Nicole Davenport, Mahdi Hassan, Shahrbano Iqbal, Friday Skelton – young researchers recruited by and in employ of YoungMinds Starting date: October 2022 Ended: July 2025 Published in journal of psychiatric research online: Use or no use? Young People's engagement with mental health services https://doi.org/10.1016/j.jpsychires.2026.01.034 Many young people in the UK experience anxiety or depression, but most can’t get mental health support when they need it. From the very beginning of this project, young people, both as young researchers and as participants in four co-production workshops, played a central role in shaping our questions, interpreting the findings, and explaining what the results mean in real life. Their insight guided every stage of the work. This study looked at what affects whether young people use mental health services and what happens to those who don’t. The biggest factor in getting help was whether health care professionals recognized the young person’s distress was a mental health disorder. Other things like, severity of symptoms, being a female, having fewer supportive people around, or having unemployed parents played a smaller role. Young people who didn’t use services were less likely to be female, come from single-parent families, have caring responsibilities, or have been bullied. They were also more likely to have good relationships with their parents. Those who did use services had poorer outcomes later in adulthood, suggesting they faced greater difficulties overall. Because specialist mental health services are overstretched, responsibility has shifted to GPs and teachers, who often feel under-resourced and not fully trained to meet these needs. The GPs we spoke to faced strict referral rules, long waiting lists, short appointments, and limited mental health training. The teachers we spoke to also felt pressure to support students without the resources or guidance they need. After hearing these findings, a group of young people from the “missing middle” (those struggling but not qualifying for specialist care) recommended: Training all school and college staff in mental health. Better support for apprentices at work. Peer support groups in schools, colleges, and universities. Safe spaces and housing support for LGBTQIA+ students. More help for young carers and fairer benefits. Better training for all health workers to support diverse communities. Looser referral rules so young people don’t have to be “ill enough” to get help. Youth hubs offering safe spaces, activities, and mental health support. Overall, the findings show the need for more inclusive, preventative, and joined-up mental health support for young people. Reflections on Young People involvement with shaping analysis framework for mental health .docx Download DOCX • 2.37MB What did we find out? Presented the findings at national and international conferences (e.g. MQ/DATAMIND, ADRUK, NIHR Statistics Group, EPA Epidemiology & Social Statistics, International Congress of the European Society for Child and Adolescent Psychiatry) Presented the findings at ARC Wessex webinar Presented findings on ARC Wessex website Where next? The young people who took part in our workshops were very clear about one thing: we need to start much earlier. They told us that helping children learn emotional skills, like understanding their feelings, managing stress, and asking for help, before stigma takes hold could make a big difference in preventing mental health problems later on. Taking this guidance seriously, our team has now grown to include experts who know how to design effective mental health programmes for primary schools, as well as researchers who can identify exactly which elements such a programme should include. Our next step is to develop a primary school–based intervention shaped by what young people told us matters most. Because this type of work sits outside ARC Wessex’s remit, we are now seeking external funding to take the project forward and bring this early-intervention programme to life. https://video.wixstatic.com/video/6fe132_c8aa61002b864940a8aac2b8d7754c07/480p/mp4/file.mp4 https://video.wixstatic.com/video/6fe132_ee6a84e1cd6a4745a6de0f05e2034688/480p/mp4/file.mp4 https://video.wixstatic.com/video/6fe132_fc53aac3539f4f839ea71adcfb34b517/720p/mp4/file.mp4 Olly Parker, Head of External Affairs and Research at YoungMinds , said: “This research from YoungMinds and the University of Southampton shines a vital light on the record numbers of young people needing mental health support. Growing up today is incredibly tough. Many young people are experiencing multiple pressures which impact their mental health, including poverty, inequality, intense academic pressure and the online world, so it’s no wonder so many are struggling. One of the clearest recommendations from the young people involved is the urgent need for early support hubs in every community. We know many young people face long waits for mental health support and become more unwell while waiting, which can lead to needing more urgent care. We need major reforms to address the root causes of poor mental health and for the Government to focus on reducing waiting lists so young people can get the support they need. The recent 10 Year Health Plan showed promising commitments with Young Futures Hubs and Mental Health Support Teams. These initiatives are vital to reducing pressures on the system, improving support and reducing waiting times - their rollout must be a political priority. But more is needed to tackle the scale of need - we need radical solutions that will address the reasons why so many young people are struggling in the first place.” Corine Driessens, one of the researchers based in Southampton, said: “It has been a truly wonderful and positive experience working with these groups of young people. Their innovative and fresh ideas across a wide range of ways to help others get the mental health support they need have been inspiring.”

3832ef1c-ee61-4cdf-8362-5cdbe7212017 Wessex NHS Insights Prioritisation Programme Project (NIPP) Wessex NHS Insights Prioritisation Programme Project (NIPP) National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex and Wessex Academic Health Science Network (AHSN) Digital innovations for people living with frailty Read the Health Innovation Network report Project team Nicola Andrews (NIHR ARC Wessex), Cindy Brooks (NIHR ARC Wessex), Cheryl Davies (Wessex AHSN), Linda Du Preez (Wessex AHSN), Richard Finley (Wessex AHSN), David Kryl (NIHR ARC Wessex and Wessex AHSN), Susi Lund (NIHR ARC Wessex), Michelle Myall (NIHR ARC Wessex), Rebecca Player (Wessex AHSN) and Phoebe Woodhead (Wessex AHSN). Background to the project NIPP was funded by NHS England’s Accelerated Access Collaborative to enable ARCs and AHSNs to work together to accelerate the evaluation and implementation of innovations that support post-pandemic ways of working, build service resilience and deliver benefits to patients. The Wessex NIPP project focused on the use of digital interventions to support the care of people with frailty. We worked collaboratively with stakeholders from across the Integrated Care Systems in Dorset and Hampshire and Isle of Wight to identify system priorities in this area. The project had several components: 1 – Evaluation of uptake and use of the myCOPD app by older people We undertook a mixed methods evaluation of the myCOPD app , a digital monitoring and self-management tool, in relation to its use by older people. The findings showed a higher prevalence of COPD in the myCOPD eligible population than the general population, highlighting the importance of understanding the impact of frailty on uptake and use of the app. Those aged 75 and over, or living with moderate or severe frailty, were less likely to register with and more likely to decline the app. There was also evidence that follow-up support to promote use of the app could increase activation and help overcome technical barriers. Evaluation of myCOPD app - Summary of findings (ARC Wessex) .pdf Download PDF • 180KB Evaluation of myCOPD app - Full Report .pdf Download PDF • 368KB 2 – Development of a Theory of Change on use of data to enhance care of people with frailty Theory of Change is a method to develop understanding of how an initiative can achieve impact. This is displayed in a Theory of Change map. The development and refinement of the Theory of Change map drew on a review of the evidence and individual discussions with a wide range of stakeholders. Participants were from primary care, community services and acute care working in digital health or care, frailty, commissioning and population health management. Stakeholders identified that a lack of availability of routinely collected data from across organisations to inform decision-making impacted the care provided to people with frailty. Theory of Change map - Use of data to enhance frailty care .pdf Download PDF • 176KB Theory of Change Report - Use of data to enhance frailty care .pdf Download PDF • 461KB 3 - Investigation of the use, applicability and acceptability of digital remote monitoring for older people a) Listening activities with older people’s community groups to understand perceptions of digital remote monitoring We held face-to-face events at six older people’s community group meetings, including a carers’ group, an exercise class and a community group serving a majority black ethnic population. At these events we discussed benefits, concerns and barriers to the use of digital remote monitoring (the ability to monitor aspects of an individual’s health remotely using technology). We also asked group members how they thought their views might change as their health or abilities declined. b) Research study investigating use and acceptability of digital remote monitoring for older people with frailty in the community This mixed methods research study investigated digital monitoring at home approaches among older people with frailty, using Artificial Intelligence (AI)-facilitated sensors to monitor daily activities and routines. c) Evaluation of digitally enabled care within frailty virtual wards The evaluation used qualitative data from two frailty virtual wards ( NHS England » Virtual wards ) to explore the use, decision-making and impact of digital remote monitoring. We combined the qualitative data from the above three work packages (a, b and c) for thematic analysis. We found that a personalised approach is important, with a need to consider practicalities (such as cost and sensor positioning) and design of the technology. Face-to-face care is highly valued and should not be replaced by digital remote monitoring. Users and carers need to know what to expect, how the technology works, who is monitoring and when; this would aid trust. NIPP 2022-23 summary report .pdf Download PDF • 624KB NIPP 2022-23 Full report .pdf Download PDF • 838KB 4 - Co-production, piloting and evaluation of an online Implementation Toolkit Implementation is a complex process. For those tasked with introducing an innovation or a change to practice, service provision or delivery, there are a range of models, frameworks and tools to choose from to support the implementation journey. However, these can be inaccessible, specific to particular user groups, or fail to take implementation considerations into account at the outset. The Web-based Implementation Toolkit (WIT) was co-produced with a range of stakeholders by NIHR ARC Wessex. It is a user-friendly and accessible guide on what needs to be considered when implementing and how to achieve this. WIT can be accessed at: Helpful resources | NIHR ARC Wessex More details can be found at: Implementation | NIHR ARC Wessex Rapid Insights Guide for 2022/23 work A Rapid Insights Guide (with project highlights) was produced for NHS England at the end of the 2022/23 projects (work packages 3 and 4 above). Rapid insights report NHS E_for submission .pdf Download PDF • 322KB

65894af6-1d61-4f27-8b10-ff3b90451d8b Safer Nursing Care Tool and nurse staffing requirements What did we learn We found that for some wards using the Safer Nursing Care Tool (SNCT) gives a good estimate of the number of nursing staff needed. However, for other wards, relying on the estimate provided by this tool without further thought could lead to unsafe staffing levels for different reasons. For example, the current guidance recommends setting staffing levels to meet the average requirement, but following this logic, 18 wards in the three Trusts would often have been short-staffed. Also, a quarter of wards needed a sample of over 182 days to estimate the number of staff needed precisely, when the current recommendation is 20 days. Nursing workforce leaders at the three Trusts suggested characteristics of wards where the tool performed least well, for instance, high patient throughput and differences in workload between mornings and evenings. What difference can this new knowledge make? This project and the previous related project (NIHR-funded study https://doi.org/10.3310/hsdr08160 ) led to a direct collaboration with NHS England and NHS Improvement and an invitation to work with them to further develop and update the guidance on using the Safer Nursing Care Tool. The team have spoken about the research findings and implications at a series of NHS Improvement safe staffing fellows training events. They have co-developed a set of resources to help nurses plan staffing. Impact has been achieved through this research shaping revised guidelines published by NHS England and NHS Improvement on using the SNCT in combination with professional judgement to determine nurse staffing requirements. We were invited to help facilitate workshops to co-develop a template for nurses to record their professional judgements. We are also in early-stage discussions with hospital managers in Greece about how the professional judgement framework might be relevant there, as well as discussions about how to achieve wider reach through the World Health Organization website. Why is this important? The professional judgement framework we developed as a result of these projects will benefit nurses, who use this tool nationally, by giving them concrete guidance on issues to consider when deciding staffing levels. It will benefit patients admitted to inpatient wards, through better matching of staffing levels to demand. Having too few nursing staff is related to adverse effects for patients (more deaths, more falls, longer stays in hospital), staff (turnover, sickness) and organisations (higher costs from temporary staff to fill gaps). Diagram 1 We presented the list of wards which were flagged as having overall poor fit to three nursing workforce leaders Some of the common factors they suggested as potential reasons for poor fit are shown here above. They highlighted wards with large morning-evening differences in staffing requirements (based on acuity-dependency ratings) may be among those where the tool fits least well. For wards that are particularly small or large, it is possible that the number generated by the SNCT is less likely to be sufficient to maintain minimum registered nurse levels when rostering staff to shifts. They highlighted some ward characteristics that mean the SNCT multipliers, as they are applied, may underestimate the true workload. These were high patient turnover, older patient population, cancer infusion/device activity. a high proportion of patients requiring one-to-one care AKA enhanced care/specialling. The factors suggested are on the whole congruent with published evidence What next? Our next step is conducting research predicting demand for nursing staff which we plan will also lead to tools and resources to guide decision-making around staffing. Research team: • Professor Peter Griffiths, Chair of Health Services, University of Southampton • Rosemary Chable, Deputy Director of Nursing, Education & Workforce, University Hospital Southampton NHS Foundation Trust • Nicky Sinden, Head of Nursing Workforce, Portsmouth Hospitals NHS Trust • Tracy Moran, Lead Nurse for Nursing Workforce, Education & Practice, Poole Hospital NHS Trust Project partners: • University of Southampton • University Hospital Southampton NHS Foundation Trust • Portsmouth Hospitals NHS Trust • Poole Hospital NHS Trust More information Evi dence Brief Publication 24_11_Professional_Judgement_Staffing_Eprints[16] .pdf Download PDF • 186KB Publications: Saville, Christina and Griffiths, Peter (2021) Ward staffing guided by a patient classification system: A multi-criteria analysis of “fit” in three acute hospitals. Journal of Nursing Management, 29 (7), 2260-2269. ( doi:10.1111/jonm.13341 ). Saville C, Griffiths P, Casey A, Chable R, Chapman H, Radford M, and Watts N (2023) Professional Judgement Framework, doi: 10.5258/SOTON/P1102 University of Southampton ( https://doi.org/10.5258/SOTON/P1102 ) Saville, Christina and Griffiths, Peter , Ejebu, Ourega-Zoé and Fogg, Carole (eds.) (2023) Introducing the Professional Judgement Framework to guide nurse staffing decisions (Evidence Brief, 24) 2pp. http://eprints.soton.ac.uk/id/eprint/484412 Saville, Christina and Griffiths, Peter , Ejebu, Ourega-Zoé and Fogg, Carole (eds.) (2024) Nurse staffing decisions: the Professional Judgement Framework. Nursing Times, 120 (7). https://www.nursingtimes.net/c...4-06-2024/ The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study ( nihr.ac.uk ) Video: Computer simulation what and why? https://sho.co/1E34T The importance of professional judgement in nurse staffing decisions https://southampton.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=87fcb9bb-e9dc-4b43-8377-acb700e3bec2 Here is the orginal research outline Identifying wards for which the Safer Nursing Care Tool is appropriate for assessing nurse staffing requirements Principal Investigator: Dr Christina Saville Team members: Dr Christina Saville (Research Fellow, University of Southampton) Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences, University of Southampton), Rosemary Chable RN (Deputy Director of Nursing, Education & Workforce, University Hospital Southampton NHS Foundation Trust) Ms Nicky Sinden (Head of Nursing Workforce at Portsmouth Hospitals NHS Trust), Tracy Moran (Lead Nurse for Nursing Workforce, Education & Practice, Poole Hospital NHS Foundation Trust) Start: 1 December 2019 End: 1 August 2020 Partners: University of Southampton, Portsmouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust Lay summary It is important to have enough qualified (registered) nurses looking after patients staying on hospital wards, because having too few is associated with worse patient care and more patient deaths. On the other hand, there are extreme shortages of nurses, so having “too many” on a ward could be considered a waste. The Safer Nursing Care Tool is used in many hospital wards in England to work out the number of nursing staff (including nursing assistants) needed. However, a recent study showed that it is more suitable on some wards than on others. For example, we found that factors not accounted for in the tool, e.g. whether a ward is surgical or medical, and the proportion of single rooms, also affected professional judgement of whether staffing was adequate. Aim This study aims to understand which ward characteristics mean that the Safer Nursing Care Tool gives a good estimate of the nursing staff required, and which ward characteristics mean that the number might need to be adjusted or further considered by taking into account the expertise of ward leaders. It also aims, if possible, to provide some general rules or an add-on tool to help nursing managers with setting staffing levels. Methods We will analyse the data that were collected for a previous study in a different way. This time we will focus on differences between wards rather than hospitals. We will use analytical techniques for finding patterns in data to identify similar wards. In our team we have experienced leaders in nursing who will provide expert professional insights into ward characteristics. Patient, public and community involvement and sharing results We will involve nursing managers in the study because they are the potential users of any rules or tools we develop. We plan to develop a resource (rules or a tool) for nursing ward managers and to run a workshop to test use of this resource. We plan to write one academic paper about what we find out. We also can share the plans for this with lay members from the PPI group as appropriate. We are developing a smaller user group across Workforce and Frailty and Older People teams.