Healthier Southampton Many of the things that affect our health also affect the environment. For example, the foods that we eat and whether we walk or drive. Some of these things also affect whether we can access good quality, nutritional food- for example, what lunches are provided by schools or colleges, and whether people can get a local allotment. It can be useful to see weight, food, and the environment as part of a complex system, a web of things that all influence each other. We are running a research exercise with local community members in Southampton on the 26th November, and we’ll share the results of that meeting here. We will run some more community gatherings on 3rd December 2025 where we will talk through the results of our research exercise and take part in a series of activities in small groups designed to explore the Southampton system in more detail. If you have any questions or comments about this research, please email j.l.barker@soton.ac.uk .

54d3d6a4-2f97-4fa8-8c83-e41613f3b35d Co-POWeR - Consortium on Practices of Wellbeing and Resilience in BAME Families and Communities Principal Investigator: Professor Iyiola Solanke, University of Leeds Team: Professor Maria Stokes, School of Health Sciences, University of Southampton; Professor Sabu Padmadas, School of Economic, Social & Political Sciences, University of Southampton; Professor Monica Lakhanpaul, Institute of Child Health, University College London; Professor Claudia Bernard, Professor of Social Work. Department Social, Therapeutic and Community Studies, Goldsmiths College; Professor Shirin Rai, Politics and International Studies, University of Warwick; Professor Raminder Kaur, School of Global Studies, University of Sussex; Professor Gargi Bhattacharyya, Law and Social Sciences, University of East London; Professor Florence Ayisi, Faculty of Creative Industries, University of South Wales; Professor Anna Gupta, Department of Social Work, Royal Holloway, University of London. Duration: 18 months Summary Two viruses - COVID-19 and discrimination - are currently killing in the UK (Solanke 2020), especially within BAMEFC who are hardest hit. Survivors face ongoing damage to wellbeing and resilience, in terms of physical and mental health as well as social, cultural and economic (non-medical) consequences. Psychosocial (ADCS 2020; The Children's Society 2020)/ physical trauma of those diseased and deceased, disproportionate job-loss (Hu 2020) multigenerational housing, disrupted care chains (Rai 2016) lack of access to culture, education and exercise, poor nutrition, 'over-policing' (BigBrotherWatch 2020) hit BAMEFC severely. Local 'lockdowns' illustrate how easily BAMEFC become subject to stigmatization and discrimination through 'mis-infodemics' (IOM 2020). The impact of these viruses cause long-term poor outcomes. While systemic deficiencies have stimulated BAMEFC agency, producing solidarity under emergency, BAMEFC vulnerability remains, requiring official support. The issues are complex thus we focus on the interlinked and 'intersectional nature of forms of exclusion and disadvantage', operationalised through the idea of a 'cycle of wellbeing and resilience' (CWAR) which recognises how COVID-19 places significant stress upon BAMEFC structures and the impact of COVID-19 and discrimination on different BAMEFC cohorts across the UK, in whose lives existing health inequalities are compounded by a myriad of structural inequalities. Given the prevalence of multi-generational households, BAMEFC are likely to experience these as a complex of jostling over-lapping stressors: over-policed unemployed young adults are more likely to live with keyworkers using public transport to attend jobs in the front line, serving elders as formal/informal carers, neglecting their health thus exacerbating co-morbidities and struggling to feed children who are unable to attend school, resulting in nutritional and digital deprivation. Historical research shows race/class dimensions to national emergencies (e.g. Hurricane Katrina) but most research focuses on the COVID-19 experience of white families/communities. Co-POWeR recommendations will emerge from culturally and racially sensitive social science research on wellbeing and resilience providing context as an essential strand for the success of biomedical and policy interventions (e.g. vaccines, mass testing). We will enhance official decision making through strengthening cultural competence in ongoing responses to COVID-19 thereby maximizing success of national strategy. Evidenced recommendations will enable official mitigation of disproportionate damage to wellbeing and resilience in BAMEFC. Empowerment is a core consortium value. Supporting UKRI goals for an inclusive research culture, we promote co-design and co-production to create a multi-disciplinary BAME research community spanning multi-cultural UK to inform policy. CO-POWeR investigates the synergistic effect on different age groups of challenges including policing, child welfare, caring and physical activity and nutrition. WP1 Emergency Powers investigates these vague powers to understand their impact on practices of wellbeing and resilience across BAMEFC. WP2 Children, Young People and their Families investigates implications for children/young people in BAMEFC who experience COVID-19 negatively due to disproportionate socio-economic and psychosocial impacts on their families and communities. WP3 Care, Caring and Carers investigates the interaction of care, caring and carers within BAMEFC to identify how to increase the wellbeing and resilience of older people, and paid and unpaid carers. WP4 Physical Activity and Nutrition investigates improving resilience and wellbeing by tackling vulnerability to underlying health conditions in BAMEFC. WP5 Empowering BAMEFC through Positive Narratives channels research from WP1-4 to coproduce fiction and non-fiction materials tackling the vulnerability of BAMEFC to 'misinfodemics'.

894e3c82-d20e-4fbc-a56a-7d96277ba61e PARTNERS Project: Development and implementation of a digital tool for multisectoral support and management of long-term condition PARTNERS Project: Development and implementation of a digital tool for multisectoralsupport and management of long-term condition Principal Investigator: Professor Mari-Carmen Portillo Co Applicants : Line Bragstad, Dr Dorit Kunkel, Dr Kat Bradbury, Dr Lindsay Welch, Hayden Kirk, Dr Caroline Barker, Sandra Bartolomeu Pires, Christopher Edwards, Lindsay Cherry, Francesca White, Caroline Aylott, Cathal Doyle. Partners: University of Southampton, University of Oslo, Hampshire and Isle of Wight NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Hampshire and Isle of Wight ICS, Versus Arthritis, and Parkinson’s UK. Lay Summary Background to the research : Self-management is an approach to help people with long term conditions manage their health daily. Existing NHS self-management tools focus on healthcare (medication management, appointments) and fail to capture aspects of how people live with and adjust to 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 their family/carers. This intervention recognises the role of social support, voluntary sector, industry, and community groups in adjusting to living with a condition. Our next step is toadapt this intervention to the needs of people living with other conditions like Arthritis and for those living with more than one condition and create a digital tool. Aim of the research : To develop, implement and evaluate a digital tool that supports the management of people with Parkinson’s Disease and/or Arthritis. The 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: The research will take place in community settings in Wessex. We will prioritise disadvantaged groups (those less comfortable using technology and less able toaccess available resources and support). We will : 1. Work with our patient and public involvement (PPI) representatives, relevant voluntary organisations, health and social care providers, and key people involved in policy making and NHS strategy. They will have a voice ineach decision to ensure our tool is relevant and acceptable to those using it. 2. Host discussion groups with people with Parkinson’s Disease and/or Arthritis and theirfamily/carers to understand the positive and negative aspects of existing digital tools, from a patient perspective. 3. Design our self-management tool. 4. Test the tool through two primary care surgeries (GP) 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. Deliverables : The research will generate: a digital tool to support more effective self-management of Parkinson’s Disease and/or Arthritis, recommendations for policy development, evidence for how to improve NHS services. Public Patient Involvement: We willwork with people with Parkinson’s Disease and/or Arthritis and their families/carers. We will work together as equal partners to define their level of involvement, roles, methods to input and training needs. We will also explore what works best or what we should do differently intheir involvement. Dissemination : We will share our learning across the different groups involved. This will include presentations, policy briefings, newsletters, and public events. What did we find out? We found that people with Parkinson’s and/or arthritis, their carers and professionals involved in their care wanted a digital app that was: • Simple • Easy to navigate • Hybrid – in person contact also signposted Included: • Community resources from voluntary/charity sector • Free or inexpensive resources • Links to peers/buddy for support What next? PARTNERS 2 has evolved, as a continuation project. This allowed time for: A suitable digital company to be found with previous experience of working with people with health condition Full briefing of the digital company about what was required of the digital web app. Development of a 'Life Boost' app Trade marking 'Life Boost' Real-world evaluation of the app with Social Prescribers in Hampshire Linking 'Life Boost' to MyMedical Record (University Hospital Southampton NHS Foundation Trust) The PARTNERS 2 project will now: Ga in full exposure by having it adopted onto the My Medical Record platform at the University Hospital Southampton NHS Foundation Trust Be used in the real-world and a business/company/organisation will be sought to adopt the app for further development and management

Research Fellow < Back Stephanie Hughes Research Fellow Ageing and Dementia Steph Hughes is a Research Fellow in the ARC Wessex Mental Health Hub at The University of Southampton conducting research into alcohol use disorder in older adults. Steph has a PhD from The University of Southampton where she explored the impact of significant others on men undergoing active surveillance for prostate cancer. Steph has expertise in qualitative research, self-management of illness and intervention development. Past projects span topics such as irritable bowel syndrome, chronic pain, weight management and primary care communication. Previous Next

e57a4343-00e9-4e08-9056-d084e47c8870 Reframing responsibility through public empowerment: examining environmental cues influencing poor diet Team Dr Nestor Serrano-Fuentes. Senior Research Fellow. School of Health Sciences, University of Southampton. Dr Lyn Ellett. Associate Professor of Clinical Psychology. School of Psychology. University of Southampton. Prof Mari Carmen Portillo. Professor of Long-Term Conditions. School of Health Sciences University of Southampton. Prof Janis Baird. Professor of Public Health and Epidemiology, MRC Lifecourse Epidemiology Centre, University of Southampton. Prof Christina Vogel. Deputy Director, Centre for Food Policy City, University of London. Rachael Eckford, Occupational Therapist Partners Dr Lindsay Welch. Clinical associate professor at the University of Bournemouth. Previous Program Lead Health Inequalities (Health Innovation Wessex) Start: 27th February 2023 End: 30th September 2024 What's the issue? The United Kingdom (UK) consumes the most ultra-processed diet of any country studied in Europe. This scenario indicates that poor diets have become normalised in this country. Consequently, there has been a dramatic increase in diet-related conditions, such as obesity, type 2 diabetes, cardiovascular disease or several types of cancer and the financial costs attached to them. The UK food system is a complex setting for individuals to navigate. Individuals choose which foods to purchase and eat based on many determining factors (both internal and external). Our food environment has changed in the last 50 years and the term ‘obesogenic environment’ is now used to describe some of our food environments. Obesogenic environment meaning a setting which encourages weight gain and discourages weight loss by making unhealthy foods readily available. The environment we live in is a large factor for determining our food choices and poor-quality diets cluster in disadvantaged groups, for example those with low levels of education, low incomes or living in deprived areas. Responsibility for our food choices is culturally framed on the individual What did we find? I n the ARC Wessex project ‘ Reframing responsibility through public empowerment: examining environmental cues influencing poor diets ’ we completed a review of thirty-six articles. Studies exploring public perceptions of poor diets acknowledged personal and broader systems drivers, with individual responsibility predominating across studies. Research analysing media portrayals showed similar patterns of individual responsibility among right-leaning newspapers, which focused on individual lifestyle changes. However, left-wing newspapers highlighted the role of the food industry and the government. Studies analysing government policies identified citizens as the primary agents of change through rational decision-making. Policies and media portrayals provided limited emphasis on these populations, with individual responsibility narratives prevailing. Following this review, we undertook a qualitative study with 15 individuals with obesity/overweight exploring their perceptions of responsibility for poor food diets, with particular attention to how individuals understood and positioned personal and environmental influences on food practices. Our findings highlighted that despite food choice being complex and having many external and internal factors, the public perception has been framed to hold the individual accountable for their food choices. There is consensus that lifestyle factors alone will not fix the problem of obesity and therefore individuals being ultimately responsible for their diets is not the solution. NIHR ARC Wessex supported this project, enhancing opportunities for dissemination, implementation and networking with key local authorities and organisations. We expect our findings to raise awareness of good food choices and the development of tools that could support community care of people with obesity or at high risk of obesity. Further policy work is needed to address the root causes of diet-related health inequalities to implement mandatory regulatory frameworks that set standards for commercial practices. Developing tools to raise awareness of poor diet choices and increase informed decisions Research papers and books Serrano-Fuentes N, Rogers A, Portillo MC. Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity. PLoS One. 2024 May 8;19(5):e0302927. doi: 10.1371/journal.pone.0302927. Serrano-Fuentes N, Ellett L, Vogel C, Baird J, Tavares N, Portillo MC. Mapping how responsibility for poor diets is framed in the United Kingdom: a scoping review. Public Health Nutrition. 2025;28(1):e167. doi:10.1017/S1368980025101079

Clare Phillips - Hepatology Nurse Specialist, MSc Global Health < Back My journey into research My interest in research came as a bit of a surprise. Clare Phillips - Hepatology Nurse Specialist, MSc Global Health My interest in research came as a bit of a surprise. In 2016, I started an MSc in Global Health part-time at BSMS. I had previously completed the Diploma of Tropical Nursing at London School of Health and Tropical Medicine and was working as a clinical nurse specialist in viral hepatitis at the time. I started the MSc thinking I’d be more interested in the policy side of the course or, where it might take me from a clinical perspective. But, it was working with Prof Gail Davey’s research group, for my MSc dissertation, that was the game changer. Prof Davey’s work in Ethiopia had shed light on the neglected tropical disease, podoconiosis , in quite a remarkable way - improving care for those living with the condition, giving a voice to the seldom heard, influencing national policy, challenging stigmatising attitudes and building research capacity (across disciplines) within Ethiopia. It was hugely inspiring and a clear example of how research had enormous scope to influence change. Having completed my MSc, I began voluntarily joining various research projects that were going on at work – collecting data for some, writing manuscripts for others. This helped me build my CV and confirmed that a career in research was right for me. I moved back to Southampton in summer 2019 and began working for the Alcohol Care Team at University Hospital Southampton. Inadvertently, I stepped into a research-focused team, who wanted to use research to make a difference to our patient group. And it made all the difference. In 2021, with my manger, Anya Farmbrough, and Richard Darch from Adult Safeguarding, I wrote a paper challenging perceptions of self-neglect in patients with alcohol use disorder ( More than a ‘lifestyle’ choice? Does a patient's use of alcohol affect professionals' perceptions of harm and safeguarding responsibilities when it comes to self-neglect? A case study in alcohol-related liver disease | Gastrointestinal Nursing ( magonlinelibrary.com ) ). With support from Anya and our medical lead, Prof Julia Sinclair, I applied for the ARC Wessex Mental Health (Alcohol) Internship in 2022. My internship focused on older adults with alcohol use disorder (AUD), analysing some pre-collected service evaluation data and working on a systematic review of AUD interventions in this cohort. The internship gave me the time (and funds) to focus on developing gaps in my skillset e.g. I took an online statistics course and had the opportunity to work 1:1 with the ARC statistician to refresh my statistics skills. I am not sure how or when I would have been able to do this without the internship. The internship also provided opportunities to present my work, from academic conferences to departmental meetings and PPI groups. This allowed me to get familiar with answering direct questions about my research, and how to deal with the trickier ones! As a result of the ARC Wessex Internship, I had 2 abstracts accepted at national conferences this year ( 1586 OLDER AGE IS AN IMPORTANT PREDICTOR OF NON-REFERRAL TO COMMUNITY ALCOHOL SERVICES FOLLOWING AN INPATIENT EPISODE: FINDINGS FROM | Age and Ageing | Oxford Academic ( oup.com ) , P28 Mortality and cause of death in patients aged 50–59, 12 months after review by an alcohol care team | Gut ( bmj.com ) ). The internship also got me thinking about my next steps and enabled some key conversations to take place. I am certain my future career is a research-focused one and am currently working on my application for Round 11 of the NIHR Doctoral Fellowship programme. I have an important research question that needs answering, and so its full steam ahead! More about Clare Previous Next

07abb52d-c8db-43f8-85d4-b392467d6ada Developing training for person-centred care: adapting the Chat & Plan for use in domiciliary care Chief Investigator: Dr Teresa Corbett, Visiting Research Fellow, School of Health Sciences , University of Southampton and Senior Lecturer in Psychology, Solent University. Co-Investigators: Professor Jackie Bridges, Professor of Older People's Care, School of Health Sciences, University of Southampton Dr Nicola Andrews, Research Fellow - NIHR ARC Wessex , School of Health Sciences, University of Southampton Cindy Brooks, Research Fellow - NIHR ARC Wessex , School of Health Sciences, University of Southampton Dr Pippa Collins, Advanced Clinical Practitioner, Post Doc Research Fellow – NIHR ARC Wessex, School of Health Sciences, University of Southampton Collaborating organisations: Hampshire County Council – Maria Hayward, Learning & Development Service Manager and Implementation Champion Bournemouth, Christchurch and Poole Council – Alison Pearman, Service Improvement Manager Wessex AHSN – Cheryl Davies, Senior Programme Manager (Healthy Ageing) Skills for Care – Debbie Boys, Locality Manager – Hampshire, Southampton, Portsmouth and Isle of Wight Purple Lilac Healthcare - Violet Chatindo, Registered Manager Right at home – Andrew Davis, Registered Manager Partners in Care – Kate Blake, Manager Start date: 1/6/23 End date: 1/9/24 Aim of the research The aim of this research is to adapt a communication tool for use by social care workers and to find out what type of information we should include in a training package for social care workers providing domiciliary care (e.g., practical help and support in the community) to support its use. This study will help us to make a training course that we can try out with social care workers in future research. Background to the research We made a tool to help healthcare staff to talk to older adults about their needs. This tool has 8 steps that should be followed in a discussion with people about their needs and personal goals. However, the tool might need to be changed if we want to use it in domiciliary or other social care settings instead of healthcare (e.g., the NHS) settings. In this research, we want to see if we need to change the tool so that it can be used by social care workers. We also want to find out about how we might be able to train social care workers to improve how they talk to older adults about their needs. Design and methods used We will study existing courses, workshops and training so that we can find out more about how we should plan our training. We will also interview social care workers to find out more about what they do in their role. We will ask them to tell us what they think of the tool, and what changes we might need to make to it. Up to 15 social care workers will take part. We will make a draft of what will be included in the training. Experts will discuss the training and we will make changes based on what they say. We will interview some more social care workers to find out what they like or do not like about the training plan we have made. Patient, public and community involvement Members of the public have been part of the study so far in many ways. They have helped us to make the tool that we will ask social care workers about. We will also work with experts in social care who have agreed to help us to in a number of ways. These include: · Looking over content and letting us know what they think. · Coming to project meetings. · Helping to plan the study. · Looking over study information that we will send to participants. · Helping us to make sense of the research findings. Dissemination We will share our findings at conferences and at events with audiences who are interested in our study. We will also write about our findings for academic and public audiences via Communications channels (e.g. relevant websites, social media, newsletters). We will also share findings with those working in social care, e.g., via domiciliary care forums (each local authority has one) and with Learning and development teams in local authorities. What did we find out? An adapted version of the CHAT&PLAN is viewed as feasible to use in homecare settings. We needed to change some of the language to make it more relevant to homecare settings and improve clarity. There is an appetite and need for co-designed, evidence-based, person-centred care training in homecare settings. Much of the existing training on this topic is not specific to homecare workers and may not always apply to their role. CHAT&PLAN provides an overview of skills that should be used flexibly, depending on the needs and preferences of the service user. The training will emphasise that it may not work well for all service users, and further communication skills training is required alongside this course. We identified key factors we would need to consider in the development of a training package: 1.Teaching style and methods should be practical to support skills development. Training should involve learning from each other and reflection. 2.The training must be viewed as relevant to the homecare workers and be pitched at a level that is clear and easy to understand. 3.Buy-in from managers, organisations and service users is required for homecare workers to attend sessions, and then apply skills in practice. What did we do with this new knowledge? •Study summary was shared with supporting organisations and participants •Systematic review paper has been submitted to PLOS One Where next? We did not have time in this study to test out the training with homecare workers. This is important as we want to know how the training works in practice. We will need to test the package to see what homecare workers and managers think of the entire set of materials and methods used in the training. We will then apply for funding to see whether the training is acceptable and feasible in practice and improves the quality of person-centred care provided by homecare workers.

Mapping pathways of response for adult & child victim-survivors of domestic abuse in Southampton City Have you been affected by domestic abuse? Do you live in Southampton? Hide this page in an emergency Jump to tips on safe web browsing A team of researchers from the Faculty of Medicine at the University of Southampton are doing an evaluation to learn more about how individuals and families are referred to Southampton City Council for support with a domestic abuse situation. We want to learn more about the experiences of those individuals and families, after they are referred for support. The goal is to help the Council improve the services they can offer, for people who are experiencing domestic abuse. You can take part in this evaluation by having an ‘interview’ – a discussion with a researcher. This would be completely confidential and would take about an hour. Would you like to share your experience? We would be very interested to hear from you. If you have any questions, or if you would like to take part in this evaluation, please contact: Katerina Porter at 02380 594 644 or k.a.porter@soton.ac.uk or Eunice Aroyewun at 02380 594 554 or e.o.aroyewun@soton.ac.uk . Please watch this video to learn more. SAFE BROWSING TIPS Domestic abuse is not just violence and often includes controlling behaviour. If you are scared your partner will find out you’ve been here, here’s how you cover your tracks. How do I turn on private browsing on Google Chrome (incognito window)? Start Chrome and click the three dot icon in the top right corner of the screen. Click New Incognito Window and start browsing. You can press Ctrl + Shift + N to bring up a new incognito window without entering the Chrome settings menu. Before opening the browser, you can right click the Chrome icon, then select New Incognito window How do I enable InPrivate browsing in Microsoft Edge? Open Microsoft Edge, and click on the three Dots at the top right corner of the browser Window. Now click on New InPrivate window. You can press Ctrl + Shift + P to bring up a new InPrivate window without entering the settings menu. Before opening the browser, you can right click the Edge icon, then select New InPrivate window How do I enable InPrivate browsing in Internet Explorer? Open Internet Explorer, and click on the Tools icon at the top right corner of the browser Window. Now click on Safety then InPrivate Browsing. You can press Ctrl + Shift + P to bring up a new InPrivate window without entering the settings menu. Before opening the browser, you can right click the Edge icon, then select New InPrivate window How do I turn on private browsing in Mozilla Firefox? Click or tap the Open menu button in the top right side of the browser window. It has the shape of three parallel lines. Then, choose New Private Window. You can press Ctrl + Shift + P to bring up a New Private Window without entering the settings menu. How do I turn on private browsing in Safari on an iPhone? Tap to open Safari, then tap the 2 overlaid squares in the bottom right corner, then tap Private to enable Private Browsing Mode and finally tap Done and start browsing. When finished be sure to tap the 2 overlaid squares again and then tap x on each page to clear the pages before finally tapping Private to go back to normal. How do I turn on private browsing on an Android phone? Tap to open Internet, then tap tabs in the bottom right corner, then tap Turn On Secret Mode and start browsing. When finished be sure to tap x on each page to clear the pages before finally tapping Turn Off Secret Mode to go back to normal. Information from STOP DOMESTIC ABUSE - https://stopdomesticabuse.uk/cover-your-tracks

9ae71e9b-aaf2-477f-a174-17b115a2513a ADOPTED PROJECT: Neuro LTC: Assessing Baseline Factors, Critical Events and Fatigue in Long Term Neurological Conditions Principal Investigator: Dr Chris Kipps, Neurologist and Hon Senior Lecturer, University of Southampton Team Members: Dr Helen Roberts Veena Agarwal Dr John Spreadbury Dr Emma Stack Dr Sarah Fearn Prof. Ann Ashburn Start Date: 23/08/17 End Date: 31/12/22 Project Funder: University Hospital Southampton NHS Foundation Trust Lay Summary Many neurological conditions have a long-term impact on quality of life with varying requirements for intervention and care over time. This has the potential to create a mismatch between the needs of patients at particular stages in their illness, and the skill levels of clinicians and available resources required to assist them appropriately. This project aims to identify the factors that influence everyday care requirements (baseline factors) and to identify the critical events that have the potential to lead to an increase in care requirements. In many neurological conditions, there may also be ‘hidden’, less evident or more subjectively perceived factors that influence care requirements, of which fatigue may be amongst the most common. Thus, this project also includes research into the prevalence and effects of fatigue in neurological conditions. By identifying and better understanding baseline factors, critical events and the features of fatigue in long term neurological conditions, this project will help to enable future research to stratify long-term neurological conditions by the degree of complexity and individual burden and match service users more effectively to appropriate clinical and social care resources. Method The research will focus on the following five neurological conditions: epilepsy, Huntington's disease, motor neurone disease, multiple sclerosis, and Parkinson's disease. The study will involve the use of mixed methods. We will use surveys and focus groups with service users (patients and caregivers) to identify the factors that help to maintain an individual’s optimal level of living with the neurological condition (baseline factors), the critical events that can cause a change in care requirements in each of the five neurological conditions, and the impact of fatigue. What did we learn? 1. What factors affect the care that people living with a neurological condition require? We found that mobility was the most important factor for assessing care needs from the patient perspective. This was followed by dexterity, eating and drinking, speech and communication, cognitive impairment and mental health. This order of relative importance was found to be constant by age, disease progression, gender, living alone, or presence of co-morbidities. However, younger patients, more progressed patients, females, those living alone and those with co-morbidities tended to produce higher average scores of importance, meaning they felt their symptoms in these areas had a higher impact on their care needs. We asked participants what helped them to manage their condition and live well. The most important factors were: Social support, exercise, lifestyle factors and supportive equipment. Less recognised factors such as access to healthcare professionals, the patient’s mentality and diet were also noted. We found that recently diagnosed patients cited ‘employment’ and ‘feeling informed’ more frequently, whilst less recently diagnosed patients mentioned ‘having a carer’ and ‘getting out of the house’ more frequently. 2. What events lead to an unplanned GP or hospital visit for people living with a neurological condition? We found that there are specific events that are likely to lead to an unplanned GP or hospital visit for people with neurological conditions. In addition to well-recognised causes of crisis such as falls, trigger events less widely associated with crisis were identified, including difficulties with activities of daily living and carer absence. The less-recognised trigger events tended to be managed more frequently in the community. Many of these community-based crises had a greater impact on care needs than the better-known causes of crisis that more frequently required hospital care. Patient and carer responses indicated a good general knowledge of potential crisis triggers. Patients were more aware of mental health issues, and carers were more aware of cognitive impairment and issues with medications. 3. What is the frequency and impact of fatigue for people living with neurological conditions? We found that the prevalence of clinically significant fatigue across five neurological conditions (Parkinson’s, MS, epilepsy, MND and Huntington’s disease) was 51%. The highest prevalence of fatigue was amongst people with MS and MND, and lowest was amongst people with epilepsy. More than a third of participants reported that fatigue frequently impacted their social life and ability to concentrate. Factors associated with clinically significant fatigue were male gender, age, frequency of fatigue greater than twice a week and fatigue often having a detrimental effect on social life. What difference can this new knowledge make? Understanding the factors that affect the care needs of people living with neurological conditions can help to ensure care resources are targeted at those most at risk of high care needs. Understanding that younger patients, more progressed patients, females, those living alone and those with co-morbidities generally considered their symptoms to have a higher impact on their care needs, can allow us to target these patients with relevant support and interventions. Identifying the most important factors for people with neurological conditions to self-manage their conditions and live well can enable us to share this information more widely and promote self-management tools and techniques amongst this population. By increasing understanding of events that lead to a GP or hospital visit, we can better inform strategies to prevent them. Similarly, by identifying under-recognised crisis triggers we can build a better understanding of ‘risk factors’ for an unplanned GP visit or hospital admission. Identifying that Patients were more aware of mental health issues, and carers were more aware of cognitive impairment and issues with medications means that we can ensure healthcare professionals are asking the right questions to the right person. We also noted some differences in how patients and clinicians describe the events that precede a GP or hospital visit. This can help to ensure healthcare professionals are using the right language when assessing the risk of individual patients. By increasing understanding of events that lead to a GP or hospital visit, we can better inform strategies to prevent them. Similarly, by identifying under-recognised crisis triggers we can build a better understanding of ‘risk factors’ for an unplanned GP visit or hospital admission. Identifying that patients were more aware of mental health issues, and carers were more aware of cognitive impairment and issues with medications means that we can ensure healthcare professionals are asking the right questions to the right person. We also noted some differences in how patients and clinicians describe the events that precede a GP or hospital visit. This can help to ensure healthcare professionals are using the right language when assessing the risk of individual patients. Why is this important? The number of people with a neurological condition is rising, with around 17 million cases in the UK. Approximately 4% of NHS funding goes to neurology care. People with a neurological condition are more at risk of unplanned hospital visits and admissions than many other groups. Identifying factors that promote self-management and well-being could improve patient diagnosis and quality of life, reducing care requirements from the NHS. Reducing unplanned GP and hospital visits could improve patient quality of life and reduce resources spent by the NHS. Identifying the frequency and impact of fatigue and ways to manage it could improve patient and reduce resources spent by the NHS. What Next? We have already taken some of the findings from this study to: -Publish academic publications -Present at medical conferences -Present to groups of people with neurological conditions -Present to national support organisations -Create an impact inventory for neurological pathways -Create questionnaires that aim to identify those most at risk of an unplanned GP or hospital visit (implemented through My Medical Record) We are continuing to analyse the data and disseminate findings to a wide audience. Publications The Causes and Impact of Crisis for People with Parkinson’s Disease: A Patient and Carer Perspective - Sarah Fearn, Sandra Bartolomeu Pires, Veena Agarwal, Helen C. Roberts, John Spreadbury, Christopher Kipps, 2021

1810d0c8-e9bb-4a7c-9947-bbac48f4dd69 Mental Health, Workforce and Well-being Research Framework - ARC Collaboration More details on ARC Greater Manchester website What are we trying to do? The purpose of the document is to propose a pan National Insititue of Health Research (NIHR) Applied Research Collaboration (ARC) workforce focused mental health and well-being research framework. The aim is for the research framework to serve as a reference point to: Create coherence and comparability across the research carried out by NIHR ARCs Reduce duplication of work to reduce workforce burden. Adopting a coherent approach with an agreed purpose and broad aims will maximise the potential for cross-ARC collaboration, synergy and impact. While the focus of this research has a COVID-19 focus, the ambition is that this framework should facilitate research beyond the current pandemic, ensuring programme sustainability and longevity across the lifetime of this 5-year NIHR ARC funding cycle. This framework is not intended to be prescriptive, rather, it is a call to colleagues doing research under the NIHR ARC umbrella to use the framework as a point of reference in the development of research projects and programmes. It is a modular approach which allows flexibility to fit the scientific questions and data collection to the needs of the specific workforce and context being studied. Why is it important? The NIHR has invested £135 million to support 15 collaboratives covering every region within England. The NIHR ARC collaborative provides a framework within which key stakeholders are brought together locally and nationally with a mandate to tackle difficult issues facing our health and care system including: patient outcomes, effectiveness of our health and care system, system sustainability, and carrying out research with an applied focus to facilitate the rapid translation of research into practice. Moreover, the designation of ARC South London and ARC East of England as national leads for mental health and the establishment of a National Mental Health Priorities Network provides a further opportunity for effective collaboration. The NIHR ARC network presents a unique opportunity to develop a coherent and consistent approach to workforce mental health and well-being research which embodies these principles. What will we do? The framework is available for any NIHR ARC to review and align with, to guide the development of work that aligns to the fundamental principles of the NIHR ARC programme. Who are we working with? The NIHR ARCs and their research themes are set out in a table included in the document. In line with the framework, colleagues are encouraged to work collaboratively to maximise synergy, impact, and reduce duplication and burden. The origins of this framework arose out of conversation with colleagues from across NIHR ARC sites between April 2020-June 2020. The framework has been developed by: Kirsten Windfuhr (ARC Greater Manchester), Jane Ball (ARC Wessex), Karina Lovell (ARC Greater Manchester) Penny Bee (ARC Greater Manchester). Additional contributions and comments were gratefully received from ARC colleagues, and in particular Kristy Sanderson (ARC East of England). More information For further information about this work, please contact Alison Littlewood (Programme Manager). (ARC GM) Download - Mental Health, Workforce and Well-being Research Framework

e6a8c355-7b95-44d8-b23d-7f8c17a1573a ADOPTED: Consequences, costs and cost-effectiveness of different workforce configurations in English acute hospitals: a longitudinal retrospective study using routinely collected data Principal Investigator: Professor Peter Griffiths Deputy Principal Investigator: Dr Chiara Dall’Ora Professor Jane Ball Co-investigator – nursing workforce, Dr David Culliford Co-investigator - statistics, Dr Jeremy Jones Co-investigator – health economics, Ms Francesca Lambert Co-investigator – patient and public involvement (lay researcher), Dr Paul Meredith Co-investigator – health informatics, Paul Schmidt Co-investigator – clinical medicine, Talia Emmanuel PhD student, Bruna Rubbo Senior Research Assistant / Research Fellow and Christina Saville Research Fellow Partners: Portsmouth Hospitals University NHS Trust, University of Southampton Started: March 2020 Ends: February 2023 Summary of findings Staffing shortages are a major concern for the NHS. A lot of research shows that low nurse staffing in hospital is correlated with worse patient outcomes, including an increased risk of death. However, lots of this research has only looked at hospital average staffing and has not considered other staff, such as doctors and allied health professionals, so it is hard to be sure if improving nurse staffing on wards leads to better outcomes. It is also hard to know the most cost-effective approach to addressing staff shortages. Our study used existing data from national reports and daily staffing data from hospital wards to answer some of the main uncertainties from past research. Using data from national reports, we found low staffing levels from doctors and allied health professionals were linked to increased risk of death. Nurse staffing levels were linked to important aspects of patient experience and staff wellbeing, but to properly understand the effects of nurse staffing we needed to know the staffing patients experience when on hospital wards. Our study included 626,313 patients in four hospitals. We found that when patients spent times on wards with fewer-than-expected registered nurses or nursing assistants, they were more likely to die and their stay in hospital was longer. Low registered nurse staffing was also associated with more readmissions. We looked at the cost of avoiding low staffing and the cost of gaining the equivalent of one year of healthy life. We compared these ‘cost-effectiveness’ estimates for different ways of avoiding low staffing and for different patient groups. Overall, we concluded that a focus on avoiding low registered nurse staffing gave more benefits than using assistants to fill any gaps, and should be the priority, although it is still not clear what the best level of staff is. What have we done with the knowledge? In addition to the full report ( https://doi.org/10.3310/ZBAR9152 ) we have published several peer reviewed papers short briefings, and continue working to disseminate finding, taking opportunities to discuss the implications with policy makers. As a team we are well placed to do this and have recently contributed to consultations on safe staffing legislation in Wales, the NHS workforce strategy in England and the Health Foundations Productivity commission. We have close contacts with NHS England and work with the safe Staffing Faculty, as well as advising policy makers in Ireland, Iceland and the WHO. In addition to engagement with policy makers, our papers have attracted local, National, and International press attention. Dissemination has been supported by interviews given by staff for print, online and broadcast (TV, Radio) media. See for example https://www.altmetric.com/details/166479277/news We worked with Channel 4 News to support their series of specials on nurse staffing shortages ( https://www.channel4.com/news/factcheck-englands-missing-nurses ). Next? Issues related to ‘safe staffing’ in the NHS tend to ‘grab the headlines’ but operationalising findings beyond general acknowledgments in policy can be challenging. This is especially the case in the face of persistent staffing shortages. We are crafting our message to show the benefits from addressing the problem, the likely cost effectiveness of doing so and the absence of evidence for many of the proposed alternatives. We are also increasingly moving towards developing ‘diagnostic tools’ that may be able to prioritize deployment and use scant resources as efficiently as possible while not undermining the core message about the importance of having sufficient well-trained staff to maintain patient safety. Original proposal and details below Aim: This study seeks to understand how variation in the size and make-up of care teams on hospital wards in England influences patient outcomes and the costs of care. Background: Research shows that low registered nurse (RN) staffing levels on hospital wards are linked to undesirable outcomes. These include increased poor experiences for patients, an increased risk of dying and, potentially, other outcomes that are bad for patients and increase the cost of care. These include falls, longer stays and unplanned readmissions. For a long time, studies used hospital level averages rather than looking at what happened to individual patients. This uncertainty makes it hard to understand the likely costs and benefits from investing in staff differently. Developments in information technology now make it possible to link nurse staffing levels experienced by individual patients on every day of their stay, to the outcomes experienced by those patients. Our research group was the first to use these new sources of information to explore how the mix of staff in the nursing team affected outcomes and cost of care. We found that each additional hour of RN time per patient reduced the risk of death and shortened their hospital stay. We found that a small reduction in assistant staff, and a small increase in RNs would improve outcomes with no overall increase in costs. Such findings have implications for how hospitals respond to nurse shortages, but the results come from one hospital and use limited costs and outcomes. It is important to see if the conclusions apply more widely. As RNs are in short supply it is also important to better understand how other staff contribute. Design & methods: Our study is in two parts. Study 1 uses information about ward staff and patients' outcomes drawn from hospital electronic systems. We will use anonymous records gathered from all patients and staff in at least 4 NHS Trusts. Using statistical models, we will estimate the impact of RN and assistant staff levels on outcomes. For example, whether the risk of death is lower when more RNs are working on a ward. We will estimate staff costs and also the costs of events such as unplanned readmission or longer hospital stay. We will estimate the cost per 'quality adjusted life year' associated with changes in nurse staffing. Such measures help policy makers to compare the results of investments in health care and put more value on each year where people are expected to be healthy and independent. Study 2 will analyse national data at a whole hospital level to see how the size of other staff groups (e.g. therapy staff and doctors) might influence outcomes. Patient and Public Involvement: Safe staffing in hospitals is an area of public concern. We developed this proposal with this concern in mind, and shaped it through conversations and consultations with patients and members of the public. A member of the public/carer (who is a co-applicant) will facilitate PPI at all stages of the project, with ongoing engagement and sense checking with patients/public to inform analysis, interpretation and presentation of results. Dissemination: Results will be of interest to a diverse audience. We will present findings to national and international conferences and to policy makers, publish in academic journals and present to stakeholders. We will use professional networks and social media to ensure that outputs reach professional, research and public audiences. Background: The NHS is facing significant challenges in recruiting and retaining staff, particularly registered nurses (RNs). Recruiting unregistered staff is often adopted as a solution to the RN shortage; however, our recent research - the first in England to use longitudinal routinely collected data - found a negative effect of low RN staffing levels on mortality with no evidence that high levels of assistant staff could mitigate the increased risk. Our economic modelling suggested that increases in RN skill mix were potentially cost-effective, but these findings derive from a single NHS hospital Trust with limited cost and outcome data. Aims and objectives: This project aims to estimate the consequences, costs and cost effectiveness of variation in the size and composition of the staff on hospital wards in England. We will build on findings from our previous study, where we looked at staffing on wards in a single hospital. In order to provide estimates that are more likely to apply across the NHS, this study will include at least four hospitals and consider a wider range of outcomes and sources of costs, including death within 30 days of admission, adverse events such as infections, length of hospital stay, readmissions and rates of staff sickness. In order to determine if results are likely to be sensitive to staff groups not on ward rosters we will use national routine data to explore the associations with staffing levels of other groups including medical and therapy staff. Methods: Study 1 will be a retrospective longitudinal observational study with routinely collected data on ward and shift level nurse staffing, and patient outcomes. Data will be derived from the E-Roster systems, used by hospitals to record all planned and worked shifts. We will consider all rostered direct care staff. These data will be linked to patient data derived from the hospital patient administration system (PAS); and other clinical systems and databases of adverse events (e.g. datix). Relationships between RN and assistant staffing levels and outcomes will be explored using survival models incorporating mixed effects. We will use the results of these analyses to model the costs and consequences of different staffing configurations and to estimate the incremental cost-effectiveness associated with change. We will estimate cost per Quality Adjusted Life Year gained or lost (QALY), associated with each staffing configuration using the DANQALE approach. Study 2 will be a panel study using routine national workforce data and outcomes (standardised mortality indicators, patient experience) to consider all staff groups including medical and therapy staff at the hospital level. This study will generate hypotheses about staffing for other groups, confirm the independence (or otherwise) of nurse staffing effects and fill a significant gap in international literature about the association between hospital safety and non-nursing staff levels. Timelines for delivery and impact: our study will be undertaken over 30 months and will provide evidence to inform staffing levels and skill mix planning in the NHS, highlighting potential cost savings, and offering improved patient safety and reduced adverse staff outcomes. To ensure impact, we will work with patients, nurses and key policy makers at all stages; we will publish papers and present to academic and professional conferences, as well as writing lay reports and engaging with traditional and social media

de23ed25-467a-496e-b29a-68a949839608 ADOPTED: FLOWS Planning for Frailty: Optimal Health and Social Care Workforce Organisation Using Demand-led Simulation Modelling Principal Investigator: Dr Bronagh Walsh, Associate Professor, School of Health Sciences, University of Southampton. Team: Professor Peter Griffiths , School of Health Sciences, University of Southampton: Dr Carole Fogg, School of Health Sciences, University of Southampton: Mr Mike Hepburn, Southampton Business School, University of Southampton: Dr Abigail Barkham, Southern Health NHS Foundation Trust: Honorary Professor Martin Vernon, Tameside and Glossop Integrated Care NHS Foundation Trust: Professor Lee-Ann Fenge, Department of Social Work and Social Sciences, Bournemouth University: Professor Jane Ball, School of Health Sciences, University of Southampton: Professor Sally Brailsford, Southampton Business School, University of Southampton: Ms Francesca Lambert, PPI lead, School of Health Sciences, University of Southampton. Start: 01/11/2022 End: 31/10/2025 Background: As the population ages, robust workforce planning to meet future demands for health and social care by older people is needed. A lack of evidence in this area has led to a mis-match between the health and social care demand from the ageing population and the current workforce capacity. The proposed study will use demand-led simulation modelling of the workforce required to address the specific challenge of providing health and social care for the growing numbers of older people living with frailty. Aims & Objectives: The aim of the study is to use simulation modelling to explore long-term trends in frailty-related health and social care use in the ageing population and its implications for future workforce size and competencies to support high quality care. The primary objective of this study is the creation of a simulation model that will inform service and workforce planning to meet health and social care needs associated with frailty. Methods: The study will use a System Dynamics design to develop and test the simulation model. Work packages comprise a scoping review, gathering of public and professional perspectives on service provision via a survey and stakeholder engagement activities, and analysis of linked health and social care data, all of which inform the simulation modelling work package and development of a workforce planning toolkit. Timelines for delivery: The scoping review will be completed in year 1. Routine health and social care data specification and extraction will occur in year 1, as will service mapping and classification and survey preparation. Survey data collection and analysis will occur in year 2. Simulation modelling will commence in year 2, with validation, sensitivity analyses and scenario modelling in year 3. Development of workforce guidelines and toolkit will occur in. year 3 Stakeholder engagement, including patient public involvement, will run throughout the study, reviewing study results and informing development of the other work packages. Anticipated impact & dissemination: This study will provide new, direct evidence about the impact of frailty on health and social care workforce requirements within the ageing population The improved understanding of workforce requirements offered by this study will inform workforce planning for frailty services across health and social care, ensuring future benefit for patients through provision of timely and appropriate care and a workforce planning toolkit to support local decision-making.