32e7d264-0fc5-4abd-9de2-3d80f41ddbb6 PROCED: PROactive, Collaborative and Efficient complex Discharge Joint Lead: Dr Carlos Lamas Fernandez and Professor Michael Boniface . Co Applicants : Antonio Martinez-Sykora (CORMSIS), Professor Peter Griffiths, Abigail Barkham (Southern Health NHS FT), Eleanor Corbett Partners: University of Southampton, Southern Health NHS Foundation Trust & University Hospital Southampton NHS Foundation Trust. Lay Summary Aims: PROCED aims to improve complex hospital discharge by using computer algorithms to support the way community and social care services are planned for patients fit to leave hospital. The goal is to avoid patients staying in in hospital longer than needed when they are well enough to be discharged. Leaving hospital at the right time is better for patients for many reasons. It reduces physical and mental deconditioning and chance of hospital infections. It also allows patients to recover with families, friends, and carers. By planning care earlier during hospital stays, PROCED aims to provide more time for patients and families to discuss care needs with care workers. Also, integrated care services are expected to be more efficient as resources can be planned using better predictions of patient needs. Background : In 2018/2019 patient discharges from hospital in the UK were delayed by over 1.5 million days. Almost 75% of delays were due to arrangements for community care not being in place. Plans require many services including further non-acute care, residential homes, nursing homes, care packages, community equipment and public funding. Avoiding delays to discharge from hospital is desirable as it leads to better outcomes. The University Hospital Southampton has recently developed a digital system supporting complex discharge. The system allows patients, families, and care providers to share information about a care needs and resources during discharge decisions. PROCED will now extend this system with advanced computer algorithms to support better decisions making. Approach: PROCED will develop computer algorithms that can predict care needs and schedule care services. Predictions will be developed using machine learning. Machine learning is a way to train a computer by using data about patients and services they use. Scheduling will use optimisation algorithms to find the best use of resources from available options. The prediction and scheduling algorithms will be integrated within a discharge decision process. The process will be part of a patient journey co-designed with patients and healthcare workers. The algorithms will be tested to ensure they are accurate and useful.The approach will be assessed by patients and the workforce for acceptance and overall satisfaction. Patient and Public Involvemen t: Patients and public have helped develop the research concept and will be involved in co-design, testing and evaluation. PPI will influence data usage, patient journey, algorithms, and visualisation. The public will participant in a Steering Committee. A PPI Committee will organise eight workshops to involve patients and public in the research. Dissemination: Communication materials will engage the public and decision makers.Evidence of effectiveness, safety and acceptance will be published. A complex discharge system with computer-based decision support will be demonstrated. The outcomes will be championed with institutional, regional, and national implementation teams.

d1fc46a9-cf57-4dda-98fb-a4ccb44fa87b FORTH – FORecasting Turbulence in Hospitals Chief Investigator: Edilson Arruda, Associate Professor, University of Southampton Team: Christine Currie University of Southampton Alexandra Hogan NHS Salisbury/ University of Southampton Jamie MacNamara University Hospital Southampton Mark Wright University Hospital Southampton Michael Boniface University of Southampton Carlos Lamas-Fernandez University of Southampton Partners: Salisbury Hospitals NHS Foundation Trust, University of Southapton, University Hospital NHS Foundation Trust. Start: 1 October 2024 End: 31 March 2026 Summary Over time, health systems face changes. Population grows older or hospitals can perform new treatments. It is difficult to match the resources of hospitals with population needs. If they do not match, waiting times for treatment increase and hospitals become fuller. Hospitals being too full can result in worse care for patients. For example, hospitals might need to cancel surgeries. Aim(s) of the research When the usual demand for hospital resources changes, it becomes difficult for hospitals to provide care. We call this turbulence. Our first objective is to define how turbulence can be measured from data. Then, we will use artificial intelligence to understand the causes of turbulence. We will also create models for short-term prediction of turbulence. This will help hospital plan better. Design and methods used This project will look at the records of patients in hospitals to understand what resources they use. The data will give us an understanding of how long certain activities take. For example, the recovery from surgery. We will predict when these times are changing using artificial intelligence. This can help hospitals be alert of upcoming changes, so they choose the best way to react. Patient, public and community involvement (PPCI) We will engage with the views of public, patients and communities during the project execution phase. We will hold workshops with patient groups that have been to hospital. We will understand their views on the planning services. We will also take into account their ideas when defining turbulence. Dissemination This project was co-designed and will be supported by University Hospital Southampton (UHS) and Salisbury Hospital. The results will be disseminated and championed within the partnering institutions, and further presented in workshops involving neighbouring NHS Trusts in Wessex and in the south east and south west of England. We will also publish papers and reports to disseminate the work to a larger audience within the UK and internationally.

860cb5e1-0b96-40d2-ae12-634f4a925c64 ADOPTED PROJECT: Exploratory research to examine the health impact of scams and fraud and the current knowledge and systems in the police and partner agencies for targeting and delivering victim support services Team: Ruth Halkon Dr Michael Skidmore Dr Felicity O'Connell Dr Amy Meenaghan Professor Mark Button Start Date: 1st May 2024 End Date: 30th November 2024 Project Partners: Police Foundation and University of Portsmouth This research explores how being a victim of fraud affects people’s health and wellbeing and what help they need to recover. We used surveys and interviews to reach fraud victims and spoke to the professionals who support them. How fraud affects health Most fraud victims have emotional or mental health problems. In the study, 92% had at least one symptom. Common issues included worry (58%), stress (56%), fear of becoming a victim again (52%), and feelings of anger (46%), weakness (46%), or distress (45%). Victims also had more serious symptoms like depression (18%), hopelessness (16%), panic attacks (8%) and feeling out of control (14%). Physical health was also affected. Over half (58%) of victims had symptoms such as trouble sleeping (45%), headaches (27%), or tiredness (24%). Changes in behaviour were common too. Victims often became distrustful (44%) or stopped going out (19%). We found that symptoms often happened together. Victims with emotional symptoms often also had physical ones. We found six separate patterns or “clusters” of symptoms, such as a “worry and distrust” group, and a more severe “hopelessness and self-harming” group. The impact varied widely. Some felt only mild, short-term symptoms. Others felt long-term effects that lasted for years. These were worse among the old or those in poor health. Nearly 19% said their daily lives were seriously affected. Some stopped using technology or thought of taking their own lives. Why some victims are more affected than others We found many things can impact how much a victim is affected including: the tactics used by fraudsters (e.g. building fake relationships or using threats), the amount of money lost, any pre-existing health issues, feelings of shame or self-blame, and lack of a support network. Victims who had a mix of these factors often suffered more. What support do victims want or need ? Many victims wanted practical help – such as advice on avoiding further fraud or help getting their money back. Others wanted help to come to terms with what had happened. But only those the police deemed "vulnerable" received further support. The report highlights a mismatch between what victims want, what they need, and what is available. Some people who could benefit from support don’t qualify or don't think they need or deserve it. The concept of "vulnerability" is also vague and needs to be better defined. How services should improve Many victims felt blamed, ignored or treated with suspicion by the police, banks and tech companies. This often made their health worse. Those who got the right help from family and friends, case workers or peers were best able to recover from the fraud. Recommendations include: •Keep support options open beyond the initial police report. •Define vulnerability more clearly in policy. •Adopt trauma-informed approaches across all service •Launch public campaigns to challenge victim-blaming attitudes and explain how fraud happens. In short, we need better understanding and better support to help fraud victims recover and reduce long-term harm. What did we do with this new knowledge This study has been completed but has not yet been published. It has been submitted to an academic journal and will also be published by the Police Foundation in the autumn. The research study was presented at Portsmouth University’s 2025 Counter Fraud, Cybercrime and Forensic Accounting Conference in June, where it was the keynote speech. Through this conference we shared our findings with public health experts, academics, police leaders and representatives from the private sector. We also hope to present the work at the Australasian and the Pacific Conference on Law Enforcement and Public Health, having been invited to present because of the global impact this research could have. Where next? This project was an exploratory study which we are planning to use as the basis of a much larger study. This is particularly important as while the impact of fraud is beginning to be known amongst specialist circles, it is a struggle to get this issue noticed in general policing/policy circles who do not realise there is a problem let alone understand the impact that our poor responses to fraud is having on millions of victims. •We are currently in the purpose of drawing up a proposal for a follow up study. This study will explore a) the sheer scale of fraud, its impact on health, evidence gaps in relation to both; b) what is known about the policy response/interventions (e.g. what exists, what's known about the effectiveness of responses) Methodology: •Phase 1: Review of: a) the evidence and theory to explain and account for the impact of fraud on victim health; b): of policy responses/interventions •Phase 2: Empirical research: (not just the health impact of fraud but also policy responses/interventions) •Phase 3: Develop a risk assessment tool and health toolkit to guide frontline support staff •Phase 4: Preliminary evaluation of the toolkit The project team for the new research proposal would include the Police Foundation and Portsmouth University along with Professor Mike Levi of Cardiff University and Thara Raj, Director of Public Health for Warrington.

5464c879-04a7-47dc-8751-6ab5a9ad6d1c ADOPTED: Incidental Interaction: Novel Technology to Support Elders-as-Athletes through Augmenting Everyday Interactions Lead: Professor M.C Schraefel Team: Professor C T Freeman, Dr M B Warner Start date: October 2022 End date: January 2024 Partner organisations: Abri Different Strokes Southampton Solent NHS Trust Z-Health Performance Solutions Background Elders classically are framed as people who are inevitably getting weaker, losing muscle and bone mass, cognitive capacity, and inevitably requiring care to manage simple "activities of daily living" such as walking, feeding, toileting and bathing. These effects limit their capacity to live independently and healthily in their own homes.To address this decline, research in even just the past five years has been looking for new molecules and therapies to slow or reverse aging, to provide if not longer life, then better quality of life throughout the life course. While these advances in science and technology promise wonders (for those who will be able to afford them), there is already established science that demonstrates how we can all improve our life quality over our lifespan. This same science can, today, improve the life quality of our elders - starting these interventions at any age. It's building strength:a well understood, human practice. No technology is required to build and maintain strength; only to move against gravity. Repeatedly. Research has repeatedly shown that resistance training for elders can improve quality of life while mitigating if not eliminating age associated co-morbidities. And yet, for all its proven effective, cheap - even free - benefits for healthful longevity, many elders are simply too weak to take care of themselves. According to a 2019 report from AgeUk on the State of Elder health, 15% of those aged 65-69, rising to 1 in 3 citizens over 85 in the UK require care.Some of the well-documented challenges to strength building are that, unlike a pill or garment or augmentation, to achieve the benefits of strength, one has to do the work oneself, actively. That takes time, effort, as well as the knowledge, skills and practices to support it. Mustering the effort can be even harder to achieve when one is already feeling weak, recuperating from an injury, a hospital stay, or from loneliness of isolation.The research in this project is specifically designed to address the challenges that keep elders from actively engaging in strength work. Our approach is to co-create interactions to help build the knowledge skills and opportunities to practice to build and preserve the strength needed to maintain healthful independence at home. Our approach is simple: design interactive technology and gestures to leverage what we - including elders - do every day that is already strength work: stand, sit, grip, pull, push, reach, balance - and translate these into activities for building strength. We call it this novel protocol "do it twice." Stand from sitting? That's strength. Do it twice. That's strength building - and that supports the knowledge skills and practice of "elder athletes" building capabilities rather than requiring assistance.Our approach is interdisciplinary: experts in Human Computer Interaction, Sensors and Physiotherapy, developing novel, affordable interactive technologies to make strength practice accessible effective and enjoyable with support to guide these activities, reflect progress, and share with friends. We call the approach "incidental interaction for everyday strength."So far, we have tested the approach for feasibility. In this small project, with our partners in sustainable, assisted living housing, NHS Trusts, professional therapy and coaching, and with participating elders as co-designers, we will be refining the interaction, the sensors and the exercise protocols. We will be able to tune our work at each stage to ensure best engagement. In three phases from design, to testing, to in-home evaluations we will together be validating the accessibility and efficacy of our approach.By realizing with this project the potential our preliminary work indicates and that our partners anticipate, we will contribute a new affordable breakthrough approach to help transform elder health and care, to enable longer, stronger elder independence@home.

a2f4485f-e939-4775-b10a-095900320a55 FinCH Implementation study: Falls prevention in care homes led by NIHR ARC East Midlands working with NIHR ARC North East North Cumbria, NIHR ARC West Midlands and NIHR ARC South London. Project: Falls in Care Homes (FinCH Imp2 study) Principle Investigator: Professor Pip Logan Team members: Dr Jane Horne , Dr Fran Allen, Maureen Godfrey , Professor Adam Gordon , Professor John Gladman , Dr Katie Robinson , Dr Paul Leighton , Dr Janet Darby , Michael Fletcher, Professor Gillian Manthorpe , Professor Barbara Hanratty , Professor Dan Lasserson , Professor Elizabeth Orton . Partners: Nottingham University Hospitals (NHS) Trust; Leicestershire County Council (Local Government); University of Newcastle, Kings College London; NHS Bromley CCG; Northumbria-Healthcare NHS Trust. Research sites: East Midlands , North East (North Cumbria), West Midlands and South London. Starts: 1/10/2021 Ends: 30/9/2023 Lay Summary People who live in care homes are at great risk of falling. Falls are common, harmful, costly, and difficult to prevent. The Guide to Action for Falls Prevention Care Homes (GtACH) programme trains and supports care home staff to identify the reasons why residents fall and then guides them to complete actions to reduce falls. In a large multicentre randomised controlled trial called the FinCH trial (1), the GtACH programme was cost-effective and reduced falls by 43%. We now need to research how to deliver the GtACH programme in ‘real life’ outside a research trial. We will work with three regions – East Midlands, South London and the North-East - to develop and research ideas about taking up the GtACH training programme which can be used nationwide. Using an approach to talking to people in care homes called Normalisation Process Theory (NPT) we will consider the work that people do in managing falls to assess whether GtACH becomes routine practice. NPT will help us to think about those things which help and those which hinder the adoption of GtACH. We have three work packages: WP1. Quality Improvement Collaboratives (QIC) will bring care home and healthcare staff together to develop and research ways to implement the GtACH. WP2. The QIC site teams will implement GtACH in 25 care homes per region (60 in total). Data from all homes and residents (about 2000 residents) will tell us the extent to which GtACH has been taken up in the homes. WP3. We will develop ‘toolkits’ of materials for care homes; containing the GtACH, a ‘return on investment’ calculator, the implementation package, and a ‘how to’ guide for establishing Communities of Practice to deliver and sustain the GtACH across regions. This study has been developed in collaboration with care home managers, care home staff, NHS clinicians and our active Patient, Public, Involvement (PPI) group who are co applicants. Going forward we have identified new PPI partners from Ashington and Bromley. We will talk by videoconferencing if needed. The study will be completed by July 2023 and we will disseminate our findings on the ARC-EM website, producing a short trailer video for YouTube, and through articles in journals and MyHomeLife Magazine. We will link our website on the national forums of the National Care Forum, Skills for Care, and Care England, Age UK, and the Alzheimer’s Society, and hold webinars for funders and managers Method Using monthly stakeholder meetings, consensus groups, interviews and literature searching we re-designed the GtACH into a suite of resources that care homes were happy to use and renamed it, on their request, to the Action Falls programme. Using an implementation theory called Normalisation Programme Theory we designed a research study to test how the Action Falls programme worked in 60 real world care homes. Care homes are being recruited across four ARC locations. All care home staff included in the 60 homes are being invited to complete the Action Falls training and complete a questionnaire (called the NoMAD) to assess how ready they are to use the programme. Interviews with care home staff and the trainers are being completed to get a first-hand view of how well the Action Falls is getting embedded into routine care. Care home staff are coming together in supportive collaborations, called Action falls Collaborations (AFC) to share knowledge, with researchers collecting data at these events. Results Ethical approval for the study has been granted by HRA East Midlands and Derby Research Ethics Committee Ref: 22\EM\0035. The study is adopted by the NIHR portfolio and the NIHR Clinical Research Network are helping to deliver the study in all locations, which are listed below in brackets. 36 care homes (60%) have been recruited, 13 in ARC North East (NE), 9 ARC London South (SE), 14 ARC East Midlands (EM). ARC West Midlands (WM) will start recruitment soon. In the ARC EM location we have four separate NHS Trusts/ Local authority areas involved. 7 NHS/ Local Authority/HEI Falls Leads have been trained in ARC’s NE, LS and EM and have begun training of the care home staff across the locations. One AFC has taken place in NE with the East Midlands AFC and South London due to take place later this month. The NoMAD questionnaires have been delivered to care homes. No interviews have yet been completed as these are due to start in November. In addition to the four locations the team have interacted with 83 individual care homes and 47 stakeholder groups sending them the Action Falls resources and talking over how they might be used, but no training has been offered. The images below show the spread of these enquiries Conclusion The study is progressing well, and care homes are very keen to take part and recruitment for the study is currently at 60%. The sites are set up and staff are in posts. We are approximately three months behind target on the activities due to care homes being reluctant to engage early in 2022 due to COVID. We consider that we may need a no cost 6-month extension to complete all the activities and to also get the Action Falls programme ready for wider spread. All our study meetings are well attended, and we have good participation from our PPI members with information being communicated from out Study Steering Group to the Stakeholders and vice versa sharing knowledge and experience. The study has gathered a lot of interest from outside of the study areas, from care homes and a range of other stakeholders. The research team have been sending out study materials and meeting with these groups over MS Teams meetings sharing resources and information about the study.A PhD student will be working with the care homes outside of our study locations from October 2022.

cd5ab336-348b-44b5-a285-82d9866dca9c Adopted Project: ACCESS D: Advancing Community Collaboration and Engagement Strategies in Dementia Collaborators University of Southampton; University Hospital Southampton NHS Foundation Trust; South Central Ambulance Service; University of Sheffield Project team Patricia Fuller, Andy Claxton, Helen Pocock, Nicola Claxton, Amanda Wollam, Daniel Blackburn, George Devitt, Sarah Fearn, Chris Kipps Start date 14 July 2025 End date 30 September 2026 Project summary Many people are interested in taking part in dementia research but do not know how to get involved, are unsure what participation would involve, or do not feel that research is for people like them. As a result, studies often struggle to recruit enough participants, and those who take part may not reflect the wider population. ACCESS D developed and tested a community-based model to make dementia research more visible, accessible and easier to take part in. Instead of expecting people to come into clinical or university settings, ACCESS D brought research opportunities into familiar community venues, with real-time support from South Central Ambulance Service research paramedics and nurses. The model was shaped through co-production workshops with public contributors and community stakeholders. These helped define the format, language and support needed to make research feel relevant and closer to people’s everyday lives. Early findings show that 71% of participants had not previously heard about research, 68% were interested in hearing about future dementia research opportunities, and 91% reported a positive experience of taking part. A quarter of participants were from ethnic minority backgrounds. This suggests substantial hidden interest in dementia research, including among groups often under-represented in research, and demonstrates that access and support are critical. ACCESS D shows that recruitment is better understood as a supported pathway from awareness to participation, rather than a single step. It also connects dementia research with wider questions about healthy communities, prevention, long-term conditions, digital inclusion, and the use of real-world participation data to understand who is reached, who is missed, and what support enables people to take part. What have we done with our new knowledge? The findings from ACCESS D are already being used to inform practice, support wider dissemination, and contribute to adoption and system learning. ACCESS D demonstrates that community-based, supported approaches can reach people who are not engaged through traditional routes. This helps research feel more visible, understandable and relevant, particularly for groups currently under-represented in dementia research. The work also shows that recruitment efficiency is not only about identifying eligible participants. It is also about creating the conditions in which participation feels possible. This has implications for how research pathways are designed, especially where studies struggle to recruit to time and target. The findings are supporting the development of community-based approaches to research delivery beyond conventional clinical settings. This includes exploring how trusted, community-facing services, such as ambulance teams and other outreach teams, could widen access, build research readiness closer to home, and generate practical learning about participation across different communities. ACCESS D is also generating useful pathway intelligence: who is reached, who progresses, where uncertainty or drop-off occurs, and what forms of support help people move from interest to participation. This has relevance for data-informed approaches to improving research access, inclusion and delivery. Supported by Public Engagement with Research funding from the University of Southampton, the project is also contributing to practical tools for wider adoption. These include co-produced visual materials to help diverse participants see themselves reflected in research, and a toolkit to help research teams design more inclusive and supported approaches to dementia research participation. Finally, the work is being disseminated through academic and practice-focused channels. The study protocol has been published as a preprint and submitted for peer review, helping to make the model visible to wider research, delivery and implementation audiences. What next? ACCESS D has demonstrated early feasibility and is now moving towards wider implementation and further testing. The next phase will aim to deliver the model across a broader range of teams, settings and communities, and examine its impact on progression into dementia research opportunities. A key question is whether this approach can improve recruitment to time and target in NIHR portfolio studies by supporting and reaching people earlier, reducing uncertainty and reducing avoidable drop-out. Alongside this, ACCESS D will produce co-produced visual resources, a practical toolkit and a training approach to support wider adoption. These outputs will help move the work from a single feasibility study towards a transferable model that can be used and adapted by other teams. ACCESS D has been designed to support future scalability and transferability across teams and settings. It uses existing trusted workforce roles, adaptable community settings and low-burden research activities with integrated co-production, allowing it to be implemented in different contexts while retaining its core principles. This gives it potential relevance beyond dementia, particularly in areas where research participation is limited by access barriers, uncertainty or lack of visible routes into research. Longer term, ACCESS D has the potential to contribute to a more inclusive and efficient model of community-based research delivery. It aligns with national priorities around healthy communities, prevention, long-term conditions, digital inclusion, research inclusion, decentralised delivery, improved recruitment performance, and applied research that can move from local need to wider adoption. Publications Mixed-methods feasibility study of a community-based model to improve equity and efficiency in dementia research participation: protocol for ACCESS D | BMJ Open

7a002421-31aa-4897-bd4d-da37a8b4cf6a Avoiding care escalations through targeted care coordination for people with multiple long-term conditions – a knowledge mobilisation project Chief Investigator: Simon Fraser, Professor of Public Health, University of Southampton Team: Nisreen Alwan, Professor of Public Health, University of Southampton, Lead for the Healthy Communities theme (from 1st Oct 2024), NIHR ARC Wessex. Robin Poole, Consultant in Public Health, Southampton City Council. Michael Boniface, Professorial Fellow of Information Technology, Director of the IT Innovation Centre, University of Southampton, and lead for the Workforce and Health Systems theme, NIHR ARC Wessex. Kelly Cheung, PPI lead, NIHR ARC Wessex and University Hospitals Southampton. Emilia Holland, Public Health Registrar, University of Southampton. Seb Stannard, Research Fellow, MELD-B project, University of Southampton. Claire Sheikh, Senior Pharmacist, Living Well Partnership, Southampton. Kelly Hislop Lennie, Principal Academic in Adult Nursing, Bournemouth University. Lynn Laidlaw, Patient and public contributor and researcher, PPI contributor MELD-B Sally Dace, PPI contributor MELD-B and Wessex ARC James McMahon, PPI contributor MELD-B, School of Primary Care Research UoS, South West Genomic Medicine Service. Lead PPIE for DIALOR, a digital intervention addressing frailty in Bournemouth University Partners: Hampshire and Isle of Wight Integrated Care Board, University Hospital Southampton NHS Foundation Trust, Bournemouth University, Southampton City Council, Living Well Partnership. Start: 1 October 2024 End: 31 March 2026 Summary This project is about taking knowledge that has been learned from two ongoing research studies about living with multiple long-term health conditions to see if we can apply it in a ‘real life’ setting in a large general practice in Southampton. Two research projects called ‘MELD-B’ and ‘the ARC Treatment Burden study’ have identified many aspects that make living with multiple long-term conditions challenging for people. This ‘workload’ might make it more likely that people feel overwhelmed by their health conditions. If people have a high workload, and particularly if they are frail, this can end up with them needing to be admitted to hospital. We have also identified that some aspects of people’s early life can make it more likely that they are admitted to hospital in middle age. If such challenges are recognised in advance and appropriate help provided, such unplanned admissions might be avoided. Care coordinators are people working in NHS settings, including GP surgeries, to identify and support people at risk of such admissions. They have a lot of people on their books and it can be challenging to know who needs what help, and who needs it most urgently. We want to see if the things we have learned from our previous research study can help the care coordinator make these decisions. In this short project we plan to do this in a large practice in Southampton, the Living Well Partnership, which looks after about 45,000 people. We plan to: · collate all the aspects identified in these studies that might make people more vulnerable · make sure we understand the current way care coordinators identify and engage with patients · work with all the relevant people in the practice to make sure we take people on this journey with us · undertake some workshops, co-led by PPI contributors, to co-develop the strategy for adding new aspects (such as the ‘workload’ and early life aspects mentioned above) to current approaches · test the addition of adding these in Living Well Partnership and evaluate the process We will share our findings at an event involving as many of the team from the Living Well Partnership as we can and get their feedback. This event will also include other relevant interested parties, such as those from the Integrated Care Board. PPI contributors have been deeply involved in the work of MELD-B, have helped to shape this proposal and will continue as co-investigators. They will be reimbursed for their contributions according to NIHR guidance. Read the public policy briefing

bd39e9d4-a228-4123-b44c-d499a7f27a45 Prevention schemes for female vicitms and offenders in Hampshire and Dorset Principal Investigators: Dr Sara Morgan Team members: Dr Sara Morgan ( Lecturer in Public Health School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Fiona Maxwell (Public Health Registrar School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Sergeant Ali Attwood (Hampshire Constabulary, Restorative Justice Lead) , Debbie Willis ( Hampton Trust charity, Domestic Abuse Service Manager), Vicky Atkinson (Hart District Council, Domestic Abuse Project Coordinator), Patricia Durr ( One Small Thing ), Mona Samiy ( Stop Domestic Abuse charity , Project Manager) Start: 11 November 2019 Ends: 11 November 2021 Project Partners : University of Southampton, University Hospital Southampton NHS Foundation Trust, Hampshire Constabulary, Hampton Trust, Hart District Council, One Small Thing, Stop Domestic Abuse. Lay summary: Background and study aims Compared to the previous year, in 2018 there was an overall 8% increase in theft in England and Wales and a 6% increase in crimes involving sharp instruments or knives. In order to tackle this increase in crime, many believe that more needs to be done to address the reasons why people commit crime in the first place, as well as the damage it causes to peoples’ lives. This means working together in the community to offer solutions to those affected by crime, including victims and offenders. When we discussed possible solutions with local service providers, it was felt that a tailored approach is needed for women, as their needs are unique. Women in prison are very likely to be both victims and offenders whilst, in the general population, one in four women are also victims of abuse within the home and more than half the women in prison have experienced domestic abuse themselves. In response, three projects are being piloted in Hampshire and Dorset to address the needs of women affected by crime. What does the study involve? To understand how these projects are working, we plan to carry out group interviews with those delivering the pilot intervention projects in the community. This will primarily be to understand how the projects are working. We will also use information gathered from the project staff about the women using the service to understand whether women go on to seek further assistance in the community, what sort of women engage with the project, and what changes for them as a result of using the service. This study proposal was developed in collaboration with public representatives; including offenders, victims, social care workers, domestic abuse service manager, and police officers. They have all shaped the design of the study; by informing us what types of research questions we should be asking. Going forward, we will continue to involve similar representatives throughout the research study; for example, to co-produce the materials used in the study, such as information sheets, and to gain feedback on the write up of the study. What will we do with the study findings? It is important that the information gained from the study reaches the widest number of people. We will therefore consider who to engage, and how to reach them, from the very start of the study. The main findings will be developed into a short summary report, which will be accessible to the general public through our public representatives and collaborators. They might include charitable organisations in the community (e.g. Stop Domestic Abuse, Hampton Trust) or services that work directly with women affected by crime (e.g. NHS, probation services).

26c4cdf6-472a-4d3e-94e8-fa2c11941202 Neuro Digital: From Attitudes to Strategies Principal Investigator: Professor Chris Kipps Team members: Dr Sarah Fearn, Dr John Spreadbury, Dr Rachel Chappell, Dr Corine Driessens Project Partners: University Hospital Southampton NHS Foundation Trust, University of Southampton Starts: 01 October 2021 Ends: 30 September 2023 Background The COVID-19 pandemic has changed the way neurological care is delivered to involve greater use of digital technology such as videocalls, smartphone apps or online platforms. University Hospital Southampton (UHS) has been developing its own electronic personal health record and self-management platform called My Medical Record. This online care platform offers patients more control over their healthcare by allowing them to: access their clinical letters and appointments in one place message their clinical teams for advice read relevant information on their condition monitor and share outcomes. Data from the platform, however, indicates differences in uptake and use amongst different groups of patients and healthcare professionals. Existing research also tell us that there are still important issues to understand around the uptake and use of digital technology in neurological care and long-term conditions more generally. Aims and Methodology The main aim of the research is to understand how to optimise the use of digital health technology in neurological conditions ( multiple sclerosis, Parkinson’s disease or Atypical Parkinsonian Syndrome (APS), headache, epilepsy, motor neurone disease or other neuromuscular disorder, Huntington’s disease, atypical or early onset dementia ). This will include how to optimise the use of My Medical Record for patients at UHS. The research will involve three interrelated pieces of work or ‘work packages’: Work Package 1 will use interviews and focus groups with neurological patients, carers, and healthcare professionals to investigate attitudes toward digital health technology and My Medical Record. Work Package 2 will use surveys with neurological patients to investigate relationships between personal and clinical characteristics and how people use digital health and My Medical Record. Work Package 3 will use the findings from Work Package 1 and 2 to produce some strategies to support people with neurological conditions to use digital health and My Medical Record. The strategies will be produced together with patient, carer, and healthcare professional groups in co-production workshops. Outcomes The NHS has highlighted the greater use of digital health technology as a way to improve the delivery of care over the next 10 years. The findings from the research will help us to better understand how to promote, optimise and support the use of digital health for people with neurological conditions, including the use of My Medical Record. Taking Part If you would like more information about the study or are interested in taking part, please contact Dr Sarah Fearn via email at S.Fearn@soton.ac.uk or Dr John Spreadbury on 07876818404 or jhs101@soton.ac.uk . What did we find out? With regards to personal characteristics affecting use: We found that older age, lower education, lower income, lower literacy and lower patient activation* were all associated with lower digital health technology uptake and use and more negative views. * Patient activation is a person's level of knowledge, skills and confidence to manage their condition(s) We found that gender and health status were not associated with uptake, use* or views. * Exception of health status and direct contact with healthcare team when participant has a specific issue Whilst we found that symptoms associated with having a neurological condition impacted the use of digital healthcare, we found that people with a neurological condition had access to digital healthcare (e.g. the tech / internet connection etc) comparable to the general population. We also held three co-production workshops to identify strategies that could support or promote the use of digital health technology amongst people with neurological condition. • These were the suggested strategies: What difference can this new knowledge make? Understanding the attitudes towards, and use of, digital health technology for people living with neurological conditions, their carers and their HCPs allows us to identify areas where more support might help promote and improve use. Identifying personal and health characteristics associated with more negative views and / or lower rates of use can help us to identify those more likely to need, or benefit from, additional support. Co-designing strategies to help support and promote the use of digital health technology for people living with neurological conditions, their carers and their HCPs, allows us to create support mechanisms that have been co-developed with the users themselves. 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. The use of digital health technology offers an opportunity The NHS Long Term Plan highlights the use of digital mechanisms as key enablers to improve NHS care delivery over the next 10 years. The use of digital health technology has the potential to help reduce variation or inequality in care, make care more integrated or joined up, identify people at higher risk of poorer outcomes, and promote self-management. It can also support clinicians to be more efficient, freeing up time for the sickest patients. 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. Our findings can help to improve support to people with neurological conditions to use digital health technology. It can do this by: Understanding the benefits and challenges of use Identifying those most likely to need or benefit from additional support Co-developing implementable strategies to support or promote use What Next? We will be using 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 -Present to ICB (digital transformation work programme); UHS (IT); Neurological Alliance -Inform the Optimising Outpatients project, which aims to create recommendations for the use of remote care in neurology outpatient services. We are continuing to analyse the data and disseminate findings to a wide audience.

4d75ba35-779f-4c29-9dd6-a4bbffb8ad71 Determining the effectiveness and outcomes of innovative interventions for people who have used stalking behaviours: An extension of the exploration of the Hampshire & Isle of Wight Multi-Agency Stalking Partnership (MASP) Chief Investigator: Dr Sara Afshar Morgan, Associate Professor of Public Health, Faculty of Medicine, University of Southampton Team: Mrs Katerina Porter, Senior Research Assistant, Faculty of Medicine, University of Southampton Dr Rebecca Harris, Research Fellow, Faculty of Medicine, University of Southampton Ms Lana Weir, Senior Research Assistant, Faculty of Medicine, University of Southampton Lisa Allam, Commissioning Manager, Hampshire and Isle of Wight Office of the Police and Crime Commissioner Dr Kirsty Butcher, Principal Clinical Psychologist and Clinical Lead, Multi-Agency Stalking Partnership, Hampshire and Isle of Wight NHS Foundation Trust Detective Chief Inspector Abigail Leeson, Hampshire and Isle of Wight Constabulary Dr Andrew Bates, Regional Forensic Psychologist, South Central Probation Region (HM Prison and Probation Service) Rachel Windebank, Operations Director, STOP Domestic Abuse Partners: Hampshire and Isle of Wight NHS Foundation Trust, University of Southampton, Hampshire and Isle of Wight Office of the Police and Crime Commissioner, Hampshire and Isle of Wight Constabulary, South Central Probation Region (HM Prison and Probation Service), STOP Domestic Abuse. Start date: 1 April 2023 End date: 1 October 2026 Overview The Hampshire and Isle of Wight Multi-Agency Stalking Partnership (MASP) brings together policing, NHS services, probation, and victim/survivor advocacy organisations to respond to stalking in a coordinated way. Researchers at the University of Southampton are working with partners to evaluate MASP and understand how multi-agency approaches and psychological interventions may reduce stalking behaviours and improve outcomes for those affected. This programme of work spans multiple phases of research and evaluation, combining qualitative and quantitative approaches to build a comprehensive understanding of how MASP operates and its impact. This evaluation is co-funded by NIHR Applied Research Collaboration (ARC) Wessex, the Home Office, and the Hampshire and Isle of Wight Office of the Police and Crime Commissioner. Why This Research is Needed Stalking involves fixated, obsessive, and repeated behaviours that cause significant distress and fear. It is strongly associated with serious violence, including in cases of homicide. Despite this, there is limited evidence on how best to intervene with people who have engaged in stalking behaviours, particularly in real-world, multi-agency settings. Existing research on psychological interventions is often based on small samples and short-term outcomes. This project addresses this gap by evaluating stalking interventions delivered as part of a whole-system, multi-agency response. The MASP Approach MASP is a whole-system model that integrates: · Multi-agency case management across policing, NHS, probation, and victim/survivor advocacy services · Psychologist-led specialist interventions (PLSIs) for individuals using stalking behaviours · Use of legal and safeguarding tools alongside therapeutic support · Close collaboration between agencies to manage risk and support victim/survivors How MASP is Being Evaluated This research combines multiple strands of work to understand both how MASP operates and its outcomes. The evaluation includes: · Qualitative research with professionals and individuals who have engaged in stalking behaviours · Longitudinal follow-up of people who have completed psychologist-led interventions · Analysis of police data to examine reoffending and ongoing risk · Comparison of perspectives across individuals, victim/survivors, and practitioners · A planned health economic analysis (in collaboration with colleagues at the University of Sheffield) Together, these approaches aim to identify what works, for whom, and in what contexts. What We Have Learned so Far Over a 26-month period of implementation, MASP identified nearly 1,500 individuals using stalking behaviours across Hampshire and the Isle of Wight. Key findings include: · Individuals ranged in age from 13 to 87 at referral · Victim/survivors ranged from 14 to 87 · Stalking behaviours had typically been ongoing for several months prior to referral, with some cases lasting many years · Around 30% of individuals were offered a psychologist-led intervention · Children appear to be underrepresented in current data, highlighting an important gap for future work Ongoing analysis is examining whether engagement with MASP activities reduces further stalking behaviours. Outputs and Impact This work is already contributing to national policy and practice: Standards and Guidance Co-created standards for interventions with perpetrators of stalking have been developed with multi-agency partners and shared with the Home Office. These represent one of the first publicly available frameworks of this kind (available as a preprint ) Research Outputs: A series of papers are being developed, including: · A whole-system model of MASP (manuscript in preparation) · A psychological framework for measuring change in stalking interventions (available as a preprint ) · An evaluation of intervention outcomes, involving data linkage between police and health services · Qualitative research exploring lived experiences of MASP Knowledge Sharing: Alongside presentations at local, national, and international conferences, two animations have been developed as part of knowledge exchange activities: · The first animation outlines how professionals can work safely and effectively with people who have engaged in stalking behaviour, highlighting the role of psychological approaches and evidence-informed interventions. · The second animation provides an overview of the whole-system MASP model. The team also engages in public awareness activities, including participation in Stalking Awareness Week, with on-campus events involving practitioners such as Independent Stalking Advocates and police safeguarding leads to raise awareness and share learning. Policy Relevance · Findings are informing Home Office work on national standards and commissioning of stalking interventions. · The work also responds directly to recommendations from the super-complaint on the police response to stalking . Ongoing and Future Work The project is continuing to examine whether, and how, MASP activities reduce the risk of further stalking. Planned work includes: · In-depth qualitative research with individuals who have engaged in stalking behaviours · Exploration of how MASP can better identify and support children affected by stalking · Co-development of improved measures of behavioural change alongside service users · Continued evaluation of long-term outcomes following intervention Further Information For more information about this project, please contact: MASPinfo@soton.ac.uk Additional information about the MASP service can be found via partner organisations, including Hampshire and Isle of Wight Healthcare NHS Foundation Trust and Hampshire and Isle of Wight Police and Crime Commissioner .

16c59677-d7b2-4332-b74a-b4b17ed064ed How to Support children with cancer, or another serious condition, and their parents during the COVID-19 outbreak How to Support cHildren with cAncer, or another serious condition, and theiR parents during the COVID-19 outbreak?: understanding Experiences, information and support needs, and decision-making – the SHARE study Research team Chief Investigators: Professor Anne-Sophie Darlington- Professor of Child and Family Psychological Health- University of Southampton Dr Bob Philips- Senior Lecturer and Honorary Consultant in Paediatric / Teenage-Young Adult Oncology-The Leeds Teaching Hospital NHS Trust Dr Jess Morgan- Senior Research Fellow & Paediatric Oncology Trainee- University of York Mr Ashley Ball-Gamble- CEO of Children’s Cancer and Leukaemia Group (CCLG)- CCLG Project team members: Dr Nicole Collaço- Research Fellow- University of Southampton Dr Luise Marino- Clinical Academic Paediatric Dietitian- University Hospital Southampton Dr Arvind Nagra- Paediatric Nephrologist- University Hospital Southampton PPI group Organisations involved: University of York, Children’s Cancer and Leukaemia Group, University of Southampton, University Hospital Southampton, The Leeds Teaching Hospital NHS Trust, Kidney Research UK, Kidney Care UK, British Heart Foundation, Children’s Heart Foundation ,Cystic Fibrosis Trust, Together for Short Lives, The Martin House Research Centre, Harry’s Hat, Shine. Summary Children and young people with cancer may be particularly vulnerable. Those undergoing treatment have a weakened immune system, meaning they will find it more difficult to fight infections. [1] Comprehensive advice for parents has been compiled by experts and disseminated through the UKs Children’s Cancer and Leukaemia Group (CCLG).[1] However, we urgently need to increase our understanding of evolving experiences, information needs and decision-making of these families under these extraordinarily stressful circumstances. Only through investigating parents’/main carers’ experiences and needs will we be able to tailor and provide the right support, in terms of guidance, information updates, and online interventions to reduce distress and anxiety. What did we find out? We found that the impact of COVID-19 on different populations shared some common experiences: Disruption to healthcare services- all populations faced challenges due to disruptions in healthcare services which affected access to necessary medical care and treatments Increased anxiety and stress- COVID-19 brought about increased anxiety and stress levels in all populations, particularly amongst caregivers who had specific concerns about their child’s health and safety Limited social interactions- the pandemic led to limited social interactions for all populations, resulting in feelings of isolation and loneliness Social support networks: families in general faced amplified challenges due to limited social support networks, emphasizing the importance of community resources in managing the pandemic’s effects. Reassurance gained that certain populations may not be at significantly higher risk of adverse outcomes or psychological distress. Findings emphasised the need for tailored support services, clear communication, education and psychological support to address challenges faced by these populations during the COVID-19 pandemic. What difference will this make? Insights provided valuable information for healthcare providers and relevant charities organisations to make informed decisions about how to support people and allocate resources effectively. In addition the information can be used to develop targeted strategies and interventions that address the specific challenges faced by different populations such as disruption to healthcare services, increased anxiety and stress and limited social interactions. By understanding the impact of COVID-19 on various populations, policies can be developed to address the specific needs and concerns of different groups. Findings emphasised the importance of prioritising clear communication, education and psychological support to ensure the wellbeing of these populations. Why is this important for patients, health and care providers and policy makers? Patient care: understanding the impact of COVID-19 on different populations helps healthcare providers tailor their services to meet specific needs; including ensuring access to healthcare services, managing increased anxiety and stress and providing psychological support. Health & Care Providers: the findings provide valuable insights for healthcare providers to address the challenges faced by different populations. This includes adapting healthcare services, clear communication and providing education to effectively support patients. Policymakers: Knowledge of the impact of COVID-19 on various population helps policymakers make informed decisions, including allocating resources, developing tailored support services, and implementing policies to address the specific needs of different populations. Research outputs: COVID-19: experiences of lockdown and support needs in children and young adults with kidney conditions Yincent Tse, Anne-Sophie E. Darlington, Kay Tyerman, Dean Wallace, Tanya Pankhurst, Sofia Chantziara, David Culliford, Alejandra Recio-Saucedo & Arvind Nagra COVID‐19 and children with cancer: Parents’ experiences, anxieties and support needs Anne‐Sophie E. Darlington, Jessica E. Morgan, Richard Wagland, Samantha C. Sodergren, David Culliford, Ashley Gamble, Bob Phillips https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.28790 https://journals.sagepub.com/doi/full/10.1177/21501351211007102 https://link.springer.com/article/10.1007/s00467-021-05041-8 https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.25537 https://onlinelibrary.wiley.com/doi/pdf/10.1111/apa.16229 https://link.springer.com/article/10.1007/s00381-023-05980-7 https://adc.bmj.com/content/108/3/198.abstract https://www.thesun.co.uk/news/11968084/coronation-street-mitochondrial-disease/ https://www.togetherforshortlives.org.uk/forgotten-families-families-feel-more-isolated-than-ever-under-lockdown/ https://www.southampton.ac.uk/news/2021/04/share-study-results.page https://www.ncri.org.uk/areas-of-interest/cancer-covid-19/ 11-share-study | Institute for Life Sciences | University of Southampton Life Sciences Annual Reports | Institute for Life Sciences | University of Southampton Conferences/presentations: SIOP (International Society of Pediatric Oncology)- E-poster discussion (2021) Royal College of pediatrics and child health- poster presentation (2021) 53rd ESPN Annual Meeting- oral presentation (2021) 7th King John Price pediatric respiratory conference- poster presentation (2021) Webinar- Nutricia- What's next for improving nutrition & growth outcomes in infants with congenital heart disease? (2021) Webinar- University of Surrey: Impact of Covid-19 on families: a focus on new parents, children, and people with learning disabilities, with reflections from professional practice (2021) Webinar: Pediatric Oncology Educational meetings (2021) Webinar: European Paediatric Psychology Network (EPPN) – background and mission (2020)

Dr Preeti Dhuria (University of Southampton) and Professor Christina Vogel (The Centre for Food Policy, City St George’s, University of London) discuss how weak enforcement lets retailers bypass UK obesity regulations < Back Chocolate at the checkout Weak enforcement of obesity regulations is undermining public health Dr Preeti Dhuria (University of Southampton) and Professor Christina Vogel (The Centre for Food Policy, City St George’s, University of London) discuss how weak enforcement lets retailers bypass UK obesity regulations It’s far too easy to choose unhealthy options in retail stores in the UK. This isn’t just a personal challenge for citizens, it’s a public health crisis. The places we shop shape our food choices and quite frankly, the odds are stacked against us in selecting healthy food. There is a growing momentum for strong policies to rein in the aggressive promotion of unhealthy foods, and that’s a positive step. In fact, the UK government introduced a ban on placing unhealthy foods at checkouts, aisle-ends and store entrances in 2022. But you wouldn’t necessarily know it as a shopper. Our research shows there is a significant lack of resources for adequate enforcement. This situation means we still see chocolate at checkouts in some stores and alcohol at the aisle-ends in others because stores are either breaking the rules or using loopholes to continue making money at the expense of the country’s health. Regulating the food retail environment is an important part of the solution to lower levels of obesity but weak enforcement can undermine health goals. The Food (Promotion and Placement) Regulations 2021 are designed to limit the promotion of unhealthy foods in most retail stores and online equivalents in England. When 22 local government officers were asked about their approach to enforcement before the regulations came into effect, the clear narrative was that these regulations would not be robustly enforced because of a lack of staff and training. Our research showed the key obstacles to enforcing these regulations include: Staffing Constraints : There is limited capacity within local authority enforcement teams to enforce these regulations. Their scarce resources are used for immediate threats to life like knife crime rather than assessing breaches, issuing notices and processing fines for these anti-obesity regulations. Inadequate financial support: Funding constraints further hinder enforcement because only £281k in funding has been allocated across the 317 local authorities in England to support these enforcement tasks, leading to inconsistencies across regions. Minimal training: Enforcement officers are likely to rely on personal judgment and experience due to limited training and guidance on how to interpret the definitions in the regulations, leading to significant variations in the interpretation and enforcement of the rules across regions. Despite the regulations’ long-term health goals, it is clear that they are ranked as a low priority and the process of issuing infringement notices is cumbersome. This situation is leading to patchy enforcement, and businesses not being held accountable uniformly. The processes for reporting breaches are also unclear meaning even action by the public is usually difficult. A freedom of information request covering a three-month period showed that no improvement notices had been issued despite instances of non-compliance being observed. A Call for Stronger Enforcement Our research outlines actions at the national and local levels that could help to improve the level of enforcement being undertaken. National-level actions Provide adequate and dedicated funding to local authorities to recruit and allocate staff specifically for compliance assessment of these regulations. Provide centralised training and detailed guidelines for enforcement officers to ensure consistency and build confidence among enforcement teams. Streamline compliance assessments by requiring manufacturers to disclose nutrient profile scores for their products and retailers to provide key details, such as store square footage and employee count, to their local authorities. Local-level actions Instigate linkages within local authorities by supporting cross departmental activity between trading standards, environmental health and public health officers to make enforcement efficient. Raise regulations’ priority by incorporating into joint strategic needs assessment within local authorities to increase buy-ins from councillors and Directors of Public Health. Lack of enforcement compromises impact Investing in enforcement is essential to securing regulation compliance and achieving the level playing field that food businesses and public health advocates called for. Early enforcement ensures that businesses fully understand their obligations, comply with the rules, and help build a precedent for healthier retail environments. Proactive enforcement sends a clear message- the regulations are here to stay, and compliance is non-negotiable. But local authorities cannot achieve strong compliance without adequate funding and the right tools. A lack of enforcement risks being misinterpreted as a sign of regulatory failure and withdrawal of the regulations. This outcome would be detrimental to the health of British children and families. Here are a few instances recently where our research team have spotted non-compliance but do not know how to effectively report the instances, and even approaching the store manager has not led to an immediate removal of products from restricted areas. To truly make an impact, future food policies must incorporate robust enforcement strategies and dedicated funding from the outset to maximise the regulations’ impact and safeguard public health. Previous Next